In the early 1960s, India accounted for nearly 60 percent of the reported smallpox cases in the world. The Indian government had launched the National Smallpox Eradication Program which focused on mass vaccination. By 1966, the Indian government reported approximately 60 million primary vaccinations. Mass vaccination campaigns had become part of the culture, and there was wide trust in this singular approach. However, the number of smallpox cases in India was increasing and India needed a new strategy.

In Mozambique, there was local distrust of the health clinic. A woman did come into the health clinic to deliver her child but both she and the child died in childbirth. The doctor, Hans Rosling, felt terrible and worried that he would never regain the trust of the people in the surrounding villages. But he learned that it was important for him to return the bodies to the village for a proper burial as a sign of respect for the local culture.