An effective vaccine for preventing smallpox had been discovered and tested by 1796. And by the 1970’s widespread vaccination resulted in most people in rich countries being vaccinated and almost completely protected. Smallpox was actually eliminated from developed countries in the 1970s. But the burden of smallpox was inequitably distributed. People in some poor countries remained vulnerable and faced high risks of mortality from smallpox. It was within the poorest communities that smallpox was spread.

Partners in Health (PIH) is a non-profit global health organization established by Paul Farmer, Jim Kim, and three colleagues to bring health care to the poorest people in low-income countries. PIH believed that these people deserve healthcare that was as good as the healthcare that rich people in the most advanced countries received. They found that poor people living in a shanty town outside of Lima, Peru had very high rates of multidrug-resistant tuberculosis (MDRTB), a disease that was notoriously hard to treat.