To apply the surveillance and containment strategy, it was necessary to know where the smallpox virus was, which villages had active cases of smallpox. The struggle against smallpox could not be won without knowing where the enemy was and what it was doing. But India did not have accurate surveillance data. Many villages with active cases had not been reported.

In the battle to eradicate smallpox in India in 1974, finding and containing thousands of outbreaks was the key to getting smallpox under control. In mid 1974, the number of new outbreaks was starting to decrease slightly. The strategy of surveillance and containment - which included a massive workforce, tireless efforts, and rewards for identifying new cases - was paying off. But then we started to notice that members of previously vaccinated families were still coming down with smallpox. We should not have been seeing these new cases.

In early 1974, smallpox outbreaks were appearing in areas of India that had been smallpox-free for months. After a week of plotting the epidemic with pushpins on hand-drawn maps, a pattern emerged. Each outbreak began with a working-age young man who had returned home to his village. These cases were “importations.” The young men had come from—or traveled through—the bordering state of Bihar. Cases were originating in Tatanagar, the company town of the corporate behemoth, Tata Companies. Tatanagar, a city in the state of Bihar, had no centralized government, and no public health structure in place.