Mark Pendergrast

"Pendergrast is an affable guide on a wondrously labyrinthine tour. He explains complex phenomena with remarkable clarity, in a relaxed tone, and with a sense of humor." —Philadelphia Inquirer
"Mark Pendergrast, the ultimate free-lance journalist with an eclectic mind, writes about deceptively narrow topics that in fact have figured in world history for millennia." —Atlanta Journal-Constitution
Mark Pendergrast speaks at universities, schools of public health, business conferences, management seminars, and psychological meetings. His presentations are tailored to his audience but are always entertaining, thought-provoking, and challenging. Contact him to arrange an event. Click here for links to speeches, TV, and radio appearances. Click here for comments on his presentations.

Archive for May, 2010

The Living Room, Colchester

Thursday, May 27th, 2010

Tuesday, June 22, 2010, 7:30 p.m. — Mark Pendergrast will speak about Inside the Outbreaks and offer a slide show and video clips of his research trip to Africa at the Living Room on West Lakeshore Drive in the little mall opposite Mazza’s General Store (  Entrance fee is $10, with half of the money going to the Living Room and half to the CDC Foundation to support the work of the Epidemic Intelligence Service.  Unlike most book-related events, this literary evening offers an intimate setting — i.e., like a living room — and a more leisurely, in-depth presentation. There will be a 15 minute break for wine and cheese around 8:30 p.m., followed by a more wide-ranging informal chat about Pendergrast’s other books, the process of research, writing, and getting published, the uncertain future of the book, etc.   Limit of 30 people.  Advanced ticket reservations suggested through the Living Room website.  This will be the first of a series of such literary evenings on alternate Tuesday nights, hosted by Pendergrast.

Unitarian Universalist Church in Burlington

Thursday, May 27th, 2010

Sunday, May 30, 11:30 a.m. — Mark Pendergrast will speak about Inside the Outbreaks at the Unitarian Universalist church at the head of Church Street, on Pearl Street in Burlington

Jimmy Carter Presidential Library & Museum speech

Wednesday, May 26th, 2010

Wednesday, September 8, 2010, 7  p.m. — In the Theater of the Carter Library & Museum (located at the Carter Center,, Atlanta native Mark Pendergrast will speak about Inside the Outbreaks, his history of the Epidemic Intelligence Service, the front-line disease detectives of the CDC.  Presentation will include photos and video clips.  Books provided by Acappella Books,

Decatur Book Festival

Wednesday, May 26th, 2010

Sunday, September 5, 2:30 p.m.- 3:30 p.m. — Mark Pendergrast will be speaking at the Decatur Book Festival ( at Decatur High School in Decatur, GA, about Inside the Outbreaks and his other books.

Global Health Council Conference

Thursday, May 20th, 2010

Tuesday, June 15, 12:45 p.m. – 1:30 p.m., Omni Shoreham Hotel, Washington, DC  — Mark Pendergrast will be speaking about Inside the Outbreaks in the “Speaker’s Corner” in the Exhibition Hall of the annual Global Health Council Conference.  He will discuss the history and impact of the Epidemic Intelligence Service and will look at likely future trends and problems faced by public health practitioners.

Smallpox Eradication

Sunday, May 16th, 2010

May 17, 2010

Smallpox Eradication – 30th Anniversary Celebration

On Monday, May 17, 2010, a statue was unveiled at the World Health Organization headquarters in Geneva, in honor of the thirtieth anniversary of the certification of smallpox eradication.  The last wild case of smallpox actually occurred in Somalia in 1977, though the last actual case (and death) occurred in 1978 because of a laboratory leak in the UK.  WHO waited until 1980 to certify that the hideous disease was truly eradicated.

Smallpox, which had an enormous impact, afflicting people from Egyptian pharaohs to modern times, was a scourge that disfigured and killed millions – probably billions.  The campaign to rid the world of this virus (except in freezers where it is kept for study) is a shining example of how coordinated global effort can have a lasting impact.

I documented the involvement of Epidemic Intelligence Service officers in the smallpox eradication effort, particularly in West Africa, India, and Bangladesh.  EIS officers and other international epidemiologists were vital to the endgame in Asia in 1975.  One chapter of Inside the Outbreaks, “Target Zero,” documents that incredible time.  Here is the final section of that chapter:

The Legacy of Smallpox Eradication

Epidemic Intelligence Service officers always relied heavily on people around them.  Nowhere was that truer than in the smallpox eradication effort.   Epidemiologists from all over the world deserve credit for the success of the effort, but the greatest heroes were the Indians and Bengalis who devoted themselves to the cause.

It was not always easy for EIS officers to return to normal American life after the intensity of smallpox eradication.  The urgency of their task and the immediacy of the results were addictive, and it gave them a perspective on what really mattered.  “It was a very humbling experience,” Wilbert Jordan recalled.  “It made me appreciate what I had.  I made myself a vow that if I ever got back to America and heard myself complaining, I would kick myself in the ass.”

But it was also jarring to return and be treated like a regular person.  “I was a superstar in India,” Jordan said.  Wynn Hemmert had reverse culture shock when he came home to his wife and two small children.  “I was sort of a sick stranger for a while.  My wife looked at me, obviously thinking, What happened to you?

Mostly, though, they came back with an overwhelming feeling of pride and accomplishment.  “It was almost a religious experience,” Walt Orenstein said.  “It was so dramatic to see the disfigurement, the dead children, and to know you were getting rid of it.”  For Rick Greenberg, “Everything else in my life goes back to this moment in India, what we accomplished.  It was a wonderful thing.  You almost felt the earth should have stopped.”

Many veterans of the smallpox eradication crusade went on to become leaders in the world of public health.  They brought a self-confident, can-do attitude, a refusal to accept that anything was impossible, a sublime impatience with stodgy bureaucracy or indifference to suffering.  “We were cocky and arrogant, we smallpox warriors,” Stan Music said.  “We became tough to deal with sometimes.  We knew you could overcome any obstacle if you just pushed hard enough.”

Sometimes that pushiness in India and Bangladesh amounted to intimidation and coercion.  “We overstepped,” Steve Jones admitted.  But the crusaders were, after all, trying to save lives, trying to rid the world of an ancient scourge.  A few years later, Bill Foege called smallpox eradication “an incarnation of Gandhian ideals” which led to “non-violent social change [and] a better world.”

D. A. Henderson summarized his approach to supervising field epidemiologists:  “Give them running room, some support, and some back-up.  Ask them questions, make them think about what they are doing, but by God give them the room to move, then you have great things happen.”

Don Francis, writing back to his colleagues about his 1973 smallpox eradication efforts in Sudan, wrote about qualifications an EIS officer should have. “I think what the EIS course teaches us all is how to fly by the seat of our pants and come out on top.  Just give all graduates a bit of baling wire, a piece of bubble gum, and a slide rule, and send them off.”

In addition, officers should know how to repair Landrovers and learn foreign languages.  “Tolerance must be part of the curriculum” – tolerance for eating raw camel’s liver, incredible heat, horrible roads, and cultural differences.  Add to that “the ability to enjoy something in all this chaos,” including scenes of great beauty, wonderful people, and “finally seeing one of the most wicked diseases disappear from the faces of children.”

Politics & Public Health

Sunday, May 9th, 2010

May 9, 2010: I have spoken to several Rotary Club groups about Inside the Outbreaks. Rotary International clubs have given over $850 million to support global polio eradication, which is tantalizingly close to succeeding.  I covered a great deal about polio in my book, from the Salk vaccine to the present eradication effort.

But that’s not why I’m writing this.  It’s to lead into a frustrating phone conversation I had recently.  One Rotarian in charge of programming told me, “Our members wouldn’t be interested in hearing from you because they are primarily interested in politics.”  This flabbergasted me.  I blurted out, “But public health is politics!”  I couldn’t convince him, but it is true.  The more I researched the history of the Epidemic Intelligence Service, the more I found that politics influenced what impact EIS officers could have.  The CDC (of which the EIS is a subset) has no regulatory power.  It can only make recommendations.  Thus, for instance, when EIS officer Karen Starko first documented that aspirin caused most cases of Reye syndrome – a horrible affliction that killed thousands of otherwise healthy children – the FDA quickly moved towards insisting on a warning label for all aspirin-containing medicine for children.  The powerful aspirin industry lobby interceded and managed to block the label, insisting on more delaying studies for another five years.  In the meantime, nearly 300 more children died of Reye syndrome.  Once aspirin was finally removed from children’s medications, Reye syndrome became an extremely rare disease in the United States.

It is clear that legislation (i.e., politics) is a potent public health tool.  Putting high taxes on cigarettes and keeping ads for them off television are good illustrations.  Yet our legislators are generally not terribly well-informed about public health issues.  So here is my sermon for this Sunday – I would like some public health veterans – perhaps EIS alums – to run for public office, nationally and locally.  One of the few criticisms I have of these folks (whom I admire a good deal on the whole) is that they aren’t vociferous enough about what they discover and what urgent issues we face.  The CDC led the way in documenting foodborne E. coli O157:H7, for instance, but it took citizens’ groups to push successfully for new legislation for beef inspection, which the USDA has implemented.

I have heard inspirational public health speakers such as Bill Foege and Nils Daulaire, and I found myself thinking, I would love to vote them into office, any office.  I want more people to hear them.  I want them to have more clout.  Foege is too old now, I’m afraid, but Daulaire, who for years headed the Global Health Council and has now been tapped by President Obama as his new Director of the Office of Global Health Affairs, would be a good candidate.  Instead of waiting to be appointed, how about public health experts running for president next go-round?

A Generation Without Smallpox, Tewksbury, MA

Sunday, May 9th, 2010

Monday, May 17, 2010, 2:00 – 5:00 p.m. — Mark Pendergrast will attend and sign copies of Inside the Outbreaks at “A Generation Without Smallpox,” at the Old Chapel, Tewksbury Hospital, 365 East St., Tewksbury, MA 01876.  This event celebrates the 30th anniversary of the certification of smallpox eradication and will feature those who helped make it happen.  For more information, contact Marilyn DelValle, 781-774-6733,

May 3, 2010 — In Kenya

Monday, May 3rd, 2010

Making a Difference in Kenya

January 31, 2006, Homa Bay, Kenya. After Niger, I traveled to Kenya, where I visited three rural elementary schools with Ciara O’Reilly.  A five-foot tall, 100-pound blonde Irish native, the 31-year-old EIS officer presented quite a contrast to the Africans she served.

[That is to introduce this blog post and get your attention!  I must apologize to my blog followers (not sure who is reading this — drop me a line!) for not posting for a couple of weeks.  Life has been hectic, with book signings, interviews and travel.  And it is continuing.  So I am cutting and pasting again from Inside the Outbreaks from the chapter on my African sojourn, this time in Kenya.  I introduced the Safe Water System in a previous blog.  You will see its impact here.]

After earning a Ph.D. in Food Microbiology, Ciara began with the CDC Foodborne and Diarrheal Diseases Branch in August 2004.  Just before I met her in Kenya, she had spent two days aboard a cruise ship in the Caribbean, where norovirus was spread by passengers’ vomitus.

The transition from the luxurious cruise ship to African poverty was jarring, but Ciara had been to Kenya the previous year to set up a diarrhea study, so she knew what to expect.  “Kenyans are better able to appreciate small things than we are,” she told me.  “If something good happens, they have such joy.”

At one of the schools we visited, children stood on the barren school grounds to sing songs and recite poems they had written for their Safe Water Club.  Though many were barefoot, they wore the school uniform – boys in white shirts and blue shorts, girls in blue dresses with white collars – and there was indeed joy on their faces, even though a storm had recently ripped the corrugated roof from their school building, built from bricks they had made themselves, and even though many of them were AIDS orphans.

Ciara and Matt Freeman, a young epidemiologist with the Center for Global Safe Water at Emory University, were there to assess the impact of the Safe Water System (SWS), which had been implemented by CARE (with funding from Coca-Cola) the previous summer in 45 primary schools in Nyanza Province in western Kenya. Ciara and Matt had trained local enumerators to administer questionnaires to randomly selected students and their parents/guardians.

Diarrhea from polluted water kills over two million people annually, mostly children in developing countries.  The SWS teaches people to treat their drinking water with dilute bleach and to dispense it from spigots in narrow-topped containers too small for hands to reach in.·

This school had two sources of water. The better one was a river down the dirt road, a half-hour away.  The other was a ten-minute walk, but it was foul and  stagnant.  We were looking at the latter when an old man told us that people who drank this water went loco and got diseases.  As he spoke, several emaciated cows ambled up and waded in to drink.

At the schools, I watched children stop at a hand washing station after leaving latrines, as they had been taught.  They drew water to drink from brown narrow-topped clay pots with metal spigots, and they demonstrated how they added a capful of WaterGuard, the dilute bleach solution, to treat new water.

The next day, I walked through the dry scrub with Elvis, a Luo-speaking enumerator, as he visited parents or guardians in their small mud homes, questioning them about their knowledge of WaterGuard and the Safe Water System.  The third house was very small, with a bare double-bed foam mattress leaning against the wall.  The woman in the house was a recent AIDS widow with seven children.  Her husband had had three wives, but one of them, with six children, had also died. The third remaining wife was childless.  So these two women had 13 children to care for and were very poor.  Yet this woman still managed to buy WaterGuard for their water.

Over the next few days, I helped Ciara and Matt enter data from the questionnaires into laptops.  “Now you know what being an EIS officer is really like,” Ciara told me, referring to the tedious job in oppressive heat.  Some of the surveys were heart-rending: an 86-year-old woman caring for three AIDS-orphaned grandchildren; two adults, 11 children, all sleeping in one room.  An enumerator’s comment on the last situation:  “The family is very desperate and I really wondered how they manage their daily bread.”

As I walked the single paved street of Homa Bay every morning and evening, I encountered women carrying 20-liter plastic buckets of water on their heads – water retrieved from a pool, ditch, or rivulet.  Children riding bicycles carried jerry cans of water.  All polluted.  Ciara told me about a local “control” school she had visited that did not have the SWS program.  “A teacher showed me a bucket of water they drank.  Scum floated on top of the brown water, and sediment coated the bottom,” she said.  With most people earning less than a dollar a day, even the pennies needed for WaterGuard were hard to come by.

When the data from Ciara’s survey were tabulated, they told a positive story.  Student absenteeism in the intervention schools had dropped by 35 percent, while in non-project control schools it had risen by 5 percent.  More parents had heard about WaterGuard than during a baseline survey, though only a few more actually used it at home.

My final day in Kenya, I drove with Ciara over terrible, dusty roads one more time, to visit hospitals and clinics where she was conducting a baseline study of what caused diarrhea in another area of Nyanza Province.  One hospital was located in Siaya, hometown of Barack Obama’s father.· Stool samples from the hospital were tested twice a week at the CDC lab in Kisumu to determine what had caused diarrhea and what sort of drug resistance had developed.  In Bondo District Hospital, the drinking water was not treated with WaterGuard, and about 15 children a month died there.

Ciara’s study found that in children under five, three bacteria – Shigella, Campylobacter, and Salmonella – together accounted for about half of the pathogens identified.  The other half was caused by rotavirus, which is impervious to WaterGuard.· Ciara also found that the bacteria were highly resistant to three common antibiotics, but responded to others.

Since the time I followed Ciara in Kenya, she has graduated from the EIS but stayed on as a staff member in the same branch.  She helped to launch the Global Enterics Multi-Center Study (GEMS), which will expand the Kenyan diarrhea project to eight locations worldwide in an unprecedented prospective case-control study to determine what diarrheal pathogens are killing children under five, and to what drugs they are susceptible.

And CARE (with funding from many public and private organizations) has begun to implement the Safe Water System in an additional 200 schools in Nyanza Province.  Some schools will also get latrines, while others will, in addition, get a borehole well or rainwater harvesting.  The idea is to see which interventions are cost-effective and sustainable.  It is a three-year project, and there are plans to expand it to 1,500 more schools.

The programs were nearly derailed by ethnic violence in Kenya following the disputed presidential election of December 27, 2007.  “Kisumu looks different these days,” Ciara emailed, “with many buildings burnt to the ground.”   Still, she had managed to train staff for the prospective diarrhea study and was preparing to launch it.  A power-sharing agreement between the incumbent Mwai Kibaki and his opponent Raila Odinga was hammered out in late February, and Kenya settled back into an uneasy peace.

That February 2008, EIS officer Sapna Bamrah, 34, arrived in Kenya to assess the impact of the violence on AIDS and tuberculosis health clinics, where 180,000 people had been taking antiretroviral drugs.  As an EIS officer, Sapna Bamrah had already ventured to Azerbaijan to look at mortality surveillance from land mines, to Vietnam to study the impact of Pur, a water treatment product made by Procter & Gamble, to Nepal to assess the nutritional status of Bhutanese refugees, and to Swaziland to conduct a randomized survey of rape and molestation of young girls.  Now in Kenya, she found that while many health clinics had been temporarily closed or abandoned, the system was beginning to recover more quickly than had been feared.

I interviewed Sapna Bamrah in August 2008, a month after she completed her EIS service and remained with the CDC.  She acknowledged that “sitting on committees, wearing a uniform, and following rules and regulations has little to do with public health,” and that politics sometimes subverted science.  But Bamrah concluded:  “For every moment I am frustrated, I am continually inspired and amazed at what people in the EIS and in this agency are doing.  The average American has no idea the amount of energy spent in the United States and the world by people who really believe in protecting the public.”

  • · See Chapter 17.
  • · Six months later, in August 2006, then-Senator Barack Obama came to Siaya to visit his grandmother.  At the CDC outpost in Kisumu, at the request of EIS alum Kayla Laserson, Obama and his wife Michelle publicly submitted to HIV testing to encourage locals to do the same.
  • · Later in 2006, two oral rotavirus vaccines were found to be safe and effective, though getting them to poor children around the world is another matter.