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Lewis W. Hackett joined the staff of the International Health Board (IHB) in 1914. He was sent to Brazil in 1916, where his original responsibility was hookworm control, but he was gradually and inevitably drawn into combating other diseases. Hackett had a strong influence on public health in Brazil. In 1922 he instituted grass-roots (local) health units and programs. The next year, he negotiated with the federal government a cooperative yellow fever control program, which was described in the IHB's 1923 annual report as the "new and final campaign against yellow fever" in Brazil. Eleven offices were established in northern Brazil, where it was expected that yellow fever would quickly be eradicated. Just as the new program got underway Hackett was reassigned to Italy, where he remained until the beginning of World War II. Nonetheless, Hackett had done a classic job of developing the IHB program in Brazil, moving carefully but authoritatively from the initial focus on hookworm, to the development of a more comprehensive public health program, and then to the strategic thrust toward yellow fever.