Contemporary Authors

• Global Health Leadership and Management Jossey-Bass (San Francisco, CA), 2005
• House on Fire: The Fight to Eradicate Smallpox University of California Press (Berkeley, CA), 2011
• The Task Force for Child Survival: Secrets of Successful Coalitions Johns Hopkins University Press (Baltimore, MD), 2018

1. Global health leadership and management LCCN 2005003187 Type of material Book Main title Global health leadership and management / William H. Foege ... [et al.], editors ; foreword by David Rockefeller. Edition 1st ed. Published/Created San Francisco : Jossey-Bass, c2005. Description xxxvi, 241 p. ; 24 cm. ISBN 0787971537 (alk. paper) Links Table of contents only http://www.loc.gov/catdir/toc/ecip057/2005003187.html Contributor biographical information http://www.loc.gov/catdir/enhancements/fy0621/2005003187-b.html Publisher description http://www.loc.gov/catdir/enhancements/fy0621/2005003187-d.html Book review (E-STREAMS) http://www.e-streams.com/es0911/es0911_4513.html CALL NUMBER RA441 .G5685 2005 Copy 1 Request in Jefferson or Adams Building Reading Rooms 2. House on fire : the fight to eradicate smallpox LCCN 2010041703 Type of material Book Personal name Foege, William H., 1936- Main title House on fire : the fight to eradicate smallpox / William H. Foege. Published/Created Berkeley : University of California Press ; New York : Milbank Memorial Fund, c2011. Description xxi, 218 p. : ill., maps ; 24 cm. ISBN 9780520268364 (cloth : alk. paper) 0520268369 (cloth : alk. paper) CALL NUMBER RA644.S6 F64 2011 Copy 1 Request in Jefferson or Adams Building Reading Rooms CALL NUMBER RA644.S6 F64 2011 Copy 2 Request in Jefferson or Adams Building Reading Rooms 3. Budgets, burglars, and other threats : directing the CDC LCCN 2017035213 Type of material Book Personal name Foege, William H., 1936- author. Main title Budgets, burglars, and other threats : directing the CDC / William H. Foege. Published/Produced Baltimore : Johns Hopkins University Press, [2018] Projected pub date 1804 Description p. ; cm. ISBN 9781421425290 (hardcover : alk. paper) 1421425297 (hardcover : alk. paper) Item not available at the Library. Why not? 4. The Task Force for Child Survival : secrets of successful coalitions LCCN 2017051886 Type of material Book Personal name Foege, William H., 1936- author. Main title The Task Force for Child Survival : secrets of successful coalitions / William H. Foege ; foreword by Jimmy Carter. Published/Produced Baltimore : Johns Hopkins University Press, 2018. Projected pub date 1807 Description p. ; cm. ISBN 9781421425603 (hardcover : alk. paper) 1421425602 (hardcover : alk. paper)

• The Fears of the Rich, the Needs of the Poor - 2018 Johns Hopkins UP, Baltimore, MD

• Emory U - http://www.ph-leader.emory.edu/people/bio-section-faculty/foege-william.html

  William H. Foege, MD, MPH
  Photo of William Foege
  Emeritus Presidential Distinguished Professor of International Health
  Rollins School of Public Health, Emory University
  Gates Fellow
  The Bill and Melinda Gates Foundation
  Biography
  William H. Foege, MD, MPH is an epidemiologist who worked in the successful campaign to eradicate smallpox in the 1970s. Dr. Foege became Chief of the Centers for Disease Control and Prevention (CDC) Smallpox Eradication Program, and was appointed director of CDC in 1977.

  In 1984, Foege and several colleagues formed the Task Force for Child Survival and Development, a working group for the World Health Organization, UNICEF, The World Bank, the United Nations Development Program, and the Rockefeller Foundation. Its success in accelerating childhood immunization led to an expansion of its mandate in 1991 to include other issues that diminish the quality of life for children.

  Dr. Foege joined The Carter Center in 1986 as its Executive Director, Fellow for Health Policy and Executive Director of Global 2000. In 1992, he resigned as Executive Director of The Carter Center, but continued in his role as a Fellow and as Executive Director of the Task Force for Child Survival and Development. In 1997, he joined the faculty of Emory University, where he is Presidential Distinguished Professor of International Health at the Rollins School of Public Health. In 1999, Dr. Foege became a Senior Medical Advisor for the Bill and Melinda Gates Foundation. In 1999, Dr. Foege resigned as Executive Director of the Task Force for Child Survival and Development, and in 2001, he retired from both Emory University and the Gates Foundation. However, he remains active in both organizations as Emeritus Presidential Distinguished Professor of International Health and as a Gates Fellow.

  Dr. Foege has championed many issues, but child survival and development, injury prevention, population, preventive medicine, and public health leadership are of special interest, particularly in the developing world. He is a strong proponent of disease eradication and control, and has taken an active role in the eradication of guinea worm, polio and measles, and the elimination of river blindness. By writing and lecturing extensively, Dr. Foege has succeeded in broadening public awareness of these issues and bringing them to the forefront of domestic and international health policies.

  Dr. Foege is the recipient of many awards, holds honorary degrees from numerous institutions, and was named a Fellow of the London School of Tropical Medicine and Hygiene in 1997. He is the author of more than 125 professional publications. He attended Pacific Lutheran University, received his medical degree from the University of Washington, and his Master of Public Health from Harvard University.

• Johns Hopkins UP - https://jhupbooks.press.jhu.edu/content/fears-rich-needs-poor

  William H. Foege, MD, MPH, is emeritus presidential distinguished professor of international health at Emory University and an early consultant to the Bill & Melinda Gates Foundation. He is the author of House on Fire: The Fight to Eradicate Smallpox. In 2012, he was awarded the Presidential Medal of Freedom.

  The Fears of the Rich, The Needs of the Poor

  My Years at the CDC

  William H. Foege

  In its seventy years, the Centers for Disease Control and Prevention (CDC) has evolved from a malaria control program to an institution dedicated to improving health for all people across the world. The Fears of the Rich, The Needs of the Poor is a revealing account of the CDC’s development by its former director, public health luminary William H. Foege.

  Dr. Foege tells the stories of pivotal moments in public health, including the eradication of smallpox (made possible due in part to Foege’s research) and the discovery of Legionnaires’ disease, Reye syndrome, toxic shock syndrome, and HIV/AIDS. With good humor and optimism, he recounts the various crises he surmounted, from threats of terrorist attacks to contentious congressional hearings and funding cuts. Highlighting the people who made possible some of public health’s biggest successes, Foege outlines the work required behind the scenes and describes the occasional tensions between professionals in the field and the politicians in charge of oversight.

  In recent years, global public health initiatives have come from unanticipated sources. Giants in the field now include President Jimmy Carter and his wife, Rosalynn, who promote programs aimed at neglected diseases. Melinda and Bill Gates have invigorated the field through research and direct program support, especially in the area of vaccine-preventable diseases. And the Merck Mectizan program has dramatically reduced river blindness in Africa. Foege has been involved in all of these efforts, among others, and he brings to this book the knowledge and wisdom derived from a long and accomplished career. The Fears of the Rich, The Needs of the Poor is an inviting but unvarnished account of that career and offers a plethora of lessons for those interested in public health.

• Harvard School of Public Health - https://www.hsph.harvard.edu/news/features/william-foege-medal-of-freedom/

  William Foege awarded Presidential Medal of Freedom
  William Foege

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  May 10, 2012

  Former CDC Director and Global Health Champion Helped Eradicate Smallpox

  Harvard School of Public Health (HSPH) alumnus William Foege, MPH ’65, legendary for his work in the late 1970s to eradicate smallpox, has been named one of 13 recipients of the 2012 Presidential Medal of Freedom.

  Other recipients of this year’s medal—the nation’s highest civilian honor—include singer Bob Dylan, former Secretary of State Madeleine Albright, and astronaut John Glenn.

  As director of the U.S. Centers for Disease Control from 1977 to 1983, Foege, a physician and epidemiologist, helped develop the vaccination strategy that ultimately broke the cycle of smallpox transmission. In other public health roles, he has worked for universal basic immunization for children and has sought to eliminate river blindness and guinea worm, two diseases that plague Africa. He has served as director of The Carter Center; and is a senior fellow at the Bill & Melinda Gates Foundation, a professor emeritus at the Rollins School of Public Health at Emory University in Atlanta, and an affiliate professor of epidemiology at the University of Washington School of Public Health.

  Foege has also been honored at HSPH. In 1994 he received the Alumni Award of Merit for his significant career in public health. And in 2006 he received the School’s highest honor, the Richmond Award, for the promotion of high public health standards among vulnerable populations. And in 1997 he was awarded an honorary doctor of science from Harvard University.

• U Michigan - https://president.umich.edu/honors-awards/francis-medal/recipients/william-foege/

  2005 Recipient
  William Foege

  William Foege

  William Foege, the recipient of the first-ever Thomas Francis Jr. Medal in Global Public Health, pioneered a successful strategy to eradicate smallpox in the 1970s. Foege is the former director of the Carter Center and now senior advisor to the Bill and Melinda Gates Foundation.

  Foege is an epidemiologist who became chief of the U.S. Centers for Disease Control (CDC) Smallpox Eradication Program; he was appointed director of the CDC in 1977. He joined the Carter Center as executive director in 1986 and became a senior adviser to the Bill and Melinda Gates Foundation in 1999, where he is now emeritus as a fellow.

  As a medical missionary in Nigeria in 1966, Foege faced a fast-moving outbreak of smallpox without enough vaccine to protect the population in the traditional manner of inoculating as many members of a population as one can reach. Instead, he and his colleagues invented a new approach that modeled the most likely routes of transmission by geography, travel patterns, and familial relationships and then contained the outbreak by focusing the limited amount of vaccine on just three “hot spots.”

  During another smallpox outbreak in India in 1973, Foege, then chief of the Centers for Disease Control’s smallpox eradication program, again proved that targeted containment vaccination worked better than mass vaccination. “In a year, India went from a country with the highest rate of smallpox to zero cases,” Foege recalls. Since then, his approach has become the standard of care for controlling outbreaks of emerging disease. In 1979, the World Health Organization declared smallpox eradicated.

• PBS - http://www.pbs.org/wgbh/rxforsurvival/series/champions/william_h_foege.html

  William H. Foege
  William H. Foege, MD

  Professor and Health Policy Fellow, Emory University
  Former Head, CDC (Centers for Disease Control and Prevention)

  William H. Foege stands tall as a front-line leader in one of the most ambitious public health efforts of the 20th century: the successful eradication of smallpox. He has also been instrumental in child survival efforts, HIV/AIDS prevention, and the current quest to eradicate polio.

  Foege is also literally quite tall. The former director of the Centers for Disease Control and Prevention, Foege tells the story of a time his stature came in handy. In the 1970s, when he went to India to lead the smallpox eradication campaign there, he enlisted a creative village chief's help in assembling the local people. "The chief told his drummer to begin pounding on a 'talking drum,'" Foege recalls. "People came flowing into the village. Almost as fast as people moved past, we vaccinated them. After two hours we had finally finished. I said to the chief: 'I'm very impressed. How do you have such control over your people?' He said, 'I told them through the talking drum to come to the village market if they wanted to see the tallest man in the world.' And I guess I looked that way to him since I'm 6'7"."

  Foege derives inspiration from his childhood hero, Dr. Albert Schweitzer, who went to Africa to treat the poor. "One measure of civilization is, how well do we treat the most vulnerable members of our society?" says Foege. As a professor at the Rollins School of Public Health at Emory University, Foege himself has inspired many students to enter the field of global public health, championing the benefits of public health and disease prevention. Still, Foege knows preventive health can be a hard sell: "Nobody ever thanks you for saving them from the disease they didn't know they were going to get."

  A man of deep integrity and personal charm, Foege has been instrumental in persuading heads of governments and CEOs of pharmaceutical companies to lend their support to public health efforts. He helped recruit Rotary International into the polio eradication effort; that organization has now been working to end polio for 25 years and, by the time the disease is eradicated, will have donated $600 million — more than any other organization besides the U.S. government.

  Foege also worked to set up the Global Alliance for Vaccines and Immunizations and has been a leading adviser to the Bill & Melinda Gates Foundation. He believes that we are entering a new era: "People are beginning to understand there is nothing in the world so remote that it can't impact you as a person. It's not just diseases. Economists are now beginning to say if we are going to have good markets in Africa, we're going to have to have healthy people in Africa." And scientific tools such as drugs and vaccines are improving rapidly, he says. "Science is beginning to catch up with global health problems."

  Foege is also on the front lines in the battle to overcome the public's resistance to the use of vaccines. As he frequently says in his public talks, "Vaccines are the tugboats of preventive health." But he emphasizes that the public's health will only be protected if the entire community agrees to participate. When he sees parents reluctant to have their children vaccinated against infectious diseases like diphtheria, tetanus, polio, measles, and whooping cough, he says, "I believe what's happened now is that parents do not know what those diseases are like, and so they've lost the fear of the disease, and it's harder for them to get the feeling they're contributing to something when they can't see that disease anymore."

  Foege has seen vaccination rates wax and wane as long-term outreach efforts to encourage vaccination lose momentum. That phenomenon has piqued his interest in studying the attributes of leadership necessary to sustain preventive health programs with each new generation. He remains optimistic about the possibility of inspiring young public health leaders as well as the public itself to care — especially when the health of children is at stake.

  "My friend and colleague Jim Grant of UNICEF used to say, 'Children are the Trojan horse for global health.' He was even able to get the guerrilla war in El Salvador stopped so that children could be vaccinated," Foege says. "We need leaders and followers held together by shared goals. Just imagine a world where all children could be protected against these killer diseases. It's within our grasp."

• US News & World Report - https://www.usnews.com/news/best-leaders/articles/2007/11/12/william-h-foege

  QUOTE:
  he made good on his boyhood promise, going to Nigeria to care for villagers from a small church in a remote area.

  All too quickly, Foege faced the excruciating dilemma that practitioners of public health know all too well. He had signed on to help with the smallpox eradication effort in Nigeria through the U.S. Centers for Disease Control and Prevention. Smallpox was devastating the communities all around him, but there wasn't enough vaccine to go around. Foege decided that to mount an effective response, he would need to think like the virus.

  William H. Foege | physician

  A lifelong battle against disease.
  By Jim Yong Kim, Contributor Nov. 12, 2007, at 12:01 a.m.
  More
  U.S. News & World Report

  William H. Foege | physician
  More

  Foege decided that to mount an effective response, he would need to think like the virus. (Brian Smale)

  At a recent tribute to one of his colleagues, Bill Foege spoke of a "golden age of global health," a time when achievements once only imagined were now possible. Characteristically, the epidemiologist credited the arrival of this new era to the work of others—Bill and Melinda Gates, political leaders, and other people in the audience.

  What he did not say was that this celebratory moment could not have arrived without his own extraordinary work. Because arguably more than anyone else, it is Foege who has built the foundation for the recent explosive progress in the field of global health. Attacking a range of illnesses in developing countries, Foege has literally saved millions of lives.

  Driven since childhood, Foege was inspired by the life of Albert Schweitzer and the missionary work of an uncle in New Guinea. He was just a teenager when he declared his intention to become a physician in Africa. After serving as an epidemiology intelligence officer in the United States Public Health Service and studying public health at Harvard University, he made good on his boyhood promise, going to Nigeria to care for villagers from a small church in a remote area.

  All too quickly, Foege faced the excruciating dilemma that practitioners of public health know all too well. He had signed on to help with the smallpox eradication effort in Nigeria through the U.S. Centers for Disease Control and Prevention. Smallpox was devastating the communities all around him, but there wasn't enough vaccine to go around. Foege decided that to mount an effective response, he would need to think like the virus.

  Realizing that the virus was likely to concentrate in busy markets and other crowded settings, he set out to inoculate every person there, even finding and vaccinating visitors. With this innovation, Foege created human shields against the spread of smallpox. The strategy, ultimately adopted globally, is credited with leading to the only successful global disease eradication campaign in history.

  Containment. Foege went on to head the CDC's overall smallpox eradication efforts. Then, in 1973, anxious to get back in the field, he went to India to lead the smallpox battle there. Soon he realized that in another six months, smallpox would be contained in the last village where the virus was still active. Against his boss's urgings, he insisted on coming home. "I'm sorry," Foege told him. "But if I'm here in six months, all the credit will go to the foreigners who worked on this campaign, and the credit really needs to go to the Indian people." He went home. By 1979, the World Health Organization declared that smallpox had been eradicated not just in India but worldwide.

  Foege's next assignment was no less daunting—or successful. In 1978, the WHO member states committed to immunizing 80 percent of the world's children against a range of childhood diseases by 1990, a huge increase from a starting rate of about 5 percent. By the mid-1980s, immunization rates were still only about 20 percent, so in 1984, WHO and other organizations called on Foege. As director of the Task Force for Child Survival and Development, Foege created a model for collaboration that has been replicated for other global health problems. By keeping the focus on the problem instead of turf wars, he played a central role in boosting immunization rates in the developing world to 80 percent within six years. James Grant, then the director of UNICEF, the United Nations Children's Fund, called the effort "the largest peacetime mobilization in the history of the Earth."

  In 1987, Merck & Co. found that a drug used to treat heartworm in dogs was effective in treating river blindness, then such a serious problem in Africa that in many villages all of the men over 40 were blind. At Foege's urging, Merck pledged to supply a form of the drug, ivermectin, for no charge. But the company would do so only if the task force oversaw distribution. Suspicious of the industry, many of Foege's colleagues advised him to reject the conditions.

  But Foege had his mind on the victims. He took responsibility for the distribution, and what developed was arguably the first venture into pharmaco-philanthropy. One of the most effective public-private partnerships in global health, it virtually eradicated river blindness. Since then, other such partnerships have tackled drug-resistant tuberculosis, lymphatic filariasis, trachoma, and guinea worm.

  Foege, 71, may have started his life's work in a church, but his career has been defined by his belief in scientific solutions to the most difficult problems. His is a world of cause and effect: By understanding the science of the cause, he has proved, man can change the effect. Foege's optimism and passion for global health have infected generations of global health professionals. Now, as a senior fellow with the Bill and Melinda Gates Foundation and with the Carter Center, his influence has spread far beyond the practitioners in his own field.

  Jim Yong Kim, one of the 2005 U.S. News Best Leaders, is François Xavier Bagnoud professor of health and human rights at Harvard University.

• Lasker Foundation - http://www.laskerfoundation.org/awards/show/smallpox-eradication-implementation/

  2001 Mary Woodard Lasker Public Service Award
  Smallpox eradication implementation
  Photo of William H. Foege
  William H. Foege

  Emory University Rollins School of Public Health

  Nature Medicine Essay

  This year's Lasker Public Service Award honors a public health physician who pioneered a new technology to eradicate disease and who has been a key figure in getting the fruits of medical research into the public health programs in developed and underdeveloped countries. With gusto and audacity, William Foege has led battles against recalcitrant microbes and tackled mysterious diseases. He played a crucial role in purging smallpox from Earth and has since guided projects aimed at eradicating other devastating infectious diseases. Under his direction, the CDC unraveled the medical enigmas of toxicshock and Reyes syndrome, and issued early warnings about how AIDS spreads. After completing his work for the government, he signed on with several nonprofit groups aimed at improving health worldwide, especially for children. Foege gravitates toward monumental challenges; when he arrives, his drive to solve problems and his relentless optimism allow him to surmount them.
  Isolate and conquer

  By imagining that he was a virus, Foege beat smallpox at its own game. He outsmarted the lethal microbe by zeroing in on its next potential victims — and inoculating them with a protective vaccine. This triumph provided the blueprint that public health workers used to obliterate smallpox from the planet.
  Award presentation by Daniel Koshland, Jr.

  William Foege, this year's awardee of the Mary Lasker Award for Public Service, is long on wisdom, long on inventiveness, and long in the length of his legs. As you will hear from what I say, all of these measures of longitude are significant in his award.

  William Foege was Director of the Center for Disease Control when he set out with a few others to eradicate smallpox from the world. Later the CDC under his direction unraveled the medical enigmas of toxic shock and Reyes syndrome and issued early warnings about the spread of AIDS. When the Merck Company decided to make its drug against river blindness available free in Africa, they said they would do so if William Foege were responsible for administrating the program. It was done so well that other companies followed suit and offered their drugs, also free, to underdeveloped and impoverished countries.
  William H. Foege
  Acceptance remarks, 2001 Lasker Awards Ceremony

  Nature Medicine Essay

  In 1965, I stopped at the London School of Tropical Medicine on my way to live in Africa. Of the many people I talked to, as I desperately tried to understand the health conditions I faced in Africa, was a Dr. Cochrane who had retired as medical director of Vellore Medical School in India and who had authored the definitive textbook on leprosy. Having asked a simple question on leprosy, I was trapped for the next three days at his house reviewing leprosy slides since he felt he would be a failure if I left London knowing as little as I did. It was the week that I discovered that the compulsion to teach far surpasses the compulsion to learn.

• MMWR CDC - https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5539a4.htm

  CDC's 60th Anniversary: Director's Perspective --- William H. Foege, M.D., M.P.H., 1977--1983
  Expansion of Public Health

  Modern public health began 210 years ago, in 1796, when Edward Jenner, using material from a cowpox lesion on the hand of Sarah Nelmes, vaccinated James Phipps. A later attempt to give Phipps smallpox demonstrated his immunity, and the vaccination era had begun. Although Jenner lacked our understanding of viruses, the immune system, or vaccinology, his clinical observations had convinced him that milkmaids were protected from smallpox because of their previous exposure to cowpox, and he acted to see if nature could be replicated.

  David Sencer reported on the conclusion to the smallpox saga in his Director's Perspective (1), describing how Jenner's actions were taken to their logical extension during the smallpox eradication program in the 1960s and 1970s. CDC contributed more than 300 workers to this global effort, many of them assigned to the World Health Organization for deployment throughout the world. The importance of this event in the collective energy that defined CDC in 1977 cannot be overstated. Workers at CDC believed they could make a difference. They thought globally, understood teamwork, and were proud to be part of the organization.

  For much of the past 210 years, public health has been synonymous with combating infectious diseases. As Sencer points out, although public health had made excursions into occupational health and environmental health, nutrition, birth defects, smoking, and even family planning, the focus was predominantly on the prevention and control of infectious diseases. However, interest in the health of the public increasingly required concern over the toll of chronic diseases, exposure to chemical toxins, the role of intentional and unintentional injury, and the interaction of many risk factors beyond microbes. Public health was changing, and so were the demands on CDC.
  Changing CDC Priorities and Structure

  In 1977, an invitation went out to health workers in cities, counties, states, academic institutions, industry, government, and global organizations to provide suggestions regarding what CDC needed to do in its pursuit of three objectives: 1) reducing unnecessary suffering, 2) reducing premature mortality, and 3) improving life quality. Hundreds of responses and thousands of suggestions were received and assembled into categories by a team led by Seth Leibler.

  Next, an outside committee, with J.D. Millar acting as liaison to CDC, was asked to consider these suggestions, along with patterns of morbidity and mortality in the United States and to provide guidance on the highest future priorities for CDC. The committee determined that mortality figures often were misleading in defining the importance of a health problem. At CDC this led to the use of "Years of Potential Life Lost," a concept used subsequently in many publications. Age 65 was accepted as the age for comparison, not because it defined the median or the desired, but because age 65 was commonly used in the reporting of global statistics. The committee recommended a dozen priorities for CDC.

  During two retreats, managers at CDC considered the priorities to see whether they could support them. They accepted all 12 recommendations and, in the course of discussion, added an additional three for a total of 15 priorities for CDC to pursue.

  Having agreed on objectives, priorities, and the need to expand CDC's activities, the difficult task of reorganizing the agency remained. In preceding years, every outbreak investigation had required matrix management, with experts drawn from epidemiology, statistics, laboratory sciences, and other disciplines to find the solution. With expanding priorities and the need for many additional forms of expertise, the solution of public health problems required a new structure. A new structure, with all of its unknowns, was not easy to implement and required special attention to communications and suggestions from those affected by the changes. The crucial ingredient was a director in each center who defined a path that workers were eager to follow. CDC was reorganized into different centers (e.g., Infectious Diseases, Occupational Health, Professional Development and Training, and Environmental Health), each staffed with persons with the various skills needed to solve particular problems. Matrix management was still required (e.g., to determine whether an outbreak was infectious or toxic), but the majority of health problems now related to a given center, and the agency name was changed to Centers for Disease Control.
  Solving New Problems

  Solving health problems was and still is a daily task at CDC. Sometimes these problems emerge as new outbreaks or observations. In the late 1970s and early 1980s, dozens of outbreak solutions were chronicled in MMWR. Investigators determined that newly identified Legionnaires organisms actually were common and had been involved in previously unsolved outbreaks (2). New problems included toxic shock syndrome, which made headlines in 1980 when hundreds of previously healthy women of child-bearing age exhibited fever associated with shock, multi-organ failures, and high death rates (3--5). Rapid identification of tampons as a risk factor, and identification of a specific product as posing especially high risk, helped to reduce but not eliminate this problem.

  During the late 1970s, the world appeared faced with a new, emerging infectious disease (e.g., Lassa fever, toxic shock syndrome, and Legionnaires disease) every year. CDC workers, during the course of some of the most difficult outbreak investigations in history, defined the dynamics of virus transmission and isolated the Ebola virus in Zaire and Sudan (6,7). However, increasingly, outbreak investigations involved noninfectious health problems such as those involving baby foods and diet preparations. The deaths of women attempting to lose weight while consuming liquid-protein diet products led to an understanding of the risk for physiological consequences on cardiac function posed by such products and resulted in their subsequent regulation.

  Although outbreak investigations command much of the media attention, the more routine daily work of thousands of health workers throughout the United States is what ultimately moves morbidity and mortality numbers to lower levels. Monitoring hospital infection rates and their causes, daily maintenance of water supplies, monitoring food handling practices, and improving air quality are only a few of the tasks that, when performed correctly, never become known to the public. Lead poisoning in children provides an example of successful intervention for a problem not involving infectious disease. Leaded gasoline and paint exposed thousands of children to harmful levels of lead. The development of an inexpensive and rapid test in the 1970s made possible the screening of children, resulting in better surveillance, treatment, and prevention measures. The number of children with high lead levels was reduced, and the health and collective intelligence of subsequent cohorts of children was improved (8).
  Redefining the Unacceptable

  In the infectious disease field, immunizations have been both highly effective and cost effective and have resulted in the prevention of diseases that were leading causes of death a century ago. In 1977, with the support of the White House and the Department of Health, Education, and Welfare, new measures were taken to improve immunization rates. Many have noted that public health is constantly redefining the unacceptable. A quarter century ago, the objective of 90% school-age immunization coverage with common childhood vaccines was regarded by many as too ambitious. That objective proved achievable but still insufficient, as researchers determined that such levels of immunization coverage must be reached by age 2 to achieve optimal disease control.

  In 1978, improvements in immunization rates led to the possibility of interrupting measles transmission in the United States. Some thought this unachievable and believed pursuing such an objective would only harm the reputation of CDC. Others felt the true barriers would not be determined unless this ultimate objective was selected; consequently, CDC set a goal of interrupting indigenous measles transmission. Month by month, every measles solution revealed a new problem, including transmission among military recruits (solved by vaccinating all recruits regardless of history), in day care centers, preschools, colleges, and even in unexpected settings such as stadiums or theme parks. Ultimately, when every other problem appeared solved, a final barrier was uncovered, namely the importation of measles into the United States on an average of twice a week. Today, implementation of measles immunization programs around the world continues to decrease the rate of importation into the United States. Meanwhile, in 2003, measles was declared no longer endemic in the Americas (9), and in the United States, rubella was declared no longer endemic in 2005 (10).

  In 1981, the most devastating of the emerging infections, which would become known as human immunodeficiency virus (HIV) infection, was described in MMWR. During the following months, CDC investigators of sexually transmitted diseases under the leadership of Paul Weisner, and later agency-wide investigators headed by Jim Curran, devoted more resources to understanding HIV and acquired immunodeficiency syndrome (AIDS) than any other investigation in CDC history. Two years later, even before a virus had been isolated, the CDC team was able to outline in MMWR, on the basis of epidemiologic evidence, what was known about transmission and what could be done to reduce transmission rates. Their recommendations were remarkably accurate and reinforced by later findings. The frustration of the early years was gaining insight into transmission dynamics but having inadequate screening techniques for risk reduction. For example, with the second clinical report of HIV involving a person with hemophilia, the team knew the virus would pose risks for recipients of blood transfusions in general, yet no specific screening technique existed to identify contaminated units of blood. The only recourse was exclusion of groups as blood donors, based on risk factors. In later years, after a screening test for HIV infection was developed and implemented, frustration changed to disappointment as scientists found themselves able to understand HIV/AIDS transmission patterns but still faced with the difficulties of altering human behavior.

  As CDC expanded beyond infectious diseases, new surveillance systems were developed for chronic diseases and risk factors that are followed inevitably by health impairments. CDC continued to document the impact of smoking on health but also worked on how best to educate the public and how to evaluate the value of school health curricula. In addition to smoking, work on heart disease, cancer, and obesity required expertise in nutrition, exercise, and human behavior, leading to a need for more public health workers trained in the social sciences. The methods used for infectious disease surveillance not only had relevance for determining risk factors for chronic diseases but also for violence and injuries. Three of the top five causes of years lost prematurely involved homicide, suicide, and unintentional injuries. Creative work was done to define measures for preventing violence and injuries. The groundwork was set for the future establishment of the National Center for Injury Prevention (11).
  Science Versus Politics

  Every public health decision involves political decisions. A price came with CDC's expansion beyond infectious diseases, which generally do not have a group of persons who benefit from the disease and are lobbying to reduce control efforts. With infectious diseases, public health decisions usually can be based on the best science available; this is not always true in the larger public health arena. Tobacco companies make their profit by selling cigarettes and will actively fight efforts to reduce tobacco consumption. The new reality at CDC involved groups disputing its findings, such as gun lobbyists, and political pressures from both congressional and administrative personnel regarding occupational health decisions, lead abatement recommendations, and tobacco statements. One Senate Committee demanded the names of persons investigated in the liquid-protein diet deaths so that it could perform its own investigation. The names were not provided. A congressman demanded the names of persons in CDC files who tested positive for HIV. Again, the demand was refused. But the time and effort required to counter such political intrusions increased and became a fact of life that continues to decrease the efficiency of public health workers. CDC needs to continue to base its decisions on the best available science, but factors beyond science continue to contribute to public policy decisions.

  A final example involves Reye syndrome, a problem that had concerned CDC for some years. By 1979, CDC had the results of three case-control studies from Arizona, Michigan, and Ohio, indicating that salicylates (i.e., aspirin) were a risk factor under certain conditions. Michigan performed another study during the 1980--81 influenza season that also determined salicylates were a risk factor for Reye syndrome.

  None of the studies had reached statistical significance, in an era when meta-analysis for combining studies for statistical analysis was in its infancy. The National Institutes of Health, Food and Drug Administration (FDA), and CDC all had made statements regarding the possible association of medications with Reye syndrome; however, those statements had fallen short of advising against use of salicylates in children with influenza or chickenpox. Outside consultants all agreed that the various shortcomings of the studies were insufficient to neutralize the consistency of the findings. The aspirin manufacturers were unrelenting in their arguments that CDC's scientific reputation would be ruined if the studies were reported without having achieved statistical significance. But CDC and FDA decided to report on the studies in a joint statement, making their shortcomings very clear, in the belief that pediatricians and parents should have all the information that the Public Health Service had. The night before publication, FDA called to say it had received new information from the aspirin manufacturers and that CDC should delay publication.

  However, the next day, CDC decided to proceed with its publication plan. The report in MMWR detailed the shortcomings of the studies and concluded with the following statement: "Until definitive information is available, CDC advises physicians and parents of the possible increased risk of Reye syndrome associated with the use of salicylates for children with chickenpox or influenza-like illnesses (12)."

  The very surprised aspirin manufacturers descended on the assistant secretary of health, who supported the statement. They went to the secretary of Health and Human Services, who supported the statement. They then went to the White House, which told CDC to start a new study. But the word was already out. Salicylates were withheld in children with chickenpox and influenza, reports of Reye syndrome declined, lives were saved, and science had trumped politics. The challenge for the future is to continue making the best science available for the benefit of everyone.
  References

  CDC. CDC's 60th anniversary: director's perspective---David J. Sencer, M.D., M.P.H., 1966--1977. MMWR 2006;55:745--9.
  Fields BS, Benson RF, Besser RE. Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev 2002;15:506--26.
  Reingold AL, Hargrett NT, Shands KN, et al. Toxic shock syndrome surveillance in the United States, 1980 to 1981. Ann Intern Med 1982;96(6 Pt 2):875--80.
  Hajjeh RA, Reingold A, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: surveillance update, 1979--1996. Emerg Infect Dis 1999;5:807--10.
  CDC. Toxic shock syndrome---United States. MMWR 1997;46:492--6.
  World Health Organization. Ebola haemorrhagic fever in Zaire, 1976. Bull World Health Organ 1978;56:271--93.
  World Health Organization. Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team. Bull World Health Organ 1978;56:247--70.
  CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control: January 1985. Atlanta, GA: US Department of Health and Human Services, CDC; 1985.
  Katz SL, Hinman AR. Summary and conclusions: measles elimination meeting, 16--17 March 2000. J Infect Dis 2004;189(Suppl 1):S43--7.
  CDC. Achievements in public health: elimination of rubella and congenital rubella syndrome---United States, 1969--2004. MMWR 2005;54;279--82.
  Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine. Injury in America: a continuing public health problem. Washington, DC: National Academy Press; 1985.
  CDC. National surveillance for Reye syndrome, 1981: update, Reye syndrome and salicylate usage. MMWR 1982;31:53--6,61.

  In commemoration of CDC's 60th Anniversary, MMWR is departing from its usual report format. This is the second in a series of occasional commentaries by directors of CDC. The directors were invited to give their personal perspectives on the key public health achievements and challenges that occurred during their tenures.

  William H. Foege, M.D., M.P.H., joined CDC in 1962 as an officer in the Epidemic Intelligence Service and was director of CDC during 1977--1983. His other positions have included executive director of the Carter Center during 1986--1992. He is currently a senior fellow at the Bill & Melinda Gates Foundation in Seattle, Washington. He lives in Vashon, Washington.

• Theranos - https://news.theranos.com/2016/07/27/former-cdc-director-dr-bill-foege-on-why-he-stands-behind-theranos-how-to-build-an-effective-coalition-what-presidential-candidates-must-address-this-fall/

  Former CDC Director Dr. Bill Foege on Why He Stands Behind Theranos
  July 27, 2016

  This interview originally appeared on Becker’s Hospital Review on July 25, 2016.

  The world’s brightest minds work every day to untangle the complex issues that plague healthcare. And while many problems remain, occasionally someone succeeds.

  One of those breakthroughs was led by William H. Foege, MD, MPH, an epidemiologist and former director of the CDC. Dr. Foege is credited with developing a strategy to eradicate smallpox when vaccine supplies ran out in the late 1970s. His resourcefulness and advocacy became an integral part of the World Health Organization’s global immunization campaign, helping wipe out an infectious disease for the first time ever.

  Now, more than 35 years later, Dr. Foege has set his sights on another project with the capacity to change global health: miniaturized blood tests. Dr. Foege serves on the Board of Directors and Scientific and Medical Advisory Board for Palo Alto, Calif.-based Theranos, a startup developing affordable blood tests with smaller sample sizes. Though the company has faced significant challenges over the past several months — including class-action lawsuits, investigations and lab license revocation — Dr. Foege says he stands behind the Theranos’ technology and promise.

  We checked in with Dr. Foege to discuss why he is so excited about the global health potential behind Theranos’ technology, what implications Zika could have on the U.S. and his advice for those leading change in healthcare today.

  Editor’s note: Responses have been edited lightly for length and style.

  Question: In your May commencement speech at Emory University, you advised graduates to always question tradition. Are there any traditions in healthcare you think our readers should question?

  Dr. William Foege: When I graduated from medical school 55 years ago, I was receiving a lot of warnings from the American Medical Association about the possibility of socialized medicine. They had all of us looking over our left shoulder to see if socialized medicine was gaining ground, and no one ever said, ‘Look over your right shoulder to see if capitalism is gaining ground.’ And of course, it did. Our tradition has been that the marketplace is the place to deliver medicine. We’re now in the position of spending more money per person on healthcare than any country, but our outcomes don’t reflect that. We are not in top five, 10, 15, or even 20 countries when it comes to health outcomes. It’s time to challenge the tradition: Is the marketplace is the best place to deliver medicine? I don’t think it is because once profits become the bottom line, it skews everything.

  Another tradition that’s worth looking at is the concentration on process measurements. We put a lot of attention on process measurements rather than on health outcome measurements. In 1993, the World Bank came up with a new way of looking at this called disability-adjusted life years. It changed global health because you could combine illness, suffering and death into a single number. We should be clever enough in healthcare to figure out how to do a better job of measuring health outcomes, and at least part of reimbursement should be based on health outcomes.

  Q: When you first came up with the “surveillance/containment” technique to eradicate smallpox, people felt it was a top-down approach. But, as William Watson Jr., then-deputy director of the CDC, said in Columns Magazine in 1994, “Bill has a great talent for coming up with creative ideas and presenting them in a way that doesn’t threaten people.”

  How did you convince people to get on board with this technique — and based on your experience — what advice would you give hospital and health system leaders who want to lead innovation and change at their organizations?

  WF: I have to admit coming up with that approach was largely by accident. We did not have enough vaccines to do what we had been trained to do, which was to mass vaccinate. We were looking for shortcuts. [The surveillance/containment strategy] worked so well, we [took it] from an individual outbreak [and applied it] to all of eastern Nigeria, from there to other places in Africa, and finally we tried it in India. That was the most difficult place because in 1974, in one state alone, there were 1,500 new cases of smallpox every day. That’s a new case every minute. It was just massive and overwhelming.

  The bottom line is we had the vision, and then we worked on managerial improvement. One thing that became clear to me is we don’t do anything without a coalition. No one does anything on their own. So the question becomes: How can you better the coalition?

  Leadership today is defined by the person who can make the coalition truly productive. The most effective coalitions are those built around an outcome — a definition of a last mile — rather than an interest. If you get people together because they are the same religion or the same political party, that’s not nearly as good as getting them together against an outcome that is defined from the beginning. We also know leadership has to practice ego suppression for the coalition really to work. Success becomes group success, not a turf some person gets.

  An example of all of this in healthcare would be if a health system decides we are not only going to have the best, state-of-the-art treatment for heart attacks, but we are also going to reduce the number of people who come in with heart attacks. That would force them to get prevention involved. That’s the sort of last mile objective that could really change things.

  The best decisions are based on the best science, but the best results are based on the best management. It’s this combination of science and management that can make a coalition really work.

  Q: What are one or two healthcare issues you feel are absolutely essential for the presidential candidates to address in the coming months?

  WF: I would sure like to see them address the issue of prevention. Each day, life expectancy for the average American increases by 6-7 hours. That’s just an incredible figure, and a big share of that is prevention. Yet prevention is always the last thing funded. We don’t seem to learn the lesson. This is true for individuals, cities, states and the nation: We don’t truly value health until we lose it. It’s hard to get people to speak about prevention ahead of time.

  The other thing I would like to see them discuss is global health. When I started at the CDC, I was told over and over we had to justify everything we did on the basis of what it meant for the health of an American, and not the health of the world. All you have to do is look at Ebola and Zika and you realize how short-sighted that is. It’s the same with smallpox eradication. The U.S. saves as much money every 3 months because of smallpox eradication as its total investment in smallpox eradication. Every year we get four times return on our total investment, and that will continue forever. It becomes almost an infinite figure.

  We should have more discussion on how related we all are in this world and how important it is to be investing in global health. It’s especially important when you see the political discussions now becoming very nationalistic. Einstein said nationalism is an infantile disease. He called it the “measles of mankind.” When it comes to health, we have to talk globally.

  Q: Do you expect the Zika virus to be a major challenge for U.S. healthcare providers this summer? Why or why not?

  WF: I don’t know what’s going to happen with Zika. This virus has been known about for decades. It was recovered in Africa and other places, and the vector was in the Americas for a long time, but for some reason it didn’t spread. When it did spread, it spread fast. I would expect that’s what will happen in part of the U.S., but I can’t be sure. I know we have to be ready for the worst-case scenario. One of the good things that Zika has done — it’s caused people to do a better job of conveying their research findings. Just [recently] The New York Times talked about how people are putting their findings online before they even publish them. That’s a nice step in medical research.

  Q: You mentioned we have to be ready for the worst-case scenario with Zika. What is that?

  WF: The worst case would be massive spread wherever we have Aedes aegypti mosquitoes, and we pretty much know where that is. Then, it’s pregnant women becoming infected and having infected children. One of the hard things about Zika is this is the first virus we’ve ever known about that is spread by a mosquito that causes birth defects. It isn’t as if we have a track record of knowing how this will play out.

  Q: You recently were named to Theranos’ Board of Directors and its Scientific and Medical Advisory Board and previously served on the company’s Board of Counselors. What first attracted you to this company and what made you decide to stick with it through its recent troubles?

  WF: My interest initially was very much around global health. What they have done is what the computer industry has done. That the industry has gone from computers that take up an entire room to desktop computers, to laptops, to smartphones. This miniaturization is now being done by Theranos in technologies and equipment. This means it is possible to consider using this technology in developing countries, even without electricity. You could hook up this technology to a car battery.

  Why is that so important in global health? One example: You see a person with tuberculosis in a clinic in Nigeria. You take a sample and it takes three weeks to see if that person has tuberculosis or not. By the time you get the result back, you may or may not be able to find that person again. But with Theranos and this miniaturization, you can actually make a diagnosis in the clinic the day you see a patient and you can tell whether that organism is resistant to antibiotics. It’s a huge leap forward. That’s what originally attracted my attention.

  Having had the opportunity to look at their technology, it’s very robust. The problems they have been vilified for have to do with lab operations and the fact that they have not published in peer reviewed journals. They are correcting the operational problems, and changes are being made. As for the science, they are preparing to send articles to peer reviewed journals. For me, the bottom line is that global health needs this sort of technology and Theranos is going to solve the problems to provide it. That’s what has me excited.

  Q: Why didn’t they initially choose to publish in peer review journals?

  WF: Theranos was trying to get to a point of development where they had the entire package before they released the specifics of it. Now they realize that did not work so well, and they are going to share their technologies with the scientific community.

  Q: Are they at the stage now where they have the whole package or are they still working on it?

  WF: They have tests now for many entities, but the number of things to be tested continues to increase. In one sense, [Theranos has] a platform in which they will be working on new technologies forever. Not only are there so many organisms we don’t know about, but one new problem organism emerges every year, like Ebola and Lassa fever, and the other hemorrhagic fevers of the past.

• UC Press - https://www.ucpress.edu/book/9780520274471/house-on-fire

  William H. Foege, Senior Fellow at the Gates Foundation, has held a succession of distinguished positions, including Director of the Centers for Disease Control and Prevention and Professor and Health Policy Fellow at Emory University. Before becoming director of the CDC, he was chief of its Smallpox Eradication Program. Foege is the author of Global Health Leadership and Management.

  House on Fire The Fight to Eradicate Smallpox

  by William H. Foege (Author)
  June 2011
  First Edition

  About the Book

  A story of courage and risk-taking, House on Fire tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India. In House on Fire, William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective—eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, House on Fire gives an intimate sense of what it is like to work on the ground in some of the world’s most impoverished countries—and tells what it is like to contribute to programs that really do change the world.

• Hilton Foundation - https://www.hiltonfoundation.org/news/133-a-tribute-to-william-h-foege-m-d-m-p-h

  Our News
  A Tribute to William H. Foege, M.D., M.P.H.
  March 10, 2016

  After eight years of service, William H. Foege, M.D., M.P.H., has retired from the Conrad N. Hilton Foundation board of directors. Dr. Foege previously served for seven years on the prestigious international jury of the Conrad N. Hilton Humanitarian Prize, the world’s largest humanitarian award.
  Bill Foege Humanitarian Prize, Tribute

  Dr. Foege is a world renowned epidemiologist who worked in the successful campaign to eradicate smallpox in the 1970s. Dr. Foege became Chief of the CDC Smallpox Eradication Program and was appointed Director of the U.S. Centers for Disease Control in 1977.

  In 1984, Dr. Foege and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, The World Bank, the United Nations Development Programme, and the Rockefeller Foundation. Its success in accelerating childhood immunization led to an expansion of its mandate in 1991 to include other issues which diminish the quality of life for children.

  Dr. Foege has championed many issues, but child survival and development, injury prevention, population, preventive medicine, and public health leadership are of special interest, particularly in the developing world. He is a strong proponent of disease eradication and control, and has taken an active role in the eradication of Guinea worm, polio and measles, and the elimination of River Blindness. By writing and lecturing extensively, Dr. Foege has succeeded in broadening public awareness of these issues and bringing them to the forefront of domestic and international health policies.

  Dr. Foege received the Presidential Medal of Freedom in 2012, in addition to many other awards during the course of his career. He also holds honorary degrees from numerous institutions, and was named a Fellow of the London School of Tropical Medicine and Hygiene in 1997. He is the author of more than 125 professional publications.

  It is with profound gratitude that we thank Dr. Foege for his exemplary service on the Hilton Foundation board. We were fortunate to benefit from both his broad vision of life as well as his deep knowledge of the health field. His personal style motivated others to want to engage and explore issues further. While we are sad to be losing an influential and prominent member of our board, we remain grateful that Dr. Foege raised the bar of our deliberations. We wish him all the best in his future endeavors.

  Steven M. Hilton
  Chairman of the Board
  Conrad N. Hilton Foundation

• Wikipedia - https://en.wikipedia.org/wiki/William_Foege

  William H. Foege
  William H. Foege.jpg
  Director of the Centers for Disease Control and Prevention
  In office
  1977–1983
  President Jimmy Carter
  Ronald Reagan
  Preceded by David Sencer
  Succeeded by James Mason
  Personal details
  Born March 12, 1936 (age 82)
  Decorah, Iowa
  Nationality American
  Spouse(s) Paula Foege
  Residence United States
  Education Pacific Lutheran University (BA)
  University of Washington (MD)
  Harvard School of Public Health (MPH)

  William Herbert Foege[1] M.D., M.P.H. (/ˈfeɪɡiː/;[2] born 1936 in Decorah, Iowa[3]) is an American epidemiologist who is credited with "devising the global strategy that led to the eradication of smallpox in the late 1970s".[4]

  Foege also "played a central role" in efforts that greatly increased immunization rates in developing countries in the 1980s.[5]

  In June 2011, he authored House on Fire: The Fight to Eradicate Smallpox, a book on modern science, medicine, and public health over the smallpox disease.[6]

  Contents

  1 Early life
  2 Education
  3 Career
  4 Personal life
  5 Awards and honors
  6 Selected publications
  6.1 Books and book chapters
  6.2 Journal articles
  7 References
  8 External links

  Early life

  Foege was born March 12[citation needed] 1936 in Decorah, Iowa. He was the third of six children born to William A. Foege, a Lutheran minister, and Anne Erika Foege.[7] The family lived in Eldorado, Iowa in Fayette County, starting in 1936 and moved to Chewelah, Washington, in 1945.[7]

  In his younger days he was inspired by the life of his uncle, a Lutheran missionary to New Guinea.[5] He became interested in science at age 13 when working at a pharmacy, and read extensively about the world (e.g., Albert Schweitzer's work in Africa) while in a body cast for several months at age 15.[8] When a teenager he expressed a desire to practice medicine in Africa.[5]
  Education

  Foege received a B.A. from Pacific Lutheran University in 1957.[9] He attended medical school at the University of Washington, where he became interested in public health while working "after school and on Saturdays" at the Seattle–King County Health Department.[8] After receiving his M.D. in 1961, he completed an internship with the United States Public Health Service hospital at Staten Island in 1961–1962.

  He participated in the Epidemic Intelligence Service (EIS) of the Centers for Disease Control and Prevention (CDC) between 1962 and 1964, assigned to Colorado.[10][11] When Foege was with the EIS, he was inspired by Alexander Langmuir to pursue global health, and spent a short time with the Peace Corps in India under Charles Snead Houston. Upon reading a lecture on priorities in public health by Thomas Huckle Weller,[12] Foege entered the Master of Public Health program at the Harvard School of Public Health where he studied with Weller.[8] He received his M.P.H. in 1965.[9]
  Career

  Foege's research includes child survival and development, injury prevention, population, preventive medicine, and public health leadership—particularly in the developing world. He is a strong proponent of disease eradication and control and has taken an active role in the eradication of Guinea Worm Disease, polio and measles, and the elimination of river blindness.[13]

  He has held various positions during his career:

  Director, Centers for Disease Control, 1977–1983
  President, Co-Founder, The Task Force for Global Health, 1984-1999[14]
  Senior Fellow, Global Health Program, Bill & Melinda Gates Foundation[15]
  Advisory Board Member, Emory University Global Health Institute[16]
  Professor Emeritus, Rollins School of Public Health[17]
  Health Policy Fellow, The Carter Center, 1986–present[18]
  Executive Director, The Carter Center, 1986–1992[18]
  Advisory Medical Board Member, Theranos[19]

  Personal life

  Also known as "Bill Foege," he is noted for his height of 6 feet 7 inches (2.01 m).[4][20] Foege and his wife Paula had three sons, the eldest of whom died in 2007.[21] He has been described as a "religious man";[22][23] between 1997 and 2006 he served on the Board of Regents of Pacific Lutheran University.[24][25]
  Awards and honors

  Abraham Lilienfeld Award, American College of Epidemiology, 1990[26]
  Fries Prize for Improving Health, James F. and Sarah T. Fries Foundation (formerly known as the Healthtrac Foundation), 1992[27]
  Sedgwick Memorial Medal, American Public Health Association, 1993[28]
  Frank A. Calderone Prize, Columbia Mailman School of Public Health, 1996[29]
  Honorary Doctor of Science, Harvard University, 1997[1]
  Honorary Fellow, London School of Hygiene & Tropical Medicine, 1997–present[16][30]
  Honorary Doctor of Humane Letters, Pacific Lutheran University, 2000[31]
  Wittenberg Award, The Luther Institute, 2001[32]
  Mary Woodard Lasker Award for Public Service, 2001[33]
  C.-E. A. Winslow Medal, Yale University, 2004[34]
  Thomas Francis, Jr. Medal in Global Public Health, University of Michigan, 2005[35]
  Public Welfare Medal, United States National Academy of Sciences, 2005[3]
  Honorary Doctor of Medical Sciences, Yale University, 2005[36]
  Albert B. Sabin Gold Medal, Sabin Vaccine Institute, 2006[37]
  Julius B. Richmond Award, Harvard School of Public Health, 2006[38]
  The William H. Foege building, named in his honor and dedicated in 2006, houses the University of Washington School of Medicine's Departments of Bioengineering and Genome Sciences.[4]
  Jimmy and Rosalynn Carter Award for Humanitarian Contributions to the Health of Humankind, National Foundation for Infectious Diseases, 2007[39]
  Chosen as one of "America's Best Leaders" by U.S. News & World Report, 2007[5]
  Raymond and Beverly Sackler Award for Sustained National Leadership, Research!America, 2008[40]
  CDC Foundation Hero Award, 2009[41]
  Ivan Allen Jr. Prize for Social Courage, Ivan Allen College of Liberal Arts at the Georgia Institute of Technology, 2012[42]
  Presidential Medal of Freedom, 2012[43]
  Richard and Barbara Hansen Leadership Award, University of Iowa College of Public Health, 2014[44]

  Selected publications
  Books and book chapters

  Foege WH, Amler RW (1987). "Introduction and methods". In Amler RW, Dull HB. Closing the gap: the burden of unnecessary illness. New York: Oxford University Press. ISBN 0-19-505483-0. OCLC 16755579.
  Foege WH. "Foreword." In: Albert Schweitzer (1998). The primeval forest. Baltimore, Md: Johns Hopkins University Press in association with The Albert Schweitzer Institute for the Humanities. ISBN 0-8018-5958-1. OCLC 38925138.
  Ross DA, Hinman AR, Saarlas K, Foege WH (2003). "Foreword". In O'Carroll PW, et al. Public health informatics and information systems. Berlin: Springer. pp. v–vii. ISBN 0-387-95474-0. OCLC 133157982.
  Foege WH; et al., eds. (2005). Global health leadership and management. San Francisco: Jossey-Bass. ISBN 0-7879-7153-7. OCLC 57579300.
  Foege WH (June 2011). House on Fire: The Fight to Eradicate Smallpox. University of California Press. ISBN 978-0-520-26836-4.

  Journal articles
  Foege WH, Millar JD, Lane JM (October 1971). "Selective epidemiologic control in smallpox eradication". Am J Epidemiol. 94 (4): 311–5. PMID 5110547.
  Foster SO, Brink EW, Hutchins DL, Pifer JM, Lourie B, Moser CR, Cummings EC, Kuteyi OE, Eke RE, Titus JB, Smith EA, Hicks JW, Foege WH (1972). "Human monkeypox". Bull World Health Organ. 46 (5): 569–76. PMC 2480784 Freely accessible. PMID 4340216.
  Ruben FL, Smith EA, Foster SO, Casey HL, Pifer JM, Wallace RB, Atta AI, Jones WL, Arnold RB, Teller BE, Shaikh ZQ, Lourie B, Eddins DL, Doko SM, Foege WH (1973). "Simultaneous administration of smallpox, measles, yellow fever, and diphtheria—pertussis—tetanus antigens to Nigerian children". Bull World Health Organ. 48 (2): 175–81. PMC 2481001 Freely accessible. PMID 4541683.
  Henderson RH, Davis H, Eddins DL, Foege WH (1973). "Assessment of vaccination coverage, vaccination scar rates, and smallpox scarring in five areas of West Africa". Bull World Health Organ. 48 (2): 183–94. PMC 2481004 Freely accessible. PMID 4541684.
  Foege WH, Millar JD, Henderson DA (1975). "Smallpox eradication in West and Central Africa". Bull World Health Organ. 52 (2): 209–22. PMC 2366358 Freely accessible. PMID 1083309.
  Ravenholt RT, Foege WH (October 1982). "1918 influenza, encephalitis lethargica, parkinsonism". Lancet. 2 (8303): 860–4. doi:10.1016/s0140-6736(82)90820-0. PMID 6126720.
  Foege WH, Amler RW, White CC (September 1985). "Closing the gap. Report of the Carter Center Health Policy Consultation". JAMA. 254 (10): 1355–8. doi:10.1001/jama.254.10.1355. PMID 4021014.
  Hinman AR, Foege WH, de Quadros CA, Patriarca PA, Orenstein WA, Brink EW (1987). "The case for global eradication of poliomyelitis". Bull World Health Organ. 65 (6): 835–40. PMC 2491079 Freely accessible. PMID 3501736.
  McGinnis JM, Foege WH (November 1993). "Actual causes of death in the United States". JAMA. 270 (18): 2207–12. doi:10.1001/jama.270.18.2207. PMID 8411605.
  McGinnis JM, Foege WH (Mar–Apr 1999). "Mortality and morbidity attributable to use of addictive substances in the United States". Proc Assoc Am Physicians. 111 (2): 109–18. doi:10.1046/j.1525-1381.1999.09256.x. PMID 10220805.
  Foege W (April 2002). "Keynote address: issues in overcoming iron deficiency". J Nutr. 132 (4 Suppl): 790S–3S. PMID 11925483.
  Foege WH (March 5, 2003). "Holding our breath". MedGenMed. 5 (1): 11. PMID 12827072.
  Foege WH (December 18, 2003). "Polio and policy options". MedGenMed. 5 (4): 34. PMID 14745381.
  McGinnis JM, Foege WH (March 2004). "The immediate vs the important". JAMA. 291 (10): 1263–4. doi:10.1001/jama.291.10.1263. PMID 15010451.
  Foege WH (Winter 2004). "Redefining public health". J Law Med Ethics. 32 (4 Suppl): 23–6. doi:10.1111/j.1748-720X.2004.tb00178.x. PMID 15807317.

• WHO - http://www.who.int/social_determinants/thecommission/foege/en/

  William Foege

  Dr William H. Foege is Emeritus Presidential Distinguished Professor of International Health, Emory University, and a Gates Fellow.

  Dr Foege, an epidemiologist, worked in the successful campaign to eradicate smallpox in the 1970s. Dr Foege became Chief of the CDC Smallpox Eradication Program, and was appointed director of the U.S. Centers for Disease Control and Prevention in 1977. In 1984, Dr Foege co-founded the Task Force for Child Survival, a working group for WHO, UNICEF, The World Bank, UNDP, and the Rockefeller Foundation.

  Dr Foege served The Carter Center between 1986-1992 as its Executive Director, Fellow for Health Policy and Executive Director of Global 2000. Between 1992-1999, he contributed to the Centre's work as a Fellow and as Executive Director of the Task Force for Child Survival and Development. Between 1999-2001, Dr Foege served as Senior Medical Advisor for the Bill and Melinda Gates Foundation.

• Carter Center - https://www.cartercenter.org/about/experts/william_foege.html

  William Foege, M.D., M.P.H
  Senior Fellow, Health Policy

  FoegeWilliam H. Foege is an epidemiologist who worked in the successful campaign to eradicate smallpox in the 1970s. Dr. Foege became chief of the Smallpox Eradication Program of the Centers for Disease Control and Prevention and was appointed director of the CDC in 1977. He attended Pacific Lutheran University, received his medical degree from the University of Washington, and his master's degree in public health from Harvard University.

  In 1984, Foege and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, The World Bank, the United Nations Development Program, and the Rockefeller Foundation. Its success in accelerating childhood immunization led to an expansion of its mandate in 1991 to include other issues that diminish the quality of life for children.

  Dr. Foege joined The Carter Center in 1986 as its executive director, fellow for health policy, and executive director of Global 2000. In 1992, he resigned as executive director of The Carter Center but continued in his role as a fellow and as executive director of the Task Force for Child Survival and Development. In January 1997, he joined the faculty of Emory University, where he is presidential distinguished professor of international health at the Rollins School of Public Health. In September 1999, Dr. Foege became a senior medical adviser for the Bill and Melinda Gates Foundation. He retired from both Emory and the Gates Foundation in December 2001. In October 1999, Dr. Foege resigned as executive director of the Task Force for Child Survival and Development.

  Dr. Foege has championed many issues, but child survival and development, injury prevention, population, preventive medicine, and public health leadership are of special interest, particularly in the developing world. He is a strong proponent of disease eradication and control and has taken an active role in the eradication of Guinea worm disease, polio, and measles and the elimination of river blindness. By writing and lecturing extensively, Dr. Foege has succeeded in broadening public awareness of these issues and bringing them to the forefront of domestic and international health policies.

  Dr. Foege has received many awards, including the Presidential Medal of Freedom in 2012. He holds honorary degrees from numerous institutions and was named a fellow of the London School of Tropical Medicine and Hygiene in 1997. He has written more than 125 professional publications.

• U Washington - https://www.washington.edu/alumni/columns/top10/calling_the_shots.html

  QUOTE:
  Health authorities thought they needed to inoculate 80 to 100 percent of the population to stop smallpox. Foege was able to stop the disease with less than 50 percent. Through "surveillance" of the outbreaks and "containment" of the disease, the epidemic was stopped in its tracks, months before the shipment for mass vaccinations finally arrived.

  Calling the Shots

  The Man Who Helped Banish Smallpox from the Earth is the 1994 Alumnus of the Year.

  By Tom Griffin

  Dr. William Foege

  In 1979, smallpox vanished from Planet Earth due, in part, to a shortage of vaccine and a persuasive American doctor.

  That year the World Health Organization verified that, for the first time in history, humanity was able to stomp out forever an infectious disease. A turning point in that campaign was a 1966 incident in eastern Nigeria.

  A medical missionary, Dr. William Foege, was part of an effort to inoculate the people of West and Central Africa with smallpox vaccine. A shipment for mass vaccinations was due in a few months, but smallpox didn't wait.

  Foege got a radio message that an isolated village had a smallpox case. Could he come and verify the outbreak? "Several of us went up. The village was seven or eight miles from a road. It was smallpox all right, but we did not have sufficient supplies a d we were not going to get supplies to vaccinate everybody.

  "That night we sat around and asked ourselves, 'What would we do if we were a smallpox virus bent on immortality?' " Foege recalls.

  The medical missionary resorted to military tactics. He spread out maps of the district. He asked a ham radio network of missionaries to seek out any cases.

  "In 24 hours we had reports of every village with smallpox," he says. "Our first priority was to use vaccine in those villages - there were only three or four at first. Then we asked ourselves where would smallpox go, and followed the family and market atterns."

  Smallpox has an incubation period of 14 days. Foege and others inoculated market villages and places where relatives of the first victims were living. When the disease broke out in those secondary locations, the rest of the population was already prote ted. "Four weeks later, there was no more smallpox."

  Health authorities thought they needed to inoculate 80 to 100 percent of the population to stop smallpox. Foege was able to stop the disease with less than 50 percent. Through "surveillance" of the outbreaks and "containment" of the disease, the epidemic was stopped in its tracks, months before the shipment for mass vaccinations finally arrived.

  Foege became an apostle of this good news, but the new technique, (eventually named "surveillance/containment") was a hard sell. Sent by the U.S. Centers for Disease Control (CDC) to stamp out smallpox in parts of Africa, many field workers considered Foege's idea a "typical, cracked-brain headquarters scheme, completely out of touch with reality."

  But Foege, back at the CDC headquarters in Atlanta after civil war engulfed Nigeria, pressed his case. "Bill has a great talent for coming up with creative ideas and presenting them in a way that doesn't threaten people," says William Watson Jr., who was then deputy director of the CDC.

  A skeptical CDC doctor in Sierra Leone, Donald Hopkins, decided to give surveillance/containment a try. The West African country was one of the most heavily infected nations in the world. Within nine months, with less than 70 percent of the population vaccinated, smallpox had vanished.

  "The proof was that it worked," Foege says of surveillance/containment. "In almost every geographic area where smallpox was diagnosed, it was gone in 12 to 24 months."

  Surveillance/containment soon became part of the worldwide vaccination campaign. On any list of that effort's "heroes," you'll find the name of Bill Foege. As the architect of a radical vaccination scheme, and an unrelenting advocate of the idea, he helped banish the scourge from the Earth.

  Playing a pivotal role in smallpox eradication is one reason why Foege, a 1961 graduate of the UW School of Medicine, has been named the 1994 UW Alumnus Summa Laude Dignatus. The award is the highest honor the UW can bestow upon its graduates.

  The U.S. -- and the world-- is a healthier place thanks to his efforts. As head of the CDC from 1977-83, Foege (pronounced FAY-gy) reorganized his agency, putting more resources into preventative medicine. During his tenure, the CDC was able to pin down quickly the cause of two major health crises: toxic shock syndrome and Reye's syndrome.

  In his post-CDC career Foege has set his sights on destroying three more diseases: polio and two parasitic scourges, river blindness and Guinea worm.

  Two presidents have asked Foege for his help. In 1986 former President Jimmy Carter invited Foege to become the executive director of the Carter Center in Atlanta, a position he held until last year. "He provided leadership for a broad array of intern tional programs addressing issues of human rights and conflict resolution throughout the world," Carter said.

  President Bill Clinton recently nominated Foege to be the next executive director of UNICEF. Foege is one of five nominees; a decision by U.N. Secretary General Boutros Boutros-Ghali is expected in October.

  The globe-trotting Foege, who travels constantly for work and yet likes to takes family vacations in the Galapagos Islands, New Zealand or the Amazon rain forest, is the son of a Lutheran minister. He grew up in Chewelah and Colville in the far northeast corner of Washington.

  With four sisters and a brother, it was a close-knit family, Foege recalls. His older sister, Grace, had a particular influence on him, blazing a trail to Pacific Lutheran University in Tacoma and then the UW medical school, a trail which her brother followed.

  While he was at PLU, Foege would visit his sister at the UW. "Every time I saw it, I liked it more and more," he says. Always interested in Africa, Foege applied to medical school in the hope of using those skills on that continent.

  UW Physiology Chair Wayne Crill was a housemate during Foege's first two years in medical school. Foege is 6 foot 7 inches and Crill had the same response everyone else does on first meeting. "My reaction was 'Gee that guy is tall,' " Crill recalls.

  Foege quickly earned the reputation as a practical joker, one he carries to this day. But as his classmates got to know him, one quality stood out, adds Crill. "He was clearly interested in those aspects of medicine that were not the money- making, flashy aspects. Always, always."

  Planning to become a medical missionary, Foege concentrated in public health, which led him into contact with Dr. Reimert Ravenholt, then the King County public health officer. "He was an intriguing professor," Foege recalls, "who made public health much more interesting than it would be otherwise."

  Fresh out of medical school, Foege joined the CDC's Epidemic Intelligence Service, sort of an FBI for hunting down infectious disease outbreaks. In 1965 he earned his master's in public health from Harvard and then headed for Yahe, Nigeria, to start a medical mission for the Lutheran church. "We lived in a village in Africa with no electricity, no water, in a mud hut with a 3- year-old boy. That's not easy," he says. Exhilarated by the discovery that surveillance/containment works, he was fighting smallpox across eastern Nigeria when one of that nation's states -- Biafra -- declared its independence. Civil war broke out in 1967 and his family was evacuated.

  Foege stayed, though times were dangerous. Once he rescued a fellow health worker who had been held at gun point by a 13-year-old rebel. Foege himself was placed in detention twice, once for several days. To attend a conference in Ghana, he had to canoe across the Niger River. He never went back.

  "There were things that made you wonder what you were doing there. I remember thinking, 'Medical school wasn't ever this hard.' "

  With his mission in ruins, he returned to the CDC, working his way up to become head of the Smallpox Eradication Program. The World Health Organization had set a goal of wiping out smallpox by 1976. By the end of 1972, the scourge was active only in South Asia and the Horn of Africa.

  One U.N. official asked that the CDC "loan" Foege to tackle the problem in India. But some of his colleagues urged him not to go. "You don't need a failure like that on your record," one warned. Then-CDC Deputy Director Bill Watson recalls a "very senior World Health Organization official" telling him and Foege, "If you eradicate smallpox from India, I'll eat the tire off your jeep."

  After Foege arrived in India, the epidemic actually started to worsen. In one week in the state of Bihar, more than 11,000 cases were reported, resulting in up to 4,000 deaths.�"The number of cases reported went up," recalls Watson. "It really dismayed people. There was a lot of second guessing. The pressure was on to do it the old way; this new system isn't working."

  Foege says he couldn't convince the minister of health to stay with surveillance/containment. At a meeting the minister was prepared to order mass vaccinations when an Indian physician stood up. The physician recalled growing up in a poor village. When there was a fire, the villagers poured water on the burning hut, not on all the houses, he said. "The minister was stunned. 'I'll give you one more month,' he told us," Foege says. In that month rates finally started to go down.

  Foege says that unknown physician is the hero of the Indian eradication campaign. Watson says there's more to it than Foege is willing to admit. "I think Bill's major contribution was in the operational side," Watson says. "He convinced them to stick to it and see it through."

  Of the international effort to curb smallpox, Foege says, "It was one of the greatest professional experiences of my life. The heady time was in the '60s, when we could visualize eradication and see the prophecy come true."

  Twisting around the old proverb, he adds, "Some things have to be believed to be seen."

  By May 1975, the disease was in retreat. Foege returned to Atlanta as assistant to CDC Director David Sencer.

  The CDC's reputation -- spotless compared to most government agencies -- suddenly slipped into the barnyard over the swine flu vaccine fiasco. Sencer recommended mass vaccinations against an influenza strain (swine flu) thought to be the mass killer of the 1918-19 pandemic.

  More than 50 million Americans received flu shots, but cases of a rare, polio-like disease called Guillain-Barre syndrome suddenly cropped up. The vaccine was pulled and public health officials -- especially Sencer -- were blamed for overreacting.

  Months later, when President Jimmy Carter appointed Joseph Califano to head the Department of Health and Human Services, Sencer's days were numbered. "It is accurate to say that Califano fired Sencer. I am convinced in my mind that swine flu was part of that," recalls Watson. When Califano dumped Sencer, Foege was one of many CDC employees who signed a petition asking for Sencer's return.

  CDC staff feared that politics would take precedence over public health. At first, Watson says, Foege didn't have much of a chance with the new health secretary. "I don't think he intended to appoint someone from within the CDC to follow Sencer. We played for at least getting Foege interviewed, and then Califano was taken with him like everyone else."

  "He is not a shrinking violet," adds Physiology Chair Crill. "When you talk to Bill Foege, you find he is very approachable, solid, a deep thinker."

  In his six years at the head of CDC, Foege completely reorganized the agency. "We did it so that when you have a problem to solve, you are organized to meet that particular problem," he says. "We're going to keep finding new diseases forever, that is, ew organisms, new expressions of old organisms, or a combination of sociological factors and new organisms, such as with AIDS. We must be prepared to face new infections."

  As a director he faced three major health crises. In 1980 women started experiencing a high fever, low blood pressure, rashes, vomiting and diarrhea. With the help of state health departments, the agency was quickly able to pin down the cause -- toxic shock syndrome, stemming from a new brand of tampon. Procter and Gamble immediately pulled it off the market.

  A different industry was not as cooperative when the CDC began to link aspirin with Reye's syndrome in children suffering from flu or chicken pox. Reye's syndrome is a rare but serious disease that kills about 40 percent of its victims and leaves others brain-damaged.

  In 1981 CDC workers picked up the link in four or five studies, but each individual study was too small to show statistical validity. "We couldn't prove it statistically yet, but there was no question that this was valid," Foege recalls.

  The aspirin industry launched a full-scale attack on the studies. Foege wanted a warning printed on all aspirin bottles. He was backed up by both the assistant secretary of health and the secretary, but the Reagan White House insisted on another study first. That study confirmed the link, and warning labels finally appeared on bottles in 1986.

  "Politics still got involved in public health. I did not stay much longer," Foege says of that time.

  But before he left, the man who helped stamp out one disease, smallpox, witnessed the birth of another -- AIDS.

  In the summer of 1981 reports of young men with rare pneumonia or a rare form of skin cancer -- Kaposi's sarcoma -- trickled into the CDC. "We didn't know what it meant. But it didn't take long to realize that this was bigger than we expected," recalls Foege.

  "It was a steam roller that just got bigger and bigger and you couldn't imagine it could get worse and worse. There was nothing like it on this scale. You have to remember that there not many things that are 100 percent fatal beyond rabies. AIDS just did not follow the rules in any way," Foege says.

  While the CDC sounded the alarm, those outside remained skeptical. "We couldn't get anyone else to listen: politicians, blood banks, media. It was just so bad that people didn't want to believe it," Watson says.

  "People preferred that this wasn't happening. They thought, 'It can't be as bad as people say it is.' I've found that there is an incubation period for ideas as well as for viruses," Foege adds.

  "We used existing resources, mostly from the VD program itself. There was no extra money, no relevant articles in peer publications, very little press for a year and a half," Watson recalls. "It was a frustrating time but we did not sit around agonizing."

  Though critics often complain about the lack of money devoted to AIDS, Foege points out that line items on budgets often don't reflect the reality of those times. "A lot of research dollars got directed early on," he says. "But even that wasn't enough."

  Foege is particularly proud of publishing some of the first prevention information about AIDS, before it was conclusively proved that a virus caused the disease. The CDC "printed what we knew, and what we knew about prevention, back in 1983. And it is still valid today."

  Asked if someday AIDS will be stamped out the way smallpox has been, Foege responds, "I cannot imagine that we will not ultimately find a preventive vaccine. That's the direction we're going."

  A believer of things not yet seen, Foege has concentrated on destroying three diseases since he left the CDC in 1983. He is the head of the Task Force for Child Survival and Development, which has raised the general immunization level of the world's children from 20 percent to 80 percent in six years. Among its goals is the eradication of polio by the year 2000. "We're going to make it," Foege declares. "Polio is already finished in this hemisphere."

  The task force has also targeted river blindness (onchocerciasis), a leading cause of blindness in Latin America and Africa. Thanks to a free supply of a drug furnished by Merck & Co., about 9.5 million people will be protected by the end of the year.

  In 1986 President Jimmy Carter asked Foege to take over as head of the Carter Center, a public policy institute located at Emory University. "President Carter was very interested in international public health and he convinced me that it would be a good place to be," Foege says.

  As part of the center's Global 2000 program, Foege hopes to knock out yet another disease by the end of 1995 -- Guinea worm. A parasite found in stagnant water, the worm can grow two to three feet long within the body, causing secondary infections, scarring and crippling similar to polio.

  To combat the disease, Global 2000 uses surveillance/containment. It helps countries identify where cases occur and then focuses efforts on eradication. In four years cases decreased 90 percent in Ghana and Nigeria. Pakistan is expected to be completely free of Guinea worm by the end of the year.

  Foege recently stepped down as Carter Center director. Still a fellow at the center, he wants to spend more time on health programs. He may get his wish in spades if the U.N. secretary general taps him to head UNICEF.

  "This is the only job in the world he would leave what he is doing now to take," says his long-time colleague Watson. "He'd be able to make an impact on the welfare of the children of the world."

• Gates Foundation - https://www.gatesfoundation.org/Who-We-Are/General-Information/Leadership/Global-Health/William-Foege

  Dr. William Foege, senior fellow in the Global Health Program, advises the foundation on strategies that could be usefully pursued in global health. He has served in a variety of executive positions at the Carter Center and is senior investigator on child development at the Task Force for Child Survival and Development as well as Presidential Distinguished Professor of International Health at the Rollins School of Public Health.

  By writing and lecturing extensively, Foege works to broaden public awareness of the issues of child survival and development, population, preventive medicine, and public health leadership. In 1997 he was named fellow of the London School of Tropical Medicine and Hygiene. Foege helped form the Task Force for Child Survival in 1984 to accelerate childhood immunization. In the 1970s, he worked in the successful campaign to eradicate smallpox and served as director of the U.S. Center for Disease Control. Foege attended Pacific Lutheran University, received his medical degree from the University of Washington and his master's in public health from Harvard University.

• Humanosphere - http://www.humanosphere.org/special/2014/06/profile-global-health-prankster-bill-foege/

  special
  Profile of a global health prankster, Bill Foege
  By Tom Paulson on 3 June 2014
  3
  Bill Foege in the hills near his boyhood home of Colville, Washington

  Bill Foege in the hills near his boyhood home of Colville, Washington
  Tom Paulson

  Editor’s note: William Foege is a global health hero. Everyone from Bill Gates to Barack Obama says so. But what many may not know is that Foege is a prankster as well, and that mischief is a key to his success.

  Disclosure: Bill Foege and I both graduated from Pacific Lutheran University, though separated by a few decades. Bill serves on the Humanosphere board and I consider him a good friend. That said, I’m tired of all this hero talk. I want people to know the mischievous side.

  I wrote this article Prankster for Positive Disruption for PLU’s new magazine Resolute and am re-posting it here. Go take a look at the link to see more photos and info.

  It may sound like a stretch, but the eradication of smallpox is directly connected to a young man slipping chewed-up rubber bands into his boss’ pipe tobacco.

  That young man was Bill Foege ’57, the somewhat mischievous son of a Lutheran minister who pastored the Northeastern Washington community of Colville.

  The world today knows Dr. William Foege, now 78, as the person who came up with the strategy—“ring containment,” modeled on what he learned fighting forest fires in the Pacific Northwest—that led to the eradication of smallpox in the late 1970s: the only human disease ever completely wiped off the planet. Read his book House on Fire for the full story. That episode alone makes Foege a public-health hero.
  Bill Foege, pipe in hand, with colleagues helping refugees during Nigerian civil war in 1968.

  Bill Foege, pipe in hand, with colleagues helping refugees during Nigerian civil war in 1968.
  CDC

  Some also might know him as the man who, in the late 1990s and well into the new millennium, helped the Bill & Melinda Gates Foundation launch and rapidly expand its revolutionary mission in global health—a mission that without question has transformed the global fight against many diseases of poverty. Others may recall that Foege was head of the U.S. Centers for Disease Control and Prevention during the Carter Administration and into the first part of the Reagan Administration when a strange new disease emerged on the scene – AIDS.

  Foegegetsmedal

  White House

  In 2012, President Barack Obama awarded Foege the Presidential Medal of Freedom in recognition of all his achievements in international public health.

  So yeah, he’s pretty much Mr. (or okay, Dr.) Global Health.

  But what few may know about Foege is that he has always been a prankster and that this personal attribute – which he can disguise but seldom fully repress – has almost certainly been critical to his amazing list of accomplishments.

  How so? Well, to begin with, psychologists tell us that practical jokers are motivated (whether they know it or not) by a desire to disrupt order, the status quo.

  Foege is all about disrupting order, when he thinks it needs a little disruption. It may have started when he would sneak behind his mother at the dinner table in Colville to tie her apron strings to the chair, or when he put the rubber bands in the pipe of Jim Kohlstedt, his boss at the local pharmacy.

  “I think the best one was when my brother Dick and I filled out Jim’s name and address on 300 post cards for free magazine subscriptions and sent them all at once,” Foege said.
  Recalling the boyhood 'leg incident' in Colville.

  Recalling the boyhood ‘leg incident’ in Colville.

  Or the time he took a manikin leg from the shop and placed it in the back window of his car (to appear as if he was perhaps carting around an incapacitated woman – or worse). “I discovered that’s a good way to get stopped by the police.”

  We’ve all done our share of practical jokes. But Foege, who is quite tall, never outgrew his boyish prankster ways. They just blossomed into a talent for challenging the status quo, complacency, harmful bureaucracy or worse.

  In the 1960s, while working as a medical missionary on the smallpox campaign in Nigeria, he and a colleague were prevented by a local official from obtaining desperately needed vaccines. So he got his colleague to engage the official in conversation while Foege secretly loaded up their truck with the supplies. Not a prank, per se, but definitely a trickster move.

  “I never told (the colleague) what I had done,” Foege recalled with a chuckle. It wasn’t that he didn’t want to tell his friend that he had done something that could have gotten them both arrested. Foege was just embarrassed he had misled the colleague because, well, he decided his friend was too honest to have pulled off the bait-and-switch.

  Another time, when he was at the CDC and was getting grilled by a member of Congress who was hostile to spending American taxpayer money on foreigners, Foege asked him if he had received a flu shot that year. Yes, the Congressman replied.

  “I told him about how the vaccine was manufactured using samples obtained in the Soviet Union and that he now had Soviet antibodies in his body protecting him from the flu,” Foege said. The Congressman was not amused, but others were.
  Two Bills meet at the opening of the new Gates Foundation campus in Seattle

  Two Bills meet at the opening of the new Gates Foundation campus in Seattle

  On a more personal note, Foege once caused a ruckus at the Gates Foundation when he invited me – a journalist – to join him when the philanthropy opened its new campus in downtown Seattle. I knew the event was supposed to be for select staff only, no media, and so I suggested this might cause him problems.

  “Oh, I don’t think anyone will even notice,” he said. Wrong. Bill Gates looked at me like something the cat dragged in and the media affairs folks were apoplectic. I got a story out of it and some good photos (including one of Melinda Gates hugging Foege, which I’m told she has on her desk). But why did Foege even bring me along? Maybe he just liked causing a fuss.

  But there’s another possible explanation. Inclusion. Breaking down walls. Anthropologists who study the sociological and cultural impacts of practical jokes say it is often done to bring someone into the fold, create social bonding and a sense of community.

  All those who know Bill Foege speak of his empathy and how he so easily connects with everyone he meets. He tends to focus on others more than himself. He looks for what can bring people together as opposed to what distinguishes us from each other. In short, he has boundary issues – or issues with boundaries.

  “At PLU, I used to go in people’s rooms and put limburger cheese on light bulbs,” Foege said. “It would take a while to melt before it started to smell so nobody could figure out who had put it there…. But I eventually had to do it in my own room to deflect suspicion.”

  Okay, that’s hard to explain as either a positive disruption or method for creating social bonds. But that’s also classic Foege, disrupting the point of this article in order to try to deflect attention away from him and my thesis that his prankster side is based on his empathy for others and his desire to affect change.

  “He also uses humor sometimes as a way to keep people at arm’s length,” said Paula Foege, his wife and a former PLU student as well. Lutherans are experts at self-deprecation, but Paula sees through it. She knows her husband is up to something when he seems to be joking around.

  That’s a perspective formed from their very first meeting, when Bill was a senior but with another senior Lute snuck into a freshman orientation meeting at PLU in order to meet girls. A friend bet Bill he couldn’t get a date with the next girl to walk through the door. Paula walked through that door.

  “He was a tall, skinny good-looking blonde joking around with everyone so, sure, I noticed him,” Paula recalled. But when Foege sauntered up and said he was a senior (possibly hoping to impress), Paula basically told him, nicely, to get lost. “I said I don’t like phonies.”

  Foege persisted, eventually convincing a friend of Paula’s to get her to give him another chance. To make a long story short: She did, he got into medical school at the University of Washington, they got married, began their family with son David and went off to Africa to fulfill one of Bill Foege’s boyhood dreams – to work as a physician in Africa.

  Many of Foege’s friends and colleagues know the story, and what motivated him from his early days. While incapacitated as a teen for months in a body cast due to a hip injury, he read about the medical missionary work of physician-philosopher Albert Schweitzer. What some may not know is that his original interest in medicine was psychiatry.

  “I’d read a book about this psychiatrist who was really operating like a detective, a detective of the mind,” he said. That interest eventually lost out to his interest in going to Africa, and to becoming an infectious disease detective and a renowned leader in a field what would come to be known as global health.
  Melinda Gates hugs Bill Foege

  Melinda Gates hugs Bill Foege
  Tom Paulson

  But spend time around Foege and you can see he is still as fascinated by what makes people think what they think and do what they do as he is in fighting disease and inequity. Unlike many in the health field who approach it largely as a technical challenge – finding the best treatment for a malady, or the best methods for preventing an epidemic – he tends to see everything through the eyes of a person, a particular person.

  Ask him about his battles against smallpox in Africa or India and you will hear about the people he met – the mothers with the sick children, the health workers and community leaders he came to know so well. He remembers them all by name and talks at length about their lives, their thoughts. Ask him about being director of the CDC and the difficult politics of the early days of AIDS, the deadly delays caused by stigma and apathy. Before he can answer, the very look on his face conveys no abstraction.

  Public health is sometimes called population health because the point of it is to deal not with individual illnesses but with the population as a whole. For Bill Foege, public health is personal, deeply personal. Those who know him well recognize this attribute as key to what drives him, and what makes him perhaps one of the most influential people in the field of global health.

  But, let the record show, being a prankster was no small part of it.

• Duke - https://globalhealth.duke.edu/media/news/qa-bill-foege-father-global-health

  Q&A with Bill Foege, "Father of Global Health"
  June 07, 2016

  William H. (Bill) Foege, regarded by many as one of the most distinguished global health leaders of our time and called the “father of global health” by Duke President Richard Brodhead, received an honorary degree from Duke at its commencement ceremony on Sunday, May 15.

  In the 1970s, while working in Eastern Nigeria, Foege devised the vaccination strategy that led to the successful campaign to eradicate smallpox. He then became chief of the Smallpox Eradication Program at the Centers for Disease Control and Prevention (CDC) and served as director of the CDC from 1977 to 1983. In 1984, he and several colleagues formed the Task Force for Child Survival, a group composed of leaders of the World Health Organization, UNICEF, The World Bank, the United Nations Development Program and the Rockefeller Foundation, which successfully accelerated childhood immunization rates globally from 20 percent to 80 percent over a five-year period.

  Foege was director of The Carter Center from 1986 to 1992. In January 1997, he joined the faculty of the Rollins School of Public Health at Emory University and in September 1999 was named presidential distinguished professor of international health. At that time he became the first senior medical adviser to the Bill & Melinda Gates Foundation. He served in that capacity until last year and has had much influence on the priorities of that Foundation.

  In May of this year, Foege was awarded the U.S. Presidential Medal of Freedom for his contributions to global health.

  “No one alive today has had such an influence on the landscape of global health,” said DGHI director Michael Merson.

  We had the opportunity to pose a few questions to Foege, and his answers follow.

  DGHI: In May, more than 100 Duke University students graduated with a global health credential: as undergraduate global health majors and minors, with a master of science in global health, or as doctoral scholars. What advice to you have for students with a passion for global health who hope to make a difference in the world?

  Foege: The Earl of Shaftsbury defined “good” as the focus on the needs of the group rather than on oneself. He said the larger the group the better. Concentrating on global health gives a focus to the largest existing group. Combine that with a focus on all future people to be born and you have the base philosophy for global health, social justice.

  The tools continue to improve, making it possible to have great impact. Be a generalist to understand the problems to be solved, be a specialist with skills to apply to the problems, and seek truth so you know what the problems are and whether interventions are having an impact.

  DGHI: The U.S. presidential race has been interesting, to say the least. There has been scant mention of global health issues in the dialogue thus far. What issues do you wish were being discussed? What would you advise the front runners are the most urgent global health issues that warrant their attention?

  Foege: I would put emphasis on our interdependence. Ebola made that point. I would suggest three priority areas. Climate change is a challenge far beyond our current ability to grasp or change. Bioterrorism is a constant worry and requires the best we have in figuring out responses. The highest threat comes from terrorist groups where small numbers of people can threaten the nations collectively. Third, we need collective action on improving our public health infrastructure. From global to local. Why did WHO have trouble responding to Ebola? Not because there are incompetent people in WHO but because the U.S. and other countries tell them each year to reduce their budget. They simply don’t have the resources and people to provide global protection.

  DGHI: While population health addresses the needs of large groups of people, surely there have been individuals or singular events that you have encountered in your career that have served to motivate or inspire you in your work. Could you tell us about one of them?

  Foege: Watching Jim Grant lead UNICEF in a way that encouraged other organizations, country leaders, corporations and volunteers to improve child health was an inspiration to everyone in the field. It was possible to see changes every month. The other example I have used often. When the history of global health is written, it will be clear that a tipping point was seen about the year 2000 when a new level of attention provided increased interest in the field, career pathways, research options, and a move in academic institutions around the world to inspire students to sample, and sometimes be smitten by global health. It will then be clear that the tipping point was the result of two people, Melinda and Bill Gates!

  DGHI: You were inspired to get into a global health by the work of an uncle who was a missionary in New Guinea. Please describe the harmony or disconnect you perceive between science and faith (or spirituality).

  Foege: Another factor was the work of Albert Schweitzer a century ago in Africa. Churches provided some of the earliest impact in global health and in some fields, such as leprosy, they were the predominant force in treatment and research. Much of this interest was good but at times it strayed as churches used health as a proselytizing tool. I have always thought their work should be a result of what they believe rather than a tool in changing the belief of others.

  E.O. Wilson’s book on “consilience” or the “jumping together of knowledge,” leads me to believe the problem is not a difference between science and religion that we must deal with, but rather a difference between truth and non-truth. Certainty is the Achilles Heel for both science and religion.

  DGHI: You have the reputation of having a great sense of humor and have been known to play a practical joke every now and then. How has humor helped you to navigate some of the most serious issues of our time?

  Foege: Much of what we experience is quite grim. Plato said we should show kindness because everyone carries a heavy load. For many the load is too heavy and without respite. Being sick, malnourished, without access to the thinking of others, and with no hope for the future to be better almost demands fatalism. Fifty years ago, my wife, three-year-old son and I lived in an African village. I thought we would understand what it was like. I was wrong. We could leave, they could not. We could afford screens on our windows, vaccines and anti-malarial drugs. They could not.

  Gandhi said his idea of the Golden Rule was that he could not enjoy things not enjoyed by others. Our health, wealth and opportunity have placed a burden on us to share, so that others may experience the freedom we have.

  But, it has been said that the world does not cease to be funny when someone dies, and it does not cease to be serious when someone laughs. We need the balance. And our ability to laugh and enjoy humor, combined with our ability to be healthy, well fed and educated, as the example of the better life we want for others. It is the reason to be in global health.

• Lens - Vanderbilt Medical Center - http://www.mc.vanderbilt.edu/lens/article/?id=146&pg=999

  Bill Foege: Another mountain to climb

  Bill Foege and the end of smallpox

  Meghan Holohan
  Published: July, 2006

  Bill Foege
  Photo by Brian Smale
  One day in 1966, the two-way radio in the corner of the medical clinic crackled: “Can you come see if there is a smallpox case in the village?”

  William “Bill” Foege, M.D., MPH, jumped into his VW bug and bumped over the dirt plains of eastern Nigeria where he was serving as a medical missionary until he got to the village. Sure enough, it was smallpox.

  At the time, public health experts thought the best way to rid the world of this ancient, often-lethal scourge was to vaccinate everybody. But Foege (pronounced “Fay-ghee”) didn’t have enough vaccine for everyone in the village.

  As a consultant for the smallpox eradication program operated by the U.S. Communicable Disease Center (now the Centers for Disease Control and Prevention), he also knew blanket vaccination wasn’t foolproof. Sometimes public health workers only went to certain locations like schools to give shots. Sometimes they vaccinated the same students over and over again.

  Was there another way?

  Foege imagined himself as a smallpox virus. To jump from one person to another generally required close, prolonged contact. But what if the close contacts had already been vaccinated? Could the virus be stopped?

  Perhaps, but first he had to find everyone suffering from smallpox.

  So Foege, the lanky, gregarious son of a Lutheran minister, called local missionaries via two-way radio (there was no telephone service), and asked them to recruit a network of “runners” to canvas the villages in their areas.

  The runners carried photographs showing the small and rubbery smallpox lesions. They asked children too young to do answer anything but the truth, “Have you seen anybody who looks like this?” Small boys and girls proudly pointed to the homes where smallpox sufferers lived.

  Foege and his team then moved in to vaccinate their contacts—a technique now known as surveillance and containment or circle vaccination—and village by village, smallpox began to disappear.

  “He was charming. He was persistent. He was intelligent. He was analytical,” says long-time friend and colleague William Schaffner, M.D., chair of Preventive Medicine at Vanderbilt University Medical Center. “And so he created this new approach—the find-and-contain through ring immunization, interrupting the chain of transmission strategy of smallpox eradication.

  “That’s not laboratory science,” Schaffner continues, “but that conceptual innovation led to the eradication of one of the greatest plagues that mankind has every known. That’s public health.”

  Foege (center) testifies during a Senate hearing on Legionnaires' disease held at the CDC in 1977. Joining him are CDC virologist Walter R. Dowdle, Ph.D., (left) who later served as the agency's deputy director; and David W. Fraser, M.D., a medical epidemiologist who helped identify the outbreak.
  Photo courtesy of the U.S Centers for Disease Control and Prevention (CDC)
  Forty years ago, when Foege and his young family shared a four-room mud hut, he and his wife Paula made sure their 3-year-old son David wore shoes so he wouldn’t get hookworm. The child had received every conceivable vaccination before he left the United States. They boiled their water and slept under mesh mosquito nets.

  Foege realizes that if he’d had to survive on the average Nigerian’s income—less than a dollar a day—he would have spent his money on food instead of vaccinations and mosquito nets.

  It’s this knowledge—27 years after smallpox was eradicated from the Earth—that keeps him focused on improving public health worldwide. He can’t get away from it.

  “He has a tremendous sense of compassion and humanity, and his vision is based on intellect and experience and his understanding where things fit,” says another longtime colleague, James Curran, M.D., MPH, dean of the Rollins School of Public Health at Emory University and former director of CDC’s AIDS Task Force.

  “He has a tireless commitment of improving public health of underserved,” Curran says. “He is one of the very top public health leaders in the world over our lifetime.”
  Drawn to Africa

  These days Foege, 70, is a senior fellow at the Bill & Melinda Gates Foundation.

  He is a member of the scientific board that helped design and implement the Grand Challenges in Global Health initiative, funded largely by the Gates Foundation.

  The initiative is exciting, he says, because it gives scientists the freedom to explore areas that traditionally haven’t gotten a lot of funding. “It has the research community looking at global health,” he says.

  Foege is familiar with the criticisms leveled against the program, that its technology-based solutions might suck money from less sophisticated public health measures, like basic sanitation projects, and that it fails to account for the broader, cultural and economic factors that contribute to poor health.

  Photo of a child with smallpox taken in 1975 by Stanley Foster, M.D., a member of the CDC's Epidemic Intelligence Service, for the Global Smallpox Eradication Campaign.
  Photo courtesy of the U.S Centers for Disease Control and Prevention (CDC)
  It can only do so much, he argues. A nonprofit organization, no matter who runs it, cannot fill in for the government, which is ultimately responsible for public health—including the control of potential pandemics like avian flu.

  “The Grand Challenges program is looking at the problems that poor people face that aren’t being addressed by the U.N. or other agencies,” he explains.

  Standing 6-feet, 7-inches tall, Foege walks with long, determined strides. He walks with purpose. Give Schaffner vignette about height. Around the Gates Foundation, he’s known for his warmth and humor: he addresses everyone by name and asks about his or her families.

  “It’s his thoughtfulness that makes him a special leader and mentor,” says Jeffrey Koplan, M.D., MPH, who succeeded Foege as CDC director in 1998 and who currently is vice president for academic health affairs at Emory University’s Woodruff Health Sciences Center.

  “I’ve met many people who are concerned about people in the abstract or as amorphous groups,” Koplan says. “Bill cares about every individual he meets, but he also can see the individuals in groups and populations. He cares about those he’s never met and those yet to be born.”

  Foege’s journey to the top echelon of global health began as a boy in tiny Colville, Wash., when he first read Albert Schweitzer’s autobiography, The Primeval Forest. He felt drawn to Africa, and to medicine.

  While attending medical school at the University of Washington in Seattle, Foege worked at the Seattle-King County Department of Public Health under Reimert Ravenholt, M.D., MPH.

  Ravenholt, who later directed the global population program at the U.S. Agency for International Development, “quite deliberately converted me to the joys of global health,” Foege says.

  So did the CDC’s Epidemic Intelligence Service, which Foege joined after earning his medical degree in 1961.

  The service emerged from a government effort to develop a synthetic anti-malarial drug during World War II. Based in Atlanta, it became the surveillance arm of the fledgling CDC, on the look-out for epidemics and outbreaks of communicable disease.

  In the early 1960s, Foege, assigned to the Colorado State Health Department in Denver, got a call from a doctor on a Navajo reservation in Farmingham, New Mexico. “I’ve got a case of smallpox here,” the doctor said.

  A Nigerian child, held by his mother, receives a small-pox vaccination during the 1968 World Health Organization Smallpox Eradication Project.
  Photo courtesy of the U.S Centers for Disease Control and Prevention (CDC)
  Foege, who had never seen a case of the disease, pored over a medical textbook on the way to the reservation. There he found a young boy covered with a rash. None of the lesions looked like smallpox.

  So Foege became the medical sleuth—knocking on doors, talking to everyone who had contact with the boy and mapping the boys’ lesions every night. After a few days he had solved the mystery—the boy was recovering from measles and disseminated herpes.
  House on fire

  Foege’s experiences with the CDC only intensified his desire to go to Africa. So, after earning a master’s degree in public health from Harvard in 1965, he volunteered to serve as a doctor for a hospital operated by the Lutheran Church in Yahe, Nigeria.

  In 1967, in the midst of his smallpox eradication efforts, Biafra seceded from Nigeria, prompting civil war.

  His family, which by then included 1-year-old Michael, boarded an evacuation plane, leaving Foege and other doctors behind. They thought the war would end in a few days. Instead, they were drawn into a prolonged conflict: Foege saved a colleague from a Biafran soldier who was holding him at gunpoint, and he was detained several times by the rebels before he finally left the country.

  He returned to Nigeria in 1968 as part of an international relief effort, and soon he was again organizing smallpox eradication. After the conflict ended in 1970, he and his colleagues were able to show that their efforts had been successful—they had quenched the disease.

  In 1973, Foege moved on to India, where smallpox still raged. Within six days of starting a containment trial in four Indian states, he and his team had identified 10,000 new cases of the disease.

  The health minister of Bihar Province wasn’t convinced. If circle vaccination was working, why weren’t the numbers going down? He wanted to reinstitute blanket vaccination.

  “It was not easy to change perceptions,” Foege recalls. “There was a fear that smallpox would move so fast that we would have to do mass vaccinations to keep it down—but that was not true.”

  For three days, he and his coworkers tried to convince the health minister to continue circle vaccination. On the day of their last meeting, desperation filled the room. If the official ordered blanket vaccination, all of their work would be lost.

  Then a young Indian doctor stood up. “Mr. Minister,” he said. “I’m just a village man, but when I was growing up and a house was on fire we’d put the water on that house, not the others.”

  Suddenly, the minister understood and agreed to give Foege one more month.

  Members of a refugee relief team sent to Eastern Nigeria during the Biafran war in 1968 include Foege (center, with pipe) and nurse practitioner Annie Voigt, CPNP, MPH (right).
  Photo courtesy of the U.S Centers for Disease Control and Prevention (CDC)
  One month led to two months then three, and soon Foege and his team didn’t need to worry about the future of their plan. The health minister never mentioned stopping it again.

  In May 1974, the number of smallpox cases had peaked; 12 months later, there were no more cases of smallpox in India. In 1979, the World Health Organization declared that smallpox had been eradicated.

  “He is an extraordinarily positive person who always sees the opportunity of doing something. He is rarely pessimistic,” Koplan says. “He can usually see a victory and snatch it from despair.”

  “Bill was one of the two storied heroes of smallpox eradication,” Schaffner adds. The other, Donald A. Henderson, M.D., MPH., went on to direct the World Health Organization’s smallpox eradication effort.

  “There were huge successes already using strategy ‘A’ (universal vaccination),” Schaffner continues. “But for the endgame, strategy ‘B’—the Foege strategy—was the one that worked, and he and Henderson share a claim for orchestrating the global eradication of smallpox.”
  A good challenge

  Foege succeeded David Sencer, M.D., MPH, as CDC director in 1977. During his tenure he broadened the agency’s international activities to deal with health crises like deadly hemorrhagic fever—Ebola—in Central Africa, and oversaw the high-profile investigation of toxic shock syndrome in the United States.

  Then, in 1981, young gay men and IV drug users started dying from a rare pneumonia. By the end of 1982, even before the virus that causes AIDS was identified, Foege, Curran and their CDC colleagues had determined that the disease could be spread through blood and body secretions.

  In 1984, after President Ronald Reagan appointed James Mason, M.D., as the new CDC director, Foege and several colleagues formed the Task Force for Child Survival and Development, a collaboration of the World Health Organization, UNICEF, the World Bank, the United Nations Development Program and the Rockefeller Foundation.

  Foege served as executive director of the task force, which aimed for nothing less than universal immunization of children. During his six-year term, the proportion of children around the world who received basic vaccinations quadrupled—from 20 percent to almost 80 percent.

  Former President Jimmy Carter later recruited Foege to become executive director of the Carter Center and its Global 2000 program, which, among other projects, sought to eliminate “river blindness,” a parasitic disease that is a major cause of blindness in Africa.

  About seven years ago, Foege was teaching international health in Emory University when he was asked to advise the Gates Foundation’s Global Health program.

  Before taking the job, Foege drove to Plains, Ga., to talk with Jimmy and Rosalind Carter. He had remained close to them, and he wanted to see what they thought.

  “I never entertained the idea that a rich person would be interested in public health,” Foege recalls. “I never thought it would be the richest man in the world or that he would be emotionally invested in public health.”

  He did know there was enthusiasm and energy at the Gates Foundation, and that there was real potential to transform global health. The Carters agreed.

  Foege has received a sheaf of awards for his achievements: among them the World Health Organization's Health for All Medal; the Mary Woodard Lasker Award for Public Support of Medical Research and Health Sciences; and the Public Welfare Medal from the National Academy of Sciences.

  Photo by Brian Smale
  Foege rarely mentions them. That’s not why he did the work. That’s not what inspires him.

  And then there’s always one more mountain to climb.

  In 1997, at the age of 61 and three years after receiving a hip replacement, Foege tackled a life-long goal, to climb 19,500-foot-tall Mount Kilimanjaro in Tanzania.

  Accompanied by Paula and their three adult sons, he trudged slowly upward until—about 1,000 feet from the summit—they stopped to pitch their tents. That night as the water particles from their labored breathing formed ice crystals on the top of the tent, Paula turned to her husband. “You’d better be having a good time,” she said.

  Foege smiled. Of course he was having a good time.

  Years later this is one of his fondest memories. Yes, it was freezing and hard to breathe, but it also was a good challenge, the kind of challenge that can truly be savored by a man who helped defeat smallpox.

QUOTE:
A straightforward, informative chronicle of the CDC and one of its most dedicated, prominent officials.

Foege, William H.: THE FEARS OF THE RICH, THE NEEDS OF THE POOR
Kirkus Reviews. (Apr. 1, 2018):
Copyright: COPYRIGHT 2018 Kirkus Media LLC
http://www.kirkusreviews.com/
Full Text:
Foege, William H. THE FEARS OF THE RICH, THE NEEDS OF THE POOR Johns Hopkins Univ. (Adult Nonfiction) $24.95 5, 13 ISBN: 978-1-4214-2529-0

Wisdom gleaned throughout the career of the former director of the Centers for Disease Control and Prevention.

Foege (Emeritus, International Health/Emory Univ.; House on Fire: The Fight to Eradicate Smallpox, 2011), who was awarded the Presidential Medal of Freedom in 2012, has personally witnessed the agency's evolution alongside many changes in global health. Beginning with a harrowing bioterrorism threat depicted in the opening story, which inspired a CDC defense program, readers will get a sense of the enormity of the agency's responsibility to safeguard global health. As a collective, these condensed experiences represent many key moments in Foege's tenure with the agency and spotlight some of the CDC's significant accomplishments and enduring challenges, including the blight of Legionnaire's disease and the overwhelming devastation of AIDS. These issues form the springboard for more of the author's intensive discussions of the precariousness of vaccine therapy and immunization programs and the ultimate challenge in retaining established immunization levels when countered, in part, by parents who "no longer compare the risks of vaccine to the risk of the disease." Foege offers a brief but thoughtful history of the CDC, its protocols, and its complicated history of political entanglements, which, to the author, have a tendency to prove more counterproductive than supportive. Alternately, he notes the presence of "plenty of humor" within agency meetings, daily interactions, and other events. Foege details how he ascended to the director post following 15 years of CDC association, participating in disease outbreak investigations and completing one of his most prestigious achievements: the development of a strategic plan to eradicate the smallpox virus. He also passes on the wisdom of his CDC years in declaring that the key to effective public health advocacy lies in an "appropriate response" from official agencies and offers advice on contemporary hot-button issues--e.g., gun safety, tobacco, and evolution--that have been marred by public irrationality.

A straightforward, informative chronicle of the CDC and one of its most dedicated, prominent officials.

Source Citation (MLA 8th Edition)
"Foege, William H.: THE FEARS OF THE RICH, THE NEEDS OF THE POOR." Kirkus Reviews, 1 Apr. 2018. General OneFile, http://link.galegroup.com/apps/doc/A532700305/ITOF?u=schlager&sid=ITOF&xid=b1a8ce55. Accessed 24 June 2018.

Gale Document Number: GALE|A532700305

QUOTE:
part-memoir, part-history

House on Fire: The Fight to Eradicate Smallpox
Nature. 473.7347 (May 19, 2011): p281.
Copyright: COPYRIGHT 2011 Nature Publishing Group
http://www.nature.com/nature/index.html
Full Text:
House on Fire: The Fight to Eradicate Smallpox

William H. Foege UNIVERSITY OF CALIFORNIA PRESS 240pp. $29.95 (2011)

[ILLUSTRATION OMITTED]

Adding to the series of California/Milbank Books on Health and the Public, this part-memoir, part-history by epidemiologist William Foege recounts his involvement in the global vaccination programmes that eradicated smallpox in the 1960s and 1970s. Foege, now a senior fellow at the Bill & Melinda Gates Foundation in Seattle, Washington, reflects on the strategies that led to wide uptake of the vaccines across Africa and India and discusses their successes and vulnerabilities.

Source Citation (MLA 8th Edition)
"House on Fire: The Fight to Eradicate Smallpox." Nature, vol. 473, no. 7347, 2011, p. 281. General OneFile, http://link.galegroup.com/apps/doc/A257435056/ITOF?u=schlager&sid=ITOF&xid=58784b23. Accessed 24 June 2018.

Gale Document Number: GALE|A257435056

Free from smallpox
Nature Medicine. 18.6 (June 2012): p845.
Copyright: COPYRIGHT 2012 Nature Publishing Group
http://www.nature.com/nm/index.html
Full Text:
The American epidemiologist who led the US Centers for Disease Control's campaign to eradicate smallpox in the 1970s has been tapped to receive one of the nation's highest civilian honors. On 26 April, the White House named former CDC director William Foege as one of the 13 recipients of this year's Presidential Medals of Freedom. Among his many accomplishments, Foege (pictured) served as executive director of the Carter Center in Atlanta, as a medical advisor to the Seattle-based Bill & Melinda Gates Foundation and as executive director of the Task Force for Child Survival and Development, a nonprofit headquartered in Atlanta.

[ILLUSTRATION OMITTED]

Source Citation (MLA 8th Edition)
"Free from smallpox." Nature Medicine, vol. 18, no. 6, 2012, p. 845. General OneFile, http://link.galegroup.com/apps/doc/A293686222/ITOF?u=schlager&sid=ITOF&xid=225399dc. Accessed 24 June 2018.

Gale Document Number: GALE|A293686222

Global health leadership and management
SciTech Book News. (Sept. 2005):
Copyright: COPYRIGHT 2005 Ringgold, Inc.
http://www.ringgold.com/
Full Text:
0787971537

Global health leadership and management.

Ed. by William H. Foege et al.

Jossey-Bass/Pfeiffer

2005

241 pages

$47.00

Hardcover

RA441

Seventeen contributors from academia and the public and private sectors look to the field of for-profit management for experiences that apply to global health programs to improve the field's return on investment as measured by factors such as morbidity and mortality. The editors take as a working premise the idea that science and good intentions are not enough, and that what's needed for success in global health programs is a businesslike focus on specific objectives and strategies for reaching them. Chapters focus on the areas of identifying challenges and developing policy; developing strategies and solutions; creating networks and partnerships; learning from experience and building leaders; and managing teams. Lead editor Foegge teaches international health at Emory U. and is an adviser to the Bill and Melinda Gates Foundation.

([c] 2005 Book News, Inc., Portland, OR)

Source Citation (MLA 8th Edition)
"Global health leadership and management." SciTech Book News, Sept. 2005. General OneFile, http://link.galegroup.com/apps/doc/A138410247/ITOF?u=schlager&sid=ITOF&xid=711ed8b1. Accessed 24 June 2018.

Gale Document Number: GALE|A138410247

William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development
World Disease Weekly. (May 9, 2006): p203.
Copyright: COPYRIGHT 2006 NewsRX LLC
http://www.newsrx.com/newsletters/World-Disease-Weekly.html
Full Text:
The Albert B. Sabin Vaccine Institute (SVI) will award the 2006 Sabin Gold Medal to global health expert and epidemiologist William H. Foege, MD, MPH.

Foege has for more than 30 years been a champion of immunization programs for children around the world and was cofounder and executive director of the Atlanta, Georgia-based Task Force for Child Survival and Development.

Foege is the 14th recipient of the Sabin Gold Medal, awarded annually by the SVI to recognize extraordinary accomplishments of those who make vaccine discoveries or employ vaccines to combat vaccine-preventable diseases. The medal commemorates the legacy of the late Dr. Sabin, who in addition to discovering the oral polio vaccine worked tirelessly during his lifetime to see it and other vaccines utilized globally.

According to H.R. Shepherd, SVI chairman, & quot;Bill Foege has made an extraordinary impact on the world's health. He is eminently deserving of the Sabin Gold Medal, having deployed vaccines to their maximum effectiveness to reduce the burden of infectious diseases on the world's children, families and communities. & quot;

Foege worked in the successful campaign to eradicate smallpox in the 1970s. He championed child survival and development, injury prevention, population, preventive medicine, and public health leadership, particularly in the developing world. He is a strong proponent of disease eradication and control, and has taken an active role in the eradication of Guinea worm, polio and measles, and the elimination of river blindness. His many publications and lectures have broadened public awareness of these issues and brought them to the forefront of domestic and international health policies.

Foege attended Pacific Lutheran University, received his medical degree from the University of Washington, and his master's in public health from Harvard University. He held key posts at the CDC Smallpox Eradication Program, the U.S. Centers for Disease Control, the Task Force for Child Survival, the Carter Center, Emory University and the Bill & amp; Melinda Gates Foundation. Foege remains active at Emory University as Emeritus Presidential Distinguished Professor of International Health and as a Gates Fellow at the Gates Foundation.

This article was prepared by World Disease Weekly editors from staff and other reports. Copyright 2006, World Disease Weekly via NewsRx.com.

Source Citation (MLA 8th Edition)
"William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development." World Disease Weekly, 9 May 2006, p. 203. General OneFile, http://link.galegroup.com/apps/doc/A240291225/ITOF?u=schlager&sid=ITOF&xid=703708eb. Accessed 24 June 2018.

Gale Document Number: GALE|A240291225

William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development
Science Letter. (May 12, 2006): p198.
Copyright: COPYRIGHT 2006 NewsRX LLC
http://www.newsrx.com/newsletters/Science-Letter.html
Full Text:
The Albert B. Sabin Vaccine Institute (SVI) will award the 2006 Sabin Gold Medal to global health expert and epidemiologist William H. Foege, MD, MPH.

Foege has for more than 30 years been a champion of immunization programs for children around the world and was cofounder and executive director of the Atlanta, Georgia-based Task Force for Child Survival and Development.

Foege is the 14th recipient of the Sabin Gold Medal, awarded annually by the SVI to recognize extraordinary accomplishments of those who make vaccine discoveries or employ vaccines to combat vaccine-preventable diseases. The medal commemorates the legacy of the late Dr. Sabin, who in addition to discovering the oral polio vaccine worked tirelessly during his lifetime to see it and other vaccines utilized globally.

According to H.R. Shepherd, SVI chairman, & quot;Bill Foege has made an extraordinary impact on the world's health. He is eminently deserving of the Sabin Gold Medal, having deployed vaccines to their maximum effectiveness to reduce the burden of infectious diseases on the world's children, families and communities. & quot;

Foege worked in the successful campaign to eradicate smallpox in the 1970s. He championed child survival and development, injury prevention, population, preventive medicine, and public health leadership, particularly in the developing world. He is a strong proponent of disease eradication and control, and has taken an active role in the eradication of Guinea worm, polio and measles, and the elimination of river blindness. His many publications and lectures have broadened public awareness of these issues and brought them to the forefront of domestic and international health policies.

Foege attended Pacific Lutheran University, received his medical degree from the University of Washington, and his master's in public health from Harvard University. He held key posts at the CDC Smallpox Eradication Program, the U.S. Centers for Disease Control, the Task Force for Child Survival, the Carter Center, Emory University and the Bill & amp; Melinda Gates Foundation. Foege remains active at Emory University as Emeritus Presidential Distinguished Professor of International Health and as a Gates Fellow at the Gates Foundation.

This article was prepared by Science Letter editors from staff and other reports. Copyright 2006, Science Letter via NewsRx.com.

Source Citation (MLA 8th Edition)
"William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development." Science Letter, 12 May 2006, p. 198. General OneFile, http://link.galegroup.com/apps/doc/A248080403/ITOF?u=schlager&sid=ITOF&xid=76cc4910. Accessed 24 June 2018.

Gale Document Number: GALE|A248080403

QUOTE:
There are several recent books on the conquest of smallpox (e.g., D.A. Henderson's Smallpox: The Death of a Disease), but this is a readable and thorough account by a key player in this outstanding victory for public health.

Foege, William H. House on Fire: The Fight To Eradicate Smallpox
Kathy Arsenault
Xpress Reviews. (July 22, 2011):
Copyright: COPYRIGHT 2011 Library Journals, LLC
http://www.libraryjournal.com/lj/reviews/xpress/884170-289/xpress_reviews-first_look_at_new.html.csp
Full Text:
Foege, William H. House on Fire: The Fight To Eradicate Smallpox. Univ. of California. 2011. c.240p. illus. maps. index. ISBN 9780520268364. $29.95. HEALTH

A Center for Disease Control (CDC) epidemiologist assigned to the World Health Organization (WHO) smallpox eradication team in India in the 1970s, Foege (Global Health Leadership and Management) had a front-row seat for the global fight to eliminate smallpox. Now a Senior Fellow at the Gates Foundation, he recounts his experiences in Africa and India while generously sharing credit with his CDC and WHO colleagues and the almost 250,000 Indian government public health workers directed by doctor M.I.D. Sharma. With human-to-human transmission interruptible by an effective vaccine, smallpox became the 1958 World Health Assembly's target after millennia of killing, scarring, and sometimes blinding its victims. Foege was instrumental in developing a plan to identify and contain emerging outbreaks, rather than pursuing the nearly impossible goal of 100 percent vaccination rates. Though controversial, this "surveillance/containment" approach eliminated smallpox in India within only 20 months of its implementation.

Verdict There are several recent books on the conquest of smallpox (e.g., D.A. Henderson's Smallpox: The Death of a Disease), but this is a readable and thorough account by a key player in this outstanding victory for public health.--Kathy Arsenault, St. Petersburg, FL

Arsenault, Kathy

Source Citation (MLA 8th Edition)
Arsenault, Kathy. "Foege, William H. House on Fire: The Fight To Eradicate Smallpox." Xpress Reviews, 22 July 2011. General OneFile, http://link.galegroup.com/apps/doc/A264094170/ITOF?u=schlager&sid=ITOF&xid=039d8aea. Accessed 24 June 2018.

Gale Document Number: GALE|A264094170

Profile of William H. Foege director of Theranos
Plus Company Updates. (May 25, 2017):
Copyright: COPYRIGHT 2017 Plus Media Solutions
Full Text:
Palo Alto: Following is the Profile of William H. Foege director of Theranos:

William Foege is an epidemiologist and former director of the U.S. Center for Disease Control and Prevention (CDC) who has left an indelible mark on the field of global health. Recognized as the health innovator behind the successful campaign to eradicate smallpox in the 1970s, Dr. Foege received the Presidential Medal of Freedom in 2012, the nation's highest civilian honor. He was a senior medical advisor for the Bill and Melinda Gates Foundation from 1999 until his retirement in 2011.

Source Citation (MLA 8th Edition)
"Profile of William H. Foege director of Theranos." Plus Company Updates, 25 May 2017. General OneFile, http://link.galegroup.com/apps/doc/A493623454/ITOF?u=schlager&sid=ITOF&xid=bead9427. Accessed 24 June 2018.

Gale Document Number: GALE|A493623454

A TRIBUTE TO WILLIAM H. FOEGE, M.D., M.P.H.
States News Service. (Mar. 10, 2016):
Copyright: COPYRIGHT 2016 States News Service
Full Text:
LOS ANGELES, CA -- The following information was released by the Conrad N. Hilton Foundation:

After eight years of service, William H. Foege, M.D., M.P.H., has retired from the Conrad N. Hilton Foundation board of directors. Dr. Foege previously served for seven years on the prestigious international jury of the Conrad N. Hilton Humanitarian Prize, the world's largest humanitarian award.

Dr. Foege is a world renowned epidemiologist who worked in the successful campaign to eradicate smallpox in the 1970s. Dr. Foege became Chief of the CDC Smallpox Eradication Program and was appointed Director of the U.S. Centers for Disease Control in 1977.

In 1984, Dr. Foege and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, The World Bank, the United Nations Development Programme, and the Rockefeller Foundation. Its success in accelerating childhood immunization led to an expansion of its mandate in 1991 to include other issues which diminish the quality of life for children.

Dr. Foege has championed many issues, but child survival and development, injury prevention, population, preventive medicine, and public health leadership are of special interest, particularly in the developing world. He is a strong proponent of disease eradication and control, and has taken an active role in the eradication of Guinea worm, polio and measles, and the elimination of River Blindness. By writing and lecturing extensively, Dr. Foege has succeeded in broadening public awareness of these issues and bringing them to the forefront of domestic and international health policies.

Dr. Foege received the Presidential Medal of Freedom in 2012, in addition to many other awards during the course of his career. He also holds honorary degrees from numerous institutions, and was named a Fellow of the London School of Tropical Medicine and Hygiene in 1997. He is the author of more than 125 professional publications.

It is with profound gratitude that we thank Dr. Foege for his exemplary service on the Hilton Foundation board. We were fortunate to benefit from both his broad vision of life as well as his deep knowledge of the health field. His personal style motivated others to want to engage and explore issues further. While we are sad to be losing an influential and prominent member of our board, we remain grateful that Dr. Foege raised the bar of our deliberations. We wish him all the best in his future endeavors.

Steven M. Hilton

Chairman of the Board

Conrad N. Hilton Foundation

Source Citation (MLA 8th Edition)
"A TRIBUTE TO WILLIAM H. FOEGE, M.D., M.P.H." States News Service, 10 Mar. 2016. General OneFile, http://link.galegroup.com/apps/doc/A445901943/ITOF?u=schlager&sid=ITOF&xid=c9bea8c2. Accessed 24 June 2018.

Gale Document Number: GALE|A445901943

QUOTE:
Readers interested in the history of American public health efforts will be informed and by turns enlightened and entertained by this engaging work.

Klink, Aaron. Library Journal. 5/1/2018, Vol. 143 Issue 8, p81-81. 1/5p.
Subjects: PUBLIC health -- United States; NONFICTION; FEARS of the Rich, the Needs of the Poor: My Years at the CDC, The (Book); FOEGE, William H., 1936-

The Fears of the Rich, The Needs of the Poor: My Years at the CDC Foege, William H. The Fears of the Rich, The Needs of the Poor: My Years at the CDC. Johns Hopkins. May 2018. 280p. photos. notes. index. ISBN 9781421425290. $24.95; ebk. ISBN 9781421425306. HEALTH

Foege (emeritus, international health, Emory Univ.), formerly director of the Centers for Disease Control (CDC), provides a retrospective window into American public health, combining history and memoir while tracing national and international developments in U.S. policy. The personal narrative chronicles the author's service as a U.S. public health officer, his aid efforts in Africa, and his years at the CDC. Full of candid commentary on the approaches to public health policy that both work and don't work, the text explains the political forces behind these decisions. Foege's delightful, honest, and sometimes quite humorous and moving writing covers a range of topics, from injury prevention efforts at the CDC to toxic shock syndrome and AIDS. These discussions can help non specialist readers understand how epidemiological studies work and offer insight into why it seems to many that important decisions are delayed. VERDICT Readers interested in the history of American public health efforts will be informed and by turns enlightened and entertained by this engaging work.

QUOTE:
In summary, we commend
this book without reservations to
our colleagues in public health
disciplines and, no less strongly,
to all interested in reading about
persons who have had brilliantly
effective careers—and who write
about them with vigorous attention
to detail. This is a wonderful
introduction to the world
of public health for the newcomer
and will likely be a source
of proud reflection for the wellseasoned.
Source: American Journal of Public Health
Date: July 1, 2018

An Autobiography That Is Also
a History of Centers for Disease
Control and Prevention
William Foege, in his preface,
claimsthatthis bookis not a history of
Centers for Disease Control and
Prevention (CDC), public health, or
the breadth of CDC activities, but is
a collection of stories. This statement
is incorrect—the book is all of the
above. Our storyteller, a renowned
international leader in public health
for half a century, is a fine historian.
He is also an acute observer; extremely
smart, compassionate, and
dedicated; and his accountis enriched
by delightful flashes of humor.
A THREE-PART
AUTOBIOGRAPHY
This is the second installment
of his autobiography; the first
deals with the fight against
smallpox.1 This volume offers
narrative, stories, and analysis of
Foege’s career at the CDC: as an
officer of the Epidemiological
Intelligence Service, a senior official
in episodes of disease control
in the United States as well as
low-income countries, and its
director from 1977 to 1983. He
promises a third volume, a history
of the Task Force for Child
Survival, which he helped to
found and develop as an adviser
to President Carter and the Bill
and Melinda Gates Foundation in
the 1980s and 1990s. (Disclosure:
One of us, D. M. F., has read
several draft chapters of this
manuscript.)
Here, Foege offers 26 chapters
summarizing the history
of public health crises and interventions
since the late 18th
century; of the CDC since its
founding as a malaria program
during the Second World War;
and of the science, policies, and
politics of significant CDC
programs and interventions
since the 1960s. A gifted
The Fears of the Rich, the Needs
of the Poor: My Years at the CDC
By William H. Foege
Baltimore, MD: Johns Hopkins
University Press; 2018
280 pp.; $24.95
ISBN: 9781421425290
ABOUT THE AUTHORS
Elizabeth Fee is with the National Library of Medicine, National Institutes of Health,
Bethesda, MD. Daniel M. Fox is the president emeritus of the Milbank Memorial Fund,
New York, NY. Both authors are also AJPH editors.
Correspondence should be sent to Elizabeth Fee, National Library of Medicine, 8600
Rockville Pike, Bethesda, MD 20894 (e-mail: feee@mail.nih.gov). Reprints can be ordered at
http://www.ajph.org by clicking the “Reprints” link.
This book review was accepted April 9, 2018.
doi: 10.2105/AJPH.2018.304463
AJPH BOOK & MEDIA
July 2018, Vol 108, No. 7 AJPH Fee and Fox Book & Media 841
storyteller, he writes engaging
prose describing how he acquired
the knowledge and experience
that informed his
career in public health, globally
and in this country.
This book and its companions
will likely become classics in the
public health literature—analogous
to publications by such 19th
century giants of the field as
Farr, Semmelweis, Snow, and
Virchow. We base this prediction
on Foege’s disciplined focus—
throughout this book and in his
earlier autobiographical volume
on the smallpox campaign—on
what he calls “three essentials
for good public health
programs.”(p18)
ESSENTIALS FOR
GOOD PUBLIC HEALTH
PROGRAMS
These essentials have been
fundamental to much public
health practice, research, and
education since the middle decades
of the 19th century. But
they have rarely been articulated
as forcefully as Foege does here.
The first essential is his conviction
that the “basis for public health is
to achieve health equity . . . the
bottom line is social justice in
health.”(p18) Second “is the understanding
that the science base
of public health action is epidemiology,”(p18)
the discipline
that “determines the gaps in social
justice, identifies the groups with
poor health outcomes, discovers
the details of disease causation,
and provides clues to how corrective
action might improve
health.”(p18) Foege’s third “essential”
is “good management
for efficient implementation of
corrective actions.”(p18)
The title of this book also
encapsulates a key insight (he calls
it a “bias”) that the way to improve
health equity is to figure
out how to link the fears of the
rich to the needs of the poor.(p30)
The rich will respond to the
needs of the poor when they
understand that they can benefit
because they, too, are at risk. The
rich will thus respond to Ebola,
AIDS, and bioterrorism with
more alacrity and enthusiasm
than they will to river blindness
or intestinal worms.
FOEGE’S APHORISMS
Foege inserts remarks in his
stories and analysis that will linger
in the minds of many readers who
have studied and practiced public
health. Following are some
examples:
d The job of public health is to
try and rewrite history before it
happens.(p32)
d Every public health decision is
ultimately based on a political
decision.(p48)
d While the best decisions are
based on the best science, the
best results are based on the
best management.(p77)
d Why prevention? To save
money? . . . Yes, but it is far
more than that. It is simply
better to be alive than dead,
and healthy than disabled.(p169)
d . . . government is the only
place that can provide actual
social justice for all. It is
a revelation for social activists
when they finally discover
that.(p112)
Politicians, says Foege, “may
often be harmful to the health of
people (as when they reduce
support for immunization programs,
refuse to expand Medicaid,
or do not fund prevention
in health care delivery programs).”(p166)
They may also,
when properly motivated, be
a powerful force for positive
change in health.
Foege often uses the freedom
of the conventions of autobiography
to assert strong opinions on
controversial issues. He is a proponent
of universal coverage of
health services under a single
payer. Moreover, he despises the
commercialization of health care:
“When profit became the bottom
line, quality, equity and
outcomes all suffered.”(p168)
The financing of public health
programs should be based on two
new principles, he argues. The
first is that “programs with
proven positive benefit–cost ratios
should become entitlements
and no longer compete with
other public health programs.”(p167)
The second is that
“public health expenditures
should be indexed to total health
expenditures.”(p167)
INTRODUCTION TO
THE WORLD OF
PUBLIC HEALTH
In summary, we commend
this book without reservations to
our colleagues in public health
disciplines and, no less strongly,
to all interested in reading about
persons who have had brilliantly
effective careers—and who write
about them with vigorous attention
to detail. This is a wonderful
introduction to the world
of public health for the newcomer
and will likely be a source
of proud reflection for the wellseasoned.
We make no criticisms.
We look forward to Foege’s third
volume of stories, history, analysis,
and inspiration.
Elizabeth Fee, PhD
Daniel M. Fox, PhD

Stamping Out Smallpox. By: FOEGE, WILLIAM H., Natural History, 00280712, Sep2017, Vol. 125, Issue 9
Cooperation, resources, and a venerable vaccine combined for a landmark success.

One of the greatest plagues of humanity no longer evokes fear. Smallpox altered the history of scores of countries, including the United States, and even in the twentieth century took the lives of 300 million people. Now, as predicted by President Thomas Jefferson, it has become a footnote to the past. It has disappeared so totally, after a decade of effort in the 1960s and 1970s, that even middle-aged people in India and Africa have no recollections of the fear of the disease that used to paralyze entire communities.

It was one of the most horrendous of diseases. It often slipped quietly into a town or village. Then, after two weeks of incubation, as the virus multiplied in the body, unseen and unfelt, a person would suddenly become sick and develop a rash, which progressed to pus-filled bubbles that would break when touched. The scourge killed about one third of those afflicted and scarred another third, some of whom were blinded. Those who made it to a hospital were granted no great benefit. Indeed, the reluctance of hospital staff to touch or engage with patients was a harbinger, for those who survived, of how they were likely to be treated the rest of their lives. A half billion of those recovering in the twentieth century were left to live their lives behind a scar-filled face, with fewer chances to marry or be treated kindly at a place of work. Now there are no people under the age of forty with smallpox pockmarks.

The disease was endemic at least 3,000 years ago in China, India, and northeastern Africa, and from about 1,800 years ago in Europe. It was introduced into the Americas by early explorers. The death rate for the Indians of North and South America was higher than in other populations because they lacked a history that would allow natural selection to provide some background immunity.

The virus could change history within days, as members of royal families, country leaders, and military generals died. Even in the U.S., decades after vaccination was introduced, the toll continued. Abraham Lincoln was described, by a reporter at the Gettysburg Address, as looking tired and drawn. Why? He was coming down with smallpox. After his speech, he went to bed on the train returning him to Washington, D.C., and remained secluded for several weeks. Lincoln recovered, but his aide on the train acquired smallpox from him and died.

In regions where smallpox was common, people observed that those who survived the infection were immune from suffering it again. Certain populations in Africa, India, and China learned to moderate the terror of smallpox by inoculating people who had not had the disease. In this procedure, matter was taken from the pox of patients who had the disease and transferred to healthy people through scratches in their skin. This usually gave them a mild form of the disease. Mortality rates for those acquiring the disease in this fashion, known as variolization, ranged from one to a few percent, much less than for the natural disease acquired through the respiratory tract—yet still a risk hard to accept.

The history of smallpox took a turn in the late eighteenth century when Edward Jenner, a medical practitioner in Berkeley, England, who was experienced in the practice of inoculation, developed an alternative: inoculation with cowpox, a milder disease. He later summarized his work as follows:

My attention to this singular disease was first excited by observing, that among those whom in the country I was frequently called upon to inoculate, many resisted every effort to give them the smallpox. These patients I found had undergone a disease called the cow-pox, contracted by milking cows affected with a peculiar eruption on their teats. On inquiry, it appeared that it had been known among the dairies time immemorial, and that a vague opinion prevailed that it was preventive of the small-pox. [The Evidence at Large, 1805, p. 1]

Following that lead, however, Jenner learned that not all who had seemingly contracted cowpox became immune to smallpox. This he attributed to the fact that cows could have several similar-looking eruptions, also passed on to the hands of milkers, but not all were the “true” cowpox. He also observed that even among those who had contracted true cowpox, not all were immune to smallpox. From this he concluded that exposure to cowpox virus at different stages of the disease, or if it was decomposed, could provoke a reaction but not confer the benefit of immunity:

So it became evident a person might milk a cow one day, and having caught the disease, be for ever secure; while another person, milking the same cow the next day, might feel the influence of the virus in such a way as to produce a sore or sores … yet, as has been observed, the specific quality being lost, the constitution would receive no peculiar impression. [The Evidence at Large, 1805, p. 4]

Taking into account what he had learned after years of investigation, on May 14, 1796, Jenner made a historic experiment: he took “a little vaccine virus” from a cowpox lesion on the hand of Sarah Nelmes, a milkmaid who had been infected by a cow, and inserted it in the arm of an eight-year-old boy, James Phipps.

Notwithstanding the resemblance which the pustule, thus excited on the boy's arm, bore to variolous inoculation, yet as the indisposition attending it was barely perceptible, I could scarcely persuade myself the patient was secure from the small-pox. However, on his being inoculated some months afterwards, it proved he was secure. [The Evidence at Large, 1805, p. 5]

A public health tool was now available, marking the beginning of the modern public health era. Thomas Jefferson acquired the cowpox material from Benjamin Waterhouse of Boston and vaccinated his household and surrounding households in Monticello. He also foresaw the possibility of disease eradication: “Future nations will know by history only that the loathsome smallpox has existed.”

In 1955, the 153 delegates at the eighth World Health Assembly of the World Health Organization (WHO) voted on a motion to undertake global smallpox eradication. At that time, only three countries supported the motion, others regarding such an undertaking as unfeasible. But with persistent advocacy by the Soviet Union, the program was adopted in 1959—although owing to a preoccupation with the competing effort to eradicate malaria, the WHO did not appropriate funds until 1966.

The United States agreed to supply two early types of support. First, the U.S. Agency for International Development would provide resources, and the CDC (then the Communicable Disease Center, now the Centers for Disease Control and Prevention) would conduct a program in twenty countries of West and Central Africa. That area had high rates of smallpox as well as considerable communication and transportation barriers. The goal was to eliminate smallpox in the twenty countries in five years, by the end of 1971. Second, the CDC loaned one of its best officers, Donald A. Henderson, MD, to the WHO for eleven years to head up the program. Over the years, the CDC provided 300 people to work on smallpox. I took up extended work in Nigeria and then India; some took short-term field assignments under the auspices of the WHO; and others served as consultants to the various programs around the world to train people in field techniques or laboratory diagnosis.

At the beginning of the program, forty-three countries were considered to be smallpox-en-demic—that is, smallpox was being transmitted continuously; it was not dependent on outside importations. The initial plan was two-fold: first, to do mass vaccination to improve the immunity level of the population, and second, to concentrate on containment of the disease itself.

The first success was seen in the twenty countries in West and Central Africa targeted by the CDC program. Early on, it was found that the first priority, mass vaccination, could be skipped, if sufficient attention was given to tracking and finding where the virus was and then vaccinating those at immediate risk. In every geographic area where this strategy was tried, smallpox disappeared within a year. For a disease that had persisted for thousands of years and for 175 years after the development of a vaccine, this was astounding. The earliest success was found in Nigeria's Eastern Region (this was before states were formed), where smallpox disappeared in six months in an area harboring 12 million people. The focus was on surveillance (finding smallpox) and containment (stopping virus spread). The last cases of smallpox in the twenty-country CDC program were discovered in the spring of 1970, one and a half years before the target date and under budget.

The same approach worked in Brazil. Then country after country became free of smallpox. By 1973, the problem had been reduced to Bangladesh, India, and Pakistan in Asia, and Ethiopia in Africa.

But the intensity of smallpox in Asia was absolutely discouraging. In April 1974, Bihar state in India was recording 1,500 new cases of smallpox every day (one new case each minute)! Eradicating the disease there seemed impossible, and yet the same approach of finding the virus (surveillance) and protecting those at immediate risk (containment) was found to work. The smallpox eradicators were outpacing the virus. India went from having the highest smallpox rates in decades to zero for the entire country in twelve months’ time. Perhaps this was the most exciting year in the history of global health.

Bangladesh presented new problems. In early 1975, when political decisions destroyed urban slums, people suddenly fled back to their home villages, and smallpox was reignited throughout the country. But a massive global effort was launched, and smallpox disappeared before the end of the year.

Ethiopia remained the last country with smallpox. The world was ready to celebrate the last case when the virus, at the last moment, escaped to Somalia. It would require two more years to achieve total freedom from the disease for the entire world.

In May 1980 the World Health Assembly in Geneva celebrated the first planned eradication of a human disease. Because everyone in the world was potentially vulnerable, a worldwide effort was possible. At this writing, no other human diseases have been eliminated, but an animal virus, rinderpest, has been eradicated, saving cows from a miserable death and countless families in Africa from economic doom.

Two human diseases, poliomyelitis and dracunculiasis (so-called Guinea-worm disease), are in the final phases of being eradicated and will soon join smallpox. Others—onchocerciasis (“river blindness”), measles, lymphatic filariasis (“elephantiasis”), and rubella (“German measles”)—will follow. The precedent set by smallpox is not only one of eradication but of a global coalition crossing cultural, linguistic, and religious lines. That gives energy to global health and global development agencies to do even more. The addition of major philanthropic efforts by the Gates Foundation, Rockefeller Foundation, and others, as well as the contributions of such corporations as Merck & Co., have been a boost to the field.

The rapid advances of science have led not only to more vaccines but also to more hope. Malaria researchers now have genomes for people, vector mosquitoes, and the malaria parasite. That was beyond comprehension only decades ago. The twenty-first century has a chance to achieve global health equity. Smallpox eradication was one step in that journey.

PHOTO (BLACK & WHITE): Photographed by the author in 1966, a Nigerian youth suffers from confluent smallpox, in which the lesions are so dense that they form patches. Because of the scarring, patients who survived the disease often faced social isolation.

PHOTO (BLACK & WHITE): Aztec victims of smallpox are depicted in Fray Bernardino de Sahagún's General History of the Things of New Spain, a codex compiled in the sixteenth century. Unknown in Mexico before the Spanish Conquest, the disease decimated the indigenous inhabitants.

PHOTO (BLACK & WHITE): In An Inquiry into the Causes and Effects of the Variolae Vaccinae (1798), Edward Jenner included an illustration of the hand of Sarah Nelmes, a dairymaid infected with cowpox. “A large pustulous sore” appears where she had a previous scratch from a thorn, and two smaller pustules where she had small abrasions on the wrist. The sore drawn on her finger, based on another dairymaid's infection, was included to show the appearance of the disease at an earlier stage.

PHOTO (BLACK & WHITE): British postcard mailed in 1884 reflects resistance to the mandatory vaccination of infants. The policeman holds an order labeled “Vaccination act for Jenner-ation of Disease,” a reference to Edward Jenner, the developer of vaccination, and the Vaccination Act of 1853.

PHOTO (BLACK & WHITE): New Delhi schoolchildren are vaccinated in the 1970s during a national smallpox eradication week. The last know smallpox case in India was identified in 1975, and the nation was confirmed free of the disease in 1977.

~~~~~~~~

With an MD degree from the University of Washington, William H. Foege went to eastern Nigeria in the mid-1960s to run a Lutheran church mission medical center. Beginning in 1970, on behalf of the Centers for Disease Control and Prevention (CDC), he led the smallpox eradication effort in Nigeria, learning the effectiveness of surveillance and containment, which he then applied in India. Foege served as Director of the CDC from 1977 to 1983. From 1984 to 1999 he was Executive Director of the Task Force for Child Survival and Development, meanwhile serving as Executive Director of The Carter Center from 1986 to 1992 and entering the faculty of Emory University. In 1999 Foege became a Senior Medical Advisor for the Bill & Melinda Gates Foundation. Since his official retirement in 2001 he has been a Gates Fellow and an emeritus professor at Emory University's Rollins School of Public Health.

QUOTE:
Like rushing to a house on fire and dousing the flames, Foege and colleagues raced to smother smallpox wherever it erupted -- an approach that changed history.
Eradicating the pox. By: O'Callaghan, Tiffany, New Scientist, 02624079, 6/4/2011, Vol. 210, Issue 2815
Database:
Academic Search Complete

Eradicating the pox

House on Fire: The Fight to Eradicate Smallpox by William H. Foege, University of California Press, £20.95/$29.95

IN MAY, the World Health Organization met to discuss the fate of the last samples of the smallpox virus -- now living only in labs in the US and Russia. Yet just 50 years ago, before legions of public-health workers made it reality, eradication seemed impossible.

In House on Fire, William H. Foege, former chief of the Smallpox Eradication Program at the US Centers for Disease Control and Prevention, writes a mixture of memoir, dry public health guide and riveting tale of an all-consuming mission. He describes the early days of convincing the WHO to prioritise eradication, ensuing vaccination efforts and the strategy that ultimately banished the disease in 1977: surveillance and containment.

Like rushing to a house on fire and dousing the flames, Foege and colleagues raced to smother smallpox wherever it erupted -- an approach that changed history.

~~~~~~~~

Reviewed by Tiffany O'Callaghan

QUOTE:
Foege’s book is a personal account of systematic efforts to
eradicate smallpox in African nations and then in India, closely but
compellingly focused on practicalities and concluding with a remarkably
concise (and tellingly calm) appendix

House on Fire
Nature Medicine

Pox: An American History
By Michael Willrich
The Penguin Press, 2011
400 pp., hardcover, $27.95
ISBN: 1594202869
House on Fire: The Fight to
Eradicate Smallpox
By William H. Foege
University of California Press, 2011
240 pp., hardcover, $29.95
ISBN: 0520268369
Reviewed by Amy E Slaton
You probably didn’t have to wait in line for your flu shot this year,
because the pressing worry that some new strain of influenza—such
as the ‘bird flu’ and H1N1 that threatened in recent autumns to bring
us downs—seems to have passed. Our fear of pandemics is notoriously
variable and not entirely related to epidemiological projections or even
to media coverage of emergent health risks. Rather, cultural forces, such
as the social relations of urban life, local lore and perceptions of global
geopolitical insecurity, converge to generate the popular response to the
threat of disease. All help set the layperson’s gauge of a malady’s reach
or virulence and, by extension, of the need to protect oneself and one’s
family from infection.
Such social complexity has characterized human responses to epidemics
throughout history, but modern techniques of disease prevention,
global-scale migrations and health bureaucracies have added many
actors and tensions to the story. Emergent antivaccination movements
in the US today distress all those concerned with public health, and
it is only through acknowledging that complexity that we may see a
way to address this worrisome social trend. In Pox, a historical account
of America’s response to smallpox after 1900, Michael Willrich teases
out the social, cultural, medical and political agendas that shaped the
national reaction to that dreaded disease, finally eliminated in the US in
1949. In House on Fire, William H. Foege, an epidemiologist and former
director of the US Centers for Disease Control and Prevention (CDC),
follows the more recent international assault on smallpox, especially
his own work in Africa and India in the 1960s and 1970s. Together,
these books teach us not only about this one disease but also about
the meanings of health, illness, privacy, responsibility and the state in
modern societies.
Both books describe the elaborate scientific and institutional processes
by which public health interventions reached sufficiently large
populations to eliminate smallpox in the twentieth century, including
containment, surveillance and vaccination. Although the reduction of
human suffering brought by the control of smallpox is central to both
stories, neither author isolates the work of scientists and public health
operatives from the cultural contexts in which these people labored.
Both Willrich and Foege write of citizens who welcomed the work of
medical experts and those who feared or resisted that intervention. The
books thus draw lessons of far more value for present-day readers than
would a simpler heroic narrative that presents primarily the positive
outcomes of these interventions.
Willrich’s account, based on primary sources that he meticulously
researched, describes how local and federal health authorities in the US
attempted to limit the impact of smallpox largely through vaccination,
starting in the last decade of the nineteenth century. His narrative follows
individuals stricken with the disease, antivaccine activists, and the campaigns
of scientists, doctors, military men and bureaucrats, both obscure
and prominent, to end the scourge. Willrich’s aim throughout is to trace
smallpox as it played out in the “human community” of Progressive-era
America and its remote military outposts. In this way, Willrich is showing
that all diseases gain their entire meaning from the particular settings
and belief systems in which they play out; in other words, there is not
some purely biological version of smallpox that exists apart from such
social circumstances. As Willrich describes the environments and social
organizations of American communities, we see exactly why smallpox
was greeted with various interventions and different degrees of urgency
by diverse officials and populations.
For example, because close proximity between the sick and the well
became unavoidable in the nation’s increasingly crowded work camps,
towns and cities, authorities had no choice but to turn away from older
techniques of quarantine and emphasize vaccination to prevent the
spread of smallpox. And yet, this book makes clear that ‘proximity’ is
not how most citizens experience modern American life, structured as
it is around private households, discrete family units and self-governing
cities and towns. Thus, Willrich’s history helps us grasp why many
Americans, who understandably experienced their own homes and
neighborhoods as freestanding, safe and autonomous, were not easily
swayed toward the essential collectivism of universal smallpox vaccination,
despite watching people sicken and die from the disease. Willrich
does not come close to endorsing that public resistance to vaccination,
but he does probe its historical and cultural contingency with notable
creativity.
Willrich captures the emerging self-identity of public health officials
and doctors after 1890 or so as messengers of science, as well as their
oppositional role among ‘less informed’ communities (as more educated
Americans commonly characterized their poor, immigrant or rural
fellow citizens). This notion of experts as privileged elites, sometimes
dismissive of lay audiences’ concerns and values, is not new among historians
of Progressive-era professions. But, impressively, Willrich never
allows the patent benefits of vaccination, and our enduring relief in
knowing that smallpox is no more, to obscure these historical processes.
He notes, for example, that many African Americans, blamed by whites
in some localities for the spread of disease and harshly condemned for
their hesitancy to vaccinate, “learned how a smallpox epidemic could
transform years of official indifference and neglect into coercion and
violence.” Similarly, vaccination policies carried with US military forces
into the Philippines after 1901 brought with them improved health but
also powerful ideologies of racial distinction and US colonial domination.
Interestingly, we learn that elites also figured among the antivaccinationists
of the era. Some who opposed mandatory vaccination were
concerned with the “uncertain meaning of liberty in a modern, urbanindustrial
society,” while the philosopher William James argued that the
medical profession expressed in its hegemonic policies a “monopoly over
belief itself.” This revelation, too, helps us understand current strands
of the American anti-vaccination movement, in which demographic
heterogeneity manifests as a vast range of motivations to reject immunization.
There are a few moments when Willrich does not provide enough
interpretation to justify our taking in so many facts or so many dramatic
turns surrounding a particular historical episode. The writing can
sometimes seem florid. Yet, the narrative mostly flows well, and there are
invaluable take-home lessons here. We learn, above all, how a culture’s
faith in scientific medicine is ultimately established: citizen by citizen,
block by block. This seems a vital contribution to our understanding of
those who are today reluctant to vaccinate. That reluctance is entirely
regrettable but also as multiply determined as that seen in the smallpoxstricken
cities and towns of a century ago.
William Foege’s book is a personal account of systematic efforts to
eradicate smallpox in African nations and then in India, closely but
compellingly focused on practicalities and concluding with a remarkably
concise (and tellingly calm) appendix: “A Plan in the Event of Smallpox
Bioterrorism.” Foege served the CDC and World Health Organization
(WHO) first in Nigeria and then in India directing immense administrative
projects that successfully joined international medical expertise to
regional governmental and public health infrastructures. We learn that
improved vaccine production and mechanized vaccine delivery, coupled
with intensive planning and oversight, allowed for vast expansions in
immunization. Hugely significant, as well, were emergent understandings
of smallpox incubation and transmission and the innovative addition
of ‘surveillance and containment’ strategies, which compensated
for the near impossibility of reaching the final 20% of any population
in a mass vaccination campaign. All of these developments, not the dissemination
of the vaccine alone, led to the international eradication of
smallpox in 1977.
Logistics have always challenged those individuals implementing
medical knowledge. India inaugurated smallpox vaccination within just
a few years of Jenner’s 1796 discovery of the cowpox-based vaccine,
and one of the most haunting images in the book is that of a sequence
of children being used to deliver the live virus around the country in
1802: each child’s lesion became the source of the next child’s vaccination.
Foege writes that the restriction of these early efforts by British
authorities to “easily accessible urban areas” set up an inequitable (and
ineffectual) pattern of smallpox vaccination in India that persisted for
over a century. The nation recorded 400,000 smallpox deaths between
1947 and 1962, and those reports may represent only 1% of actual deaths.
In 1966, when the World Health Assembly, the governing body of the
WHO, determined that a funded global assault on smallpox was called
for, a public health intervention of utterly unprecedented scale began
to take shape.
Foege shows that it was not merely the massive commitment of time
and resources but a “transmission of belief ” about the possibility of
eradicating smallpox that made the system work. Personnel at each level
directed increasingly larger staffs on the level below, until a huge army
of field workers spread out to contact every corner of an afflicted nation.
Nearly all were profoundly committed to seeing the project through,
and I found myself increasingly in awe of Foege and his colleagues at
every level of the system. Their extraordinary ingenuity and energy come
across as the book spools out the mind-bogglingly detailed work needed
to create and maintain the communications, training, reporting and
transport systems required for this massive undertaking.
We could perhaps wish that Foege reflected a bit more here on the
world into which these systems were inserted. Containment of the ill
and house-by-house surveillance of African and Indian communities
clearly were central to the eventual suppression of smallpox, but those
practices will immediately remind some readers of a set of social relations
historically found throughout the imperial world: white Europeans
and North Americans intervening in the lives of indigenous peoples
through intimate and insistent observation. We do not deny the incalculable
human value of smallpox eradication when we acknowledge the
close fit of political and bodily control in colonial regimes.
This is important for a reason I suspect Foege would support: in trying
to meet public health challenges, if we see a population’s reluctance
to cooperate with health officials as noncompliance rather than as reasoned
cultural response, we may begin to reassert disturbing historical
patterns of social dominance. Willrich, as the historian, keeps a kind of
cultural contingency, and thus such matters of power, front and center.
By contrast, Foege, although he lived and worked among a diversity of
cultures and writes with deliberate respect about his indigenous staffs
and patients, reports as the expert practitioner with a practical endpoint
in view at all times. But both books are deeply constructive and compassionate,
and together they demonstrate the inseparable roles of science,
logistics and ideology in public health efforts of every era.

"Foege, William H.: THE FEARS OF THE RICH, THE NEEDS OF THE POOR." Kirkus Reviews, 1 Apr. 2018. General OneFile, http://link.galegroup.com/apps/doc/A532700305/ITOF?u=schlager&sid=ITOF&xid=b1a8ce55. Accessed 24 June 2018. "House on Fire: The Fight to Eradicate Smallpox." Nature, vol. 473, no. 7347, 2011, p. 281. General OneFile, http://link.galegroup.com/apps/doc/A257435056/ITOF?u=schlager&sid=ITOF&xid=58784b23. Accessed 24 June 2018. "Free from smallpox." Nature Medicine, vol. 18, no. 6, 2012, p. 845. General OneFile, http://link.galegroup.com/apps/doc/A293686222/ITOF?u=schlager&sid=ITOF&xid=225399dc. Accessed 24 June 2018. "Global health leadership and management." SciTech Book News, Sept. 2005. General OneFile, http://link.galegroup.com/apps/doc/A138410247/ITOF?u=schlager&sid=ITOF&xid=711ed8b1. Accessed 24 June 2018. "William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development." World Disease Weekly, 9 May 2006, p. 203. General OneFile, http://link.galegroup.com/apps/doc/A240291225/ITOF?u=schlager&sid=ITOF&xid=703708eb. Accessed 24 June 2018. "William H. Foege, MD, MPH, receives 2006 Sabin Gold Medal for vaccine development." Science Letter, 12 May 2006, p. 198. General OneFile, http://link.galegroup.com/apps/doc/A248080403/ITOF?u=schlager&sid=ITOF&xid=76cc4910. Accessed 24 June 2018. Arsenault, Kathy. "Foege, William H. House on Fire: The Fight To Eradicate Smallpox." Xpress Reviews, 22 July 2011. General OneFile, http://link.galegroup.com/apps/doc/A264094170/ITOF?u=schlager&sid=ITOF&xid=039d8aea. Accessed 24 June 2018. "Profile of William H. Foege director of Theranos." Plus Company Updates, 25 May 2017. General OneFile, http://link.galegroup.com/apps/doc/A493623454/ITOF?u=schlager&sid=ITOF&xid=bead9427. Accessed 24 June 2018. "A TRIBUTE TO WILLIAM H. FOEGE, M.D., M.P.H." States News Service, 10 Mar. 2016. General OneFile, http://link.galegroup.com/apps/doc/A445901943/ITOF?u=schlager&sid=ITOF&xid=c9bea8c2. Accessed 24 June 2018. Klink, Aaron. Library Journal. 5/1/2018, Vol. 143 Issue 8, p81-81. 1/5p. Subjects: PUBLIC health -- United States; NONFICTION; FEARS of the Rich, the Needs of the Poor: My Years at the CDC, The (Book); FOEGE, William H., 1936- Fee, Elizabeth; Fox, Daniel M. American Journal of Public Health. 2018, Vol. 108 Issue 7, p841-842. 2p. DOI: 10.2105/AJPH.2018.304463. Subjects: MEMOIRS; NONFICTION; CENTERS for Disease Control & Prevention (U.S.); Administration of Public Health Programs; FEARS of the Rich, the Needs of the Poor: My Years at the CDC, The (Book); FOEGE, William H., 1936- FOEGE, WILLIAM H. Natural History. Sep2017, Vol. 125 Issue 9, p24-27. 4p. 5 Black and White Photographs. Subjects: SMALLPOX vaccination; SMALLPOX; HISTORY; VACCINIA; WORLD Health Organization; UNITED States. Agency for International Development; JENNER, Edward, 1749-1823 By: O'Callaghan, Tiffany. New Scientist. 6/4/2011, Vol. 210 Issue 2815, p49-49. 1/5p. Subjects: SMALLPOX; NONFICTION; HOUSE on Fire: The Fight to Eradicate Smallpox (Book); FOEGE, William H., 1936- By: Slaton, Amy E. Nature Medicine. Feb2012, Vol. 18 Issue 2, p195-196. 2p. 2 Color Photographs. DOI: 10.1038/nm.2662. Subjects: NONFICTION; HOUSE on Fire: The Fight to Eradicate Smallpox (Book); POX: An American History (Book); FOEGE, William H., 1936-; WILLRICH, Michael

• Cooper Square Review
  http://coopersquarereview.org/
  Word count: 1423

  Cooper Square Review
  http://coopersquarereview.org
  June 27, 2018
  The Fears of the Rich, The Needs of the Poor
  My Years at the CDC
  Book by WILLIAM H. FOEGE
  For a time, there was no greater enemy to Reaganomics than American epidemiologist Dr. William H. Foege. During his seven-year tenure from 1977-1983 as director of the Center for Disease Control (CDC), Foege often butted heads with congressmen who were at the beck and call of gun and tobacco lobbyists. When the CDC was in the midst of establishing a causal link between tobacco and lung cancer, a congressman from Kentucky (who was also chair of the Committee of Appropriations) would begin every budget hearing by reading to Foege an antiquated quote from his predecessor at the CDC that in effect denied smoking as a significant health problem. At the height of the AIDS outbreak, a New York congressman staged a congressional hearing in an unsuccessful attempt to strong-arm Foege into revealing the names of those infected.

  “The job of public health is try to rewrite history before it happens…I had no idea how hard it would be in practice,” Foege writes in his autobiography, The Fears of the Rich, The Needs of the Poor, which recounts his half century of public service. “We are surrounded by enemies. Some are so small that they require microscopes to be seen. And some are in suits, occupying congressional offices or lobbying organizations, representing specific and special interests, rather than the interests of the public,” he continues. The CDC was headquartered in Atlanta instead of Washington, D.C., he notes, specifically to afford the agency sufficient autonomy to navigate pivotal public health challenges.

  Foege had set out to become an internal medicine physician and even accepted a residency position in that field, but a once-in-a-lifetime opportunity swept him away at the eleventh hour. Weeks from graduating medical school at the University of Washington, young Foege received a phone call from the head of the CDC’s Epidemic Intelligence Service (EIS), an elite team of epidemiologists tasked with investigating disease outbreaks. Foege took the plunge. His training at the EIS brought him to the epicenter of a major smallpox outbreak in Africa, which is where his journey into public health truly begins.

  The Fears of the Rich, The Needs of the Poor provides a thorough and intimate account of a former CDC director’s public health odyssey. It is part memoir, part medical history, and part social commentary. Foege devotes the first half of the book to his field officer days. There, he painstakingly recounts his epidemiological team’s herculean mission in the 1960’s and 1970’s to eradicate smallpox, a highly contagious and deadly disease that we now know is caused by the variola virus. He spent almost a decade in Nigeria and the Indian subcontinent supervising a labor-intensive program called “ring vaccination,” where field workers quarantine those that are infected and then vaccinate every last person that might have been exposed to the infected individual. The successful eradication of smallpox led by Foege’s team is public health at its finest: Smallpox remains the only infectious disease in human history to have been completely eliminated.

  According to Foege, responding to epidemics anywhere in the world is the “ultimate” way to shield Americans from deadly diseases like smallpox. The successful worldwide eradication of smallpox explains why the United States, with its resources and scientific know-how, has historically had both an ethical and self-serving obligation to help contain disease outbreaks abroad. The main obstacle has been at home: getting people with financial or political muscle to actually care. For them to care, the disease must pose a direct and immediate threat in their backyard – which is why drug-resistant tuberculosis gets funding, for instance, but not malaria. Foege reminds us of this with the book’s title, which succinctly prescribes a solution towards health equity: we need to “figure out how to link the fears of the rich to the needs of the poor.”

  Foege artfully gives unsung heroes their due. In one chapter, he calls American microbiologist Maurice Hilleman, a name unrecognized by most outside of the CDC, the “Louis Pasteur of our time.” Hilleman almost single-handedly developed over 40 vaccines, including those for hepatitis B and measles, mumps, and rubella (MMR), although he chose not to name any of them after himself.

  In another chapter, Foege celebrates the career of Matthew Lukwiya, an “uncommonly gifted” Ugandan physician, who heroically diagnosed and contained the 2000 Ebola outbreak in his home country. By the time the World Health Organization arrived on the scene, they had little to do in terms of disease containment, because Lukwiya had already fastidiously implemented state-of-the-art isolation procedures. His life ended tragically, however, when in an attempt to stop an infected patient from leaving the hospital in the middle of the night, Lukwiya hastily donned his protective gear – everything but his pair of goggles, which left him exposed to the Ebola virus. Two weeks later, due to this single break in protocol, Lukwiya lost his own life to the disease from which he saved thousands of others. Combatting a deadly infectious disease such as Ebola only sounds “exciting and glamorous to those who have never been in this situation,” stresses Foege. Lukwiya, like many other public health heroes, paid the ultimate price for his service.

  Perhaps due to his overly humble nature and discomfort with attention, Foege spends a disproportionate amount of his book shining the limelight on others. He seems to mention every colleague he has worked with (even if in passing), which I found at times distracting to his own narrative. At one point, he refers the reader to a “fuller list” at the appendix because he couldn’t fit all of his acknowledgements in the main text.

  Although Foege writes his autobiography like a buttoned-up historian, he still slips in nuggets of self-deprecating humor. On the day when he was appointed CDC director, Foege was told not to tell anybody including his own wife until the press photo and release were in order. The man overseeing the press release hurriedly gave his own suit coat to Foege, which comically turned out six inches short at the sleeves. Foege stood six-foot seven and although he was promised a just headshot, his official photo showed him in the entire suit. He includes this photo for the reader’s entertainment, successfully breaking the fourth wall.

  As Foege delves further into his career as CDC director, his tone, to my relief, becomes more prescriptive than summational. This at times comes across as a rebuke to the current administration’s antagonistic relationship with public health, which Foege likens to the Reagan-era bully tactics of intimidation, litigation, and blind obeisance to industry lobbyists. During the 1980’s, he notes, the CDC discovered a causal link between a rare but fatal disease called Reye’s syndrome and aspirin use in children recovering from a viral illness like chickenpox and the flu. In an attempt to suppress publication of the CDC’s findings, aspirin manufacturers repeatedly badgered Foege by phone at his every possible location (including his parents’ home) and even pressured the White House to issue a cease and desist order. Foege marched forward nevertheless, publishing the Reye’s syndrome study because the public deserved the truth.

  Over the years, the definition of public health expanded from disease prevention to preventing injury – which in turn led to “all areas of violence,” including injury caused by guns. In the 1990’s, the CDC established a subdivision to study gun violence, only to be shut down four years later by a congressional budget maneuver called the Dickey Amendment that stripped away “the precise amount” the CDC had line-itemed for firearms research. The recent mass shooting in a high school in Parkland, Florida reminds us that our communities today are not any safer from gun violence than they were two decades ago with Columbine.

  Public health “absolutely needs the support of politicians,” Foege writes. But he warns that we citizens also have a responsibility to remain vigilant and proactive for the sake of our communities. When our political representatives “vote not to provide early education, medical care, prevention, or Medicaid expansion, we as voters kill through errors of omission.”

  Alice Fok is a M.D./Ph.D. student at the New York University School of Medicine.

• Wall Street Journal Online
  https://www.wsj.com/articles/SB10001424052702304319804576387641621372896
  Word count: 1192

  QUOTE:
  While "House on Fire" isn't the first history of the smallpox-eradication program, it is perhaps the most personal.
  The drive to snuff out smallpox was conducted even as civil war erupted in Nigeria and as political opposition to the targeted-vaccination efforts mounted in India when eradication seemed slow to come. Executing the campaign required patience and precision. It took hundreds of training sessions in India just to teach health workers how to search for smallpox cases.
  "House on Fire" shows what can be accomplished when governments and thousands of health workers focus on a single objective. When he travels to India these days, Dr. Foege says, he searches faces on the street, looking for smallpox scars. On anyone under age 35, he can't find any.

  How a Scourge Was Eradicated
  What to do when family members insist on visiting an infectious relative? Vaccinate them at the door.
  By Betsy McKay
  June 22, 2011
  Smallpox, one of the deadliest diseases in human history, was eradicated more than 30 years ago by an army of public-health warriors who chased the virus across the globe, down to its last patient. The effort was a vast international project; achieving the goal took more than a decade. And it would have been a lot harder, and taken a lot longer, had necessity not forced William Foege to improvise at a critical moment, making a chance discovery.

  The American medical missionary was working as a consultant for the World Health Organization's newly intensified smallpox-eradication program in eastern Nigeria in late 1966. As he and his colleagues were preparing to launch a mass-vaccination campaign, they learned of a smallpox outbreak in a remote village. They faced a quandary. Protocol called for everyone in the area to be vaccinated. But the recently formed smallpox team was still waiting for supplies. They didn't have enough vaccine.

  The team members asked themselves: "If we were smallpox viruses bent on immortality, what would we do to extend our family tree?," Dr. Foege recalls in "House on Fire," his rich, suspenseful memoir of this historic public-health campaign. The virus, they concluded, would find the nearest susceptible person. "Our task, then, was not to vaccinate everyone within a certain range but rather to identify and protect the nearest susceptible people before the virus could reach them."

  Missionaries within a radius of about 30 miles were contacted by radio; the team asked them to send runners to every village and report any signs of smallpox. Vaccinations were given to everyone in the four villages where the runners identified cases, as well as to the residents in three other villages where missionaries said the patients and their families had traveled. The outbreak was quickly stopped in its tracks. The smallpox warriors had "built a fire line" around the virus, Dr. Foege writes. Thus was born a strategy that would become central to quelling smallpox.

  The title of "House on Fire" comes from a young Indian physician who compared the new "surveillance and containment" approach, as Dr. Foege calls it, to pouring water on a burning house rather than on surrounding houses in case the fire spreads. Mass vaccination—a huge undertaking—had been made possible by new vaccine technologies, but the more targeted approach, Dr. Foege says, eventually became the main weapon.

  How a Scourge Was Eradicated
  HOUSE ON FIRE
  By William H. Foege
  (California, 218 pages, $29.95)

  After the strategy's success in West and Central Africa, it was later put to an even tougher test in densely populated Bihar, India. In the first four months of 1974, India reported more than 67,000 smallpox cases, with more than two-thirds of them in Bihar. By identifying and then dousing thousands of outbreaks, the smallpox warriors began to reverse the tide by May of that year. A year later—20 months after the effort began—India reported its last case of smallpox. By 1980, smallpox—having killed countless millions across the centuries—was declared completely wiped out world-wide.

  While "House on Fire" isn't the first history of the smallpox-eradication program, it is perhaps the most personal. Dr. Foege, a charismatic public-health leader who went on to head the Centers for Disease Control and Prevention for six years beginning in 1977, bounces the reader along with him in his jeep, on motorbikes over rugged terrain and on bustling trains. "You can smell smallpox before you enter the patient's room," he writes, likening the odor to that of a dead animal and describing the "catatonic" demeanor of patients trying to avoid painful movement.

  The drive to snuff out smallpox was conducted even as civil war erupted in Nigeria and as political opposition to the targeted-vaccination efforts mounted in India when eradication seemed slow to come. Executing the campaign required patience and precision. It took hundreds of training sessions in India just to teach health workers how to search for smallpox cases. Another challenge was the Indian tradition of friends and relatives visiting smallpox patients. Barring the visits wasn't an option—the goddess of the disease would be offended. The solution: stationing vaccine-equipped watch guards at patients' houses and vaccinating every visitor. At the peak of the 1974 smallpox season in India, between 50,000 and 100,000 guards were posted in response to 8,000 outbreaks.

  Given Dr. Foege's vital public-health role, it would have been interesting to hear more from him about how the lessons of smallpox eradication might apply today to attempts to extinguish polio or control malaria. And he is silent on a lingering debate: what to do about the last known vestiges of the live smallpox virus, housed in labs at the Centers for Disease Control and at a Russian research institute. Proponents of destroying the virus want to ensure that the disease is banished forever; opponents maintain that the samples are needed to make vaccines in the event of an unforeseen outbreak. The matter is so divisive that the World Health Organization last month delayed, not for the first time, a plan to destroy the stocks. The question will be revisited in 2014.

  Dr. Foege does reflect at times on lessons learned, even dispensing advice on how to conduct a mass vaccination campaign to combat a smallpox bioterrorism attack. As enthusiastic as he is about the surveillance-and-containment strategy, he is careful to note that it is not suited for every disease. Almost everyone who was infected with smallpox developed telltale pockmarks, making the virus easy to track. It didn't spread as easily as some other infectious diseases. And unlike malaria, it wasn't transmitted by animals or insects. "The smallpox eradication story contains many lessons," he writes, "but giving up mass vaccination as a methodology for other diseases is not one of them."

  "House on Fire" shows what can be accomplished when governments and thousands of health workers focus on a single objective. When he travels to India these days, Dr. Foege says, he searches faces on the street, looking for smallpox scars. On anyone under age 35, he can't find any.

  Ms. McKay is the Journal's Atlanta bureau chief.

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