Dr. William H. Foege (1936-2026), but just Bill to those of us who knew and worked with him, is a legend of public health. He was born in Decorah, the son of a Lutheran minister, and lived in Eldorado until 1945 when his father was transferred to Chewelah, Washington. Bill attended Pacific Lutheran University, medical school at the University of Washington, and Harvard University where he earned a Master of Public Health degree. He served as an Epidemic Intelligence Service (EIS) officer at the Centers for Disease Control and Prevention from 1965 to 1966. Having been inspired in early life by an uncle, a Lutheran missionary in New Guinea, he began his career as a Lutheran medical missionary in eastern Nigeria in 1966.
Prompted by the Nigerian-Biafran Civil War in 1967, and by WHO’s smallpox eradication program in central and western Africa, Bill was recruited by the CDC to lead both its Nigerian smallpox eradication campaign and its relief program for famine, then causing thousands of starvation deaths as federal troops tightened the blockade of supplies to the breakaway Biafran state. There he designed and tested ring vaccination, tracing and vaccinating all contacts of smallpox cases as well as the contacts of the contacts, the method he rigorously tested and which successfully eradicated smallpox in central and western Africa by 1970. Together with WHO and Indian public health officials, ring vaccination was then used to eradicate smallpox from India and later from Somalia where the last case of smallpox was found in 1978. WHO declared the world free of smallpox in 1980 and is graphically described in Bill’s book “House on Fire — the Fight to Eradicate Smallpox.”
To confront famine among children in villages freed from the Biafran blockade, in 1968 Bill designed a famine surveillance program to direct nongovernmental organization food distribution to villages most in need. As an EIS officer myself in 1968 and 1969, I learned from Bill an early public health lesson, the importance of using systematic surveillance to document public health epidemics. Using normative data from a survey of western Nigerian children’s height and arm circumference, a volunteer Quaker medical team had designed bamboo sticks marked with 75th- and 80th-percentile scales. Together with a team composed of a Peace Corps holdover and local volunteers, we documented the validity of this method to measure the prevalence of malnutrition among village children. It became the model used to direct the distribution of food by organizations that hasten relief from famine already receding when I served there in the summer of 1969.
Bill became the director of the CDC in 1977 and served until 1983. During these years he expanded the vision and programs of the CDC including appointment of a highly qualified vaccination advisory committee to combat childhood infectious diseases, injury research and surveillance including injuries and deaths arising from firearms and expanded collaborative global health programs with the WHO and many nations around the world. He led with humility and humor. In 1979, while serving as a U.S. Public Health Service officer for the National Institute for Occupational Health and Safety (NIOSH) in Morgantown, West Virginia, I vividly recall a visit from Bill, who humorously quizzed me in front of my division, on pulmonary particle deposition and the efficacy of our national surveillance program for coal worker’s pneumoconiosis (black lung disease).
Another lesson, always be prepared with command of the scientific literature when confronting a public health epidemic.
During that visit, Bill said he was planning to move NIOSH headquarters from Washington, D.C., to Atlanta and possibly combine NIOSH with a new Environmental Health Division. His justification, as recounted in his book “The Fears of the Rich, the Needs of the Poor — My Years at the CDC,” was his concern about the influence of Washington special interests, both business and organized labor, on the NIOSH scientific research mission. I flew to Atlanta to make the case for retaining the NIOSH identity and D.C. headquarters. Bill told me “there is nothing more corrosive than special interest influence on scientific research.” NIOSH headquarters was moved to Atlanta but retained its legislatively granted identity.
Frustrated with the lack of appropriations the CDC was receiving to address the emerging AIDS epidemic, Bill left the directorship of the CDC in 1983. In 1984, he was recruited by representatives from World Health Organization, UNICEF, the World Bank, the United Nations Development Program and the Rockefeller Foundation, to co-found and lead the Task Force for Child Survival, to confront the challenge of child immunization globally. When the task force began, the only 15% of the world’s children had received at least one vaccine. By 1990, the rate had risen to 80%. Another lesson from Bill Foege is “all public health is global health,” meaning that infectious diseases, as well as many other public health epidemics, know no boundaries.
In 1986, former President Jimmy Carter and Rosalynn Carter appointed Foege as executive director of the Carter Center with its focus on global conflict and health. There he designed international eradication and prevention programs for guinea worm disease, river blindness, trachoma, lymphatic filariasis and malaria while training local volunteers and using low-cost methods. Carter wrote for Bill’s obituary, prior to his own death in 2024, “Bill Foege was a pre-eminent public health practitioner who dedicated his life to what he called science in service to humanity. He saved the lives of millions of people around the world.”
In 1999, the Bill and Melinda Gates Foundation recruited Bill Foege as a senior fellow for its Global Health Program. There he influenced the investment of $750 million to begin a global child-vaccination program called Gavi, the Vaccine Alliance and the Global Fund. The Gates Foundation focused on polio eradication, in partnership with Rotary Internation, HIV/AIDS, malaria, tuberculosis, other tropical diseases through vaccination, mass drug administration, vector control and in-country primary care programs.
With the recent defunding of the U.S. Agency for International Development, with which it partnered in its many global health efforts, the Gates Foundation has since redoubled its funding to confront these still deadly diseases.
When the University of Iowa launched the College of Public Health in 1999, the first new college in 50 years, we invited Bill to be our dedication speaker. He said he was especially pleased to be invited back to his home state for the founding of the 30th school of public health in the nation. He was an evangelical speaker, a skill he attributed to listening to years of his father’s sermons. Among his lessons that day was “the purpose of public health is social justice.” We added social justice to the university’s core values and displayed them prominently in the main corridor of our temporary home in the old General Hospital.
Foege’s Wikipedia resume lists a page-long list of awards and honors, among them the 2005 Public Welfare Medal from the U.S. National Academy of Sciences, the University of Washington School of Medicine William H. Foege Building, President Barack Obama’s 2012 awarding of the Presidential Medial of Freedom, and the 2020 Future of Life Award for the eradication of smallpox. In 2014, the UI College of Public Health awarded Bill with the Richard and Barbara Hansen Leadership Award. That occasion marked my last meeting with Bill. He inscribed my copy of “House on Fire,”, which I treasure. Our conversation focused on the importance of science in public health. He referenced the book before us in which he wrote, “knowledge is power, and even a little knowledge of the truth goes a long way.”
Bill was highly critical of the U.S. response to the COVID-19 pandemic, for its late response, retreat from traditional CDC methods and lack of international collaboration. He has been an outspoken critic of Secretary Robert F. Kennedy Jr.’s dismantling of the CDC vaccine advisory committee and his anti-vaccine statements.
But, ever optimistic, in his 2024 book, Change is Possible, his final lesson: “Humanity does not have to live in a world of plagues, disastrous governments, conflict and uncontrolled health risks. The coordinated action of a group of dedicated people can plan for and bring about a better future.”
James A. Merchant, MD, DrPH, is professor emeritus, Colleges of Public Health and Medicine, founding dean emeritus of the College of Public Health at the University of Iowa, and former director of the Division of Respiratory Disease Studies, NIOSH/CDC.
This article originally appeared on Des Moines Register: What a great Iowa humanitarian, Bill Foege, taught me | Opinion
Reporting by James A. Merchant, Guest columnist / Des Moines Register
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