years honorees included the British scientist who developed
in vitro fertilization, a team of researchers who found ways
to genetically alter mice to mimic human ailments, and Foege,
whose innovative system of strategic vaccinations helped eradicate
public service award honors a tireless leader in public health,
whose work has led to the saving of millions of lives,
said Daniel E. Koshland Jr., Lasker board member and chairman
of the selection committee. Bill Foege . . . is guided
by a humanitarian vision that all people, regardless of economic
status, nationality, or age, should live long and healthy lives.
a presidential distinguished professor at Emory and senior health
adviser to the Bill
and Melinda Gates Foundation, was in Italy when the attacks
on the Twin Towers and the Pentagon occurred and had just made
his way back to the United States to accept the Lasker Award.
Exhausted and saddened, he quickly rewrote his acceptance speech
to reflect the emotional impact of the enormous loss of life
still being tallied on the nightly news.
many years, I have repeated that thirty thousand children die
every day before the age of five. I have never been able to
visualize that number, he wrote. September eleventh
provided me the reference to see that the awful picture focused
on our television screens is repeated for thirty thousand parents
a day, every day, but is so geographically diffused that we
have trouble fathoming the total impact.
health, he continued, requires the same heroic effort
we have witnessed in this country in the past ten days.
sixty-eight, Foege is no stranger to heroic effortshe
spent decades battling horrific diseases in the field and as
director of the Centers for Disease Control and Prevention (CDC),
the Carter Center, and the Task Force for Child Survival and
Development. His stewardship of public health spending by the
Gates Foundation has steered billions of dollars into childhood
immunizations, vaccine research, and disease prevention in the
worlds poorest regions.
a professor at the Rollins School of Public Health, Foege has
long taught that science must be guided by altruism, a desire
to help those most in need. His hero is German philosopher and
physician Albert Schweitzer, son of a Lutheran minister (as
is Foege) who did groundbreaking health work in Africa in the
is better than science? Foege asked at the Lasker awards.
Better than science is science with heart, science with
ethics, science with equity, science with justice.
MID-OCTOBER, WHILE WATCHING a
television report about germs that could be used in bioterrorism,
Foege was shocked to see a film clip of himself as a young doctor
giving smallpox vaccinations in Africa.
year was 1966 and Foege, fresh out of Harvard University with
a masters degree in public health, was serving as a medical
missionary in Yahe in eastern Nigeria, running the Immanuel
Medical Center and working for the CDC
as an epidemiologist.
an explosively contagious virus that kills about a third of
its victims, had been eliminated in Western Europe, North America,
and Japan, but was still claiming more than two million lives
a year worldwide in such places as India and Africa.
clinic received a limited shipment of smallpox vaccine, and
he was instructed to immunize as many people as possible; more
vaccines, he was told, were on the way. Before the next shipment
could arrive, however, he got word of a smallpox outbreak in
a remote region of the country. Foege needed to act quickly
to prevent an epidemic but lacked enough vaccine to inoculate
the entire population.
knew he had to get to susceptible people as quickly as possiblebefore
the virus did. Foege enlisted the help of local missionaries
and, using maps and two-way radios, divided up the area around
the outbreak and sent runners to the surrounding villages. Within
twenty-four hours, they had pinpointed all existing cases of
the disease. Next, they traced routes where those who were infected
had lived, shopped, and gathered, targeting those villages and
markets with vaccinations to create a buffer zone of immunity
around the epidemics epicenter. Four weeks later, there
were no new smallpox cases in the area.
this innovative strategy of surveillance and containment,
Foege and his team eliminated smallpox in West Africa in three
and a half years. It has since become the standard for infectious
civil war in Nigeria sent Foege back to Atlanta, where he was
named director of the CDCs smallpox
eradication program in 1970. His connection with the federal
agency had begun shortly after he graduated from medical school
in the early 1960s, when he served two years as an Epidemic
Intelligence Service (EIS) officer with
the Communicable Disease Center, the forerunner to the CDC.
EIS officers are the agencys frontline
disease detectives an elite cadre of young
physicians and scientists trained as epidemiologists, who track
down mysterious diseases or clusters of illnesses.
1974, the World Health Organization (WHO)
asked the CDC
if Foege, who was becoming known in public health circles for
his team-building skills, could help with eradication efforts
in India, where smallpox was still spreading rapidly. In one
Indian state alone, 10,600 cases of smallpox were recorded in
a week. Foege, his wife, Paula, and their three sons packed
up and moved to New Delhi.
recruited, trained, and dispatched more than seventy young epidemiologists
and many more local workers who used surveillance and containment
to stop transmission of the disease. Within a year, India went
from having the highest rate of smallpox in the world to no
announced the end of the smallpox eradication effort in 1979.
It had taken a dozen years, thousands of health workers, and
about $300 million, but the scourge that could be traced back
to the time of Ramses V some three thousand years ago had been
conqueredin no small part due to the efforts of Bill Foege.
converted a flawed, mass immunization program into a supremely
successful program, said Harvey V. Fineberg, former Harvard
University provost and dean of the faculty of public health.
Bill Foege has an exceptional ability to be both a visionary
and a practical problem solver.
assistant to CDC
Director David Sencer in 1975 and returned to Atlanta from India.
The agency, with a staff of more than four thousand and a budget
of $184.9 million, soon faced the first cases of a deadly hemorrhagic
fever in Zaire and the Sudan later identified as Ebola, and
an outbreak of a fatal respiratory disease among attendees of
a Philadelphia convention that would become known as Legionnaires
1977, President Jimmy Carter appointed Foege director of the
During his six years at the helm, Foege increased the agencys
international activities, and extended its mission from infectious
diseases to include accidental injuries, homicides, suicides,
and chronic diseases. He oversaw several high-profile investigations
that received extensive media coverage, including toxic shock
syndrome and Reyes syndrome, a neurological disease linked
to aspirin use in children.
in 1981, a rare pneumonia turned up among five young gay men
in Los Angeles. A short while later, thirty-three cases of Kaposis
sarcoma, a rare type of cancer, were found in young gay men
in New York City.
cause of the outbreak is unknown, and there is as yet no evidence
of contagion, read a June 5, 1981, article in the CDCs
Mortality and Morbidity Weekly that reported these disease clusters.
But the doctors who have made the diagnoses . . . are
alerting other physicians who treat large numbers of homosexual
men to the problem in an effort to help identify more cases.
W. Curran, dean of the Rollins School of Public Health, was
head of the research branch for the CDCs
Venereal Disease Control Division at the time. He and Foege
were convinced that these illnesses signaled a larger, more
serious threat to the health of homosexual men and wanted to
devote more resources to investigating the link. But the agencys
budget was under severe scrutiny.
was during the transition of the presidency from President Carter
to President Reagan, [who] called for significant reductions
in personnel and funds for the public health service during
the time that AIDS was first being recognized,
an effort to protect funds for the investigation, Foege created
a Task Force on Kaposis Sarcoma and Opportunistic Infections
with Curran as director. This gave us sufficient leeway
and resources to pursue our most important work, Curran
issued early warnings about the disease, which it had linked
to high-risk sexual practices and intravenous drug use even
before scientists discovered the underlying virus or named the
disease. As hemophiliacs and others who had had blood transfusions
began to contract the disease, the CDC
came to the chilling realization that AIDS
was in the United States blood supply, and urged the government
to take steps to protect the public. By the end of 1982, the
had determined that AIDS
was blood borne and infectious and could spread between sexual
partners and addicts who shared needles, and from mothers to
pressed for more attention to AIDS
a public health crisis, the government was slow to realize its
implications and AIDS
took a firm hold in this country and around the world; to date,
the virus has infected about 58 million and claimed 22 million
1984, President Reagan appointed Mormon physician James Mason
to the top post at the CDC.
Foege left to help form the United Nations Task Force for Child
Survival and Development. Through this coalition of the childhood
immunization and polio programs of the World Health Organization,
UNICEF, the Rockefeller Foundation, the United Nations Development
Program, and the Rotary Clubs,
the number of children immunized worldwide increased from 20
percent to 80 percent during the next six years.
agencies would meet every three months to coordinate their work.
This in turn gave donors the confidence that there was a global
plan and they increased their giving, Foege says. So
coordination was the first step and resources followed, supporting
the old truism that money follows a plan.
President Carter, who had relied on Foeges advice on public
health matters during his presidency, called on his expertise
once again in 1986 by asking Foege to become executive director
of the Carter Center as well as its Global 2000 program, which
sought to eliminate diseases like onchocerciasis, or river
blindness, spread by blackflies; and Guinea worm, a parasite
found in stagnant water that grows two to three feet long inside
a human host.
the manufacturer of the drug Mectizan, had invented the drug
to treat heartworm in dogs, but it was discovered to also be
effective in preventing river blindness. The company agreed
to supply free medicine if Foege would oversee its distribution
in needed areas. Twenty-seven million people in more than twenty-three
African and Latin American countries are now being treated yearly.
Other pharmaceutical companies followed suit, providing medicines
free to millions in developing countries.
the Carter Center, Jimmy Carter wrote in supporting Foeges
nomination for the Lasker Award, we have a motto [Bill]
helped conceive: The only failure is not to try.
JOINED THE FACULTY of Emory in 1997 at the request
of his former CDC
ally James Curran, now dean of the Rollins School of Public
Health. Foege, who had been given an honorary doctor of science
degree from Emory a decade before, was named a presidential
distinguished professor of international health.
his classes, Foeges teaching style is informal and reality-based.
Last semester, graduate students taking Approaches to
Global Health were asked to make presentations on how
they would spend a billion dollars to have the greatest impact
on global health. The amount was a hundred million in previous
semesters, Foege says, when the exercise was geared toward influencing
the Ted Turner Foundation. A representative of the Turner Foundation
was asked to sit in on the final presentations.
students are making their pitch to the Bill and Melinda Gates
Foundation, however, so Foege has upped the ante. He folds his
lanky six-foot-seven-inch frame into a wooden chair, and strokes
his beard thoughtfully as he listens to the students PowerPoint
presentations. This is not just an academic exercise,
says Foege, who helped the Gates Foundation develop its global
health strategy. Its for real. A chance to come
up with ideas I can feed to the Foundation.
Foege was asked to become senior health adviser to the Bill
and Melinda Gates Foundation in 1999, he never hesitated. I
thought this was absolutely exciting, he says. This
sounds like hyperbole, but in a hundred years, when we look
back on how global health changed at the turn of this century,
were going to be surprised to say this was due to two
people: Bill and Melinda Gates. Its fun to be close enough
to watch it evolve.
in turn, the Gateses place a high degree of confidence in Foeges
advice, says Gordon Perkin, director of the global health program
at the Foundation. To take on the eradication of a disease
is not a small matter, and the closer you get, the more costly
it becomes, Perkin says. He gave Bill and Melinda
the confidence to move into that area. Hes a perennial
optimist and an honest broker.
Gates Foundationthe worlds largest philanthropic
organization with $24 billion in assetshas established
several global health priorities. One is to encourage wider
rates of vaccinations in Third World countries, with the goal
of immunizing all the worlds children against the six
basic childhood diseasesmeasles, diptheria, tetanus, pertussis,
polio, and tuberculosisas well as hepatitis B, yellow
fever, rotavirus, influenza, and other preventable diseases.
is to support vaccine research, from a malaria vaccine initiative
to promising work on an AIDS
vaccine. The Gates Foundation has been a large supporter of
vaccine research at Emory, recently awarding $885,000 to Harriet
Robinson, chief of microbiology and immunology at Yerkes Primate
Research Center, for work on a DNA-based vaccine for measles.
In all, the Gates Foundation is funding $1.6 million in vaccine
research at Yerkes.
through grants to programs like the Carter Centers Global
2000, the Foundation helps in the effort to combat parasitic
diseases, such as river blindness, elephantiasis, and snail
fever, with education, safe wells, water filters, and free or
far, the Foundation has given $1.9 billion to health-related
projects around the world, most in developing countries. Gates
and his wife have taken a deep personal interest in these projects,
often traveling to observe, and even assist, in the field work.
Melinda says this is what they talk about at dinner,
Foege says. Not Microsoft, but AIDS,
tuberculosis, malaria . . .
is delighted to see private foundations turning their attention
toward global health. We cannot exist with half the world
healthy and half the world sick, he said last January
during Emorys Reconciliation Symposium. Our greatest
errors in both medicine and public health are in what we fail
has been especially gratified, in the past few years, to see
an outpouring of resources directed toward AIDS
relief and prevention$450 million from the Gates Foundation
alone. Worldwide, there are still fifteen thousand new cases
of HIV each day, with 95 percent of these
in developing countries, mostly sub-Saharan Africa.
commitment to fighting AIDS
has increased so significantly, Foege says, it may soon reach
the critical mass necessary to turn back the epidemic. Were
still in for some very bad years, in Africa, in China, in the
Caribbean. But I can see light at the end of the tunnel,
Foege told the Atlanta Journal-Constitution last year.
I see an interest in AIDS
weve never seen before.
who keeps homes in both Atlanta and Vashon Island, Washington,
retired from Emory and the Gates Foundation in December, but
will stay involved in consulting roles as a professor emeritus
and fellow, respectively.
the span of a career that has encompassed the ancient scourge
of smallpox and the modern plague of AIDS,
Foege has received many prestigious awards, including the WHO
Health for All Medal, the Healthtrac Prize, the Calderone Prize,
and the Wittenberg Award. But he pays little mind to such honors.
very difficult for him to accept praise, Curran says.
He genuinely sees recognition to him as recognition of
the broader public health effort.
compares the feeling he gets from public health victories to
the elation he experienced in the summer of 1997 when he, his
wife, and his three grown sons climbed to the summit of one
of the worlds highest mountains. Its the same
as climbing Kilimanjaro, he says. You forget how
dirty and uncomfortable and cold you were. Instead, you remember,
Wow, that was something.