Volume 77
Number 4

Health for All

Fear of Flying

Flying II: High Anxiety

Virtual Vietnam

Uncovering the Past

Wired New World

Enigma: Physics Band

Emory University

Association of Emory Alumni

Current News and Events

Emory Report



Sports Updates





















































Smallpox was only the first of many daunting battles William H. Foege would face with unfaltering determination–and creativity–during his more than forty years in public health. Sometimes he fought against microbes, viruses, and parasites, other times against political shortsightedness or corporate greed. But Foege always proceeded with the single-mindedness of a man whose entire career had been forged with one goal: health for all.

TEN DAYS AFTER THE TERRORIST ATTACKS that leveled the World Trade Center, public health pioneer William H. Foege accepted the 2001 Mary Woodard Lasker Award for Public Service at a Manhattan hotel seven miles north of ground zero. The subdued gathering, held in the shadow of global terrorism, honored scientists, physicians, and others whose work has saved or improved countless lives around the world. The Albert and Mary Lasker Foundation awards are sometimes called “America’s Nobels” because sixty-three Lasker recipients have gone on to receive Nobel Prizes.

This year’s 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 smallpox.

“The 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.”

Foege, 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.

“For 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.”

Global health, he continued, requires the “same heroic effort we have witnessed in this country in the past ten days.”

At sixty-eight, Foege is no stranger to heroic efforts–he 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 world’s poorest regions.

As 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 early 1900s.

“What 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.”

IN 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.

The year was 1966 and Foege, fresh out of Harvard University with a master’s 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.

Smallpox, 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.

Foege’s 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.

He knew he had to get to susceptible people as quickly as possible–before 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 epidemic’s epicenter. Four weeks later, there were no new smallpox cases in the area.

Using 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 disease eradication.

A civil war in Nigeria sent Foege back to Atlanta, where he was named director of the CDC’s 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 agency’s frontline “disease detectives” –an elite cadre of young physicians and scientists trained as epidemiologists, who track down mysterious diseases or clusters of illnesses.

In 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.

Foege 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 new cases.

WHO 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 conquered–in no small part due to the efforts of Bill Foege.

“He 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.”


FOEGE WAS NAMED 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’ disease.

In 1977, President Jimmy Carter appointed Foege director of the CDC. During his six years at the helm, Foege increased the agency’s 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 Reye’s syndrome, a neurological disease linked to aspirin use in children.

Then, in 1981, a rare pneumonia turned up among five young gay men in Los Angeles. A short while later, thirty-three cases of Kaposi’s sarcoma, a rare type of cancer, were found in young gay men in New York City.

“The cause of the outbreak is unknown, and there is as yet no evidence of contagion,” read a June 5, 1981, article in the CDC’s 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.”

James W. Curran, dean of the Rollins School of Public Health, was head of the research branch for the CDC’s 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 agency’s budget was under severe scrutiny.

“This 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,” Curran recalls.

In an effort to protect funds for the investigation, Foege created a Task Force on Kaposi’s Sarcoma and Opportunistic Infections with Curran as director. “This gave us sufficient leeway and resources to pursue our most important work,” Curran says.

The CDC 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 CDC had determined that AIDS was blood borne and infectious and could spread between sexual partners and addicts who shared needles, and from mothers to infants.

Although the CDC pressed for more attention to AIDS as 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 lives.

In 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.

“The 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.”

Former President Carter, who had relied on Foege’s 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.

Merck, 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.

“At the Carter Center,” Jimmy Carter wrote in supporting Foege’s nomination for the Lasker Award, “we have a motto [Bill] helped conceive: ‘The only failure is not to try.’ ”


FOEGE 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.

In his classes, Foege’s 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.

These 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. “It’s for real. A chance to come up with ideas I can feed to the Foundation.”

When 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, we’re going to be surprised to say this was due to two people: Bill and Melinda Gates. It’s fun to be close enough to watch it evolve.”

And, in turn, the Gateses place a high degree of confidence in Foege’s 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. He’s a perennial optimist and an honest broker.”

The Gates Foundation–the world’s largest philanthropic organization with $24 billion in assets–has established several global health priorities. One is to encourage wider rates of vaccinations in Third World countries, with the goal of immunizing all the world’s children against the six basic childhood diseases–measles, diptheria, tetanus, pertussis, polio, and tuberculosis–as well as hepatitis B, yellow fever, rotavirus, influenza, and other preventable diseases.

Another 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.

And through grants to programs like the Carter Center’s 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 affordable medications.

So 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 . . .”

Foege 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 Emory’s Reconciliation Symposium. “Our greatest errors in both medicine and public health are in what we fail to do.”

He 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.

The commitment to fighting AIDS has increased so significantly, Foege says, it may soon reach the critical mass necessary to turn back the epidemic. “We’re 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 we’ve never seen before.”

Foege, 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.

Over 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.

“It’s very difficult for him to accept praise,” Curran says. “He genuinely sees recognition to him as recognition of the broader public health effort.”

Foege 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 world’s highest mountains. “It’s the same as climbing Kilimanjaro,” he says. “You forget how dirty and uncomfortable and cold you were. Instead, you remember, ‘Wow, that was something.



© 2002 Emory University