Dr. William “Bill” Foege was passionate about global health but he struggled to find a supportive mentor early on in medical school back in the 1950s.
“One teacher said, ‘Sure, go ahead and do that. But do it with the knowledge that you are going to spend your entire life seeing no change.”
That teacher could not have been more wrong.
Foege, a physician and epidemiologist, would go on to a lifelong career in global health, playing a lead role in eliminating smallpox and guiding health programs around the world that saved lives. Now 88, the Atlanta resident is looking back on decades of work with the nonprofit Task Force for Global Health, a Decatur-based nonprofit that marks its 40th anniversary this year.
By 1966, Foege (pronounced FAY-ghee) was a medical missionary in Nigeria working to vaccinate people of West and Central Africa with smallpox vaccine. Faced with a limited supply of vaccines, he helped devise a “ring” vaccination strategy. Vaccinating the “ring” of contacts of each known case was the key to turning around the epidemic, and eventually rid the world of the disfiguring and devastating disease.
It is estimated that 300 million people died of smallpox in the 20th century alone before the World Health Organization (WHO) declared the disease eradicated in 1980.
Credit: Public Health Image Library
Credit: Public Health Image Library
Foege, who was head of the Centers for Disease Control and Prevention from 1977 to 1983, took the helm at the newly formed Task Force for Child Survival in 1984. This new organization was established by Foege and two others: former CDC colleagues Bill Watson and Carol Walters.
They joined representatives from WHO, UNICEF, the World Bank, and the United Nations Development Programme working urgently to stem the staggering number of children dying from measles, polio, diphtheria and other preventable diseases.
While childhood diseases were at record lows in the U.S., 40,000 children a day were dying around the world from preventable diseases. Less than 20% of the world’s children had received vaccines against those diseases.
In just six years, a lofty goal was reached: the vaccination rate climbed up to 80%.
The Task Force for Child Survival was renamed the Task Force for Global Health and today the non-profit in Decatur has 180 employees, many of whom travel around the world to confront large-scale health threats.
They address diseases that are often overlooked and underfunded: neglected tropical diseases such as river blindness (onchocerciasis); lymphatic filariasis, often known as elephantiasis; and trachoma, an eye infection that is the world’s leading cause of infectious blindness. These diseases tend to be concentrated in areas of extreme poverty and contribute to a cycle of suffering and disability.
The Task Force works with partners that include national governments and other non-government organizations in about 150 countries to provide access to vaccines and medicine, and they help train partners to respond to outbreaks. They deliver $630 million worth of donated medicine every year.
Credit: Contributed
Credit: Contributed
At a recent interview at his home in Atlanta, Foege said he feels a mix of hope and concern about what lies ahead. The world has made remarkable progress in child survival. Since 1990, the global under-5 mortality rate has dropped by 59% — from 93 deaths per 1,000 live births in 1990 to 37 in 2022, according to WHO.
But there’s a new health threat for mothers and their children, he said. The U.S. now has the highest maternal mortality rate among developed nations — and it’s on the rise.
“This was not true when I started, so these are all steps backwards here,” he said.
Reflecting on his efforts to help people and agencies work together, he said for coalitions to work, “You need total support and commitment from the top people of agencies involved. You need to identify the ultimate goal: What is that final mile? It needs to be specific.”
He also talks about needing “ego suppression” for a coalition to succeed.
Foege, along with others at the Task Force, also saw enormous opportunity where others scoffed. When pharmaceutical firm Merck needed a partner to help deliver a new medicine to treat river blindness, the Task Force stepped up to help. Merck agreed to donate the product, Mectizan, free to affected countries and the program has continued for 35 years.
The partnership has been credited with eliminating river blindness in Colombia, Ecuador, Guatemala and Mexico. Many other countries are on track to follow suit.
“When I started working with Merck, this would come up almost every time I would give a talk about medicine. ‘How could you work with an organization where profit is their bottom line?’ And I would answer that there is a great desire of individuals in organizations and companies to do right. And it’s not always about profit margin.”
In recent years, Foege has been dismayed, watching the lessons he learned from eradicating smallpox be cast aside during the COVID-19 pandemic.
“First of all, know the truth, even in times when we do not want to know the truth,” he said. Avoiding certainty, which can be the Achilles’ heel of science, is another important lesson. Instead of coming together for a common goal, people were more divided than ever. That played out in the relationship between the CDC and states,” he said.
“Always in the past when we had these sorts of things — whether it was swine flu or Legionnaires and so forth — there was always a good rapport between the CDC and the states,” he said.
Early in the pandemic, Foege wrote a scathing letter to then CDC director, Robert Redfield about the handling of the coronavirus sweeping the globe. In the letter, which was disclosed by USA Today, he said not placing the CDC in charge violated “every lesson learned in the last 75 years that made CDC the gold standard for public health in the world.”
The need for a coherent plan, was ignored, “leaving it to the states, often competing for themselves.”
Foege left the Task Force for Global Health in 2000 to become a senior medical adviser for the Bill and Melinda Gates Foundation. The Gates Foundation is a major donor to issues surrounding global health, and is one of the Task Force’s top donors.
At a recent event to mark the Task Force’s 40th anniversary, Foege said, “It (the Task Force) did not answer to any global institution, it answered to an expert committee. And now we have dozens of those hybrid organizations and I see that as the future of public health. [The organization] asks ‘How do we attack a problem?’ and then develops the structure afterward, with public, private, everyone involved in doing this.”
He also offered advice for the future:
“Continue to combine science and do the best you can on science,” he said. “[British scientist Thomas] Huxley said, ‘Science is simply common sense at its best.’ You will make mistakes. Correct those mistakes. Don’t try to hide them. And then, in addition to the science, add art. So that you have creative common sense at its best. And finally, add a moral compass, so that you have moral creative common sense at its best.”
