Hailed as the health innovator behind the eradication of smallpox, past APHA President William Foege, MD, MPH, has left an indelible mark in the field of global health. Because of his dedication and service to the public’s health, President Barack Obama today presented Foege with the Presidential Medal of Freedom, the nation’s highest civilian honor.
During his accomplished career, Foege has led federal agencies, helped launch critical global health initiatives, taught new generations of public health practitioners and broadened awareness about child health and neglected diseases. He served as director of the Centers for Disease Control and Prevention from 1977 to 1983. In 1984, he co-founded the Task Force for Child Survival, which is known today as the Task Force for Global Health. He also served as the executive director of the Carter Center and later helped shape efforts at the Bill & Melinda Gates Foundation.
Below, Foege talks with APHA’s Public Health Newswire about his passion for public health, his predictions for the future and his advice to the next wave of public health leaders.
Q: You were recently honored with the Presidential Medal of Freedom. Congratulations! What was it like to learn that you received the medal for your work on behalf of the public’s health?
Public health workers are so aware of the teamwork involved that the first thought is always, “Oh oh. This should be a team award.” But evidently that is not the way the world works, and one takes comfort in the fact that at least the spotlight has been put on public health.
Q: What originally inspired you to pursue a career in global public health? And after such a long and accomplished career in the field, what are some of the most important lessons you’ve learned regarding how to implement successful public health interventions?
I was originally inspired by the work of Dr. Albert Schweitzer in Africa. But I subsequently had such a list of accomplished mentors, such as Rei Ravenholt, Tom Weller, Alex Langmuir — all global thinkers.
Some lessons that come through every program are that good results are never an accident. It requires someone formulating a future in their mind, defining that future with enough clarity for others to follow, and then the usual management steps of setting objectives, developing strategies and monitoring progress. Good managers are the key to success.
A second lesson is to seek the truth even when it hurts. Corrections in the program can only come with knowing the truth. Third (sparing you the next 22 lessons) is that every activity requires a coalition. Therefore the real leaders in public health will never be defined by a title but rather by the ability to get a group to be productive in achieving an objective.
Q: In 1984, you helped form the Task Force for Child Survival and Development, a collaboration between international health organizations to improve childhood health and achieve universal child immunization. What have been some of the task force’s biggest accomplishments to date? And what do you think are today’s most pressing child health issues — issues that if not addressed threaten to roll back gains in child survival and development?
The task force was a low-profile organization that helped UN agencies, bilateral agencies and countries to increase vaccine coverage from levels below 20 percent in 1984 to the delivery of some vaccines to 80 percent of children by 1990. This effort is now the role of the GAVI Alliance in a time when vaccines are more abundant and more complicated.
The task force, at the request of (the pharmaceutical company) Merck, developed the Mectizan Expert Committee in 1987 and for the past 25 years, it has been involved in the distribution of Merck’s unbelievable donation of 800 million treatments of Mectizan to reduce the burden of onchocerciasis (a parasitic disease also known as river blindness). Now, under the direction of Dr. Mark Rosenberg, the Task Force for Global Health (a name change to reflect its increasing activities) is involved in major programs with multiple pharmaceutical companies to reduce the toll of neglected diseases around the world.
While the number of child deaths under the age of 5 has been reduced markedly in my lifetime, it is still disheartening that millions will still die this year of preventable problems. Each of those deaths is an indictment of a world more concerned with accumulating wealth and power than in providing better chances for all children.
But certainly the major threat to the health of children is poverty. We all benefit from poverty in the sense that the poor subsidize the cost of our food, clothes, housing and even computers. Poverty is the slavery of the 21st century and we need public health people to play a lead in correcting this devastating inequity that cheapens all of our gains.
Q: You were intimately involved in the global eradication of smallpox, pioneering innovative immunization approaches to stop transmission of the disease and eventually heading up CDC’s smallpox eradication efforts. What, if any, diseases do you foresee as being successfully eliminated in the future? And how have the barriers and obstacles to disease eradication changed since your work with smallpox?
Smallpox is only the first in a long line of diseases that future historians will describe as once plaguing people and animals. Rinderpest (an animal disease also known as cattle plague) has already been eliminated — it’s the second disease eradicated. Guinea worm and polio will be next. Thereafter, measles, onchocerciasis and yaws are candidates.
Vaccine-preventable diseases are clearly candidates, but guinea worm disease and onchocerciasis demonstrate that vaccines are not essential for eradication.
The tools continue to change and become better. We don’t even know how much better they will become. For example, after decades of a very poor vaccine for tuberculosis — the BCG vaccine — there are now multiple candidate vaccines against tuberculosis in human trials. What if one of these becomes as good as smallpox or measles vaccine? Would eradication be possible?
In addition to improved tools, the interest in global health has mushroomed. Every school now has a large cadre of students interested in global health. When the history is finally written, I believe it will be clear that the tipping point for global health occurred in about the year 2000 because of Melinda and Bill Gates. Because of them, there are research, delivery and organizational approaches to global health that did not exist when I became interested. It would be so much fun to be starting over in the field today!
Q: You served as an advisor to the Bill & Melinda Gates Foundation, a massive effort to bring the opportunities for good health to all. How critical is private philanthropy in confronting global health threats, especially in developing nations?
I am retired at the present, but it was a great honor to be involved with the Gates Foundation.
The biggest financial resources will continue to come from governments, but private philanthropy is absolutely essential in defining the priorities and funding the risky research projects that corporations cannot gamble on and that governments often won’t fund. Both corporations and government, for understandable reasons, have problems planning for future decades, much less for future centuries.
Private philanthropy would like fast results but at least it has the option — in the absence of stockholders seeking a quarterly dividend or angry voters lacking a larger vision — to ask the kind of long-term questions that occupied our nation’s founders when they were at their best.
Q: What’s your advice to young public health practitioners getting ready to enter the field?
First, public health requires every occupation and skill imaginable, so it is possible to follow a passion and still be involved in public health.
Second, attempt to be a generalist and specialist simultaneously. A generalist to understand as much as possible about how the world works, what are the problems and solutions, and how do the various sectors of science, the humanities, government, business, religion, etc. interact. Then find what you enjoy, develop it and have a special skill to contribute now that you know how it contributes to the whole. Avoid the kind of blind specialization that precludes seeing where it fits into the whole.
Third, read history so it becomes clear this is a cause-and-effect world. Public health advances are not made by fatalists.
Finally, develop tenacity and an optimistic outlook. It doesn’t mean that everything will always work out or that you won’t suffer. But pessimism seems to be designed to force you to suffer before the fact!
Watch Foege win the Presidential Medal of Freedom below: