Dr. William Foege: The Public Health Pioneer Who Helped Eradicate Smallpox

In the annals of global public health, few achievements stand as tall as the eradication of smallpox—a disease that plagued humanity for millennia, killing and disfiguring hundreds of millions throughout history. At the center of this monumental triumph stood Dr. William Foege, whose innovative containment strategy revolutionized disease control efforts and helped consign smallpox to history books by the late 1970s. His groundbreaking work not only changed the trajectory of public health practice but established a framework for addressing infectious disease outbreaks that continues to influence pandemic responses today. Beyond smallpox, Dr. Foege’s visionary leadership at the Centers for Disease Control and Prevention (CDC) and his tireless advocacy for childhood vaccination programs worldwide have left an indelible mark on global health, saving countless lives across generations and continents.

The Architect of “Ring Vaccination” Who Changed Disease Control Forever

Dr. Foege’s most significant contribution to public health emerged during his work in eastern Nigeria in the 1960s, where he faced a seemingly impossible challenge: stopping smallpox transmission with insufficient vaccine supplies. Rather than following the conventional wisdom of mass vaccination—which required immunizing entire populations—Foege developed what would become known as “surveillance and containment” or “ring vaccination.” This revolutionary approach involved identifying smallpox cases quickly, then vaccinating only those in close contact with infected individuals, effectively creating a protective ring around outbreaks to prevent further spread. “We didn’t have enough vaccine to immunize everyone,” Dr. Foege once explained in an interview. “Necessity forced us to innovate, and what we discovered was that targeted vaccination was not just economical—it was more effective.” His data-driven approach allowed health workers to prioritize limited resources strategically, focusing efforts precisely where transmission was occurring. The strategy worked remarkably well, helping to contain outbreaks with far fewer vaccine doses than previously thought necessary. The World Health Organization (WHO) soon adopted this method globally, accelerating the smallpox eradication campaign and fundamentally changing how public health officials approached infectious disease control. The final naturally occurring case of smallpox was recorded in Somalia in 1977, marking one of humanity’s greatest public health achievements—the complete eradication of a disease that had killed an estimated 300 million people in the 20th century alone.

From Rural Minnesota to Global Health Leadership

William Herbert Foege’s journey to becoming a public health giant began far from the centers of global power, in the small town of Decorah, Iowa, where he was born in 1936 to Lutheran parents of German descent. Raised in Chewelah, Washington, young Bill developed an early interest in medicine, influenced by the town’s sole physician who served the community with dedication despite limited resources. After earning his medical degree from the University of Washington in 1961, Foege pursued a Master of Public Health at Harvard, but his true education came through fieldwork. His career trajectory was shaped by a decision to serve as a medical missionary in Nigeria, where he first encountered smallpox in epidemic proportions. “I went to Africa thinking I would be helping people one-on-one,” he later reflected. “I quickly realized that public health gave me tools to help thousands at once.” Standing at 6 feet 7 inches tall, Foege cut an imposing physical figure, but colleagues consistently described him as gentle, thoughtful, and driven by a profound moral purpose. This commitment to service led him from field operations in Africa to increasingly influential positions, culminating in his appointment as director of the CDC in 1977 by President Jimmy Carter. During his six-year tenure leading the agency, Foege transformed it into a more responsive, globally engaged institution while establishing its reputation for scientific excellence and public health leadership. His management philosophy emphasized data-driven decision-making coupled with deep humanitarian values—an approach that would become his hallmark throughout his career.

Beyond Smallpox: Expanding Global Immunization and Fighting New Threats

Following the smallpox victory, Dr. Foege recognized that the same principles could be applied to other vaccine-preventable diseases affecting children worldwide. In 1984, he helped establish and became executive director of the Task Force for Child Survival (now the Task Force for Global Health), a collaborative initiative that dramatically increased childhood immunization rates globally. Under his leadership, worldwide vaccination coverage for six major childhood diseases rose from 20% to 80% in just six years, preventing millions of deaths annually. “Vaccines represent the most cost-effective public health intervention we have,” Foege frequently emphasized in his advocacy work. “Every dollar spent on immunization returns multiple dollars in healthcare savings and economic productivity.” His approach to global health consistently emphasized practical solutions over ideological positions, fostering partnerships across governmental, non-governmental, and private sectors. When HIV/AIDS emerged as a new global health crisis, Foege was among the first public health leaders to recognize its potential impact and advocate for robust research and prevention programs. Similarly, he highlighted emerging infectious disease threats long before they captured widespread attention, warning that globalization and environmental changes were creating new pathways for pathogens to spread. His foresight extended to non-communicable diseases as well; he was an early advocate for addressing tobacco use as a critical public health issue and promoted preventive approaches to cardiovascular disease and diabetes. Throughout these varied challenges, Foege maintained his fundamental commitment to health equity, arguing that disparities in health outcomes between rich and poor populations represented one of the most pressing moral issues of our time.

The Philanthropic Turn: Advising Gates and Transforming Global Health Funding

Perhaps one of Dr. Foege’s most consequential roles came later in his career, when he became a key advisor to Bill and Melinda Gates as they were considering how to direct their considerable wealth toward global health initiatives. His guidance proved instrumental in shaping the mission and approach of the Bill & Melinda Gates Foundation, which has since become the largest private foundation in the world and a dominant force in global health funding. “Bill Foege helped us understand not just where to invest resources, but how to think about leveraging science and partnerships to maximize impact,” Bill Gates has said of their relationship. Foege encouraged the foundation to focus on diseases disproportionately affecting the world’s poorest populations, areas traditionally underserved by both pharmaceutical research and government funding. His influence helped direct billions of dollars toward developing vaccines and treatments for malaria, tuberculosis, neglected tropical diseases, and other conditions that primarily affect developing nations. This philanthropic work represented a natural evolution of Foege’s career-long focus on health equity and pragmatic solutions. He understood that sustainable progress required not just technical interventions but systems strengthening, capacity building, and community engagement. Under his guidance, the Gates Foundation pioneered new approaches to public-private partnerships in global health, creating innovative financing mechanisms like the Global Alliance for Vaccines and Immunization (now Gavi, the Vaccine Alliance). These initiatives have transformed the landscape of global health funding and implementation, creating sustainable pathways for delivering lifesaving interventions to vulnerable populations. Throughout this philanthropic chapter, Foege continued to emphasize that health is a fundamental human right and that disparities in health outcomes represent one of the most profound injustices in the modern world.

A Legacy of Pragmatic Idealism: Lessons for Future Public Health Challenges

At 87, Dr. William Foege’s influence on global health remains profound and multifaceted. His approach combined rigorous scientific methodology with deep humanitarian values—what colleagues often describe as “pragmatic idealism.” This philosophy is perhaps best captured in his acclaimed book, “House on Fire: The Fight to Eradicate Smallpox,” where he wrote: “The lesson of smallpox eradication is not that we can eliminate a single disease with a targeted program. The lesson is that a specific goal with a specific deadline can improve overall health systems and services.” These words reflect Foege’s understanding that successful public health initiatives must balance focused interventions with broader systems strengthening. Throughout his career, he emphasized the importance of surveillance systems, trained local health workers, and community engagement—elements that remain essential to addressing today’s public health challenges, from emerging infectious diseases to the growing burden of non-communicable conditions. His legacy lives on through the numerous institutions he helped build or strengthen, including the CDC, The Task Force for Global Health, and the Carter Center, where he served as executive director and fellow. His intellectual contributions continue to shape how health professionals approach complex global challenges, emphasizing evidence-based strategies, equity considerations, and sustainable solutions. Perhaps most importantly, Foege demonstrated that moral purpose and scientific rigor need not be separate endeavors—that compassion can and should inform how we apply technical expertise. As the world faces new health threats, from climate change impacts to emerging infectious diseases, Foege’s example reminds us that seemingly insurmountable health challenges can be overcome through innovation, collaboration, and unwavering commitment to human dignity. His career stands as testimony to what dedicated public health professionals can accomplish, even with limited resources, when guided by clear vision and humanitarian values.

The Measure of Success: A World Transformed Through Public Health

The true measure of Dr. William Foege’s impact cannot be calculated merely in statistics, though they are impressive: a deadly disease eradicated, vaccination rates dramatically increased, millions of lives saved. His greater contribution may lie in how he transformed our understanding of what public health could achieve and how it should be practiced. Before Foege and his contemporaries demonstrated otherwise, many believed that eradicating diseases was impossible, that health disparities between rich and poor nations were inevitable, and that technological solutions alone could solve complex health challenges. His career disproved each of these assumptions. Through his writing, teaching, and mentorship, Foege has influenced generations of public health professionals who continue to apply his principles in new contexts. His emphasis on data-driven decision-making, community participation, cross-sector collaboration, and ethical leadership provides a roadmap for addressing contemporary health challenges. “Public health at its best is not just about preventing disease, but about creating conditions where all people can thrive,” he often reminded students and colleagues. As we confront climate change, antimicrobial resistance, emerging infections, and persistent health inequities, Foege’s approach offers valuable guidance. His career reminds us that even the most daunting global health challenges can yield to human ingenuity, international cooperation, and steadfast commitment—not in some distant future, but within a single generation. In receiving the Presidential Medal of Freedom in 2012, America’s highest civilian honor, Foege characterized his work with characteristic humility: “The greatest privilege in medicine or public health is to be able to save even one life. To participate in saving millions has been an honor beyond anything I could have imagined.” This sentiment captures the essence of a remarkable career dedicated to improving human welfare through science, compassion, and unwavering determination—a legacy that continues to inspire and inform global health efforts around the world.