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Bill Foege
His discovery of Surveillance and Containment led to the eradication of smallpox. He found a 6% solution to the 100% problem of vaccinating everyone on earth.

Quotes about Foege and the Eradication Effort

“Except for my father, two men have helped to shape who I am. One of them was Admiral Hyman Rickover… and the other one was Bill Foege. Much more significant than changing my life, he has changed the life of millions of people around the world.”
- President Jimmy Carter, 2006

“He conceived the idea that smallpox….could be eradicated by a novel method of surveillance and containment. It sounds so simple now. Like many great scientific insights, now through the retrospective-scope, now it sounds obvious. But it was a real breakthrough, one of the great conceptual breakthroughs in public health.”
- Larry Brilliant – Executive Director, (and himself, a major contributor in the smallpox eradication effort in India).

"Dr. Foege's impact on the world's health has been extraordinary. In terms of lives saved and freed from disease, he has changed the world as we know it."
- John Brauman, home secretary of the National Academy of Sciences upon awarding Foege the Public Welfare Medal.

“In 1972 the technique (of surveillance and containment) was formulated in a scientific paper that Foege, Millar and Lane published in the American Journal of Epidemiology. Titled “Selective Epidemiologic Control in Smallpox Eradication,” it was perhaps one of the most important documents in the campaign against the disease since Jenner. It laid out the case for a complete reversal in techniques.”
- Joel Shurkin, The Invisible Fire

“If the United Nations, through its World Health Organization, never does anything else than eradicate smallpox – it has to be called a success.”     
- Billy Woodward, author of Scientists Greater than Einstein

“I could not be the ex-president that I am and do the things that I do were it not for Bill Foege.”
- President Jimmy Carter

Quotes by Foege On Africa

“Most people in the world do not present with a single problem. Whatever brings them to the hospital or clinic is with a background of malnutrition, roundworms, hookworms and a half-dozen other conditions.”
- Bill Foege on his work as a doctor at the Lutheran medical clinic in Nigeria reinforcing what he had learned in India

On living in a rural African village in a hut without running water or electricity (1965):
“In one sense it was an opportunity to know something about what it’s like to live in a village in Africa.  On the other hand, I’ve always said we could never truly feel that because we could leave anytime we wanted to – anytime it got to be too much. We were able to, during the dry season, hire a young man on a bicycle who could go to the water hole five miles away and get water and bring it back and put it in a 55 gallon drum for us. So we were able to do things that a villager couldn’t and I’ve said that the big lesson for me was – number one, that here we were living in third world conditions and yet our son was living with first world risks, and the reason being – we could apply all the knowledge we had on immunizations, on screening the windows, on boiling the water, and so forth – but, number two, if you had limited me to a dollar a day I would have to have spent that on food and shelter and could not have done these other things – could not have afforded vaccines or even firewood to boil drinking water and so this combination of knowledge applied and poverty – those are the two things that separated us.”

Quotes by Foege on Surveillance and Containment

“In retrospect it seems clear – we didn’t know how to eradicate smallpox when we started. But this was not a negative. It was a characteristic of all unsolved problems. We are always faced with making sufficient decisions based on insufficient information. If we had waited until all the answers were available, the work on smallpox eradication would never have started – selecting the target helped develop the appropriate tools and strategy.”

“After that first search, there was a lot of discouragement and some people thought we should stop the searches. I kept arguing, the reason we found so much is, this is the most efficient surveillance system we’ve ever tried and the last thing you want to do is stop using it. Let’s just wallow and get behind but let’s keep looking and that’s what we did.”

“The basics for breaking transmission of the virus were remarkably simple and similar to fighting forest fires.”

Quotes by Others about the Dark Days in India before Surveillance and Containment Kicked In

“I was under great stress and strain,” says Basu, an Indian who worked at the health ministry about Surveillance and Containment. “Whenever they asked me, ‘What is the progress of the program?’ I used to tell them the number of cases that month. It was always higher than the previous month. And they used to laugh at me and make sarcastic remarks: ‘Dr. Basu says that progress is satisfactory because more of our people are dying.’”

CDC Deputy Director Bill Watson recalls, “It really dismayed people. There was a lot of second guessing. The pressure was on to do it the old way (mass vaccination) - this new system isn’t working.”

Quotes by Foege on India

“After that first search, there was a lot of discouragement and some people thought we should stop the searches. I kept arguing, the reason we found so much is, this is the most efficient surveillance system we’ve ever tried and the last thing you want to do is stop using it. Let’s just wallow and get behind but let’s keep looking and that’s what we did.”

“Those of us in WHO started traveling by train and finding ourselves in the overnight compartments with our Indian counterparts and this turns out to be so different than going in for a weekly meeting in someone’s office.  Pretty soon, a trust level had developed where we actually were discussing the crucial things – even the sensitive things.”

Foege ordered 60 more epidemiological officers (a total of 236 from 30 countries were eventually used). It was intense -- eighteen hour days, seven days a week. Foege says, “We were having a monthly meeting in each state that was of high incidence. We were having people come back from the field for a day, reporting on what they were doing, and we were trying to learn as fast as we could and keep making tactical changes every month so that we were fine tuning this just as rapidly as we possibly could. Then, each month, we tried to pretend that we were on top of it and each month it kept getting worse.”

“I think the story is so incredible in India and the thing that turned it around is what you would always like to see in a coalition but don’t often see, which is that people suppress their own egos and you get a coalition of people who really work as an absolute team. I don’t think the Indian government would have ever have made a major decision without those of us who were now assigned through WHO agreeing, and we would never from WHO, have made a decision without the Indians agreeing. It was simply a unit working together.”

Quotes by Foege On Science

“The philosophy behind science is to discover truth. The philosophy behind medicine is to use that truth for the benefit of your patient. The philosophy behind public health is social justice. That’s the important point. Public health programs are attempts at social justice.”   
“What is it that is better than science? Better than science is science with heart, science with ethics, science with equity, science with justice.”

Quotes by Foege on Bill Gates

In the late 1990s Foege was asked to join the Gates Foundation as an advisor. He was used to such requests, saying:
“Do you know how many times before I have heard those sorts of things? Rich people say that all the time.”

Gates seemed sincere, so from 1999-2001, Foege served as Senior Medical Advisor for the Bill and Melinda Gates Foundation. One of Bill and Melinda Gates’ first requests was for a reading list. Foege provided a list of 81 books to read and says:
“I saw Bill a couple of months after that and I asked, 'How are you doing on those books?' And he said, 'Well, I have been so damn busy I have read only nineteen of them.' I didn't know whether to believe him, so I asked, 'Which was your favorite?' He didn't hesitate for a second. 'That 1993 World Bank report was just super,' he told me. 'I read it twice.'" Still skeptical, Foege pressed him on what he had learned from it. Gate’s answer proved he wasn’t just another rich guy with a momentary interest in doing a good deed. “Not only had he devoured the World Bank report,” Foege says. “But on his own he had found the weaknesses.  Incredible.” With the help of Warren Buffett, the Gates Foundation has received donations of more than 38 billion dollars to be used for global health, education, and development. Foege now says, “I think a hundred years from now, when the history of global health is put into some perspective it’s going to be clear that the tipping point was about 2000.  It’ll be due to Bill & Melinda Gates. They’ve changed everything.”

Foege’s Humor

On the question of how he would want to die.
“I’ve thought about it many times. And I’ve decided these are the characteristics of my death. First I want my death to be meaningful. Second, I’d like it to be a time of my choosing…so I can plan to say my goodbyes and put my affairs in order. Finally, if possible I’d like it to be quick and painless.
I’d like to be executed.”

Foege's 2009 Speech in India

By May 1974, with 8 months of experience and expansion of surveillance and containment as the primary approach to smallpox eradication, the program became so efficient that a virus that had eluded the best efforts of vaccination programs for 170 years was subdued in the blink of an eye.   Why?  Because, in biological terms the coalition evolved faster than the virus could evolve!

Every public health decision ultimately requires a political decision for implementation. The lesson that follows is that public health practitioners must enter the world of politics. They should take it as part of their job description to provide politicians with the information needed for good public policy decisions.  It is labor intensive to make such information flow effective as politicians change.  I suggest that in a more perfect world, a large percentage of politicians would have received their training in public health!

Next, we learned about BOSSES.  We have all had bosses who do annual performance ratings.  But in a very real sense…our bosses include every person who will ever live in the future. Because we are preparing the world they will live in.  With smallpox eradication we served our bosses quite well.

We learned about THE MEASUREMENT OF CIVILIZATION.  The measure of civilization is finally how people treat each other.  It measures a nation, a political party, a society, a university, a program.  How we treat people is the measure of us as people.  Smallpox eradication taught us how to treat people we will never actually see.

While the lessons are many, what is the greatest gift of smallpox eradication in India and the world?  It takes us back to the first lesson listed, that this is a cause and effect world.  It is the demonstration, once again, that the coordinated action of dedicated people can plan a rational future.  This does not have to be a world of plagues, disastrous governments, conflict, and uncontrolled health risks.  It is possible to plan a rational future and smallpox eradication is a constant reminder that we should settle for nothing less.

We learned the need for OPTIMISM.  The trouble with being an optimist, of course, is that people think you don’t know what’s going on.  But it is the way to live.  I tell students there is a place for cynicism and a place for pessimism and whenever you need it, contract for it but don’t get those people on your payroll.  They will ruin your day.  We were an optimistic group.

Foege's Book:  House on Fire:  The Fight to Eradicate Smallpox

Perhaps most significant, the smallpox workers were learning and improving every month, while the smallpox virus, for all of its evolutionary success, could not respond with the same agility. It continued in the way of its ancestors, unaware that its strategy for survival, adequate for millennia, would soon no longer suffice.

One had to be an optimist with a feel for numbers to be ecstatic at the same time that Bihar had over 5,000 known smallpox outbreaks and had just reported over 11,600 new cases of smallpox in a single week.

It wasn’t science that threatened to stop us. It wasn’t even nature per se. Rather, it was human nature: the human factors that involve strikes, job security, political concerns, turf. I remembered those words from graduate school: “When you tangle with culture, culture always wins.” As hard as the daily work had been, this was the only time I was discouraged and uncertain about the outcome. I thought we had lost the battle.

Every disease encounter missed is the result of deliberate actions taken by unknown benefactors in the past.

Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism, the assumption that you can’t really change your future, as one of the great challenges in global public health.