By Katherine Hedland '88
EARLY PROTECTION: Seven-week-old twin boys receive the oral polio vaccine at a clinic in Nigeria.
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She might be a student at PLU, had she been born in tacoma.
But this 19-year-old woman is the third wife of a Nigerian farmer. Every day she walks three-and-a-half miles with her year-old son on her back to get water for the family. She lost so much blood giving birth that she became anemic, and the
hookworm that has snagged her insides drains her even more. Now pregnant again, she needs four times the daily requirement
of iron, and her body is stealing only a fraction of that.
She suffers fatigue people three times her age cannot fathom. But every day, she rises, walks and tends to her family.
She may not grow old because she can’t get the simple supplements that would give her frail body the strength it needs
to survive.
And what Dr. William Foege ’57 wants to know is: how is the health conference he’s attending about iron deficiency
going to help this woman and her children?
“I’ve been to too many meetings,” Foege says, without resentment,
but rather with purpose. “We sometimes are
satisfied with meetings. We need action.”
Foege, a member of the PLU Board of Regents, has known
this feeling many times before, starting four decades ago with
questions over his proposals to eradicate smallpox by containing
the outbreaks.
“I found myself frequently set up for debate about
whether this was possible. I remember thinking in the ’60s
that this is a terrible waste of time—to be debating whether
this can be done when we could be out doing it.”
Foege and his colleagues employed his containment techniques
in India, leading to the declarations that smallpox was
gone—the first contagious disease eliminated by deliberate
public health action.
Foege, 67, has been forcing action and forming partnerships
on crucial public health issues for years. After the
successful smallpox containment, he went on to lead the Centers
for Disease Control. While there, he forced drug
companies to warn that aspirin may cause the sometimes
deadly Reye Syndrome, reacted quickly to alert women to the
dangers of toxic shock syndrome and saw the first cases of a
frightening new contagious disease in the early ’80s: AIDS.
He has also been executive director of the Carter Center—a
nonprofit public policy center founded by Jimmy and Rosalyn
Carter, established to fight disease, hunger and poverty. He
also works as a faculty member at the School of Public Health
at Emory University in Atlanta.
“A hundred years from
now when people look
back they’ll say the turn
of the century was really
the beginning of equity in
global health.”
—Dr. William Foege
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Now, when he planned to be approaching retirement,
Foege is entrenched in what he predicts will be the most im-portant
advance ever in global public health. As a senior
adviser to the Bill & Melinda Gates Foundation, he is on the
front lines of the most intense battle for global health ever undertaken.
With the foundation’s commitment, Foege says
resources—and money—are available like never before.
“There has not been anything like this in my lifetime,”
Foege said with a broad smile. “A hundred years from now
when people look back they’ll say the turn of the century was
really the beginning of equity in global health, and the two
people responsible for that are Bill and Melinda Gates.”
Though some initially questioned the motivation behind
Gates and his oft-maligned Microsoft, Foege says the commitment
is unprecedented.
“They’ve energized this field and pricked the conscience
of government. I had no idea their personal commitment
would go beyond the resources. They don’t just write checks.
They’re personally involved. This is what they talk about at
home now.”
One of the other things Bill and Melinda Gates have done
is encourage others to give—and to research.
“It has given hope to the whole field. I see people working
at a level I’ve never seen before.”
From PLU to the CDC, public health became Foege’s mission
As an undergrad at PLU, Foege didn’t plan his future. But
he knew early on he wanted to follow in the footsteps of his
hero, Albert Schweitzer, the German philosopher, doctor and
humanitarian who did groundbreaking health work in Africa.
Foege, who stands 6-feet-7-inches without being the least
bit intimidating, is recognized worldwide as an expert, but he
genuinely doesn’t seem to like to talk about himself, his motivation
or his successes. He does so only to spotlight the
important health issues facing the world, to get others to take
notice. And his conversation is peppered with the names—and
he provides the correct spellings—of those who have helped
and inspired him along the way. None of this happens because
of one person, he emphasizes, and he credits PLU for much of
his success.
“It’s such a nice place to get an education. People who go
there do not appreciate how good it really is,” Foege said. “ I
went to UW, to Harvard, and it took me a while to realize some
of the best teachers I had were at PLU.”
While in medical school at the University of Washington,
he worked with Rei Ravenholt, a former epidemiologist for the
Seattle/King County Health Department, who nudged him
toward public health.
Then he read an article in the New England Journal of
Medicine about questions of priority in public health goals
written by Tom Weller of the Harvard School of Public Health.
Foege was so taken with the article that he applied to the
school, and spent a year studying with Weller. Last year, Foege
gave his mentor an award.
Foege first went to India as a Peace Corps physician in
1963, to Tonga the next year, and in 1965 became a medical
missionary in Africa. He has returned to Africa more than 100
times.
MEASURING UP: A village health care worker with the Carter Center’s
Global 2000 program uses a makeshift yardstick to measure height,
which determines medicine dosage.
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At Harvard, Foege had written a paper on the possible
eradication of small pox in which he determined it was possible—
not knowing he’d have a chance to prove his hypothesis.
In India, Foege and his team used the successful surveillance
and containment plan that had halted an outbreak in Nigeria
a few years earlier. Eventually the program became so massive,
they went to 100 million homes in six days looking for smallpox
cases. It worked, and Foege earned the trust of the global
health community.
“Even when smallpox disappeared, I never had the urge to
celebrate because it seemed that was a sign of surprise that this
could be done,” he said.
Advances curb some diseases, but millions remain at risk or die worldwide
When Foege first started in the field 40 years ago, the polio
vaccine was relatively new, and millions of children were
dying from the measles. Today polio has been nearly wiped
out, and measles deaths have dropped from three million to
one million, thanks to vaccines.
And now, the hepatitis B vaccine, given to children, is
helping prevent liver cancer in them as adults in poor countries
where it has been a killer. Foege predicts a vaccine for the
human papilloma virus will soon be given to girls in developing countries to ward off cervical
cancer, a common cause of death for
women without access to regular gynecological
care and pap smears.
Field studies are being done on a
malaria vaccine in The Gambia, and a
tuberculosis vaccine is in the works.
Three AIDS vaccines also are being
tested in Thailand, the U.S. and Africa.
The new drug Mectizan is preventing
river blindness with simple
annual doses, and poor families are
learning to treat their water to prevent
the horrific Guinea worm.
Still, millions suffer and die
needlessly each year, often of preventable
diseases, and it’s the Gates
Foundation’s mission to change that.
“Some 30 million children living
in poor countries do not get any vaccines
to protect them from infectious
disease. This is not acceptable, and
the Bill and Melinda Gates Foundation
is committed to righting this
wrong,” said Dr. Gordon Perkin, director
of the Global Health Program
at the foundation.
The foundation formed in 1994
with a $22 billion commitment from
Bill and Melinda Gates, targeting
half the proceeds to education, the
other half to global health.
A HEALING HAND: Gen. Yukubu Gowon, a former Nigerian head of state, visits villagers. He now works to improve water quality to reduce disease.
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In May, Melinda Gates presented
a $1 million award to a group in
Bangladesh that popularized a treatment
for diarrhea that is saving
millions of children from dying of
the common ailment. Their process
of oral rehydration gives patients the
right levels of salt and sugar—and
keeps them alive. So impressed was
the Bangladeshi government, it
matched the award. The following
month, the foundation gave $100
million to the Global Fund for AIDS
and Health to find innovative ways
to prevent the disease.
“The foundation would like to
see a world free of infectious disease
and particularly a world where health
is a universal right available to all
regardless of where one lives,” Perkin
said.
Poverty is the greatest risk for disease
The Gates Foundation isn’t the
only organization to take notice. In
1985, Rotary International made polio
eradication one of its primary
goals. Since then, $500 million has
been raised by Rotary alone to fight
the crippling disease.
An anonymous donor gave $100
million to study malaria at Johns
Hopkins University. Ted Turner donated
$1 billion to the United
Nations.
Politicians are talking about global
health, from former President
Jimmy Carter, who can provide access
to heads of state, to African Gen.
Yakubu Gowon, who is fighting for
better water and helping curb political
corruption in Nigeria.
Economists encourage helping
developing nations as a way to ensure
global economic health, and journalists
are making the plight of the poor
and infirm known worldwide.
“The tools and the resources are
changing the interest,” Foege said.
It’s hard to say what the biggest
health threat is, and it depends on
what factors are used to make the
determination. Some will look at the
number of people affected, others the
number of deaths. One of the things
Foege and the foundation consider is
how preventable the diseases are.
Foege doesn’t like to pin down one
illness, but says the priorities are tuberculosis,
AIDS, malaria, and
vaccine-preventable diseases. Three
million children die each year from
illnesses a simple shot could prevent.
“It just makes no sense that the
world would allow that,” he said.
The real difference between sickness
and health is often money. Poor
people don’t get the same health
care, and poor countries don’t have
access to simple items that could
keep them well.
“The poverty gap is the real
question,” Foege said. “The impact of
poverty on one’s life is truly a different
journey for millions and millions
of people.”
Foege says he has rarely been
sick, even among so much disease.
He knew how to protect himself, and
he knew he and his family, even when
his son was as young as 3, would
thrive.
“But if you held me to the income
of a villager, I couldn’t,” he
said. “I couldn’t afford fuel to boil
my water, screens for the windows or
netting around the bed.”
AIDS in developing countries a high priority
AIDS has caused such mass destruction,
and its fatal and
contagious nature makes it a high priority. In 20 years, 58 million
people have been infected, and 22
million have died, with 95 percent of
new infections in developing countries.
In many African villages, up to a
third of the residents are infected. In
urban areas of Botswana, 44 percent
of pregnant women have the disease,
which is often passed on to their
newborns.
“If the virus is passed on, that
child is going to die,” Foege said. “If
it’s not, that child is going to be an
orphan.”
Still, as crippling as the AIDS
crisis has been, the stigma of this
killer prevents families from saying
its name aloud. Even at funerals,
when everyone knows the cause of
death, the mother says it was TB or
pneumonia. They can’t afford to be
ostracized.
Foege remembers visiting with a
doctor who every day came to the
AIDS unit knowing every patient he
tended would soon die. Foege asked
him, how do you maintain your mental
health in face of such suffering?
“He looked at me for so long
that I regretted asking the question.
Suddenly, with tears, in front of his
coworkers, he said, ‘I am one of four
sons. My three brothers died of
AIDS. I have never been able to tell
anyone.’ That’s how powerful the
stigma is.”
While scientists search for cure
and treatment, Foege says simply
making condoms available would
significantly slow transmission.
“There are only a few condoms a
year per man in Africa, which is a disgrace,”
he said. Still, he believes a
vaccine against AIDS is feasable.
“I keep saying I believe we’ve
reached the tipping point on AIDS,”
Foege said. “I think one can think in
terms of solving the problem.”
Educating the doctors and missionaries of tomorrow
Foege considers himself fortunate
that he got into public health
when not as many people were interested
in it. He’s now encouraging the
physicians and medical missionaries
of tomorrow.
“Global public health is so much
different than when I started. I just
have to be envious of students going
into the field today. There’s quite a
crop of altruistic students who when
they see what’s possible want to be a
part of it,” he said. “My mentors
didn’t give me much hope that
things would change much in my
lifetime. They thought it was important
to make changes for future
generations.”
He’s already seen much progress,
and the 21 st Century will be a turning
point in worldwide health.
“I’ve been going to India now for
40 years, and you can see the
change,” he said. “One of the nicest
things is you walk down the streets
of New Delhi and see nobody on the
street under the age of 25 with the
scars from smallpox on their faces.”
While he takes joy in that, he is
still a witness to incredible pain,
which has made him more appreciative
of the good things in life.
“The real world involves knowing
how bad and how good things
can be,” Foege said. “If you don’t enjoy
the blessings you have, it takes
the joy away from helping others find
theirs. But you have to enjoy them
with your eyes wide open, against the
blackness, confronting the disparity.”
Foege isn’t sure how long he’ll
keep working. The pace and constant
travel are difficult. But he’s never felt
quite ready to retire. He splits his
time between Atlanta and his home
on Vashon Island, Wash., with his
wife, Paula, traveling with him when
she can. They have three sons, David,
Michael and Robert, and one grandson,
Max.
“I have tried to retire several
times, but I keep getting pulled back
into things.”
He hopes to have more time to
write about his adventures “before I
forget them.” And he wants to continue
to help and to draw more
people into the field.
“The world of global health isn’t
that large. I would like it to get so big
that we don’t know each other.”
The Gates Foundation will go a
long way in helping toward that end,
he says.
“I’m just happy that I lived long
enough to see this.”
To read more about the Gates
Foundation, visit encore!
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