P A C I F I C   L U T H E R A N   U N I V E R S I T Y F A L L   2 0 0 1 

[Pacific Lutheran Scene]


Confronting the Disparity
William Foege ’57 helps lead The Gates Foundation’s fight for equity in global public health.

By Katherine Hedland '88

Early Protection
EARLY PROTECTION: Seven-week-old twin boys receive the oral polio vaccine at a clinic in Nigeria.
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
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
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.
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
A HEALING HAND: Gen. Yukubu Gowon, a former Nigerian head of state, visits villagers. He now works to improve water quality to reduce disease.
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!

Pacific Lutheran University Scene
Credits | © 2001 | Comments