By Tom Paulson '80
It may sound like a stretch, but the eradication of smallpox is directly connected to a young man slipping chewed-up rubber bands into his boss’ pipe tobacco.
That young man was Bill Foege ’57, the somewhat mischievous son of a Lutheran minister who pastored the Northeastern Washington community of Colville.
The world today knows Dr. William Foege, now 78, as the person who came up with the strategy—“ring containment,” modeled on what he learned fighting forest fires in the Pacific Northwest—that led to the eradication of smallpox in the late 1970s: the only human disease ever completely wiped off the planet. That alone makes Foege a public-health hero.
Some also might know him as the man who, in the late 1990s and well into the new millennium, helped the Bill & Melinda Gates Foundation launch and rapidly expand its revolutionary mission in global health—a mission that without question has transformed the global fight against many diseases of poverty.
Others may recall that Foege was head of the U.S. Centers for Disease Control and Prevention during the Carter Administration and into the first part of the Reagan Administration when a strange new disease emerged on the scene: AIDS.
So yeah; he’s pretty much Mr. (or, OK, Dr.) Global Health.
(Video by John Froschauer/PLU) Dr. Foege talks with PLU’s Barbara Clements during his visit to PLU in November 2013.
Stirring Things Up From the Start
But what few may know about Foege is that he always has been a prankster and that this personal attribute—which he can disguise but seldom fully repress—almost certainly has been critical to his amazing list of accomplishments.
How so? Well, to begin with, psychologists tell us that practical jokers are motivated (whether they know it or not) by a desire to disrupt order, the status quo. Foege is all about disrupting order, when he thinks it needs a little disruption. It may have started when he sneaked behind his mother at the dinner table in Colville to tie her apron strings to the chair, or when he put the rubber bands in the pipe of Jim Kohlstedt, his boss at the local pharmacy.
“I think the best one was when my brother Dick and I filled out Jim’s name and address on 300 postcards for free magazine subscriptions and sent them all at once,” Foege said. Or the time he took a mannequin leg from the shop and placed it in the back window of his car (to appear as if he were perhaps carting around an incapacitated woman—or worse).
“I discovered that’s a good way to get stopped by the police.”
We’ve all done our share of practical jokes. But Foege, who is quite tall, never outgrew his boyish prankster ways. They just blossomed into a talent for challenging the status quo, complacency, harmful bureaucracy or worse.
In the 1960s, while working as a medical missionary on the smallpox campaign in Nigeria, Foege and a colleague were prevented by a local official from obtaining desperately needed vaccines. So Foege got his colleague to engage the official in conversation while Foege secretly loaded their truck with the supplies. Not a prank, per se, but definitely a trickster move.
“I never told (the colleague) what I had done,” Foege recalled with a chuckle.
Another time, when he was at the CDC getting grilled by a member of Congress who was hostile to spending American taxpayer money on foreigners, Foege asked him whether he had received a flu shot that year. Yes, the Congressman replied.
“I told him about how the vaccine was manufactured using samples obtained in the Soviet Union and that he now had Soviet antibodies in his body protecting him from the flu,” Foege said. The Congressman was not amused, but others were.
On a more personal note, Foege once caused a ruckus at the Gates Foundation when he invited me—a journalist—to join him when the philanthropy opened its new campus in downtown Seattle. I knew the event was supposed to be for select staff only, no media, and so I suggested this might cause him problems.
“Oh, I don’t think anyone will even notice,” he said. Wrong. Bill Gates looked at me like something the cat dragged in, and the media-affairs folks were apoplectic. I got a story out of it and some good photos (including one of Melinda Gates hugging Foege, which I’m told she has on her desk). But why did Foege even bring me along? Maybe he just liked causing a fuss.
Pranks with a Purpose
But there’s another possible explanation: Inclusion. Breaking down walls. Anthropologists who study the sociological and cultural impacts of practical jokes say they often are done to bring someone into the fold, to create social bonding and a sense of community.
All those who know Foege speak of his empathy and how he so easily connects with everyone he meets. He tends to focus on others more than himself. He looks for what can bring people together as opposed to what distinguishes us from each other. In short, he has boundary issues—or issues with boundaries.
“At PLU, I used to go in people’s rooms and put limburger cheese on light bulbs,” Foege said. “It would take a while to melt before it started to smell, so nobody could figure out who had put it there…. But I eventually had to do it in my own room to deflect suspicion.”
OK; that’s hard to explain as a positive disruption or as a method for creating social bonds. But that’s also classic Foege, disrupting the point of this article in order to try to deflect attention away from him and my thesis that his prankster side is based on his empathy for others and his desire to affect change.
“He also uses humor sometimes as a way to keep people at arm’s length,” said Paula Foege, his wife and fellow former PLU student. Lutherans are experts at self-deprecation, but Paula sees through it. She knows her husband is up to something when he seems to be joking around.
That’s a perspective formed from their very first meeting, when Bill, a senior, snuck into a freshman Orientation meeting at PLU in order to meet girls. A friend bet Bill he couldn’t get a date with the next girl to walk through the door. Paula walked through that door.
“He was a tall, skinny good-looking blond joking around with everyone so, sure, I noticed him,” Paula recalled. But when Foege sauntered up and said he was a senior (possibly hoping to impress), Paula basically told him, nicely, to get lost. “I said I don’t like phonies.”
Foege persisted, eventually convincing a friend of Paula to get her to give him another chance. To make a long story short: She did; he got into medical school at the University of Washington; they got married; began their family with son David; and went off to Africa to fulfill one of Bill Foege’s boyhood dreams—to work as a physician there.
From the Mind to Medicine
Many of Foege’s friends and colleagues know the story: While incapacitated for months in a body cast due to a hip injury as a teenager, he read about the medical missionary work of physician-philosopher Albert Schweitzer. What some may not know is that Foege’s original interest in medicine was psychiatry.
“I’d read a book about this psychiatrist who was really operating like a detective, a detective of the mind,” he said. That interest eventually lost out to Foege’s interest in Africa, and to becoming an infectious-disease detective and a renowned leader in a field that would come to be known as global health.
But spend time around Foege, and you can see he is still as fascinated by what makes people think what they think and do what they do as he is in fighting disease and inequity. Unlike many in the health field who approach it largely as a technical challenge—finding the best treatment for a malady, or the best methods for preventing an epidemic—he tends to see everything through the eyes of a person, a particular person.
Ask him about his battles against smallpox in Africa or India, and you will hear about the people he met—the mothers with the sick children, the health workers and community leaders he came to know so well. He remembers them all by name and talks at length about their lives, their thoughts.
Public health is sometimes called population health because the point of it is to deal not with individual illnesses but with the population as a whole. For Bill Foege, public health is personal, deeply personal. This is what those who know him well recognize as key to what drives him, and what makes him perhaps one of the most influential humans in the field of global health.
But, let the record show, being a prankster was no small part of it.
Tom Paulson graduated from PLU with a B.S. in chemistry in 1980. He’s the editor and founder of Humanosphere, an independent online news site based in Seattle and devoted to covering aid, development, global health, poverty and the humanitarian community. Before starting Humanosphere, which was first launched as an NPR experiment based at KPLU, Tom worked for decades as the science and medical reporter for the Seattle Post Intelligencer. A Seattle native, Tom also has produced a few local plays, about the news business, and once lived in his car.
Editor’s Note: Tom Paulson met Bill Foege in the late 1990s while reporting on the newly emerging Bill & Melinda Gates Foundation. Paulson knew Foege had gone to PLU and mentioned that he did as well, and today they are friends. When Paulson asked Foege whether he had a photo of them together, Foege laughed, saying Paulson always refused to be photographed with him, which made him wonder whether Paulson was in witness protection.