Former Centers for Disease Control and Prevention (CDC) director and public health legend Willam Foege, MD, MPH, passed away on January 24 at the age of 89. 

Foege served as director of the CDC (then the Centers for Disease Control) from 1977 to 1983. He would later go on to cofound the Task Force for Global Health and was the executive director of the Carter Center from 1986 to 1992. He was also an adviser to the Gates Foundation and Professor Emeritus at Emory University’s Rollins School of Public Health.

A physician and epidemiologist, Foege is best known for leading the global effort to eradicate smallpox, an effort widely viewed as one of the one of the greatest public health achievements in history. Working in Nigeria as an officer with the CDC’s Epidemic Intelligence Service in 1966, Foege helped develop the ring vaccination strategy that was first applied in rural Nigerian villages to stop smallpox outbreaks. The strategy would later be adopted by the CDC and the World Health Organization (WHO).

Prior to eradication in 1980, smallpox killed an estimated 300 million people in the 20th century alone. 

“Bill’s contributions to the eradication of smallpox stand as one of the most extraordinary achievements in medicine and epidemiology,” Center for Infectious Disease Research and Policy (CIDRAP) Director Mike Osterholm, PhD, MPH, said in a statement. “Under his guidance, a disease that once claimed millions of lives was brought to an end, not through brute force but through ingenuity, scientific rigor, community engagement and a profound commitment to protecting the world’s most vulnerable.”

A new approach to containing outbreaks

In his 2011 book House on Fire, Foege described how he and a colleague, faced with a limited supply of smallpox vaccine, devised a strategy to contain a growing smallpox outbreak in the eastern Nigerian village of Ovirpua. At the time, the CDC and WHO strategy for combating the disease was mass vaccination, an approach that, even when effective, leaves openings for explosive outbreaks. 

“The standard response was to vaccinate everyone within a certain radius while attempting to determine the extent of the outbreak. However, we did not have enough vaccine to do this,” Foege wrote. “How could we most efficiently use the limited amount of vaccine we had on hand?”

To identify and protect the nearest susceptible people, Foege and his colleague used ham radio to contact missionaries in the area who were familiar with market patterns and family patterns to help them make predictions about where the virus might have spread. They asked the missionaries to send runners out to nearby villages to find cases and within 24 hours were able to identify four smallpox-affected villages. Those villagers were then immediately vaccinated. 

They then made an educated guess, based on the missionaries’ knowledge of where the patients and their families typically traveled, of villages where the virus may be incubating. They selected three villages within a 15-mile radius and used the rest of the vaccine there.

“It turned out that smallpox was already incubating in two of those three areas, but by the time the first cases had appeared, everyone had been vaccinated there, and the smallpox disappeared so fast, that we were taken by surprise. And we wondered if you could do this on a bigger scale,” Foege said in a 2023 episode of the National Foundation for Infectious Diseases’ Infectious Ideas podcast. 

Under his guidance, a disease that once claimed millions of lives was brought to an end, not through brute force but through ingenuity, scientific rigor, community engagement and a profound commitment to protecting the world’s most vulnerable.

He likened the surveillance-containment stratgey, which focused on finding where the outbreaks are and vaccinating those areas rather than vaccinating everyone, to the tactics he had used fighting forest fires in Washington and Oregon. “We went directly to the fire and contained that fire,” he said. “We used the same approach here…where’s the virus right now? And can we surround that virus with vaccinated people and stop the outbreak?”

Foege would go on to lead the CDC’s Smallpox Eradication Program and in 1974 took the strategy to India, which at the time accounted for nearly two-thirds of the world’s smallpox cases and was in the midst of a major smallpox surge, with outbreaks occurring all over the country and more than 36,000 cases. By May 1975, after an intensive surveillance-containment effort by thousands of epidemiologists and health care workers, smallpox transmission in India had ceased. 

The last recorded cases of natural smallpox infection were in Somalia in 1977, and the last death from the disease was in England in 1978. The WHO declared the world smallpox-free on May 8, 1980.

Foege said smallpox eradication was not an accident but the result “of a plan, conceived and implemented on purpose, by people.”

“Humanity does not have to live in a world of plagues, disastrous governments, conflict, and uncontrolled health risks,” he wrote. “The coordinated action of a group of dedicated people can plan for and bring about a better future. The fact of smallpox eradication remains a constant reminder that we should settle for nothing less.”

Efforts to eliminate other diseases

Foege subsequently became CDC director, serving under the administrations of President Jimmy Carter and President Ronald Reagan. In his time leading the agency, he was confronted with several major health crises, including the birth of HIV/AIDs. 

“We didn’t know what it meant. But it didn’t take long to realize that this was bigger than expected,” Foege told University of Washington Magazine in 1994. He noted that he was particularly proud that the CDC, in 1983, printed some of the first prevention information about the disease.

After leaving the CDC, Foege in 1984 and former CDC colleagues Bill Watson and Carol Walters helped launch the Task Force for Child Survival (now the Task Force on Global Health), an effort that aimed to address low childhood immunization rates in developing countries. The group led coordinating efforts that resulted in immunizing 80% of the world’s children with at least one vaccine by 1990. Foege served as CEO of the organization until 2000.

“Bill Foege had an unflagging commitment to improving the health of people across the world, through powerful, purpose-driven coalitions applying the best science available,” Task Force on Global Health President and CEO Patrick O’Carroll, MD, MPH, said in a tribute to Foege. “We try to honor that commitment in every one of our programs, every day.”

The coordinated action of a group of dedicated people can plan for and bring about a better future. The fact of smallpox eradication remains a constant reminder that we should settle for nothing less.

At Carter Center, Foege helped lead the effort to eradicate Guinea worm disease, a parasitic disease that can incapacitate people for extended periods. Cases of the disease have dropped from 3.5 million a year in countries in Africa and Asia in 1986 to only 15 in 2024.

“Thanks in large part to Dr. Foege’s leadership, Guinea worm disease is now poised to become the second human disease in history to be eradicated, following the eradication of smallpox,” the Carter Center said in a statement.

For his efforts in eradicating smallpox—the first and only infectious disease to be eradicated in humans—and other contributions to public health, Foege received the Presidential Medal of Freedom in 2012, the nation’s highest civilian honor.

A mentor to generations of public health professionals

O’Carroll also highlighted Foege’s role as a mentor and inspiration to generations of public health professionals, from those just starting their careers to people who’ve worked in the field for decades.

“Whenever he spoke, his vision and compassion would reawaken the optimism that prompted us to choose this field and re-energize our efforts to make this world a better place,” he said.

Osterholm said he’s among those who’ve been inspired by Foege.

“I benefited from his mentorship and insight,” Osterholm said. “For that, I count myself incredibly lucky—a feeling I know I share with many.”

Former CDC Chief Medical Officer Debra Hour, MD, MPH, called Foege a guiding force at the agency.

“At CDC, Dr. Foege believed public health is a moral responsibility to protect the most vulnerable, and he inspired generations of public servants to uphold that principle,” Houry said in an email to CIDRAP News. “His legacy endures in the lives saved, the institutions strengthened, and the leaders he mentored.”