Bill Foege: Another mountain to climb  pg. 5

In 1973, Foege moved on to India, where smallpox still raged. Within six days of starting a containment trial in four Indian states, he and his team had identified 10,000 new cases of the disease.

The health minister of Bihar Province wasn’t convinced. If circle vaccination was working, why weren’t the numbers going down? He wanted to reinstitute blanket vaccination.

“It was not easy to change perceptions,” Foege recalls. “There was a fear that smallpox would move so fast that we would have to do mass vaccinations to keep it down—but that was not true.”

For three days, he and his coworkers tried to convince the health minister to continue circle vaccination. On the day of their last meeting, desperation filled the room. If the official ordered blanket vaccination, all of their work would be lost.

Then a young Indian doctor stood up. “Mr. Minister,” he said. “I’m just a village man, but when I was growing up and a house was on fire we’d put the water on that house, not the others.”

Suddenly, the minister understood and agreed to give Foege one more month.

Members of a refugee relief team sent to Eastern Nigeria during the Biafran war in 1968 include Foege (center, with pipe) and nurse practitioner Annie Voigt, CPNP, MPH (right).
Photo courtesy of the U.S Centers for Disease Control and Prevention (CDC)
One month led to two months then three, and soon Foege and his team didn’t need to worry about the future of their plan. The health minister never mentioned stopping it again.

In May 1974, the number of smallpox cases had peaked; 12 months later, there were no more cases of smallpox in India. In 1979, the World Health Organization declared that smallpox had been eradicated.

“He is an extraordinarily positive person who always sees the opportunity of doing something. He is rarely pessimistic,” Koplan says. “He can usually see a victory and snatch it from despair.”

“Bill was one of the two storied heroes of smallpox eradication,” Schaffner adds. The other, Donald A. Henderson, M.D., MPH., went on to direct the World Health Organization’s smallpox eradication effort.

“There were huge successes already using strategy ‘A’ (universal vaccination),” Schaffner continues. “But for the endgame, strategy ‘B’—the Foege strategy—was the one that worked, and he and Henderson share a claim for orchestrating the global eradication of smallpox.”

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