An Unwavering Belief in Science, Creativity, and Equity: The Legacy of Dr. William H. Foege

In our bitterly partisan age, where science and public health are distrusted, even denigrated, there is a better part of America. It is marked by fundamental decency, modesty, and towering achievements in making the United States and the world healthier. That is the legacy of Dr. William H. Foege, public health’s quiet giant. Bill Foege changed the trajectory of human history. He was the driving force behind childhood vaccination for all and the Child Survival Revolution, advancing the insight that every child has the right to be protected.

He was instrumental in the global eradication of smallpox, the greatest scourge in human history. Bill decided to leave India before the “smallpox zero” moment was formally announced, so that Indian health workers and local teams would be celebrated. He demonstrated by his actions what genuine leadership looks like: building an historical achievement and then stepping out of the frame.

Beyond all this, Bill’s deeper legacy lies in how he chose to serve: guided by evidence, animated by creativity, and anchored by an unwavering moral compass.

Foege’s life in public service was shaped early by the writings of Albert Schweitzer, whose call to serve “those least able to help themselves” resonated deeply with him. That ethic never left Bill. Whether working in remote villages or advising presidents and global institutions, he carried with him a simple principle: serve others, with particular attention to the most disadvantaged. For Bill, this was not sentiment—it was strategy.

His scientific contributions were profound. In West Africa in the late 1960s, Foege helped pioneer the surveillance-containment strategy that ultimately made smallpox eradication possible. Rather than attempting mass vaccination everywhere—a logistical impossibility—he and his colleagues focused on rapidly identifying cases and surrounding them with rings of immunity. It was an elegant solution grounded in epidemiologic insight, operational realism, and respect for communities. That approach became the backbone of the World Health Organization’s successful global eradication campaign, saving hundreds of millions of lives over generations.

Bill was a towering figure both professionally and physically. His imposing height of 6 feet 7 inches commanded people’s attention, which was used ingeniously to great effect in his vaccination work. In West Africa during the smallpox eradication effort, local villagers came to see “the tallest man in the world” and received the vaccine.

Yet Bill Foege was never content to be merely technically right. He understood that data alone do not move societies. People do.

Throughout his career—from the field to the legendary director of the Centers for Disease Control and Prevention, from academia to global philanthropy—Foege demonstrated a rare capacity to blend analytic rigor with ethical engagement and human compassion. He asked not only what works, but what is just. He believed science must be placed in service to humanity, especially those on the margins.

Late in life, Bill distilled decades of experience into a framework he called Becoming Better Ancestors: 9 Lessons to Change the World. These lessons, now publicly shared, capture both his intellectual clarity and moral urgency:

1. This is a cause-and-effect world. Understanding the causes of a problem enables us to change its outcomes.
2. Know, share, and act on the truth. Transparency builds trust.
3. Coalitions are essential. Complex problems require partnerships across disciplines and sectors.
4. Avoid certainty. Humility and openness to new evidence prevent dogmatism.
5. Build in evaluation and continuous improvement. Programs must learn and adapt.
6. Respect culture—culture matters. Interventions must be tailored to local contexts.
7. Seek strong leadership and management. Visionary and effective leadership guide collective action.
8. Mobilize political will. Policy reform and resources follow political commitment.
9. Move toward global health equity. Justice demands that all people have access to the conditions for people to be healthy.

These are not abstract ideals. They are field-tested, forged in outbreaks, negotiations, and communities struggling under the weight of preventable suffering.

What stands out most, however, is how Bill lived these lessons personally.

He avoided certainty and arrogance, even when he was widely recognized as the foremost authority. He listened intently, especially to people whose voices were rarely heard. He built coalitions instinctively bringing together clinicians, epidemiologists, policymakers, and local leaders long before “multisectoral collaboration” became fashionable. He respected culture not as an obstacle but as essential context. And he understood that political will, once mobilized, could accomplish what science alone could not.

For Bill, the most central lesson was to move toward global health equity. Justice demands that all people have access to the conditions in which people can be healthy. This was not an abstract aspiration for Bill. It was foundational.

He lived his life in strict adherence to these values, especially the value of global health equity.

His life embodied the Golden Rule—do unto others as you would have them do unto you. For Bill, public health was not merely about metrics. It was about dignity. It was about fairness. It was about whether the least powerful among us could expect the same services as the most powerful.

He transformed institutions. He mentored generations. He saved millions of lives. But perhaps his most enduring legacy is the framework he left us—the Nine Lessons—which combine analytic rigor with ethical engagement.

In an era of polarization, disinformation, and widening inequity, those lessons are not relics. They are instructions.

Understand causes. Tell the truth. Build coalitions. Stay humble. Evaluate and improve. Respect people and culture. Lead well. Mobilize political will. And above all, pursue justice.

Bill Foege was a giant who chose to serve. The world is healthier because he did. The question he leaves us is whether we will choose to serve with the same clarity of science, creativity of mind, and steadiness of moral compass that defined his life.

If we honor him by living his lessons—by telling the truth, building coalitions, respecting culture, mobilizing political will, and insisting on equity—we may yet fulfill his hope that our generation, too, can become better ancestors.

The Milbank Memorial Fund is pleased to offer a free excerpt from Dr. William H. Foege’s book, House on Fire: The Fight to Eradicate Smallpox, originally published by the University of California Press and the Milbank Memorial Fund in 2011 as part of the California/Milbank Books on Health and the Public series. The book is available for purchase at https://www.ucpress.edu/books/house-on-fire/paper.

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