At age 61, with a hip replacement, most folks would not attempt Kilimanjaro, but Foege towers above most in both stature and accomplishments. Here, he snaps a shot of his family, (l to r) sons Robert and Michael, wife Paula, and son David at the summit of Africa's highest peak.

by Rhonda Mullen Watts or many years now, William Foege has wanted to climb Mount Kilimanjaro. So in August, he set off to Tanzania with his family--his wife, three grown sons, and daughter-in-law--to do just that. Shunning the gen eric tourist treks, Foege's group hired a guide to take them up the back way to Kilimanjaro's summit, more than 19,000 feet high. Up a rough trail through the trees at the base of the mountain, they climbed--then through the barren dirt-encrusted middle of Kilimanjaro to reach the snow line. During part of the ascent, the climbers negotiated a vertical section of mountain without ropes or crampons, carefully avoiding treacherous patches of ice. At 18,000 feet, they stopped to camp. Their breathing, even when resting, was labored. Dirty, uncomfortable, cold, they collapsed in sleeping bags in a tent, whose roof by morning was covered with a shell of ice. That morning, however, they would reach the summit. And the effort would be w orth it. Much later, back at the base of the mountain, Foege and his family sat talking with their guide. "Have you ever taken someone up who is over 60?" Foege asked during the conversation. Not very many, the guide answered. "How about anyone who has had hip replacement surgery?" No, the guide was sure he had not. "Yes," Foege grinned broadly, "Yes, you have now." For Foege, 61, had had his hip replaced at Emory three years before, the repair of a femur that had separated in a childhood accident. The guide should not have been surprised at the ease with which Foege negotiated the mountain. This well-known public health figure is used to overcoming obstacles, in doing what many think can't be done. For example, when Foege enlisted in the smallpox eradication campaign in Africa, friends believed he had signed up with a lost cause, one that would ruin his career. I nstead, a few short years later, after discovering a key immunization strategy against the dreaded disease, he saw the total eradication of smallpox, the first, in fact the only, infectious disease to have ever been completely eliminated. Later, when he u ndertook a campaign to immunize the world's children, many said it couldn't be done. Yet, in six years, in a host of countries, rates of general immunizations rose from 20% to 80%. To those in the field of public health, Bill Foege needs no introduction. His credentials are those of one at the pinnacle of his profession. From 1977 to 1983, Foege served as director of one of the world's premier public health institutions, the Cent ers for Disease Control and Prevention (CDC). From 1987 to 1992, he was executive director of The Carter Center, overseeing a host of ground breaking public health initiatives. He has been involved in many of the most important public health advances of t he century, including the eradication of smallpox, a successful attack on Guinea worm and river blindness, and development of an agricultural model for improving nutrition in developing countries. He's also provided leadership in developing the relatively new field of injury control. Foege's recognition includes the World Health Organization's Health for All medal, the Sedgwick Memorial Award from the American Public Health Association, a Distinguished Alumni Award from Harvard University, even a special commendation from President Clinton. At Emory, Foege recently added a new distinction to this impressive list, being named Presidential Distinguished Professor of International Health. In February, he joined the faculty in the Rollins School of Public Health's Department of International Health. From Foege's office window at the school, he can see the CDC complex, where he served as director years earlier. "It has taken me 30 years to move one block," he jokes. "How many years will it take to move a mile?"

In December 1966, with an outbreak of smallpox in rural Nigeria and a shortage of vaccine, Foege helped develop a strategy known as surveillance and containment, which changed the worldwide approach to smallpox eradication, saving time, m oney, and lives.

on't let Foege's words mislead you. During his career, he has moved many miles, physically and figuratively. He has the reputation of being a risk-taker, one who will take on what others believe can't be don e. "If you only did safe things," he says, "you wouldn't be in public health." Foege's career began as a CDC epidemiology intelligence program officer in 1962, just after he completed his MD at the University of Washington Medical School. In 1965, he added an MPH from the Harvard University School of Public Health to his resume a nd soon set out for eastern Nigeria, where he served as a medical missionary. He took his wife and 3-year-old son with him. "My wife, Paula, this California girl, went with me to live in a village in a hut with no running water or electricity," Foege says. It was there in a remote outpost in Yahe, Nigeria, that Foege would develop a key strategy for smallpox eradication. As a medical officer at the Immanuel Medical Center in Yahe, Foege led an eradication campaign against smallpox. Although his team was attempting to vaccinate everyone in the population, in December 1966, a shortage of vaccine made them reevaluate that approach. Smallpox had broken out in a rural area, and there was not enough vaccine to go around. The group held an emergency meeting to plan a strategy to curtail the disease's spread. Working with maps and two-way radios, they divided the region into areas that could be traversed on foot. They contacted missionaries in the field, who then dispatc hed runners throughout the area to see where the disease had already spread. With the information they received, along with an educated guess about the likely path the epidemic would follow, they vaccinated all people in the villages that already had smallpox as well as those where they thought the disease might strike. Althoug h they had vaccinated only a fraction of the population, the epidemic was contained. The strategy, known as surveillance and containment, changed the worldwide approach to smallpox eradication, saving time, money, and lives. But even with the new approach, Foege's fight in the campaign was not over. As a medical officer for the World H ealth Organization (WHO) in New Delhi, India, in 1974, he went up against the state health minister in Bihar. The minister wanted to drop the surveillance and containment strategy when in one week's time more than 11,000 new cases of smallpox were registe red, and half the vaccinators had gone on strike. Foege kept articulating the validity of search and containment, and, with the help of a local Indian physician, eventually won the administrator to his way. In 1978, when the WHO recorded the last official case of smallpox, Foege was director of the CDC. "After the last case, there was such a celebration," he says. "The timing of that seemed wrong to me. My thrill came earlier, in reaching the conclusion t hat it could be done. The thrill was in being able to see the possibility of success ahead of time."

This simple process of filtering water creates a drinking supply free of Guinea worm. Ghana, Nigeria, and Pakistan are well on their way to eradicating the disease with the assistance of a program at The Carter Center.

firmly believe that ours is a cause-and-effect world," Foege says. "This is the driving force in public health. You can accomplish good because it is actually possible to change the world. Many today are fatalistic, but not folks in public health. We are anti-fatalistic." It is August, and Foege has just returned from climbing Kilimanjaro. With his lanky, 6-foot, 7-inch frame folded into a chair in his office, he reluctantly talks about himself, but when the conversation turns to the work of public health, he grows anim ated. "I can't even imagine doing this work if you didn't think you could succeed," he says. "Let me tell you a story." (This phrase often peppers Foege's talk.) "One day I was walking down the halls of the CDC. It was in the 1970s. I was thinking to myself as I walked along looking into offices that many people would be put off by the staff working there. Here were all the political radicals and campus activists of the 1960s. I wondered, What is it that attracts these people to the CDC? I decided it was the ir sense of social justice, the thought they could make a difference." Although Foege himself was no campus radical ("I'm too old," he says. "I graduated from college in 1957.") he fit right in with people who believed in the fight for social justice. As director of CDC, he spearheaded changes that would take the center i nto a new era. In looking back to that time, Foege believes injury control was an important initiative. A committee he chaired for the National Academy of Sciences on injury moved this preventable cause of morbidity from the province of law enforcement into the domai n of public health. The committee's report eventually led to the establishment of the CDC's Center for Injury Control, which seeks to prevent injuries from violence to motor vehicle accidents, and is funded by the Department of Health and Human Services. With powerful lobbying by the National Rifle Association and other groups in recent years, the center's fate has been threatened. Despite the controversy, Foege feels the center's survival thus far "gives one a sense that, despite disorder in the world, t here is some right." Foege also nurtured a global health perspective at the CDC during his tenure. "I am absolutely convinced that what is good for the world is good for the United States," he says. "The converse, however, is not always true." A case in point: Foege is unh appy with the tobacco settlements now being made between cigarette manufacturers and several states that have sued to recoup losses. "These settlements came about without thought for the rest of the world," Foege says. "The fines could be increased tenfol d, and the tobacco companies could still pay them on the backs of the rest of the world."

It looks like an ordinary school day in Nigeria, but without the Carter Center's efforts to eradicate Guinea worm, these children most likely would be unable to attend. For instance, one study found that among area schoolchildren, school absenteeism exceeded 60% because the children had contracted Guinea worm or because they had to work in the place of other family members whom the disease had struck. The Guinea worm eradication program was just one of the health efforts undertaken at The Carter Center during Foege's tenure as executive director. In each of these programs, whether it was the vaccination of children against measles or the prevention of devastating diseases such as Guinea worm, Foege recognized that their success depended o n a cast of thousands, including scientists, corporate agencies, governmental and nongovernmental organizations, leaders in endemic countries, and people in villages.

oege's global focus continued after he left the CDC to create the Task Force for Child Survival and Development, a working group for five United Nations agencies. In just six years, with the Task Force's coo rdination, these agencies--in partnership with hundreds of nongovernmental organizations--raised general immunization levels of the world's children from 20% to 80%. Under Foege's leadership, the Task Force also created a program to overcome river blindness, distributing the drug Mectizan in 23 African and Latin American countries. Merck Pharmaceuticals, the manufacturer of the drug, agreed to supply the medicine f ree of charge if Foege would agree to oversee its distribution in needed areas. He said yes. In 1986, he said yes again to another proposal, this one from former President Jimmy Carter, who asked Foege to serve as executive director of The Carter Center. The center embarked on many projects to improve health and agricultural services in develo ping countries, including a program known as Global 2000. These projects help improve farming practices and increase agricultural yields to promote self-sufficiency in food production in targeted countries, turning famine lands to green ones. Global 2000 also has undertaken the eradication of disease, including Guinea worm, and is now looking for other opportunities. Guinea worm, known as the "fiery serpent," strikes millions of people in developing countries when they drink water contamina ted with the worm's larvae. Emerging in yard-long parasites, it leaves victims incapacitated, but with simple, inexpensive treatments of water, the disease can be prevented. The challenge for public health is to train village health agents to promote thes e safe-water treatments. Ghana, Nigeria, and Pakistan are well on their way to eradicating the disease. In describing The Carter Center's work to a group in 1989, Foege said: "What makes us different is that we try to develop a policy or an approach to a problem and then actually intervene in order to solve that problem." This action-oriented approach is one that Foege himself adopted many years ago. "I have focused on action programs, where I could bring a problem-solution approach to bear," he says. "I decided that I would keep following this approach until I was in m y 50s, then I would switch to teaching and writing. That way, if I didn't live long enough, or get around to writing things down, I'd at least get to see them done."

Foege takes his commencement addresses seriously. "You never know the influence of an article or speech," he says.

t the school's spring graduation ceremonies, Dean James Curran approached the podium to introduce the commencement speaker, his colleague and friend, William Foege. Curran's relationship with Foege goes back some 16 years when Foege appointed the dean, then a young professional at CDC, to head a task force on a newly emerging epidemic that would soon be known by a single syllable word, AIDS. Today, mixed with unabashed respect for Foege, Curran's words also reveal the lighthearted friendship that has sprung up between the two. "He is my mentor," Curran tells the student body, "and my tormentor." Foege, revered for his leadership, inspiration, and a tenacity to do the right thing, may be equally well known as a practical joker. Alongside accolades of praise, his colleagues, including Curran, describe Foege as having an essential humanity. "The things that separate him from other administrators are his humanity, compassion, and approachability," Curran says. "He feels like your next-door neighbor." From the commencement podium, Foege speaks to the hundreds as if he is talking with a small group in his home, reiterating one of his strong beliefs. "It is a cause-and-effect world," he says. "The whole history of science is based on that. Things do n ot happen in an arbitrary fashion." He tells a story. "One of the best questions I ever got was from a five-year-old who was surprised by my height. At first she was too stunned to say anything. Then she looked up at me and asked, 'How old are you anyhow?'" As the graduates laugh, Foege goes on to lend the story relevance. "My important question for you today is, Why are you so lucky? Why are you not living in a homeless shelter in Atlanta? Or a war zone in Bosnia? It is because of your parents and loved ones that you are here, not by chance. As Foege scans the crowd, he tells another story, of how a single article in the New England Journal of Medicine by Thomas Weller inspired him to pursue master's work in public health at Harvard. "You never know the influence of an article or speech. You never know where the ripples will end," says Foege, who gave the commencement address at Harvard the year Weller retired. Foege takes his interactions with students seriously, making time to talk with them about careers, even when something else in his schedule has to give. Just as Weller did for him, Foege wants to continue to spread the word. As a distinguished faculty member, he lectures on global health and serves as a mentor to students, encouraging them to pursue general knowledge first rather than too much specialization too soon. Whether in the classroom or on the graduation stage, he shares his current convictions about public health. In particular, he finds the growing disparity between the very poor and the very rich to be disconcerting. "How do we close the gap between the richest and the poorest countries, between the richest and the poorest people within a country?" he asks in his office, a question that underscores his graduation message to students: "Our job is to convince the world that it doesn't have to get used to m ind-numbing poverty," he says. "Poverty shouldn't be tolerated because we've always had it." Foege grows irritated as he discusses the impact of poverty on public health. "We tend to leave it to the economists," he says, almost on the point of pounding his fist on a table. "We in public health need to get interested in it. We need to change th e social norm. As behavioral science becomes a bigger part of public health, we need to make poverty such an issue that when events, such as the recent welfare reform bill, occur, the public health community will rise up together and take a part." At the end of his commencement address, Foege tells a story. "Students have approached me about the good old days of public health. But think about it. Would you really have wanted to work in the age of smallpox? Would you really have wanted to practic e before vaccines? Before the science of injury control? Or even one year ago, before promising therapies for AIDS? There has never been a better time to practice this profession than now." In his office some months later, Foege adds a final story. "If you have to emphasize anything, say how much fun I've had. One thing after another has been fun. "In working on smallpox in India, for example. It was daily hard work. In one week in one st ate, we had 11,000 new cases. We did house-by-house searches. It is a mind-boggling effort even to someone who went through it. But now looking back, my remembrance is that of fun. "The same with climbing Kilimanjaro. You forget how dirty and uncomfortable and cold you were. Instead you remember, Wow, that was something."