Charles Craig 0000-00-00 00:00:00
WHY THIS PUBLIC HEALTH PIONEER IS ATLANTA’S MOST ACCOMPLISHED HERO YOU’VE NEVER HEARD OF In the 70s, his surveillance-and-containment strategy led to global eradication of smallpox. In 1984, he set out to raise immunization rates in the developing world to 80 percent from 20. It’s not far-fetched to say this renowned epidemiologist launched the modern era of global health. Calling Dr.William H.Foege a lifesaver is a bit of an understatement. The 2012 Presidential Medal of Freedom recipient and long-time Atlantan is ranked No. 1 among lifesaving scientists for his leading role in eradicating smallpox from the planet nearly forty years ago. How many lives saved? A conservative estimate is 131 million, according to scienceheroes.com. Wiping out the deadly virus—a human scourge for thousands of years—has been hailed as one of the most remarkable achievements ever in medicine and public health. It was Dr.Foege’s signature success in a career spanning a half-century of improving public health in this country and across the globe, which earlier this spring rightfully earned the 76-year-old physician the Medal of Freedom, the U.S.government’s highest civilian honor. The final campaign to corner smallpox occurred in India. The end came in 1975. When recalling the triumph recently, the famously humble Dr.Foege could be forgiven for an expression of personal pride. Instead, the Iowa native and son of a Lutheran minister remarks thoughtfully that he was confident of the outcome. “I know it’s hard for people to believe it,” he says. “When other people were celebrating the last case, I thought, ‘Didn’t we know it was going to happen?’ I never went through a euphoric moment thinking, ‘Ah, we are going to make it.’The euphoria was at the beginning. That was when I believed in my head it was possible.” Dr.Foege, known as Bill to colleagues and friends, may be among the most accomplished Atlantans most people don’t know. He could also be considered the one person primarily responsible for establishing the city—and Georgia—as a premier center for global health. It was in the mid 1970s, working for the Atlanta-based U.S.Centers for Disease Control and Prevention, when Dr.Foege led the effort against the smallpox virus in partnership with Indian health officials and other groups, such as the World Health Organization. Although he felt confident, with the end in sight, his strength would be tested before the goal was achieved. The carefully crafted, bold strategy he devised for beating the disease was threatened by a breakdown of support in India. “I thought everything was falling apart, literally falling apart,” he says. “It was frustrating. I was losing heart. The [smallpox] vaccinators were going on strike, the railroads were going strike, and the number of smallpox cases was going up. [The Indian] Parliament was asking questions because they were embarrassed by the international news that the numbers were going up.” The turmoil subsided, and when the eradication program resumed, Dr.Foege says, “We went from the highest rate of smallpox to smallpox zero two months later. From the very beginning,” he adds, “I had just assumed it would happen. Optimism, unwarranted optimism perhaps, like someone who makes a list and thinks they might actually complete it.” VISIONARY LEADER Dr.Foege’s quiet and determined confidence is backed by what his good friend Dr.Mark Rosenberg, president and CEO of the Task Force for Global Health, describes as three necessary qualities of a great public health leader: “the ability to build and lead effective coalitions; the ability to see the smallest detail and the big picture at the same time; and tenacity.” It took maximum doses of all three to finally check smallpox off his list. But Dr.Foege was far from done. In 1977, he became director of the U.S. Centers for Disease Control and Prevention (CDC). Seven years later, he co-founded and served as executive director of the Task Force for Child Survival (now the Task Force for Global Health). In 1986, he became the executive director of the Carter Center, and ten years later he joined the faculty of Emory University’s Rollins School of Public Health as presidential distinguished professor of international health. In 1999, Bill and Melinda Gates asked him to serve as the senior medical adviser for their five-yearold foundation. While at the CDC, Dr.Foege expanded the scope of its programs beyond infectious diseases to include strategies for battling chronic diseases such as cancer, heart disease, and stroke as well as the health-related consequences of violence and risky behaviors such as smoking. Public health, from then on, would be focused on health in general. At the Task Force for Child Survival, Dr.Foege oversaw campaigns to boost childhood immunization rates from 20 to 80 percent in the developing world. He also forged groundbreaking partnerships between nonprofit health organizations and forprofit pharmaceutical companies to bring health care to the world’s poorest nations. At both the Carter Center and the Gates Foundation, he plotted the strategic directions for their now-renowned global health programs. NEW CONCEPT FOR PUBLIC HEALTH Dr.Foege, who earned his medical degree at the University of Washington and his Master of Public Health degree at Harvard University, essentially created a new vision for public health with a concept he called “global health equity.” Dr.Rosenberg, a former CDC colleague who would later succeed him at the Task Force, recalled when he coined the phrase. He was asked by the Gates Foundation to define a strategy for its investments in improving global health care. He was struggling. “For Bill,” Dr.Rosenberg says, “the single most important thing in every effort is defining your goal and getting it right.” The goal was narrowed to three words. “If you take away any one of the words,” Dr. Foege says in describing the phrase, “it loses its meaning. You can add thousands of words to it and not improve on it.” What is global health equity? “You want every child to have the same opportunity to have good health and a good life,” Dr. Foege says. “Some people say it’s a nebulous concept. But when you look at infant mortality rates or life expectancy rates and track them around the world, they all differ by the degree of inequality in health care.” For Dr.Foege, global health equity goes far beyond improving public health. It digs up the roots of health care inequalities and sows new seeds. “I think one of the principle reasons [for global health inequality] is poverty,” he explains. “One of the problems is that we all benefit from poverty. Our shoes are cheaper. Our clothes are cheaper. We benefit from low wages. From biblical times, it has always been noted that this is a problem.” The solution? “What we need is a William Wilberforce,” Dr.Foege says, referring to the late-18th-century British abolitionist who campaigned for 26 years to end the British slave trade in 1807 and then worked another 26 years to abolish slavery outright in most British colonies in 1833. “We need a Wilberforce to end poverty. We have to get the disenfranchised, franchised." The Medal of Freedom was not the first honor for Dr. Foege, nor will it be the last. It’s not far-fetched to say he launched the modern era of global health, and word is spreading due to the growing chorus of accolades from grateful people, organizations, and nations. GEORGIA’S GLOBAL HEALTH LEADERSHIP Like Dr.Foege, Georgia and Atlanta are not widely known as leaders in global health, but that too is changing. There’s new enthusiasm among state government leaders to recognize the economic development power of health care innovation. In addition to the CDC, Carter Center, and Task Force for Global Health, Georgia is home to CARE International, MAP International, and universities whose research is breaking ground in health care innovation. There are also new local initiatives such as the National Health Museum, whose goals include bolstering U.S. leadership in global health, and Morehouse School of Medicine’s Global Healthcare Alliance, formed to improve the quality of health care in sub-Saharan Africa and the Caribbean. And global health is about more than just treating diseases in developing nations. “Global health is local and global,” explains Dr.Rosenberg. “Whether you are a young woman struggling to survive fl esh-eating bacteria in Georgia, or a young woman struggling to survive a difficult birth in Nigeria, you are part of global health.” Laying claim, then, to being a global health center requires an extensive supporting cast of government agencies; universities; nonprofit organizations; medical centers; and pharmaceutical, biotechnology, and medical device companies. All are part of Georgia’s economic landscape. “Within our state we have a powerful array of organizations, programs, and individuals working to improve the lives of Georgians, Americans, and people around the world,” says Mike Cassidy, president and CEO of the Georgia Research Alliance. “Working together, we can not only address today’s and tomorrow’s global health challenges, but also help to secure our economic future.” There is a movement under way—a growing collaboration of industry, academia, government, and non-profit organizations—focusing on elevating Georgia as a recognized leader in global health. It received a huge boost in April when Baxter International announced it will build a $1 billion bio-manufacturing plant in Covington, employing 1,500 people. The Illinois-based global pharmaceutical company’s decision to bet its future on Georgia with such a huge commitment could be the catalyst for moving the state’s health care players beyond making nice statements about being a national and global health leader—and toward taking the next step: translating talk into economic development. Governor Nathan Deal and his team, headed by Georgia Department of Economic Development Commissioner Chris Cummiskey, are playing a key part. BAXTER’S IMPACT “Baxter is the biggest news we’ve ever had in the bioscience world in Georgia,” Cummiskey says. “Georgia has been strong in biosciences, but mostly in small to mid-size companies. For years we’ve gone after the big companies, and frankly some people had given up hope. This will open doors with other major companies.” There were many reasons Baxter chose the site outside Covington, says Julie Kim, general manager for BioTherapeutics in Baxter’s BioScience organization. “It is a new site well suited to both our current operations and for future growth. The location gives us proximity to plasma collection centers in the U.S. And of course, we looked at local resources such as water, utilities, international transportation, and a strong pool of potential employees. Finally, Georgia’s Quick Start workforce development program represented a key advantage.” The plant will be Baxter’s largest blood plasma manufacturing operation, generating therapeutic products for treating patients worldwide with immune deficiencies and patients suffering from trauma, burns and other critical care conditions. “We needed to build a new plant because our existing operations could not support an expansion of this size,” Kim says. “In addition, opening the new plant will allow us to better manage business continuity risk by having an alternate site for immunoglobulin purification, filling and packing, and plasma testing. Baxter currently has only one site for these critical operations.” BUILDING ON OUR STRENGTHS What will it take to build on Georgia’s existing strengths—its industry, its nonprofit health organizations, its universities, and its government institutions—to make Georgia the recognized global health leader it aspires to be? The redevelopment of Fort McPherson, a 488-acre former U.S. Army base in Atlanta near Hartsfield-Jackson International Airport, is a good place to start. A major part of the project’s master plan is a proposed 127-acre science and technology park that would include a global health institute. Discussion among state and local officials about the global heath institute has been ongoing for years following the decision in 2005 to close the historic base, which was opened in 1889 and became the headquarters for the Third U.S. Army in 1947. Progress was slow under former Governor Sonny Perdue, and the Army was growing skeptical that Georgia officials were serious about following through on the master plan. At stake was whether the Army would cooperate with the state or put the property up for sale. Again Governor Deal is doing his part. He resurrected the Fort McPherson project, including the science and technology park and global health institute, by persuading the 2012 General Assembly to allocate $20 million to the redevelopment effort. What’s next for Georgia? Who better to ask about achieving a goal than Atlanta’s own visionary Medal of Freedom recipient. “We can do it by choosing an objective that we can all agree we want to achieve,” Dr.Foege says, “something very specific,and then we define it and get behind it to make it happen.” Foege Chronicles End to Smallpox in House on Fire—with a Little Help HOUSE ON FIRE is an insider’s account of what has been described as the greatest achievement ever in medicine and public health. As Dr. Foege recently recalls, he owes a significant debt to his wife, Paula. “When I was writing the book,” he says “I had visual problems, but I could type. I would type a chapter and then email it to Paula and she would read it back to me. She would say, ‘This is really, really boring. Why don’t you put stories in it?’ Of course, she was right.” Paula Foege also suggested the title of the book, which alludes to the strategy of containment Dr. Foege helped devise to end the disease. Traditionally an outbreak of smallpox was attacked with mass vaccinations. She found the title in a passage of the book: “If a house is on fire, no one wastes time putting water on nearby houses just in case the fire spreads. That is the mass vaccination strategy. Instead, as in the surveillance/ containment strategy, they rush to pour water where it will do the most good—on a burning house.” Big Biotech Chooses Georgia When biotech industry giant BAXTER INTERNATIONAL selected Georgia for the site of its largest U.S. plasma processing plant, it signaled what innovative global companies such as Merial, Dendreon Corp., and UCB Inc. already know: Georgia is the place to practice global health and make a difference. The pharmaceuticals and biotechnology company searched on a global level for several years before selecting Georgia. Baxter plans to start construction by the end of this year, with the first manufacturing buildings complete by 2015. Commercial production will begin in 2018. The new plant in Covington will be in good company.Merial, a division of Sanofi, is the world’s largest producer of avian and rabies vaccines. It makes 20 billion doses of avian fl u vaccines each year in its Gainesville plant to protect birds and keep them from igniting a human pandemic. The company develops another 50 million doses of rabies vaccine in its Athens plant to prevent animals from falling victim to the deadly virus and infecting people. Dendreon produces a new prostate cancer therapy in Union City that harnesses a patient’s own immune system to fight the disease. It’s a revolutionary approach, with few harmful side effects, that may be applicable to all cancers. UCB is a Belgium-based biopharmaceutical firm with U.S. headquarters in Smyrna. It employs 400 people in Georgia. Last year it invested 24 percent of its global revenue in research and development, focusing on central nervous system and immunology diseases.
Published by EMMIS Communications. View All Articles.
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