William H. Foege is a distinguished American medical doctor and epidemiologist with extensive field experience best known as the architect of the method of ‘surveillance and containment’ for smallpox eradication work. This method replaced mass vaccination (efforts to vaccinate a very high percentage of the population), and made possible the eradication of smallpox in the late 1970s. This smallpox methodology was initially designed in Africa in the mid-1960s when Foege had to work with a limited supply of vaccines. He used these resources carefully and intensely only in the most affected villages where it was possible to contain the disease. The method required the prompt identification in homes, markets and schools of individuals exhibiting rashes and the compulsory vaccination of people in and around these locations. The result was that smallpox could be made to disappear with a fraction of the vaccinations required for a mass campaign. By the late 1960s the method was adopted by the World Health Organization and led to the success of the eradication of smallpox. As historians of public health know, smallpox is the only infectious disease in history to have been completely eliminated by human action.
Foege was also Executive Director of the Carter Center; a recipient of a number of awards such as the MacLean Prize in Clinical Ethics and Health Outcomes and the Presidential Medal of Freedom; professor emeritus at the Rollins School of Public Health at Emory University in Atlanta; and a fellow of the Bill and Melinda Gates Foundation. This book is mainly a narrative account of the author’s work at the Communicable Disease Center (today the Centers for Disease Control and Prevention – CDC), first as a member and later as a revered director between 1977 and 1983. The book is not intended to be a full autobiography or an institutional history, but it has several autobiographical moments with unique and interesting information. Moreover, it is a nuanced discussion of the political negotiations for crucial public health decisions and programmes made during the late twentieth century where Foege played an important role. The topics covered include bioterrorism, the history of the CDC, Toxic Shock Syndrome, Legionnaires’ disease, AIDS, Ebola and diverse national and global health initiatives on rare and neglected diseases. It is also a vivid account of the vicissitudes of a public health worker, who was also a Lutheran and worked for his church as a medical missionary around the world. Foege provides colourful accounts of mentors and scholars who have been important for his work. He reveals some insights into the work required behind the scenes for sound public health programmes and criticises the precariousness of immunisation programs. The author also finds moments to present his firms beliefs on the validity of global health programs (and the need of a stronger World Health Organization with an adequate budget and ‘less politics’), and on the general need in public health for good and flexible management, decisions based in epidemiological research. He also discusses the legitimacy of the overarching goals of health equity and social justice.
The title of the book – also the title of a chapter – might be misleading because social disparities and different social perceptions of epidemic disease are suggested but are not fully discussed. The title mainly means for the author the need to link the disease anxieties of the rich to the health needs of the poor. More than an integrated and structured work with an organising principle, the book is a collection of relevant public health events, characters and themes presented in twenty-six brief chapters. An important goal for the author is to offer advice for students and practitioners in public health. His advice for students is to have a life philosophy of service and values instead of a rigid life plan that might be an obstacle to embracing opportunities that might be not anticipated but that can improve and change the life of a professional. Another goal of this book is to highlight CDC’s achievements, vicissitudes and challenges, focusing on its legendary Epidemic Intelligence Service. In the Cold War and post-Cold-War periods, this became a global institution with operations all over the world with the formal mandate to protect Americans from deadly diseases. For historians of medicine, the information on the CDC might be the most useful. In addition, the book has valuable information on immunisation programmes of the late twentieth century that would be of interest to historians of medicine working on this topic. Unfortunately, the book has few references, no bibliography and no index. The fascinating theme of the tension between politics and public health science is briefly described, but not fully developed. Some of the fourteen compelling black and white photographs are presented to readers for the first time. An appendix provides valuable information on a number of people who worked with Foege. It is the hope of this reviewer that public health students and practitioners, the main targets of this book, will find inspiration, learn how to navigate adverse political systems and help to change unfair societies, not only by reading remarkable memoirs but by studying public health histories done by professional historians.
