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No Small Feat: How a Social Entrepreneur Helped Defeat One of the World’s Worst Diseases

August 11, 2016

By Sally Osberg -

This week The Task Force for Global Health was awarded the 2016 Conrad N. Hilton Foundation Hilton Humanitarian Prize, an inspired choice for this wonderful award. Since its inception in 1984, The Task Force has been a quiet leader in global health, mobilizing resources and forging partnerships to improve the health of people living in extreme poverty. Today, The Task Force’s programs range from increasing access to medicines and vaccines to eliminating diseases like river blindness and polio.

Thankfully, there is one disease that is not on The Task Force’s agenda—due in large part to work done by the organization’s co-founder, social entrepreneur Dr. William Foege, in eliminating it. While Bill Foege may not be a name that springs to mind when people think about social entrepreneurship, he is, in fact, a path-breaking social entrepreneur: the individual whose innovative approach rid the world of smallpox.

Eradicating smallpox from the planet had been a global priority for decades, if not centuries. But it was not until 1959 that the international community resolved to tackle this scourge, with participating governments at the annual World Health Assembly ratifying what was clearly an audacious goal. The program that was subsequently devised hinged on collaboration, with governments providing support to legions of partners; these ran the gamut, from village-based missionaries to global institutions like the World Health Organization (WHO).

William Foege found himself on the front lines of this war, working in Africa as a consultant to the Center for Disease Control. As Foege wrestled with the imperative to vaccinate 80 to 100 percent of the world’s population, he realized the goal would be impossible to achieve. The scope of the effort was simply too great.

Foege refused to admit defeat, though, and set his mind to the challenge. What if, he wondered, the virus could be stopped by vaccinating a limited set of individuals, only those exposed to others who were already infected? Might this create a circle of protection that could contain the virus and keep it from spreading?

Foege got to work, deploying his unique approach with the assets he had at hand. The son of a Lutheran minister, Foege tapped the network of local ministers he knew were working in Eastern Nigeria and had them canvas every village, identifying active cases of smallpox door to door. Foege then got his team of public health workers to vaccinate only those villagers who’d been exposed to individuals with the virus.

The strategy—which came to be known as “surveillance and containment” or “circle vaccination”—worked. In one village after another, smallpox began to recede and ultimately disappear. The method was employed across Africa and eventually in India, a global stronghold of the disease. In 1980, the WHO officially declared smallpox to be the first consequential human disease eradicated from the planet.

Not only did Foege’s approach transform the smallpox eradication effort and rid the planet of a terrible killer, it spawned a host of successive efforts. Inspired in large part by William Foege’s innovative approach, in 1988, three organizations—WHO, UNICEF, and the Rotary Foundation (later joined by the Bill & Melinda Gates Foundation)—banded together to eradicate polio. That effort has produced a 99.9 percent reduction in annual polio cases, restricting endemic polio to two countries—Pakistan and Afghanistan—and raising the hope for complete eradication in this decade.

Foege cracked the code to defeat smallpox, upending a methodology that was well-intended but destined to fail. As governments and partners took up his innovation, its impact scaled and achieved its ultimate objective: a world without smallpox.

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