Bill Foege, Vashon Resident and Former CDC Director, Explains How He Eradicated Smallpox

One of the ironies of the local anti-vaccine movement, profiled in this week's cover story, is that it has flourished in the very region that has drawn some of the most famous immunologists in the world. That's due largely to the Bill and Melinda Gates Foundation, which for years has been funding a huge vaccination campaign in developing countries. And so you have the spectacle of Bill Foege, the man who developed the immunization strategy that ended smallpox and now a Gates Foundation employee, living on Vashon Island, where the public elementary school has a vaccine opt-out rate of approximately 25 percent.

Foege has just come out with a book, House on Fire, that tells the story of his triumph over smallpox in the '60s and '70s. Talking by phone from his home, he recalls the genesis of what came to be known as the "cocoon" strategy.

He was working at a medical center in a remote part of Nigeria in late 1966 when he got a call from the Centers for Disease Control and Prevention. Could he help combat a smallpox outbreak that was then taking place? At that time, health officials around the world were trying to deal with such outbreaks by vaccinating everyone they could.

But Foege has another idea: "We concentrated on finding where the people were who had smallpox and vaccinating the people who were around them--family members, people in the village." It worked.

"But the real test was in India," he says. "In '73, '74, '75, smallpox was so prevalent that in one state alone there were 1,000 cases every day." In came Foege and his cocoon strategy. "We want from the highest rate of smallpox in the world to 0 in 12 months. The last case was in May 1975."

Foege went on to become director of the CDC in the late '70s and early '80s. "During that time we really expanded childhood immunization." Measles, he says, used to be a common killer among children, but now "parents don't even know what measles is anymore." Well, some are learning, given a resurgence of the disease, something health officials attribute largely to vaccine resistance.

Foege is sorry to see that happening, of course. He's been floating the idea of making parents who opt their kids out of immunization sign a form alerting them to the risks--something Vashon's elementary school has acted on.

Yet, he says he also understands the mindset of his neighbors who question the conventional scientific wisdom about vaccines. "Vashon has always attracted independent thinkers," he says. "There's a feeling of not wanting to be told what to do."

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