Willum Forge, M.D., MPH, former director of the Centers for Disease Control and Prevention (CDC) and a legend in the public health world, died on January 24 at the age of 89.

Mr. Forge served as director of the CDC (then the Centers for Disease Control) from 1977 to 1983. He later co-founded the Global Health Task Force and served as executive director of the Carter Center from 1986 to 1992. He was also an advisor to the Gates Foundation and a professor emeritus at Emory University’s Rollins School of Public Health.

Fauge, a physician and epidemiologist, is best known for leading the global effort to eradicate smallpox, an effort widely considered one of the greatest achievements in public health history. While working in Nigeria in 1966 as an employee of the CDC’s Epidemic Intelligence Service, Fauge helped develop the ring vaccination strategy that was first applied in rural villages in Nigeria to stop smallpox outbreaks. This strategy would later be adopted by the CDC and the World Health Organization (WHO).

Before being eradicated in 1980, smallpox killed an estimated 300 million people in the 20th century alone.

“Bill’s contribution to smallpox eradication is one of the most extraordinary achievements in medicine and epidemiology,” Mike Osterholm, Ph.D., MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP), said in the paper. statement. “Under his leadership, we ended this disease that once claimed millions of lives, not through brute force, but through ingenuity, scientific rigor, community engagement, and a deep commitment to protecting the world’s most vulnerable people.”

A new approach to outbreak containment

In his 2011 book house on fireFauji described how, faced with limited supplies of smallpox vaccine, he and his colleagues devised a strategy to contain a growing smallpox outbreak in the village of Obirupua in eastern Nigeria. At the time, the CDC and WHO strategy to combat the disease was mass vaccination, an approach that, even if effective, left room for an explosive outbreak.

“The standard response has been to vaccinate everyone within a certain radius while determining the extent of the outbreak. However, there was not enough vaccine to do this,” Forge wrote. “How can we most efficiently use the limited amount of vaccine we have?”

To identify and protect the most vulnerable people, Forge and his colleagues used amateur radio to contact local missionaries who were familiar with market and family patterns to help predict where the virus would spread. They asked missionaries to send runners to nearby villages to find infected people, and within 24 hours they were able to identify four villages affected by smallpox. These villagers were immediately vaccinated.

They then deduced villages where the virus might be harboring, based on the missionaries’ knowledge of where patients and their families typically travel. They selected three villages within a 25-mile radius and used the remaining vaccine there.

“We found that smallpox was already dormant in two of these three regions, but by the time the first cases appeared, everyone there had been vaccinated and smallpox disappeared so quickly that we were surprised and wondered if we could do this on a much larger scale,” Forge said. 2023 episode The National Foundation for Infectious Diseases’ “Infectious Ideas” podcast.

Under his leadership, the disease that once claimed millions of lives was ended not by brute force, but through ingenuity, scientific rigor, community engagement, and a deep commitment to protecting the world’s most vulnerable people.

He likened the surveillance-containment strategy, which focuses on finding outbreaks and vaccinating those areas rather than vaccinating everyone, to tactics used to combat wildfires in Washington and Oregon. “We went directly to the fire and extinguished it,” he said. “We used the same approach here… Where is the virus now? And can we corral it with vaccinated people and stop the outbreak?”

Fauge went on to lead the CDC’s smallpox eradication program and brought the strategy to India in 1974. At the time, India accounted for nearly two-thirds of the world’s smallpox cases and was in the midst of an outbreak. smallpox outbreakMass infections are occurring across the country, with the number of infected people exceeding 36,000. By May 1975, after intensive surveillance and containment efforts by thousands of epidemiologists and medical workers, smallpox transmission in India had ceased.

The last recorded natural infection of smallpox was in Somalia in 1977, and the last death from smallpox was in the United Kingdom in 1978. The WHO declared the world smallpox free on May 8, 1980.

Forge said smallpox eradication was not a coincidence, but the result of “a plan that was deliberately conceived and executed by people.”

“Humanity does not have to live in a world of epidemics, disastrous governments, conflict, and uncontrollable health risks,” he wrote. “By working together, a group of dedicated people can plan for and realize a better future. The fact of smallpox eradication is a constant reminder that we should never compromise on anything.”

Efforts to eradicate other diseases

Mr. Fauge later became director of the CDC, serving under the administrations of Presidents Jimmy Carter and Ronald Reagan. During his time leading the agency, he faced several major health crises, including the birth of HIV/AIDs.

“We didn’t know what it meant, but it didn’t take us long to realize this was bigger than we expected,” Forge said. University of Washington Magazine He said he is especially proud that the CDC published the first prevention information about the disease in 1983.

After leaving the CDC, in 1984 Forge and former CDC colleagues Bill Watson and Carol Walters helped launch the Child Survival Task Force (now the Global Health Task Force), which aimed to address low childhood immunization rates in developing countries. This group led coordination efforts that resulted in 80 percent of the world’s children receiving at least one vaccine by 1990. Forge served as CEO of the organization until 2000.

“Bill Forge had an unwavering commitment to improving the health of people around the world through strong, purpose-driven coalitions applying the best available science,” said Patrick O’Carroll, MD, MPH, President and CEO of the Global Health Task Force. With condolences To the forge. “We strive to honor that commitment every day and in every program.”

By working together, a group of dedicated people can plan and realize a better future. The fact of smallpox eradication is a constant reminder that we should not settle for less.

At the Carter Center, Forge led efforts to eradicate Guinea worm disease, a parasitic disease that can incapacitate people for long periods of time. The number of cases of the disease has fallen from 3.5 million cases per year in African and Asian countries in 1986 to just 15 by 2024.

“Thanks in large part to Dr. Forge’s leadership, Guinea worm disease is now poised to become the second eradicated human disease in history, following the eradication of smallpox,” the Carter Center announced. statement.

For his efforts to eradicate smallpox (the first and only infectious disease eradicated from humanity) and other contributions to public health, Mr. Forge received the Presidential Medal of Freedom, the highest civilian honor, in 2012.

Mentoring generations of public health professionals

O’Carroll also emphasized Forge’s role as a mentor and inspiration to generations of public health professionals, from those just beginning their careers to those who have been in the field for decades.

“Every time he spoke, his vision and compassion evoked the optimism that led us to choose this field and reinvigorated our efforts to make this world a better place,” he said.

Osterholm said he too was inspired by Forge.

“I benefited from his guidance and insight,” Osterholm said. “In that respect, I consider myself incredibly lucky, and I think a lot of people share this feeling.”

Former CDC Chief Medical Officer Debra Hour, MD, MPH, called Forge a leadership force at the CDC.

“At CDC, Dr. Forge believed that public health is a moral responsibility to protect the most vulnerable, and he inspired generations of public servants to uphold that principle,” Howley said in an email to CIDRAP News. “His legacy lives on in the lives he saved, the institutions he strengthened, and the leaders he mentored.”