Dr. Bill Foege, former Chief of the Smallpox Eradication Program and former Director of the U.S. Centers for Disease Control and Prevention (CDC) recently was the featured guest at the Yale Institute of Global Health Conversation Series to discuss lessons learned from smallpox eradication and relate these lessons to the ongoing COVID-19 pandemic. Saad Omer, Director of the Yale Institute for Global Health, moderated the discussion with Dr. Foege, touching upon an array of topics including disease eradication, bioterrorism, the role of organizations such as the CDC and WHO, and the importance of multi-sectoral engagement and collaboration.

The tone of the conversation was set with Dr. Foege’s reflection on the monumental impact of the smallpox eradication program, noting the significant number of lives and money saved. “It cost $300 million to eradicate smallpox. Since smallpox has been eradicated, we have recouped our investment 130 times,” said Dr. Foege. He also outlined nine lessons learned from the smallpox eradication program that remain especially relevant in global health, including:

• realizing that things do not happen arbitrarily,
• striving to know the truth, even in times when we do not want to know the truth,
• the need for coalitions to tackle pressing problems,
• avoiding certainty, which can be the Achilles heel of science,
• continuously evaluating and changing what we are doing, and noting what works and does not work,
• respecting culture,
• realizing that positive results come from management, and understanding how to put science and management together,
• acknowledging the need for political support, and
• realizing global public health is present no matter where you are located, and to striving for equity in global health.

Dr. Foege noted that these lessons were all cast to the side in the face of COVID-19. However, the COVID-19 response also carried some rewarding experiences, with Dr. Foege citing the impressive vaccine rollout effort as a notable triumph. Subsequent questions invited Dr. Foege to comment on the future direction of the CDC. Despite the tremendous growth of the public health sector in the last few decades, more needs to be done. More specifically he noted that mental health needs to be included, including surveillance systems.

Most importantly, Dr. Foege emphasized the need for trust, the “glue that keeps coalitions together.” Dr. Foege noted the pervasive atmosphere of mistrust between the public and public health, and the need for the CDC to earn that trust back day by day. “The CDC should be encouraged to have a series of conferences with states, counties, cities, tribes, and ask the question: how do we get the approach to public health in this country as seamless as it was 40 years ago,” said Dr. Foege. The topic of trust led to subsequent discussion around current difficulties dealing with fragmentation in public health. “We can get back to that what is required to make this seamless, what do states need from the federal government to make this happen? Not more authority but more trust,” said Dr. Foege.

At the end of the conversation, Dr. Foege concluded with three pearls of wisdom for aspiring public health students and young professionals:

• “Be careful about having a life plan, you have no idea what opportunities will be presented to you, no idea what the new problems will be. If you go into global health, you are not likely to get rich, you are not likely to get thanked. If you get past those things, it is rewarding. Be secure in the knowledge of what you are doing, in any program you go into, any project you go into.”
• “Science is common sense at its best. Lots of people get afraid of science these days, but people think they have common sense. Add to science, art, then you have creative common sense at its best. Adding art to your science gives you that creativity.”
• “Add a moral compass. Put those three things together and that is what it should be like to go into global health.”

To watch the full conversation, visit the YIGH YouTube Conversation Series Playlist.