When historians talk about the eradication of smallpox, they often start with Geneva, Washington, or New Delhi. But the turning point came earlier, and further south, in Nigeria, in the late 1960s, where a young American epidemiologist made a practical decision that reshaped global health.
William H. Foege, who died on January 24 at the age of 89, was not yet a giant of public health when he arrived in northern Nigeria. He was a field doctor facing a familiar problem in post-independence Africa: too little money, too few vaccines, and a disease that moved faster than governments.
Smallpox was still endemic across large parts of Nigeria at the time. The vaccine existed, but vaccinating entire populations in a vast country with weak logistics and poor cold-chain infrastructure was unrealistic. Many eradication efforts before him had stalled precisely because they tried to do too much with too little.