Godfrey Oakley died just three months ago, in October 2025. He is a hero who changed the lives of thousands of people, yet most folks have never heard of him. I certainly have. He grew up in my hometown, Greenville, North Carolina, went to the same high school I did, went to the same medical school I did (Bowman Gray, now called Wake Forest School of Medicine), and lived most of his life in Atlanta, as I have done. But he was 13 years older than me, just enough older that we never really overlapped. Our moms were friends, back in Greenville, and my mom (not realizing how big Atlanta is) would often ask me if I ever ran into Godfrey. I’m sorry to say I never did.

I want to tell you his story, so you’ll know why I call Godfrey a hero.

Every year, more than 300,000 children worldwide are born with neural tube defects (NTDs), when the spine fails to form properly in the first month of pregnancy. The most common of these defects are spina bifida (a defective spinal cord open on the back), hydrocephalus (a buildup of fluid in the brain) and anencephaly (absence of most or all the brain). All of these are devastating and lead to life-long disabilities or death.

Up until 1933 it was assumed that all birth defects were genetic, and that the uterus was so good, it protected the baby from all noxious influences. Then researcher Fred Hale at the Texas Agricultural Experiment Station fed pregnant pigs a diet deficient in vitamin A. These sows had piglets without eyes, with cleft palates and other deformities. This was the first indication that a change in diet could lead to birth defects.

Next, in 1940 there was a severe Rubella (German Measles) outbreak in Australia. Ophthalmologist Sir Norman Gregg noticed that this was followed by a rise in cases of congenital cataracts in infants. He published an article in 1941 linking Rubella infections in pregnant women with cataracts in their babies. Initially others were skeptical, due to the strong belief by doctors at that time that all birth defects were inherited. Gradually, however, the concept of maternal Rubella-related birth defects became accepted. The huge epidemic of Rubella in the US in 1964 was followed by over 20,000 cases of congenital cataracts. People were convinced. The Rubella virus was isolated in 1961, and the vaccine was licensed in 1969. We rarely see congenital cataracts now. This was the first understanding doctors had that other environmental factors like viruses could harm a developing fetus in the womb.

Enter Godfrey Oakley, humble small-town guy, with a big booming laugh and self-deprecating sense of humor. He was working at the CDC in the Division of Birth Defects and Developmental Disabilities, studying the epidemiology of neural tube defects. Rates varied in different countries, and in different parts of the US. Why should NTDs be higher on the East coast, higher in India, higher in Hispanics? As he later recalled, “June the 24th at 5 PM, 1991 was probably the most marvelous professional moment of my life….”. He received a call from British researcher Sir Nicolas Wald, reporting the hot-off-the-press results of a research study showing that folic acid (Vitamin B9) would prevent 72 percent of spina bifida and anencephaly. This was earth-shattering news in the world of neural tube defects.

Further studies showed that the most impactful way to reduce the incidence of NTDs is adequate amounts of folic acid in the diet of women before conception and during the first month of pregnancy (before most women even know they are pregnant). So, prenatal vitamins, started once a woman knows she is pregnant, wouldn’t solve this problem. Sources of folic acid include whole grains, dried beans, leaf vegetables, and fruits. It is difficult for women to get the recommended 400 micrograms of folic acid a day from unfortified foods. Godfrey reasoned that the easiest, most equitable way to get more folic acid in women’s diets was to add it to the things everyone ate. He was pivotal in the battle to convince the Food and Drug Administration to issue new regulations in 1998 requiring folic acid to be added to enriched grains in the United States. Since then, rates of spina bifida and anencephaly have been cut almost in half in the United States. 

Godfrey spent his life spreading the word, persuading other countries to implement folic acid supplementation. After 30 years doing this work at the CDC, he retired, then went on to found the Center for Spina Bifida Prevention at the Rollins School of Public Health at Emory University. He was instrumental, in his work with the WHO (World Health Organization), in accelerating food fortification worldwide. Currently, over 80 countries have mandated folic acid fortification of grains, and many more have voluntary fortification. Globally, fortified wheat flour and other cereal grains are credited with preventing 50,000–61,000 neural tube birth defects such as spina bifida yearly.

He was creative in his ideas for folic acid fortification. Last year, he was actively engaged in a project in Ethiopia to fortify salt with folic acid. Because of him, the birth control pills Beyaz and Safyral have added folic acid. He knew long-term contraceptive use can be associated with lower folic acid levels and wanted to counteract that.

He was also humorous and pragmatic. He often ended speeches with this story. “I always like to conclude by saying that Maryann and I, my wife, have started for a number of years now, every time we are invited to a wedding, we give the bride a year’s supply of folic acid, and we tell her why. And, of course, my kids say to me, “Well, you know, Dad, not everybody waits to have sex until they get married,” and I say, “Well, I understand about that, but this is the best we can do under these circumstances, and we invite everybody to join us.”

His work continues in his absence. Even with fortified grains, birth defect rates among babies born to Latinas have been consistently higher so in 2016, the federal government allowed makers of corn masa to add folic acid to their foods – but didn’t require it. Mission Foods (We have all eaten Mission tortillas.) started fortifying its foods then. This year, the states of California and Alabama have passed laws requiring folic acid fortification of corn masa products.

Even though he is gone, he is still supporting public health initiatives. He and his beloved wife Mary Ann funded a scholarship at Wake Forest School of Medicine for students from North Carolina exhibiting interest in a public health career in the prevention of birth defects and infant mortality.

As Emory Epidemiology Chair Tim Lash put it, “There are literally thousands of people alive and well, free of neural tube defects, and without knowing that they have Godfrey to thank for it. Such is the power and paradox of prevention; no one embodied it better than Godfrey.”

Godfrey often compared public health initiatives to planting trees, the maturation of which we would not personally witness. Godfrey planted many of those trees during his lifetime, and he leaves behind a vast and growing forest in the world.