Polio Eradication and The Power of Vaccines
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Following the event, Gates met with the press to talk personally about how the Gates Foundation will get this polio campaign reinvigorated:
In 2006 and 2007, we came in and helped jump up the total amount of money, by giving over 100 million a year. Why is 2010 a good year? A combination of factors: we spent more money and targeted vaccines. We had more political will and in Nigeria, we had some good luck.
Every year we go out to raise money. People think, “Should we do this or not?” They have to see progress. There are some complex things about how we do surveillance. Certain scientific things that we fund, if we don't appear to make progress, we'll lose the funding, the energy and commitment. Part of the reason we have serious commitment in Pakistan, is because the other countries did so well. They're kind of embarrassed. What? You're not funding children’s health? We've been able to keep funding going to a billion a year. If a success breeds success, failure breeds failure. It's always kind of scary. A little bit of bad luck can push you on one side of the outcome verses the other side of the outcome.
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Bill Gates is here and taking questions:
Our greatest enemy is the fact that you don't see what's going on with a lot of these diseases. It’s hard to tell politicians to care when the voters don't care. Particularly now, it's a tough time to make vaccinations the focus.
Also, it's not like, if you spent x dollars you'd eradicate polio. There's a lot of uncertainty here, and knowing for sure the number of years it's going to take is pretty tough.
As far as campaigns: Everybody has dreams about digital engagement. And we know the amount raised online for all causes is a rounding effort. It's hard with the noise out there. We think we have smart people. creative thinkers. We have some people from CAA looking at how we should do this thing and get it reinvigorated.
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Three of the panelists came for a private press conference with the live bloggers at the event:
They summarized the critical issue here: polio eradication will need 2 billion dollars in the next several years for successful eradication. Right now, the shortfall is 700 million. How are you going to convince governments and people that this is urgent and encourage people to care about this?
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Professor Rees of South Africa says that to make this happen:
We need a commitment from the government: You need the top to buy in: from political buy in all the way to community buy in. We must have adequate leadership and commitment or we can't sustain this–and sustaining it is critical.
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David Oshinsky talks about his fascination with the March of Dimes and their incredible ability to do positive propaganda. He believes you can convince today's kids that there is a moral imperative to prevent polio.
That will be a tough sell. It does seem that today's kids need more than a moral imperative. How can you get them to care to give their dimes or a dollars in the same way the kids did in FDR's day? Oshinsky says:
The March of Dimes was amazing at finding the hooks. They said, “we'll find the vaccines, you give the money. They didn't want to be labeled as going for corporations, so they went to individuals. It would be interesting to see if they could do something like that now but do the March of Dollars. But the March of Dimes don't do polio anymore.
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Dr. Ciro de Quadros says:
Polio eradication in America was followed by eradication of measles, then rubella. He says though that it is the fundamental grassroots campaigns that get people. These programs become successful when there is country ownership. Look at the Nigerian government. They've made tremendous progress. Many times, people think vaccines are the responsiblity of Unicef. Country ownership becomes a problem they have to solve. Poor countries will need help from outside. But polio eradication will need national leadership and ownership. A good example is the participation of Rotary. They've been fundamental in raising over a billion dollars.
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Did you know also that DeBeers is a big contributor of funds to eradicate polio? Professor Rees said that in some cases in South Africa, they are getting the big corporations to fund the eradication effort. She says:
Enormous efforts on how do we continue to engage the developed world? Who is going to put up the money for it? We are too divided. It cannot be anymore that the rich world hangs onto riches. It’s it a recipe for destabilization: If we don't start to address poverty, the world becomes a less stable place. We need to start to make that argument. Corporations haven't come to that party yet.
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Diane Sawyer ends the panel by saying to the panelists:
It's great to be in the same decade with you.
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One man in the audience ended the Q&A by saying:
FDR suffered at the pinnacle of his life. FDR lifted that nation and spoke about freedom from want and fear everywhere in the world. None was more personal than 10 years to the date of his death that Dr. Salk could eradicate polio. He taught the disabled that they had the possibility of independent living which was a terribly important thing.
I think there is plenty of room for a march of dollars! It seems to be we should have a balance sheet. There must be billions saved if we can eradicate polio.
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Questions from the audience have now started. The first question is from a man from Rotary International. He asks Dr. Quadros: given your role in small pox eradication and declaring America polio-free. What do you see as broad implications of polio eradication?
He answers that the creation of a culture of prevention is so important for delivering vaccines and other health interventions. No economy can really measure that. It's a tremendous impact.
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Gates says they can fund 15% of it:
Getting the word out - awareness has dropped dramatically. We need to have a renaissance. It's such a powerful story and the impact on nations, saving lives. When families have healthy children, they don't have as many children, so all the problems will come down to a commitment to these health issues. We need the government part to stay strong too. It's a time when government commitment and support for global health activities is under attack.
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Dr. Oshinsky talks about celebrities, and the birthday balls that the March of Dimes used to hold. He says:
I want to challenge the children of the world to give money for the final push (on their cell phones etc). For the first time Eisenhower broke down in tears, kids had the day off from school. Ike said, this is not America's vaccine, this is the world’s vaccine. It's for the children of the world.
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Oshinksy continues:
What is missing is to involve grassroots people throughout the world to help with that final push.
They are both really saying the same thing, but how do you get children to care about polio if it doesn't affect them?
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Diane Sawyer brings up the problem of refrigeration: The process to get the vaccines to the field are incredibly important. What about looking at technologies and get low tech solutions for low resource settings.
Professor Helen Rees says:
Why can't we have vaccines that don't need refrigeration? Technology around vaccines is part of the new thinking.
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Dr. Quadros from the Sabin Vaccine Institute works with global eradication on polio and measles. He says:
When you do the campaigns in the right way, you reinforce the health infrastructure. It will include the other vaccines down the line. In the America, eradication of polio was followed by eradication of measles. If you look at this structure and infrastructure formed by campaigns, will create a culture of prevention. The benefit of polio eradication goes well beyond lives saved, and into creating long-term infrastructure.
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His Excellency Owais Ahmed Ghani believes that
There is a resurgence of polio, & the leadership in the country is embarrassed by it. It was down to 1 and now we have 74. For us, this has become a public embarrassment. That is why I feel the political will and resolve is there to solve it.
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His Excellency Owais Ahmed Ghani talks about accountability in Pakistan.
He also says:
Even when we bring polio to 0, immunization must continue. We are insisting on permanent centers because babies keep being born. I think these community health centers will improve accountability of medical staff. That is one. The other issue is how to access conflict areas. I have discussed this with Pakistan army there. We have got them on board and we are going to use the army units for immunization campaigns.
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Ghani from Pakistan talks about improving road communications in Pakistan, but conflict is preventing access to 25% of the area and this is an improvement over last year (when 36% was inaccessible).
It's a very big challenge because people refuse. Refusals were .6 % but it's still too much. We want to tackle this challenge in different way – we can't do it in a normal way. We must be innovative and now hepatitis is surging (15,000 cases). Ghani believes the problem has been underreported.
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Dr. Rees believes the hardest thing we have globally is the quality of our health services
In the poorest countries, we can't put one intervention into a failing health service. In some countries where we really need to eradicate polio, there are problems with health personnel.We must vaccinate against all the basic childhood vaccines, but if we could introduce the new ones - pneumonia for example, that will have tremendous impact.
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With resources available, we can eradicate polio within the next few years. It is very hard to eradicate a disease. Gates says
We picked polio - it's a lot of fundraising, it’s a little improved science, and it’s a lot of execution. The disease was eradicated in 5 years in the US. The main problems we are having are sufficient funds to do the job and applying tools we have. With good management of funds in place and political will, we can eradicate this.
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Can polio be eradicated? Ghani, governor of KP and FATA, Pakistan does say polio CAN be eradicated.
Look at the worst time of Angola in civil war. The new combination vaccine shows tremendous impact in India and Nigeria. All that's missing now is the resources. The setbacks were lack of resources.
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Oshinsky says:
It's money, spirit and urgency. Having FDR with polio was an enormous plus for fundraising. March of Dimes began in the Great Depression, with no big donors, no government programs. What you need to turn philanthropy on its head was small donations from millions. That was March of Dimes strategy and urgency to revolutionize fundraising and medical research. The March of Dimes used poster children, celebrities (Elvis Presley).
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These fundraising efforts raised hundreds of millions and spent it on medical research, looking carefully at the youngest, brightest, most ambitious researchers. The two largest grants went to Jonas Salk and Sabin who each came out with an amazing vaccine!
Diane Sawyers starts the panel, asking: “What is the biggest lesson we learned in those years? Spirit?”
Bill Gates gets up to speak:
Today is the release of Gates’ Annual Letter about the work of the Gates Foundation. There has been a lot of talk about the letter, the challenges and progress. But the center of that letter is to start the polio discussion. Gates thinks this will do the most to improve the human condition.
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He describes the great heroes of the polio campaign in the audience. Feels that the idea of paralyzed children will end if the polio eradication campaign works. Why polio? Gates thinks this last 1% is the most difficult challenge. And when we do eliminate polio, it will free up resources for other activities which will be vaccinations against other diseases.
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This will save tens of billions of dollars and make a huge difference in global health. Small pox eradication took childhood immunization from 25% to over 70%. He wants us to get vaccination rates up and use the money to invent new vaccines. He and Melinda call this the decade of vaccines and invested over $10 million in vaccine related activity.
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He describes shots that can protect you for life as a magical.
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The new meningitis vaccine costs only 35 cents. Vaccines are typically taking 20 years to go the from developed world to developing world. They are working to get the delay to a few years. 2010 was a year of great progress for the malaria vaccine. GAVI and Polio Eradication Campaign face tough financial challenges. Aid budgets are being cut, including money for vaccines & for AIDS drugs. The next few years will be very challenging.
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Pakistan has one of the most challenging areas.
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Polio is like fire: You must stamp it out or it will flare up in places. Most of the cases now are the flare-ups, like in Tajikistan and Congo. You see a lot of deaths and paralyzed children. Thats why getting polio eradicated is so important. Unicef, CDC World Health Organisation all play an incredible role in this effort.
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On Friday, David Cameron UK Prime Minister committed an increase of $60 million instead of 30 million (last year’s budget) for vaccines. Gates thinks we have the science and money in hand to make this happen.
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He sees a future where children are not at risk of polio.
We owe it to the generations of people who made the progress in the past. A video is playing of Nigerian children. In Nigeria, we had 388 polio cases in 2009. In 2010, it was 18. It's incredible how fast you can affect a life or lives in one year to see the success so clearly in the efforts to vaccinate in Nigeria.
She introduces us to the 'braintrust:' A power packed panel:
David Oshinsky, Dr. Ciro de Quadros, Prof. Helen Rees, His Excellency Owais Ahmed Ghani (Governer of Pakistan) and the man who has given us a conviction that you can turn enormous pain into enormous purpose: Bill Gates.
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Sawyer quotes a poem that FDR quotes: To reach a port you must SAIL and she introduces the captain of this ship: Bill Gates.
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Gates also refers to FDR learning to walk again in this house after doctors told him to give up politics. He was only 39 when got polio!
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Diane Sawyer takes the stage, in glasses and a fabulous purple blouse:
It’s moving to think about FDR being here in this house struggling to move again. And we're here to look at the possibility of a finish line for that disease.
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Sawyer grew up in terror of polio in Louisville, Kentucky when mothers took them back from the swimming pool and watched their kids in panic as they got ill. Her aunt had polio and in her 80's still limps and reminds them of the time of the random terror in the Americas. She thinks we should anoint a day to remember the things we forgot to celebrate. Everyone of that generation remembers that lives of children changed with the polio success.
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FDR's said once you spent two years trying to wiggle a toe, it puts everything else in perspective. We need now, patience and perspective to finish this campaign.
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James Roosevelt welcomes everyone to his house, the first time he's seen it since its recent renovation. He talks about FDR's legacy and commitment to health equity - his launch of the Warm Springs Foundation and the March of Dimes. FDR believed that everyone deserved the same quality of healthcare that he received.
He introduces Bill Gates as, like his grandfather, another Champion of Health Equity and says that Gates is carrying forward what his grandfather began. Way of honoring his grandfathers legacy is to get rid of polio on the planet.
He now introduces a short video about children in Nigeria having vaccines (needles) and the video says how a few doeses in the first few years can profice a llifetime of protection. SMall pox has been eradicated. Measles deaths in africa down 98% .
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This talk is about the POTENTIAL of vaccines and what can happen if every child has access to vaccines.
Photo via Bill and Melinda Gates Foundation
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