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RIMA SALAH: How are we going to change the behavior of mothers? How is a mother going to wake up one day, one morning, and say, “I’m gong to take my child to be vaccinated.”
KRISTIN MCHUGH: This week on Common Ground, polio eradication. And a talk with the third-highest ranking official at the United Nations.
MARK MALLOCH BROWN: People have recognized that the UN and its different parts have a legitimacy which comes from being a one-country, one-vote system, which allows the poorer, weaker countries a voice in world affairs.
KEITH PORTER: Common Ground is a program on world affairs and the people who shape events. It’s produced by the Stanley Foundation. I’m Keith Porter.
MCHUGH: And I’m Kristin McHugh. Polio is a distant memory for many industrialized countries thanks to aggressive immunization programs. But in some of the world’s poorest countries iron lungs, crippled legs, and even death remain a daily reality. Now a massive global campaign is on the verge of defeating polio. Common Ground‘s Hélène Papper reports on the incredible task thousands of dedicated people are taking to rid the world of this disease.
[sound of crying baby, children talking]
HÉLÈNE PAPPER: Like children everywhere, these kids in Angola aren’t necessarily enjoying their medical visit on National Immunization Day. Mothers are having their children vaccinated for polio.
[sound of mothers and healthcare workers talking]
PORTER: Steve Cochi Is the Center for Disease Control’s Polio Eradication Director. He has worked around the world since the effort started.
STEVE COCHI: We focus with polio eradication largely on reaching the unreached children through national immunization days, which are special events where a country vaccinates every child less than five years of age, over a very short period of time. And it’s a very massive community mobilization effort.
[sounds of a rally, people on loudspeakers]
PAPPER: Dr. Cochi says national immunization days are one of the tools the world medical community uses to eradicate polio.
COCHI: Polio is a virus that can infect a child. And most children have no signs of that infection. But about one out of every 200 children have this virus attack the nerves that relate to the, to our muscle movements. And when those nerves are damaged and destroyed the child is left with either weakness or outright paralysis. And the muscles also shrink, so the result is that the child isn’t able to walk or isn’t able to use an arm, if the arm is affected. And occasionally, children have the breathing muscles affected, and they actually have to go on a respirator.
PAPPER: Rotary International, the civic group, targeted polio as a worldwide threat in the mid-1970s. The money Rotary raised for the polio cause increased the awareness of the disease as a global threat. Starting in the 1980s, Keegan says the CDC, the World Health Organization, the UN, and UNICEF combined resources to mount what is arguably the largest cooperative medical intervention in modern history. Bob Keegan is the CDC’s Polio Eradication Deputy Director.
BOB KEEGAN: It’s a bigger job than any one person or one organization can do. So I think I would say partnership and planning are, may be critical beginning steps
PAPPER: Polio is the second disease globally marked for eradication. Smallpox was the first. The CDC’s Steve Cochi explains why polio was selected as the next target.
COCHI: Fundamentally, you have to choose your disease very carefully. There’s only relatively few diseases that would be candidates for eradication. The main reasons why polio is a candidate for eradication is that this microbe only resides in humans. And so if you can eliminate this virus from humans you can eliminate the virus from the world. You have to demonstrate that you can make progress in eliminating the disease in a large geographic area before anybody wants to consider a global eradication effort.
PAPPER: In 1988 the World Health Assembly determined polio met the criteria for global eradication. At that time, cooperative partners were assigned tasks and goals based on their specialty. UNICEF’s Chief of Immunization Activities Suomi Sakai describes her organization’s specific responsibilities.
SUOMI SAKAI: Making sure that there’s enough vaccine, that the vaccines get when they’re needed to where they’re needed. The other area is mobilizing both the political commitment and the mobilization of the families, the caretakers, at the country level.
[sound of a public rally, someone on a loudspeaker]
PAPPER: UNICEF Regional Director Rima Salah.
RIMA SALAH: How are we going to change the behavior of mothers? How is a mother going to wake up one day, one morning, and say, “I’m gong to take my child to be vaccinated.” And this is what we really want. And this is where UNICEF can make the difference, because we are in the field, we are in every village, we are in every district.
[sound of mothers, children, and healthcare workers talking]
SALAH: And I can say we are privileged the presidents and states, I mean they have confidence in UNICEF. I mean, they take our word. It’s very important. Nigerian President Obasanjo, he’s willing to launch. He’s willing even to go to other countries, to motivate other presidents. We have the political will.
NIGERIAN PRESIDENT Obasanjo: [giving a public speech] That is why we in the West and Central Africa are about to embark on the largest public health event in our history.
PAPPER: Suomi Sakai hopes the political promises are carried through.
SAKAI: Now is a time to go back to the field, get the activities going. Make sure that these kind of commitments are followed up.
PAPPER: While the global eradication project relies heavily on political and social mobilization, it also relies heavily on science: work done by thousands of doctors, nurses, and volunteers, both in the field and in the labs. When the global polio eradication effort started in 1988, the disease plagued 125 countries across five continents. But today only 20 countries in sub-Saharan Africa and the Indian subcontinent are still affected. And these impressive results, says CDC doctor Steve Cochi, can largely be attributed to a medical surveillance system, a system put in place to monitor where the disease is still active and who it’s affecting.
COCHI: In trying to track polio, we know that polio is not a totally unique disease in the way it manifests in humans. That there are other diseases and conditions that can mimic the way polio looks, at least in the early phase. And so we are throwing the net out very widely to look for all children who have acute flaccid paralysis. Then we investigate those suspected cases of polio. This is the way that we can confirm or rule out that polio is the cause of this acute flaccid paralysis, rather than some other disease or condition.
PAPPER: Breaking the chain of wild polio transmission is the key to the eradication campaign’s success. Breaking the chain, Keegan says, is done through the administering of an oral form of the polio vaccine, which contains the live virus, versus an inactivated kind used at times in nonendemic countries such as the United States. He adds, oral vaccines are the first step in breaking polio’s grip. Keegan says there are very specific and stringent rules set to determine that polio has in effect been eradicated from a region.
KEEGAN: There’s an International Certification Commission. They require that we have these, every case of acute flaccid paralysis investigated, to be sure that it’s not polio. And that, this polio-free status must continue for several years. And the international commission determines there must be no cases for three years.
PAPPER: “Certify” and “declare” are the key words of the global polio eradication campaign. Initially the year 2000 was set as the target year for the start of the polio-free world. And three years later, if no more cases occurred, polio would be certifiably eradicated. Unfortunately, Cochi says the World Health Assembly’s goal is a little off-track. The reasons include war and civil conflict and a lack of health infrastructure in the 20 remaining countries. Nevertheless, both Cochi and Keegan are optimistic the world will be rid of the polio virus by 2002, and the International Certification Commission will officially certify the eradication in 2005. But Cochi says the global eradication campaign will be far from over, even after the polio transmission chain is broken.
COCHI: There are two parts to achieving the certification of the eradication of polio by the year 2005. The first piece of it is interrupting the transmission of the virus worldwide and documenting that. The second part is just as important, ultimately, which is the laboratory containment of the wild polio virus worldwide.
[a clicking sound]
MARK PALLANSCH: Those are clicks, and if you don’t pass all three clicks, you don’t get in. And then the virus is then in a lab under lock and key. So you cannot get to those viruses without going through several levels of barriers.
PAPPER: Level of containment number three?
PALLANSCH: This is three.
PAPPER: Dr. Olen Kew and Dr. Mark Pallansch are two virologists who work in the Center for Disease Control’s Polio Eradication Lab. Kew says the polio lab dates back to the 1960s, but it’s involvement in polio eradication started in 1985 when the Pan American organization declared the eradication of polio in the Americas.
OLEN KEW: We’ve been supporting that activity and the global effort since that time. We look at the lab as a component of surveillance.
PAPPER: Dr. Kew says one of their major objectives is to continue strengthening the global lab network to connect labs around the world. And Dr. Pallansch says the laboratories play a central role in tracking the virus more efficiently.
PALLANSCH: At the laboratory here we perform almost all of the tests that are available throughout the laboratory network. So that we receive original stool specimens here and any polio viruses present would be grown. We also receive polio viruses that are isolated from other laboratories in the global network, that are sent to us for further characterization. The primary test being to determine whether the viruses are wild viruses or whether they are vaccine-derived viruses.
PAPPER: And Pallansch says a vaccine-derived virus is not dangerous. A child will usually carry that virus around for about eight weeks after vaccination. What they are concerned with is the wild polio virus. Refined methods at a genetic level distinguish the two categories.
[sound or running lab equipment]
PAPPER: Okay, so what is this?
PALLANSCH: When specimens are received one of the first steps is to prepare a suspension from the stool. And this is just making it easier to release virus.
PAPPER: Pallansch says while all of this lab work on the live polio virus is an absolute necessity in the eradication process, it also poses a significant containment risk after polio has been eradicated.
PALANCHE: So what you see down this long hallway is actually the freezers which are containing the viruses and the specimens that are sent here to CDC for testing. So an additional level of containment as well. Over the course of the last two years or more, there has been an effort to develop a plan to achieve that containment.
PAPPER: Dr. Olen Kew explains.
KEW: So to give you an example, there is now in the Western Pacific region, in these countries, which is about 25% of the world’s population, inventory lists. And some countries are fully complied, and they’ve not only gone through all the freezers, where they might have potentially wild polio virus stocks or material containing wild polio viruses, and either lock that material up or destroy it. The chief concern, and the most realistic way that the containment of the polio viruses could fail is that people have virus stocks that they don’t recognize as containing virus-maybe the label has fallen off the vial, it’s been in a freezer for a long time. And they begin to work with it. And they get infected. And then they go out into the community and infect others in the community. So that’s actually our greatest concern.
PAPPER: And while doctors, scientists, volunteers, social and political mobilizers work around the clock to take care of these concerns and rid the world of polio, funding the effort remains an issue. The global eradication process is extremely costly. Rotary International and the United Nations Foundation have been hard at work on the money issue since the beginning of the campaign. The United Nations Foundation Polio Eradication Campaign Director, Steven Strickland??, says the entire process costs hundreds of millions of dollars annually. The estimated cost for the next two years is about $1 billion and the estimated shortfall, says Strickland??, is about $450 million.
STEVEN STRICKLAND: Obviously we are working hard to get governments and-new governments and government who have contributed [to] do more. They sometimes are very poor countries. And so it takes the rest of us to contribute.
PAPPER: Although the polio eradication project is still ongoing, Strickland and many world health officials say they are starting to identify what may be next on the eradication list.
STRICKLAND: I think the world will be able to broaden its horizons. I will say that we are deeply concerned about AIDS and the transmission thereof and the cure for it, and have already begun some work in support of the AIDS effort, especially in Africa.
PAPPER: Ambitious goals. But for the next few years eradicating polio will remain the top priority on the long list of diseases threatening the world.
[sound of children playing]
PAPPER: For Common Ground, I’m Hélène Papper.
[sound of children playing]
MCHUGH: Coming up, United Nations Development leader Mark Malloch Brown.
MARK MALLOCH BROWN: Our view is that in the same way that banking and financial services for those of us in the United States or North America, have been transformed over the last few years, the delivery of development services for the world’s poor will equally be transformed over the coming years.
PORTER: Mark Malloch Brown is one of the highest ranking officials in the United Nations. He has just finished his first year as Administrator of the United Nations Development Programme. His initial priorities were to blow the cobwebs out of the institution and use twenty-first century technology to tackle poverty and human development. Recently, Brown gave Common Ground a description of his first year on the job.
BROWN: Breathless and exhausting. But actually also very exhilarating, in that we’ve been doing a lot of things to change the organization, and that has given a certain momentum and new direction to the place. But it’s combined with a very happy coincidence, which is the whole set of questioning and political shifts going on in the world as people come to terms with globalization and how to manage it. And those have really re-legitimized the United Nations. People have recognized that the UN and its different parts have a legitimacy which comes from being a one-country, one-vote system, which allows the poorer, weaker countries a voice in world affairs. And when it comes to development, our bit of it, UNDP, that is enormously important, because it means we may not be as rich as some other development organizations, but we have a certain trust and standing in the eyes of our developing country partners which is unique. They really look at us as their development agency.
PORTER: As the third-highest ranking person in the UN system, you must have had some parts of this job that came as a surprise to you. What were the unexpected things?
BROWN: Curiously, I was bracing myself for a protocol onslaught and stumbling from one diplomatic cocktail party to the next. And I’ve been remarkably free of that, because I’ve been on the road a lot. I mean, the big crisis of UNDP has been raising resources and getting, rebuilding donor support. So I’ve been out there doing that and also obviously trying to come to learn a lot about our program in the field. So I haven’t had time to rest on my laurels or enjoy those dubious perks of high diplomatic status in New York.
PORTER: The last time you and I talked we were just on the cusp of Netaid. You were deep into preparations for both the concert and the Web site. As it turns out even Saturday Night Live did a parody of the concert. What happened?
BROWN: You’ve certainly made it when Saturday Night Live picks you up. And actually, here on the wall of my office I have a couple of Doonesbury cartoons signed by Garry Trudeau, because he too went after Netaid in an affectionate way. Mixed things happened with Netaid. We had three concerts. And one of them in London was a sell-out success, as was the one in Geneva. Here in New York the concert wasn’t as full as we wanted. And so there was some immediate commentary of “Oh well, perhaps Netaid didn’t succeed.” But Netaid was a uniquely new event for the age of the Internet, because rather than being like earlier concerts about poverty, a once-off effort to raise money on the night of the concerts, this was the beginning of a process. It was to try and build a constituency of people who’d not previously had their imaginations or interests caught by development, to now network them together through the Internet as an interactive group of men and women who care about development and want to learn more about it, want to participate, want to be active, either through financial contributions or lending their support. And so the Netaid Web site, the real legacy of the concerts, has gone from strength to strength and has become a very new and innovative interactive model of how you give to support development.
PORTER: This is only one small part of, what I know is a personal interest for you in using information technology with development. What are the other ways? How else are you using information technology to promote development?
BROWN: It’s been one of our most important priorities here. And it’s been one which, you know, it’s open to some controversy and skepticism because there’s a lot of people in development who throw up their hands when they hear all about how IT is going to solve the issues of development, and say, “Look, when there’s a billion people in the world who can’t read or write, when huge parts of the world don’t have drinking water or access to basic conventional schooling, why on earth do you think a technology, which is a rich man’s technology, has got any application to the lives of the very poor?” And it’s an answer-well, you against that have other people, on the other extreme, who argue the contrary proposition: that development is going to be transformed and there’ll be an Internet terminal in every mud hut in the world. Well, I try to position myself in UNDP between the two extremes. But if we’re on one side of the argument, it’s on the side which says IT is going to transform development. Now our view is that in the same way that banking and financial services for those of us in the United States or North America, have been transformed over the last few years, the delivery of development services for the world’s poor will equally be transformed over the coming years.
PORTER: I want to move on to a few different areas. I know you’ve launched a major new program to deal with HIV/AIDS. Tell us who your partners are there and what the goals are.
BROWN: Well, there, we’re not a health agency. And we look to WHO on that, just as we look to UNICEF, for example, to intervene on the critical mother-and-child issues related to HIV/AIDS. But we are a development agency. And we see in southern Africa a situation where the capacity of countries to cope is being overwhelmed by this crisis. For example, the number of healthcare professionals and the number of teachers in many countries in that region will be reduced by a third over the next five years as people fall victim to the disease. So there’s a huge sort of capacity-building, development challenge which is central to this. And that’s what we’re focusing on, trying to meet that dimension.
PORTER: It’s interesting that you mention that you’re not a health organization, yet there’s this direct tie. Another area where there’s a little controversy, I guess, is your work with democracy and good governance. You recently announced a big initiative with the National Democratic Institute in the United States. And sometimes people wonder again if you’re stretching the mission of UNDP here. And maybe you can explain to us again how you get from anti-poverty to democracy.
BROWN: Well, it’s a very good point, and, you know, in a sense, Amartya Sen, the famous Indian economist who probably won his Nobel laureate for economics for one insight above all others, which was that in India over the last 50 years there’d never been a major famine despite high levels of poverty, because people had the vote. They had the opportunity to make a fuss, even down to the simplest, poorest village level. When they saw a food shortage on the horizon and they made a fuss, and it reached up through their MP to Delhi, where the powers that be in Delhi did something. They responded. And that is an illustration of the relationship of political power to poverty. When people have a voice and they have a means of expressing themselves in the national political debate, they get a bigger share of resources. And that, and they get the empowerment that comes from that to start exercising some control and choice over their life. So I think there is a link in that sense.
And you know, there are plenty of other countries which, while they were doing better economically, were much less effective at protecting their poor from food shortages. For example, in China there has been at least one very major famine which cost millions of lives, in that same period. Because there wasn’t the same opportunity for people to make a fuss. And so we do think there’s a clear link. Now having put it at that conceptual level, you know it breaks down into some very practical things. Which is that when the poor have got the franchise resource distribution changes. Without some political participation, more often than not, urban elites command the lion’s share of public spending. You get fancy healthcare systems or school systems which see their kids all the way through tertiary education, while the village schools aren’t even functioning for primary education for the poor. And time after time it’s addressing the issue of getting some power to the power, which is the best way to solve these distribution issues in development. And I think the striking thing about my first year or so at UNDP is well, when I began saying this there was some controversy. I feel we won this argument hands down. Not because of the power, my powers of persuasion, but because when countries stopped and looked at how they were actually using UNDP resources, at the country level, they found it was around this governance agenda.
PORTER: In the short time that you’ve been here you’ve pushed this agency, you’ve launched new initiatives. What’s next? What’s next on the agenda for UNDP?
BROWN: Well, I think we’ve had a tremendously, I’m glad to say, tremendously successful first year in that we’ve recovered our footing. I think people understand where we’re going. There’s a sense of focus, a sense of excitement amongst all of our governments that support us. They for the first time ever came together at the ministerial level, 50 ministers to endorse what we were doing. So all of that’s there. Now the next bit is to demonstrate that at the country level we can carry out this ambitious program for development that we’ve laid out. It’s the issue of performance, if you like. And that’s where the UN has often stumbled in the past. There’s been a terrible vicious circle-governments haven’t given us the resources to hire the first-class people to do a first-class job. We’ve attracted a lot of first-class people because it’s such a vocation to work for the UN on development. But we’ve never resourced that in the way it should be. So now we’ve got to break out of that trap and demonstrate by the quality of our performance at the country level that we merit the extra resources to really complete our mission. And so this next year is all gonna be about the micro-management level of fulfilling the opportunity we’ve been lucky enough to create for ourselves over the last year, of a fresh, expanded mission. This year it’s all gonna be about delivering on that.
PORTER: That is Mark Malloch Brown, Administrator of the United Nations Development Programme. For Common Ground, I’m Keith Porter.
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