“A spoon full of sugar makes the medicine go down”

RI General Secretary John Hewko’s Address to the World Vaccine Congress – 12 April 2012

Washington, DC

It is my honor and privilege to be here at the World Vaccine Congress and to proudly represent the 1.2 million men and women of Rotary

And on behalf of the 34,000 Rotary clubs worldwide, let me also express my sincerest gratitude to every person in this room. Because if it weren’t for you — the professionals who fund and conduct vaccine research — who develop, produce, and distribute these lifesaving agents — we at Rotary could not do what we do.

And what do we do?

As you saw in the video: We eradicate polio.

We do other things too, of course. Rotary clubs support literacy and education. We promote maternal and child health. We improve access to clean water and sanitation.

But Rotary’s highest priority is the eradication of polio.

This crippling childhood disease has been Rotary’s sworn enemy for more than three decades, and you provide us and our partners with the weapons — the vaccines — that have carried us to the threshold of victory. Thanks to vaccines, humanity was able to conquer smallpox. And now we are poised to make history a second time by eradicating polio.

But before I talk in more detail about how close we truly are to a polio-free world, I want to share a little story about the polio vaccine. Call it a pop-culture tidbit that perhaps illustrates just how much a part of our lives vaccines have become — in ways that we don’t always expect.

A few weeks ago, I came across a news story about a gentleman named Robert Sherman, who had just passed away at the age of 86.

His obituary indicated that he was an award-winning composer who did a great deal of work for Disney Studios. One of his assignments was to write the songs for the 1964 musical, Mary Poppins, a very popular movie that I certainly remember, and I imagine many of you do too.

One day, Mr. Sherman found himself struggling with the lyrics for one of the film’s most important songs. He needed a catchy phrase around which to build the song — to anchor it. Something memorable! But try as he might, nothing seemed to work.

Then his 8-year-old son came home from school.

The father asked the age-old question: “So how was school?”

“Great, we got the polio vaccine today,” came the response.

Mr. Sherman assumed it was delivered by injection. “Did it hurt?”

“Nah,” the boy said. “They just stuck the medicine on a lump of sugar.”

A light bulb popped above the father’s head, and an instant classic was born.

“A Spoon Full of Sugar Helps the Medicine Go Down.”

Yes, the same vaccine that has saved millions of children from a lifetime of disability also inspired one of the most memorable songs in Hollywood history, a song that helped Mr. Sherman win an Academy Award for Best Original Score that year.

I would say that’s a great example of creative, off- label use.

Now let me shift gears and take a look at how Rotary and our partners in the Global Polio Eradication Initiative have put the oral polio vaccine to its intended use.

And to great effect, I must say.

Rotary officially took on polio eradication as our number one priority when we started our PolioPlus Program in 1985. We were the first NGO to address the problem.

In 1988, Rotary was joined by the World Health Organization, UNICEF, and the US Centers for Disease Control and Prevention to launch the Global Polio Eradication Initiative. And more recently, the Bill & Melinda Gates Foundation has joined the cause.

Rotary’s chief responsibilities are fundraising, advocacy, and mobilizing volunteers — and we do a very good job at all three.

In fact, to date Rotarians have contributed more than $1.2 billion to the polio eradication effort.

Many consider the polio eradication initiative to be the most ambitious and successful public-private partnership ever forged. And I want to get back to the private sector part of the equation in a few minutes, because it’s very important and it speaks directly to many of us here today — as private sector professionals.

But first, let’s look at what this partnership has accomplished so far.

Since the initiative began its work to immunize the world’s children against polio, the incidence of polio has dropped by more than 99 percent — from 350,000 cases a year to fewer than 700 for all of 2011. This year, we’ve had 36 cases worldwide as of April 1, well below the case-count at the same point in 2011.

Think about these numbers.

We have reached more than two-and-a-half BILLION children with the oral polio vaccine. Polio eradication activities have reached more families than any other public health initiative in history – introducing millions of parents to the basic concepts of preventive health care.

In doing so, we have prevented more than 5 MILLION cases of childhood paralysis and hundreds of thousands of pediatric deaths.

Already this year, we have celebrated the long-anticipated milestone of seeing India removed from the list of polio-endemic countries, leaving only Afghanistan, Nigeria, and Pakistan as nations where the wild poliovirus has never been stopped.

And because this is such an important milestone, let’s look a little more closely at India, a country of more than a billion people and a host of challenges — among them poverty, pollution, and poor sanitation — challenges that until recently made India an epicenter of polio.

When the eradication initiative began, India was experiencing about 75,000 new polio cases a year.

And if you have spent any time at all in India, you have seen the ravages of polio for yourself —children and adults permanently disabled, unable to walk — the so-called crawlers of the streets — and most of them with little hope of receiving any meaningful treatment or rehabilitation.

However, defeating polio in India didn’t “just happen.” Instead, India’s progress demonstrates — perfectly — how determination, persistence, and planning will ultimately win the day.

Year after year, thousands of health workers and volunteers — many of them Rotarians — have methodically carried out massive immunization rounds — called National Immunization Days — in an effort to reach every Indian child under age five with the oral polio vaccine.

This means going door-to-door — from the remotest villages to the teeming urban slums — to make sure no child is missed.

Public awareness rallies drive home the importance of vaccinations.

Parental misgivings and cultural misconceptions are identified and addressed.

Detailed records are kept. Home addresses are logged.

Even the children themselves become living medical records — their pinky fingers dyed purple to show they have received the vaccine.

Over and over again these immunization rounds take place — vaccinating more than 170 million children each time. Then come the mop-up rounds, targeting communities where children may have been missed or where risk is particularly high.

And sure enough, over time, India’s polio infection rate began to drop. By 2009, new cases totaled just over 700. In 2010, only 42 cases were reported. In 2011, there was only one case — a young girl in West Bengal — recorded on January 13 of that year.

And that was it.

On January 13, 2012, India celebrated a full year without one new case of polio. India’s removal from the endemic list was announced in February during a Polio Summit in New Delhi — a meeting convened jointly by Rotary and the Indian Health Ministry.

Ladies and gentlemen, if polio can be beaten in India, it can be beaten anywhere.

Of course, the vaccine industry has been vital to our progress.

In India, for example, it was very likely that the introduction of the new bivalent vaccine — which targets poliovirus types 1 and 3 — contributed substantially to the steep case-count reductions we saw in 2010 and 2011.

The swift production and deployment of the bivalent vaccine resulted from an extraordinary collaboration between WHO, UNICEF, government regulatory agencies and — of course — the vaccine companies.

Throughout the history of the polio eradication initiative, the vaccine industry has been amazing in its ability to continually and quickly reconfigure the polio vaccines to make sure we have the right weapons at the right time to use against this tenacious disease.

Polio vaccine producers have been incredibly generous in negotiating prices to help make vaccines affordable to developing countries, even donating vaccine supplies for use in emergency responses to sudden outbreaks.

When such emergencies occur, we know we can rely on our pharmaceutical industry allies to deploy the right vaccine in the quantities needed to respond swiftly and effectively.

Trivalent. Monovalent. Bivalent. Each type of oral polio vaccine has proven indispensable to our effort. And as we approach the end game with polio, it is almost certain that injectable, inactivated polio vaccine — IPV — will be introduced into the mix to help in the final stages of eradication and our transition into the post-eradication era.

Yes, I said post-eradication era, but let us not get ahead of ourselves. There is still much to do — and serious challenges to overcome — before we reach that point.

The Global Polio Eradication Initiative retains an Independent Monitoring Board that issues quarterly reports that take a very critical look at our strategies and practices.

These reports provide a valuable reality check that keeps us from becoming too giddy over our successes – even India’s milestone, as wonderful and important as that is.

While acknowledging India’s success, the board in its most recent report said we simply have to do a better job on-the-ground – at the local level – to reach every child with the vaccine in the remaining polio-affected countries.

This means giving the vaccinators the resources and tools they need to get the job done — better training, fair compensation, creative incentives, adequate support, continuous motivation.

We have to make sure that the changes and improvements we make at the organizational level are put into practice at the community level, where it counts.

The Independent Monitoring Board reminds us that beyond the three endemic countries, so-called “re-established polio” has become persistent in Angola, Chad, and the Democratic Republic of Congo.

And 20 additional countries have had smaller polio outbreaks since the start of 2010. Again, these are countries where the poliovirus had once been stopped.

This is alarming, to be sure. And it demonstrates why it is so critically important to stop the transmission of the poliovirus in the three endemic countries, which are the reservoir that enables the disease to re-establish itself elsewhere.

For example, in 2011, polio cases in non-endemic countries totaled 310, almost as many as the 340 cases in the endemic countries.

To me, one of the most surprising outbreaks last year occurred in China, which had been polio-free for more than a decade. The 21 cases there were genetically linked to the same strain of the type 1 poliovirus circulating in neighboring Pakistan – once again, proof that we must stop polio in the endemic counties at all costs.

And speaking of costs.

As you would expect, funding remains the single biggest challenge to the Global Polio Eradication Initiative.

To date, the world has spent more than $8 billion on polio eradication. Yet, the initiative right now faces a funding gap of more than $1 billion in order to carry out immunization activities through 2012-2013.

Believe me — we are working hard to close that gap.

In January of this year, we at Rotary announced that our membership had succeeded in raising more than $200 million in new money for polio eradication. And when you think about the state of the global economy during the past few years, it makes what our members did even more impressive.

This fundraising effort was in response to a $355 million Challenge Grant from the Bill & Melinda Gates Foundation, which has added another $50 million to the total to recognize Rotary’s commitment.

To date, Rotary and the Gates Foundation each has contributed more than $1 billion to polio eradication.

In addition to raising funds for polio eradication, Rotary advocates as a global organization to encourage the world’s governments to commit public resources to a cause that benefits all families, no matter where they live. Because Rotary is present in more than 200 countries and regions, this has proven to be a very effective tactic.

As I mentioned earlier, you can see how important the private sector is to polio eradication.

Without the leadership, participation, support, and cooperation of the private sector — vaccine manufacturers, foundations, the professional and community leaders in Rotary clubs — polio eradication would still be a pipe-dream, not a global health initiative that is 99 percent of the way to achieving its goal.

In fact, for the purposes of polio eradication, we could reverse the order, and call it a PRIVATE-public partnership, because the private sector was there first, leading the way.

It was the private sector — Rotary — that proved to the World Health Assembly that polio eradication was even feasible.

In 1979, the same year that smallpox was declared eradicated, Rotary committed $750,000 through its own grant program to buy polio vaccine to immunize 6.3 million children in the Philippines, which at the time had the highest polio rate in the West Pacific.

By 1982, the incidence of polio in the Philippines had dropped by 68 percent. Using the Philippine experience as a model, Rotary launched successful polio immunization projects in several other Asian, African, and South American countries over the next few years.

Rotary’s early successes in these countries demonstrated that millions of children could be systematically immunized against polio.

Rotary then mobilized its worldwide membership to raise an initial war chest of $247 million to vaccinate all of the world’s children, easily doubling its original goal of $120 million. And as I said earlier, we established our PolioPlus Program in 1985.

With such solid groundwork in place, in 1988 the World Health Assembly adopted the historic resolution that formally targeted polio for eradication, thus creating the Global Polio Eradication Initiative, the wonderful partnership we’ve been talking about.

And I must add that a key vaccine researcher was with us from the beginning. Dr. Albert Sabin was a staunch ally of Rotary and spoke at two Rotary International conventions, in 1980 and 1985, to encourage Rotary to embrace polio eradication as our global cause.

Dr. Sabin was a visionary. He could see the history-making potential of his oral polio vaccine, delivered to the world’s children through the resources of Rotary, an organization of everyday business and professional people committed to the goal of a polio-free world.

Yes, it has become increasingly clear to me that private sector leadership is one of the key components to any valid solution to community problems the world over — and polio historically has been a major one.

The continuing support of the world’s governments is by all means crucial to our success – of course it is — but governments alone cannot eradicate polio.

But by working together, as a team — leveraging the strengths of both the public and private sectors — WE CAN eradicate polio. And we will.

So what will be our legacy when polio is finally gone for good?

For one thing, the world’s $8 billion investment will be protected. In fact, eradication will result in net benefits estimated at $40 billion to $50 billion over the next two decades.

Most of the benefits will accrue in developing countries, as per capita production goes up and health care costs drop after the burden of polio is lifted.

Another tangible benefit is the solid public health infrastructure that polio eradication will leave in place — systems that can be used for the delivery of other vital health services.

For example, active disease-surveillance networks have been established in all of these countries, assets that can be readily repurposed to address other diseases, such as measles, malaria, and HIV.

Once achieved, polio eradication will set the stage – and provide the inspiration — for the next great global health initiative.

But the most important legacy, of course, will be our collective gift to children everywhere: a polio-free world.

This realization hit me hard — and in a very emotional way — last November in Mumbai, where my wife and I had our first opportunity to vaccinate children as part of a Subnational Immunization Day.

The first child I immunized that day was a little girl. I can honestly say that the feeling of joy and pride that I felt as I placed the vaccine drops into her mouth will live with me forever.

Two small drops and a lifetime of misery is prevented.

There are few certainties in life, but at least her parents can be certain — as I am certain — that polio will not rob that child of her future.

What more can I say?

It was a truly humbling experience, and I thank you for enabling me — and the thousands of my fellow Rotarians who have devoted countless hours to immunize the world’s children — to have such a profound and powerful impact on another human’s life.

And I also invite YOU to become personally involved in our cause.

Use your voices. After you leave the World Vaccine Congress and return to your homes and to your jobs, tell your families and colleagues how the polio vaccines that you develop — that you manufacture, distribute, and regulate — are helping us to make history.

Together, we WILL End.Polio.Now.

Thank you.

 

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