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Chris Elias on immunizing the developing world

Lessons from a life’s work dedicated to making it easier, faster, and cheaper to deliver high-performing vaccines to the world’s most vulnerable people.

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Director of Innovation Strategy, International Rescue Committee
Chief Innovation Officer, International Rescue Committee

The public health sector is home to some of the greatest victories in the field of international development. New and more widespread vaccines, cleaner water, and improved sanitation have helped cut the number of children around the world who die before their fifth birthday by more than 50% since 1990, even as the global population increased by over 2 billion people in the same period. Not only are people living longer, healthier lives worldwide, but public health gains are spurring economic gains: For every dollar invested in immunization, there is a $44 dollar return in terms of economic growth.

But advances in public health have not been distributed equally. The segments of the population who have not benefited from improved healthcare are primarily concentrated in conflict and crisis affected settings , posing new and complex challenges for public health practitioners. As the international community strives to realize universal healthcare, the push to reach those at the “last mile” of services delivery is reshaping how the sector allocates resources and thinks about innovation.

For example, in 1980, vaccine coverage for an array of the world’s most widespread diseases hovered in the single digits. Today, four out of five of children worldwide receive a suite of vaccines against diseases like measles, TB, diphtheria, tetanus, pertussis, and hepatitis thanks to universal immunization programs. According to Chris Elias, the president of global development at the Bill and Melinda Gates foundation on today’s show, “We have to reach that fifth child. But...that fifth child isn't standing next to the other four. That child is in a war zone, is a displaced person in a vulnerable area where they may not even be counted. They're in an urban slum.” In fact, 60% of children who do not receive universal immunizations live in just ten countries, seven of which are fragile states.

Chris Elias

Elias’s job is to find ways to ensure that solutions and products get into the hands of people in developing countries who need them most. Over his four-decade career in global health and development, he has worked as a pediatrician in a refugee camp on the Thailand-Cambodia border, piloted HIV/AIDS prevention programs in Southeast Asia, and overseen the development of an affordable meningitis vaccine that he predicts will save 150,000 lives by 2020. Prior to joining the Bill and Melinda Gates Foundation, where he oversees an annual $4 billion spend on global health, education, and poverty reduction programs, Elias served as the president and CEO of public health nonprofit PATH.

Many of the innovations center around the supply chain, ensuring medicines remain viable while they’re in transit from the manufacturer to the patient, which can be a journey of thousands of miles. The cholera vaccine, for example, can only be stored in a narrow band of temperatures (2-8 °C). Health workers trying to vaccinate the roughly 13.8 million people in Yemen currently at risk of contracting cholera need to keep the medicine within those temperatures at all times -- while simultaneously dealing with electricity outages, active conflict, and blockades that restrict imports of essential goods.

You have to go beyond just creating new technologies. You have to think about the systems into which those technologies will have to be delivered in order for you to have the impact that you want to have in improving children's livelihood and reducing their mortality.

Elias previews a suite of solutions designed to surmount those challenges, including the introduction of vaccines that don’t need to be kept cold, affordable cold storage equipment that’s responsive to electrical surges or weak electricity, and management innovations that optimize how medicines are delivered. And the fact that supply chains now dominate the public health discussion represents a sea change in a sector that now seeks to escape innovation pile-up. “If you go back 18 years ago, initially [the Bill and Melinda Gates Foundation was] very focused in our investments on new tools and technologies. We had a strong pipeline of new technological innovation for people living in very poor countries,” Elias says. “But that technological innovation was then facing health systems that were ill prepared to adopt it or to scale it. One of the things I think we've learned is that you have to go beyond just creating new technologies. You have to think about the systems into which those technologies will have to be delivered in order for you to have the impact that you want to have in improving children's livelihood and reducing their mortality.”

Elias says that the key to implementing these advances will be partnerships between the public sector, private industries, and nonprofits. That’s something he has plenty of experience in: Between 2000 and 2012, Elias forged an innovative partnership with the WHO and over 30 other organizations to develop and roll out an affordable vaccine for meningitis, with support from a $75 million grant from the Gates Foundation. Of those affected by the virus, 10% die and another 10% are permanently disabled. The 1996-1997 epidemic resulted in more than 250,000 cases and 25,000 deaths in Sub-Saharan Africa, many of them children. It took PATH nine years to develop the vaccine, which since it was introduced among the 26 meningitis belt countries in Africa, has eradicated meningitis in many places and eliminated meningitis as a public health problem.  

Elias has a privileged view from the leading edge of the sector of public health. The Bill and Melinda Gates Foundation has been at the forefront not only of some of the most important public health advances in the past two decades, but has also helped build much of the modern global infrastructure dealing with epidemics and diseases. This is the conversation you need to listen to if you want to understand where public health has been and where it’s going.

Related Reading

The Global Development Community Asks Tough Questions Here are the Answers – Devex, Chris Elias

Gavi, the Vaccine Alliance, is exploring new partnerships to increase access to immunization – Devex, Catherine Cheney

Why We Still Haven’t Stopped Cholera – Mosaic, Rose George Since the publication of this article, Yemen has surpassed Haiti as the site of the world’s worst cholera epidemic. But because of travel restrictions, reporting on Yemen’s crisis has been limited.

The Media Loves the Gates Foundation. These Experts are More Skeptical – Vox, Julia Belluz

Money or Die – Foreign Affairs, Laurie Garrett

How Private Companies Are Transforming the Global Public Health Agenda – Foreign Affairs, Sonia Shah

The future of routine immunization in the developing world – Global Health Science and Practice, Angela K. Shen, Rebecca Fields, and Mike McQuestion

Can We Provide Vaccines for the World? – Seth Berkley, Christopher Elias, Jeff Sturchio and Lyndon Haviland at Aspen Ideas Fest

Interested in learning more about what went behind this episode? Check out Airbel's Medium.

Opinions and views expressed by guests are their own and do not reflect those of the International Rescue Committee.