Bill Gates' Goal: Get Rid Of Polio, Forever

Guests

Bill Gates, co-chair, Bill & Melinda Gates Foundation
David Oshinsky, Pulitzer Prize-winning author of Polio: An American Story

The Bill and Melinda Gates foundation has released its annual letter, outlining goals for the coming year. What's on the list? Getting rid of polio, once and for all. Vaccines reduced the disease in the U.S. by 99 percent, but it still erupts in India, Pakistan, Afghanistan and Nigeria.

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan, in Washington.

The Bill and Melinda Gates Foundation released its third annual letter today, which focuses largely on the campaign to eliminate polio. Many may believe this is a problem that was solved 50 years ago, when vaccines virtually eliminated this once-dreaded disease in the United States and other developed countries.

But despite a concerted worldwide campaign, polio persists in about a dozen countries, with about 1,500 cases reported last year.

The Gates Foundation wants to make the disease the first to be eliminated in the 21st century and has donated about $200 million a year to that end. On Friday the foundation increased this year's pledge by an additional 102 million.

In a moment, Bill Gates will join us, as soon as he fights his way through cross-town traffic in New York. We're also following events in Egypt closely. Later, on the Opinion Page, Romesh Ratnesar will argue that it's time for the U.S. to get off the fence and embrace change.

But first, if you've had experience with polio, either as a healthcare worker or as a patient, particularly if you've worked overseas, call and tell us your story. 800-989-8255 is the phone number. The email address is talk@npr.org. You can also join the conversation at our website. Go to npr.org. Click on TALK OF THE NATION.

As we mentioned, Bill Gates should be with us in a few minutes, but we'll go first to David Oshinsky, who in 2006 won the Pulitzer Prize in History for his biography of this disease called "Polio: An American Story." He holds the Jack S. Blanton Chair in History at the University of Texas at Austin and joins us today from our bureau in New York. Nice to have you with us today.

Professor DAVID OSHINSKY (University of Texas, Austin): Thank you, good to be here.

CONAN: And you wrote about the struggle to find the vaccine and then the struggle to get people on board. In retrospect, why was it so difficult to get people on board?

Prof. OSHINSKY: It was difficult early on because nobody really knew much about polio. It was a relatively new disease and a very frightening one. Fortunately for the campaign against polio, the most important polio survivor was Franklin D. Roosevelt, and in the 1930s FDR decided to form the March of Dimes as a way of finding a vaccine and hopefully a cure for polio and also providing free rehabilitation to every polio survivor in the United States.

CONAN: But even after the development of the vaccine, first the Salk vaccine that was injected, and then the Sabin vaccine later, it seems like there's always resistance, even though the benefits are demonstrable.

Prof. OSHINSKY: Yes. I think there's more resistance today because people simply don't have the same risk-versus-reward concept that, say, my parents did in the 1950s. They had seen polio every year. They knew how devastating it was. They knew that a vaccine was - taking a vaccine was far less riskier than actually risking the disease itself.

So these were people who saw, every summer, swimming pools closed. They saw movie theaters closed. They saw children in iron lungs, children in wheelchairs, many children dying of this disease. So for them the vaccine was a godsend. They fully understood its value, and in fact it did, within a very short period of time, eradicate polio in the United States.

CONAN: And I know Mr. Gates has just arrived, but I wanted to ask you one more question before we turn to him, David Oshinsky, and that is: What lessons do you think the example of the United States gives us to act in the world today to try to eliminate this disease once and for all?

Prof. OSHINSKY: Well, I think there are there are many lessons to be learned. One is that you have to be very focused. You need good leadership. You have to be really relentless in going after this disease. I think you have to really, as the Gates Foundation has done, is give grants to best and most ambitious scientists.

And I think the most important lesson of all is that it has to be inclusive. I mean, this was a campaign that included tens of millions of Americans. This was really a campaign that became everyone's campaign to end this insidious childhood disease.

So inclusion, leadership, focus, these are all the things that - the lessons that we've learned, and we're very, very close now to ending polio in the world. And the Gates Foundation, I'm quite confident, will take us over the finish line.

CONAN: Well, as we just mentioned, Bill Gates, co-chair of the Bill and Melinda Gates Foundation, is with us now from our bureau in New York. I hope you've recovered from your struggle with the traffic.

Mr. BILL GATES: (Bill and Melinda Gates Foundation): No problem.

CONAN: Nice to have you back on TALK OF THE NATION. And I wanted to talk about that. You note in your letter that was released today that in 2003 you would have said we're just a year or two away from the eradication of polio.

Mr. GATES: That's right. The last one percent is by far the most difficult. And we have four countries where we've never managed to eliminate the disease. And then as long as it's in those countries, it spreads around, and you see outbreaks anywhere there's not very high vaccine coverage.

CONAN: And those countries include Nigeria. And you were there in Nigeria to try to talk with people who were, at least initially, resistant to the idea. The rumor had spread that the polio vaccine made women sterile.

Mr. GATES: Right. A political leader actually spread that rumor, and it was the religious leaders who helped us get the truth out. In fact, they made sure the vaccine was being made in Indonesia and had various scientists they trusted look at it.

And so the trust came back, and in fact in 2010 we had a dramatic reduction, over 80 percent reduction, in the cases in Nigeria. So we're at the lowest level of cases ever now, partly because we've got it so people didn't refuse it. Partly we improved the vaccine, and we raised the political will to get coverage.

CONAN: And some people might say, well, you know, isn't close-close enough? You've got 1,500 cases last year. Well, that's peanuts compared to malaria, cholera, AIDS, any of a dozen other diseases. Why focus all this money and effort on polio?

Mr. GATES: If you withdraw the incredible focus on polio, it will spread back, and in poor countries you'll get something like 100,000 cases a year. So by being very intense these next three or four years and getting the cases down to zero, what you do is you avoid all the future cases.

And so it's actually an incredible bargain. All vaccines are amazing, and our foundation has polio as a top priority, but other vaccinations that aren't part of eradication campaigns are also super-important.

CONAN: What did you learn on that trip to Nigeria?

Mr. GATES: I've been several times now - and I met with the Sultan of Sokoto, who is the traditional leader, the first time, and the Emir of Kano on the last time - that religious set of people are very helpful. They're kind of a check on the political set, where the actual funding and delivery takes place. But they see where things aren't happening, and they become a real asset.

CONAN: And they become an asset, so how much of the many millions that you, that the foundation has donated, how much of that - as you said, you've improved the vaccine, so some goes to research, some goes to, obviously, buying vaccine and distributing it - how much goes to education?

Mr. GATES: You mean education about vaccines or education in general?

CONAN: Education about vaccines?

Mr. GATES: Well, the delivery campaigns include a lot of social marketing so that mothers know when to bring their kids and why to bring their kids.

Routine immunization, fortunately, is a habit in a lot of countries. When you have a newborn, you know, that if you don't take it in for those shots, that child has a very high chance of dying.

And so, you know, you can - fortunately, you can spend a lot of the money on the delivery system and the vaccines themselves. You don't have to do that much marketing.

CONAN: We're talking with Bill Gates, co-chair of the Bill and Melinda Gates Foundation. Also with us from our bureau in New York, David Oshinsky, Pulitzer Prize-winner for the history category for his book "Polio: An American Story."

We want to hear from those of you with experience of this once-dreaded disease or once-dreaded in the United States. There are parts of the world where it is still a scourge, 800-989-8255. Email us, talk@npr.org. Ivy's(ph) on the line from - well, I'm not sure how to pronounce that name in Georgia.

IVY (Caller): It's Rabun Gap.

CONAN: Rabun Gap, okay.

IVY: Hi. I'm a post-polio survivor and sufferer. I actually met Dr. Oshinsky at a Warm Springs conference a year and a half ago. And I actually have some parents who were students when I was a teacher a while back who are now voicing their opposition to taking any immunizations. And their options are then to home-school their children, but that means they're still having children who don't have the immunizations to the disease.

CONAN: And what do you tell them about your experiences, and does that help change their minds at all?

IVY: Well, the amazing thing in my case is that for 45 years I behaved like a normal, average person, served in the military, started running marathons and whatnot. And in 2008 my body actually began to suffer from post-polio in such a way that now I can't walk unaided. I am in a chair a lot of the time.

I actually have them, if I can see them and get them to me, I'll have them feel part of my leg and say that - you know that was normal, now look at it. This is what post-polio can do...

CONAN: David Oshinsky...

IVY: ...(unintelligible) polio in a severe case.

CONAN: David Oshinsky, we should point out Warm Springs is the resort that, of course, where, among many others, Franklin Delano Roosevelt took treatment for polio.

Prof. OSHINSKY: Right. He actually bought the resort and turned it into a rehabilitation center for polio survivors.

I would say that post-polio syndrome is quite serious. It's not the return of the polio virus. What it really means is that polio survivors have had to use different sets of muscles and the like to compensate for what they lost, and over time those muscles begin to break down.

And it's a very, very serious problem, but it is not the return of the polio virus. And as for people not taking the vaccine here, all I would say is that what they're really doing is piggy-backing off people who are taking the vaccine here, which to me is very, very selfish.

And one of the reasons they think that they do not have to vaccinate their kids against polio is that the polio vaccine here has been so successful that they do not have to enter into this.

But it's a fool's bargain, because polio virus is out there, wild polio virus. The more people you don't vaccinate, the more potential victims there are for that wild polio virus. So my very, very strong recommendation would be to vaccinate.

CONAN: And are there any adverse effects from the polio vaccine?

Prof. OSHINSKY: There have - literally since the late 1950s, when there was a problem, which was immediately solved, there have been no health problems associated with the polio vaccine.

CONAN: Ivy, thanks very much for the call, and we wish you the best of luck coping with the post-polio problems.

IVY: Well, thank you very much. And if I could encourage Mr. Gates to actually consider encouraging folks who have thought they had finished off the polio vaccine program, to consider how they could help the children and adults who are now affected, even a crutch makes a world of difference for somebody who can't walk.

CONAN: Ivy, again, thanks very much for the call. Bill Gates and David Oshinsky are with us. We're talking about polio. Stay with us. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION, from NPR News. I'm Neal Conan.

We're speaking with Bill Gates this hour, co-chair of the Bill and Melinda Gates Foundation, the world's largest charity. Among its many recipients, the foundation has generously supported NPR News for several years. We thank them for that.

Today, the foundation released its third annual update on the foundation and its work, a large portion of the letter devoted to the eradication of polio.

And we're taking your calls today if you've had experience with polio, either as a health care worker or as a patient, and we'd particularly like to hear from those of you who have had experience with it overseas. Give us a call: 800-989-8255. Email us: talk@npr.org.

Bill Gates, I wonder, can you tell us - you said only four countries in the world where it continues to erupt. Obviously, it erupts other places after people travel to there from Nigeria, India, Pakistan. And what's the fourth one?

Mr. GATES: Afghanistan.

CONAN: And so what are you encountering in terms of difficulties of eliminating - you've talked some about Nigeria. Well, what about India and Pakistan and Afghanistan?

Mr. GATES: Well, India's another really positive story, where the cases went way down this year. The Indian government funds its own campaign, and they intensified the marketing, even finding kids whose families move around a lot. Bihar is an area where they have floods. The way agriculture is done, you really aren't sure where all the kids are. And so that one was particularly tricky.

It may be that Pakistan will be our toughest location. That is the only one of the four where the number of cases went up last year.

CONAN: And so what is involved in getting the caseload down there?

Mr. GATES: Well, everywhere, it's a matter of finding the children, and at least three times having them take these OPD drops. And that protects almost all the children.

So it's really the coverage. Now, if kids are in a war zone, an area where you can't get to because of floods, if the people you hire to do the vaccination don't speak their language or can't relate to them - you know, the mother doesn't want to come out and let her kids be vaccinated - you run into huge logistical problems.

But what you do is you survey, and you find out how many kids are missed, and then you intensify wherever that's higher than a few percent.

CONAN: And even if you got down to a case, you know, zero cases, the fight would not be over, would it?

Mr. GATES: Well, you'd have several years where you'd have to monitor to make sure that you hadn't missed a pocket somewhere. And smallpox - 1977 was actually the last natural case, and it took two years. They had a committee, including skeptics, went around and looked for smallpox everywhere, and then they achieved their certification.

So, you know, this is going to take a number of years of intense funding and focus before we can say it's completely done.

CONAN: Let's go next to Patrick, Patrick's on the line with us from Downingtown in Pennsylvania.

PATRICK (Caller): Hello?

CONAN: Hello.

PATRICK: Yes. My name is Patrick Shanu(ph) from Downingtown, Pennsylvania. First, I want to be thankful to God for being live with Mr. Gates. I want to say thank you for him and his wife and their organization for what it's doing for (technical difficulties).

And I'm the (unintelligible) polio, because one of my older biological brother suffered from polio. He was (unintelligible) the polio. And there's a myth (technical difficulties) from Liberia, West Africa. And there's a myth that if people take polio vaccine, they become sterile. They won't have kids, or they might have some future illnesses.

So one thing I wanted to tell Mr. Gates, recommend to your organization, is the awareness of the importance of the polio vaccination for the kids in Africa.

CONAN: Bill Gates, he's addressing what you mentioned earlier in Nigeria, the experience there, that - this myth that the polio vaccine causes sterility. And, well, our caller says it's - that's a widespread myth across West Africa.

Mr. GATES: Well, that's terrible. We have to make sure that people hear that's not true, because otherwise, enough of that would block us from success.

CONAN: Patrick, thanks very much for the phone call.

PATRICK: Thank you so much. I appreciate it. Thanks, Mr. Gates.

CONAN: Let's go next to Larry. Larry's calling us from Sheraton, Oregon.

LARRY (Caller): Yeah, thanks for taking my call. Prior to a trip I did this past fall to Uganda to work in an orphanage, we went to - or I went into the county health department for all the barrage of vaccines. And the briefer there, in a consultation, I think she had 11 different vaccines that were recommend or possibly recommended. One of them was polio, even though I was vaccinated in the '60s for polio as a child.

And she said that there's some sort of a recurrence, potentially - very low risk, potentially of a recurrence of a polio infestation within a previously vaccinated person. What can the doctor tell us about that?

CONAN: Well, we don't have a doctor with us, but David Oshinsky, an historian, can you help us out?

Prof. OSHINSKY: Yes. There are instances where, if you've had the polio vaccine years and years ago - particularly the kill virus injected vaccine - if you go to a polio hotspot, it probably is a good idea to be revaccinated.

CONAN: Larry, did you have any problems after taking all your shots?

LARRY: No. And actually, I didn't take the polio one because she gives sort of odds on these things, and it was the calculated risk. It was a very low risk. And - but she just had to mention it. I guess it was the CDC had put out the publication or something.

CONAN: OK.

LARRY: But I thought it was amazing that it can come back, even though you've been vaccinated.

CONAN: And did you encounter any polio while you were in Uganda?

LARRY: No. There was one young fellow in an orphanage, a beautiful kid, but I'm not sure what his affliction was, but it had all the signs of polio, as naive as I am on it. You know, he was crippled up that way, but there was no sense amongst all the other workers at the orphanage that it was an issue.

CONAN: All right, Larry. Thanks very much for the call. Appreciate it.

LARRY: Thank you. You guys have a great day.

CONAN: And it's interesting, Bill Gates, one of the curiosities of the disease, we think of kids in iron lungs. In fact, not everybody who contracts polio is paralyzed, and you can spread the disease even if you don't suffer from the physical effects of it.

Mr. GATES: That's right. The vast majority of cases, you either suffer no symptoms or something that's minor enough that you don't know that you've had polio.

And so it means that, by the time we see a paralytic case, it's probably been passed on through quite a few kids before we'd see the next paralytic case.

We have a much better understanding of this now, because we actually can sequence the virus and see how far it is from one case to another. In fact, that gives us a sense whether our surveillance system might be missing some cases.

CONAN: Let's go next to Burt(ph), and Burt's with us from Albany in Oregon.

BURT (Caller): Thank you, Neal, for having me on. I'm a Rotarian here in one of my local Rotary Clubs, and as Mr. Gates well knows, Rotary has been one of the catalysts for polio eradication efforts since 1985. And I was wondering if he might be able to speak for a moment about the relationship that the Gates Foundation has had with Rotary International in their efforts to eradicate polio.

Mr. GATES: Well, the help that Rotary has provided for this polio eradication is unbelievable. There's no way we'd be even close without both the money they've put in, but also the volunteer time they've put in and their voice reminding people that this thing isn't done, and there's more work ahead. So Rotary has got that long-term commitment, and they've been helping us out whenever we've run into a problem.

CONAN: Burt, thanks very much for the call.

BURT: Thank you, Neal.

CONAN: But, Mr. Gates, even with the efforts of the Gates Foundation and the Rotarians, reading your letter, it suggests there's more than a half-a-billion-dollar funding shortfall this coming year.

Mr. GATES: Right. If you look at the next two years, we have $700 million to raise to fund the campaign. And normally you'd think, well, that's, on a worldwide basis, ought to be pretty easy. But these are times when people are cutting budgets, particularly for overseas spending, without even looking in to what it's about.

So we've got to remind people polio's close, and if we don't fund it, we'll miss this once-in-a-lifetime opportunity for eradication.

CONAN: Well, how close are you to getting that extra money? I mean, obviously, the Gates Foundation is a big piece of it, but it's not all of it.

Mr. GATES: No. The biggest donors have been governments: the United States, Japan. We did get the U.K. to double, come up to $60 million a year in what they give. I got some money from Abu Dhabi, which they're a new donor. That's great to see.

The United States is spending about $120 million. We are asking them to make a significant increase. So it's going to take a lot of people coming along. You know, we've given now about a billion to it, and we're going to keep giving, but without the other rich governments, this thing will fall short.

CONAN: And you've obviously been aware of calls for severe budget cuts in the United States. Are you confident the United States government is going to be able to come through with a contribution? And you say you want even more this year.

Mr. GATES: Right. I think if a politician knew that they were voting to paralyze kids and have this campaign fail, they might not do it. But this gets grouped in with a lot of things, and, you know, there's a big sledgehammer being used here.

So going and telling the story, how United States' generosity is critical for these global health issues and how it transforms societies to improve child health. We got to get the word out on that because it isn't something that should be a partisan issue. You know, this is about getting these countries to be self-sufficient, to be stable, and so there's every reason that, left or right, this small part of the budget should not be cut.

CONAN: Let's go next to Michael, Michael with us from Coral Springs in Florida.

MICHAEL (Caller): Yes. I went to Africa, and I saw a lot of polio problems. But my question is: Isn't it possible to develop technologies that would allow us to actually infiltrate all these very difficult zones by, for example, infusing the polio vaccine in the water supply systems? Because we do that with chlorine and other agents. Whether you like it or not, you're going to drink that water.

CONAN: Well, chlorine keeps the water clean. Fluoride helps to keep your teeth strong. But, David Oshinsky, is it a possibility to put polio vaccine in the water?

Prof. OSHINSKY: Well, if you're using live virus oral polio vaccine - I'm no expert on this, but I would be very, very, very hesitant to put it into a water supply. It has to be done very, very carefully.

CONAN: Bill Gates, as you've done research and talked to people who do research into this, what do they say about that possibility?

Mr. GATES: Well, there are people we fund who had still not proven, but where killed virus might be possible to put into a plant format where you could eat something. You know, today, the tools we have are the drops, the OPV and the shot, and so all our plans don't assume that some new tool will come along. But we've made sure there's tens of millions being given to people with new ideas every year.

CONAN: So not just a better vaccine, but better delivery methods for the vaccine, if you could put it into wheat or corn or something like that.

Mr. GATES: Yeah. There could be some advantages to that.

CONAN: All right. Michael, thanks very much for the phone call.

MICHAEL: Thank you. Thank you very much.

CONAN: We're speaking with Bill Gates, co-chair of the Bill & Melinda Gates Foundation. Also with us from our bureau in New York is David Oshinsky, who's the author of the book "Polio: An American Story." He holds the Jack S. Blanton Chair in History at the University of Texas at Austin.

And you're listening to TALK OF THE NATION, which is coming to you from NPR News.

Let's go to Kathy, Kathy with us from Fowler(ph) in Minnesota.

KATHY (Caller): Hi. I'm just - I'm interested about the premise that was made before that people aren't getting the polio vaccine because they're, you know, just - the risk is low. I don't have my polio vaccine. My parents didn't get it for me, and I didn't get it for my children, and therefore my brothers and sisters and their kids don't have it, either.

And the main concern was the fact that of the extra things that they use to stabilize the vaccines with, the additives that they put in extra in it, is not this polio vaccine. It's other things that are in it. And if you, you know, you can Google some things. You can look online. You can do a bunch of things. And, you know, one of the additives that you find in some vaccines is also an additive (unintelligible). And that scares the heck out of me.

CONAN: David Oshinsky, can you address some of her concerns?

Prof. OSHINSKY: Yes. The main problem, certainly, for the people who will not get vaccinated with Thimerosal, which was put into polio vaccine. And the belief was that it may cause autism. And there's been an awful lot done in terms of studies in Western Europe, Canada, the United States, and no correlation was found between Thimerosal and autism from those children who took vaccines. Indeed, when Thimerosal was taken out of many of these vaccines, the autism rate in the United States still rose.

So, obviously, autism - which is the key in this - is a very big problem. We need more studies about it. We certainly have to try to figure out what causes it and why and do something about it. But to tab it to vaccines, I think, is a real mistake. Not only is there no evidence, but what it leads to is larger numbers of unvaccinated children. And that's not only a problem for polio. It's a problem for a wide range of vaccine-preventable diseases. And to me, that's nothing short of a tragedy.

KATHY: Well, I'm not even thinking about autism. I'm thinking just how it manifests in the body, how your body may store it someplace or it comes out in a different - you know, just in different health problems later. I'm not thinking about autism. I'm thinking about just in general. You know, it can react, like, in the body for people.

Mr. GATES: Yeah. Vaccines have been proven to be safe, and what happens if you don't take vaccines is children get measles and die. So the anti-vaccine crowd has, you know, kept measles around in a way that - you know, it's a tragedy, because so much is done to make sure these things are safe.

CONAN: Kathy, thanks very much for the call.

KATHY: Thank you.

CONAN: Bye.

Here's an email from Karen in North Carolina: I have a good friend who formally worked with World Vision and is now working with David Newberry at CARE in polio eradication programs. She is, in fact, in Nigeria now. What she credits much of the success of the programs to is the use of local people to travel from community to community to help identify polio sufferers. Once a polio case is identified, they specifically target that area with treatment.

Bill Gates, are you aware of that, and is that something that's working?

Mr. GATES: Yeah. There's a great surveillance system that looks at all the kids who have any type of paralysis of the limbs. And then you take a stool sample, and you see if that kid had polio. And by tracking the cases, even looking at the genetics of that virus, we can understand where we need to focus. And so that's a wonderful way that we're making sure we're intensifying where it's necessary.

CONAN: And one final question - we just have about a minute left, though. What's the endgame? Emails Paul in Tallahassee. Does the virus exist in the wild? Do we continue to vaccinate indefinitely?

Mr. GATES: There will certainly be a period of time where we're not absolutely sure that the virus is gone, and we'll probably switch to using the IPV primarily over time, which has happened in the United States. And whether we get to where we've got the small pox, that you take no vaccine at all, that's an interesting question. But we will be able to avoid the main expense with polio right now, which is running these huge national immunization days that are in addition to your normal vaccines. That won't be necessary once we're fully certified as having eradication. So it would just be in the routine program.

CONAN: Bill Gates, thanks very much for being with us, and, of course, we wish you the best of luck with this.

Mr. GATES: Thank you.

CONAN: And, David Oshinsky, thank you for your time today.

Prof. OSHINSKY: My pleasure.

CONAN: David Oshinsky holds the Jack S. Blanton Chair in History at the University of Texas at Austin. Again, his book, "Polio: An American Story."

When we come back, we're going to be talking about Egypt on the Opinion Page. Stay with us. It's the TALK OF THE NATION, from NPR News.

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