Hilton Humanitarian Prize
Colleagues, friends, ladies and gentlemen,
It is a pleasure to be with the winners and awarders of the Hilton Humanitarian Prize. It creates an infectious feeling of success and optimism: goodwill and good ideas are alive and well in the world today, and they are being translated into good work. It is not always easy to see this fact. I would like to thank you all for making it so clear for us here today.
My warmest congratulations to Heifer International for winning the prize, and for their many successful activities around the world for many years.
Like most people, I can easily appreciate the beauty of the idea of donating livestock and encouraging the recipients to "pass on the gift". As a child I looked after some chickens. I fed them and collected the eggs, seeing some of the eggs hatched and the chicks growing gave me a good introduction to biology and nutrition.
I would like to use this opportunity to make just one point: the struggle for health and development is the most important one in the world and, ultimately, the most effective way to work for justice, security and solidarity. I think this was the great insight that started the Hilton Foundation, and Heifer International as well. In fact, both of them began in 1944 when large parts of the world were being destroyed by war. The absolute need for activities that protect and foster life was as clear then as it is now - perhaps even clearer.
Rather than present you with an argument to prove the value of health work, I would like to tell it with a story. This is the story of the fight to free the world from polio.
Polio is a viral disease that attacks the nerve cells in the spinal cord, which control the muscles. If the muscle needed for breathing or swallowing are affected, the patient may die. Unless the attack is minor, most victims of polio will be crippled for life. The recorded history of this disease is long - three or four thousand years - but I will concentrate on some of the recent and current events.
In 1916, there was an outbreak of polio here in New York City. That year there were 27 000 cases in 26 states of the US, with 6000 deaths. New York alone had 9000 cases with 2400 deaths.
This epidemic naturally generated a great deal of fear. Thousands of people tried to move out of New York with their children to safer places. The surrounding towns tried to keep them out, for fear of infection. The health authorities tried to reduce the panic by improving hygiene and restricting movement. But, although the virus had been identified in 1908, they still did not know exactly how it was transmitted. Attempts to find a vaccine had failed. Eventually it was the winter that ended the outbreak. But epidemics recurred with the warmer weather for the next four decades.
Children with polio were isolated in hospitals. There were tragic scenes of families gathering outside, weeping and praying for their children and waving at the hospital windows. Some wards were filled with iron lungs which looked like metal coffins, each with a child labouring to stay alive in it.
When Franklin Delano Roosevelt, a New Yorker, was 39 years old, he contracted polio and was paralysed. That was in 1921. He requested the media never to publish pictures of him that showed his leg-braces. They respected his request.
In 1938, Franklin Delano Roosevelt helped to start the National Foundation for Infantile Paralysis. The Foundation's drive to support research for a vaccine produced the March of Dimes campaign, funded by individual contributions from Americans. This marked the beginning of a huge mobilization of support in this country for the fight against polio.
One of the scientists working with the Foundation was Jonas Salk, born here in New York. He discovered and developed inactivated polio vaccine in 1952.
Two years later, some 1.7 million US children participated in the field trials for this new vaccine. Its successful introduction caused a sensation in countries panicking over polio epidemics.
Things moved quickly in those days. One factor that greatly helped was Salk's approach to patenting. When asked who was the owner of the new vaccine, he famously answered: "The people! Could you patent the sun?" Not only had he made a wonderful discovery but he had a wonderful attitude to it.
Danny Kaye and Bing Crosby supported the March of Dimes, posing for the cameras together, enthusiastically, in 1954 with a smiling little girl in leg-braces. Elvis Presley was pictured in 1956 flanked by a doctor and a nurse, looking happy to be getting a polio shot in his left arm. Many other celebrities joined in.
And so the fight against polio became a massive popular movement in the United States, and a highly successful one.
There might be several ways to explain this phenomenon. One was solidarity with the large population of children on crutches, in leg-braces or lying in iron lung machines. Another was belief in science and human ingenuity to solve even the most cruel and frightening problems. A third was the effect of strong support from the top. In this case, commitment from Franklin Delano Roosevelt to successive American Presidents was a decisive help.
You could say that, in those ways, polio was a major public health challenge that brought out the best in people, and the best in American Presidents.
Meanwhile there was increasing international recognition of the power of immunization against other diseases to save the lives of children worldwide.
This and increased production capability led to the realization that some diseases could be eradicated entirely. The most feasible of these was smallpox. A vaccine that provided complete protection against it had been in use for 150 years. In 1959, the World Health Assembly gave its full support to a bid to wipe out smallpox. That 20-year campaign ended in victory in 1980, with smallpox being officially declared the first human disease ever to be deliberately eradicated. One of the main players in this effort was Dr Bill Foege, who is with us today.
Though smallpox was finished, polio was still disabling half a million children every year. Especially in conditions of poverty, paralysis condemns its victims to a lifetime of extreme suffering and deprivation.
One of the most remarkable aspects of the fight against polio in recent times is the involvement of Rotary International. It began in the Philipinnes, where The Rotary Club organized immunization activities and showed how transmission could be dramatically reduced with the help of volunteers.
This encouraged Rotary International to set in 1985 the amazing target of immunizing every child in the world against polio. They have raised 600 million dollars for this effort and are raising a further 100 million. The World Health Assembly, the US Centers for Disease Control and Prevention, and UNICEF took up the challenge in 1988, and launched the Global Polio Eradication Initiative.
The campaign involves administering three doses of vaccine in the first year of life as part of routine immunization and, in addition, through national immunization days. It has been advancing region by region. The Americas were certified polio-free in 1994. The Western Pacific Region followed in October 2000, and the European Region, which includes the former Soviet Union, in June 2002.
In the remaining three WHO regions - Africa, the Eastern Mediterranean, and South-East Asia - we are very close.
In Asia, polio transmission can be stopped by the end of this year. It has been occurring in India, Pakistan and Afghanistan but so far, this year, only 102 cases have been reported - well below half the number for the same period last year. The key to success will be continued strong political support and ensuring that every child in every district is reached in the upcoming immunization days.
In Egypt, improved surveillance has revealed the persistent presence and transmission of poliovirus in some areas. This can be overcome in the next few months but it calls for a big increase and improvement in immunization activities.
In Africa, transmission can be stopped by the end of next year. But, to achieve this, a dramatic improvement is needed in each campaign, so as to reach more children. To stop the epidemic, the largest ever immunization campaigns have begun in 23 countries in west and central Africa. They were launched two week ago, with 23 heads of state rallying behind the African Union. More than a million volunteers and health workers are going from house to house to immunize 80 million children. The first round was earlier this month. The second will start on 18 November. This is the largest internationally synchronized peacetime activity ever to have been undertaken in Africa.
This will be a fight to the finish.
Until transmission is broken worldwide there can always be setbacks. There was an explosion of cases in India in 2002, which required an emergency response to contain. In Africa, incidence had gone down to 191 cases last year, thanks, in part, to the inspiring leadership of Nelson Mandela in the Kick Polio out of Africa campaign. Then immunization stopped in one state of Nigeria because of demagogic claims that the polio campaign was an international plot to sterilize their women.
Immunization was resumed there on 31 July, after an almost one year gap. In the meantime, 12 countries had been re-infected. Hence the need for the massive campaigns going on now. We aim to stop polio transmission by the end of next year.
So that is where we stand today. The fight against polio has brought out the best in people not only in the United States but in countries all around the world.
It is continuing to do so now. Even in extremely difficult conditions like those in Afghanistan, Iraq and Sudan, health workers have been willing to risk their lives to get the vaccine to the children, and combatants have suspended hostilities to let them through.
We could say that this whole global effort began exactly 50 years ago with the first big polio vaccine trials, which started right here in New York.
The success we are fighting for now has enormous practical implications, of course. It will protect everyone without exception from a crippling disease, strengthen health systems and ensure a massive return on a bold investment. But, I would like to stress its symbolic value as well. In a time of fear and uncertainty it will restore confidence in the ability of human goodwill, ingenuity and cooperation to prevail over trouble and achieve a common goal.
We cannot be simplistic about this kind of effort. Each new advance brings with it a new challenge. Victory over smallpox led to the danger of the smallpox virus being used as a biological weapon. We have to ensure that the poliovirus will not have that fate.
The March of Dimes took place in another time, but looking at the achievements of an earlier generation can provide a wealth of insight for the present and the future. Perhaps the most striking and encouraging one is that everyone in every generation can see the value of a healthy life and be glad to join in the struggle to achieve it.
Heifer International and the Hilton Foundation have found excellent ways to let this aspect of human nature flourish and fulfil its potential. With today's award they put a well-deserved spotlight on the enormous contribution that private organizations and foundations make to international health. They encourage all of us to do everything we can to support these efforts and join forces with them. Nothing could be more worthwhile.