Letter from forum where Melinda Gates used the E word

I wanted to share a message I received from our good friend Billy Shore. The letter below reflects the kind of thinking and vision we need to see in the world. It doesn’t negate those efforts — like long-lasting insecticide-treated nets — that help reduce suffering and malaria in the short-term, but it is a view we need to keep as well. We can solve these big problems — it will take many different kinds of efforts to get there.

Dear Jacqueline,

Last week Melinda Gates used the E word.  I want to share what she said, and what Bill Gates said too, and why it is so directly related to our childhood hunger strategy at Share Our Strength.

It is an article of faith among experts in malaria research to never talk about eradication of the disease, but instead to set goals for controlling it.  In dozens of conversations I’ve had over the past three years every doctor, professor, vaccine developer, and pharmaceutical executive I’ve met has warned against even thinking about eradication.

History has traumatized and scarred the malaria community. Several times over the past fifty years it was believed that the world was on the verge of eradicating malaria. The result of premature celebrations was a decrease in focus, funding, and research, and soon a dramatic increase in the prevalence of the disease. Too often the malaria parasite has been underestimated. Discussion of eradication has been seen as somewhere between naïve and recklessly dangerous.  Last week that all changed.

The Bill and Melinda Gates Foundation hosted a three day forum in Seattle on malaria, drawing in prominent experts from around the globe.  Melinda gave the opening address. Although I couldn’t be there in person, I was able to catch every word via webcast and every word was worth catching. Her speech was candid and courageous, passionate and provocative.  Historians may look back on it as a pivotal moment. Not just in the battle against malaria, but in the way we confront hunger and other seemingly unsolvable social issues. .

Here are a few excerpts from Melinda Gates’ opening remarks: 

“In the history of humanity, it’s likely that no disease has ever caused more suffering, more sickness, and more death than malaria….Malaria deaths worldwide peaked in the 1930s at nearly three and a half million and then began to drop with global efforts to fight the disease, reaching a low of about half a million at the end of the 1960s. But the disease has been on the rise ever since. Now there are five hundred million cases of malaria every year and more than one million people die from it, mostly children. We wouldn’t let it happen here. We shouldn’t let it happen anywhere.”

“But over the course of the last century, malaria changed from a disease that afflicted a broad range of countries to a disease that affected only poor countries. It changed from a celebrated cause of our scientists and politicians to a source of suffering that the rich world was willing to accept and the poor world was helpless to prevent.”

“Now we have a historic opportunity not just to treat malaria or to control it but to chart a long term course to eradicate it.”

Anticipating the concern of those in the audience with far more expertise than her, she added: “We know the word eradication is troubling to some of you in this room. It is an audacious goal. But to aspire to less is far too timid a goal and a waste of talent and a waste of intelligence.  And it is wrong and unfair to people who suffer from the disease. When you ask people to donate time and money to save lives, they can be very generous.  When you ask them to give time and money to eradicate a disease, their generosity can multiply. There are also risks. Failure can sap morale and lead to cuts in funding.  But eradication has the power to create great expectations, grand efforts and record funding.”

Gates gave three specific reasons for embracing the goal of eradication: First was the ethical. “Every life has equal worth.” The second was financial.  “If we plan only to control it we will never eradicate and expenses will escalate. That means we will keep bearing forever the human costs of malaria, even as we keep paying forever the financial costs of trying to treat and control it.”  The third was epidemiological.  “Because of the parasites ability to adapt and resist, no set of control strategies can succeed for long. The only way to end death from malaria is to end malaria,” she concluded.

Both Melinda and Bill argued made the case that with enough time we could develop the partnerships, political will and scientific breakthroughs necessary.  It will take relentless research, coordination, and especially long-term commitment.  And eradication requires intensifying efforts as fewer and fewer get infected, which is counterintuitive. 

As you may know, I’ve been diligently following developments in this field. Not because my interests have shifted from hunger to malaria. They have not. But rather because the strategies being deployed are probably the most advanced in the nonprofit sector and they suggest new ways of thinking, and a new glimpse of what is possible, not only for fighting tropical diseases, but for fighting hunger, poverty, and a wide range of social ills.

At Share Our Strength we know a little bit about the E word. The pros and cons that Melinda Gates articulated were almost identical to those we heard from our own colleagues when we debated whether to set a goal of ending childhood hunger. Not reducing it, but ending it.  Many of the experts in our community cautioned us about the complexities of measuring, and the risk of failure. But as Gates understood in making her remarks yesterday, the experts are often expert in what has been, not what could be.

Today’s world is different in critical ways from that earlier time and place marked by failure. There is greater knowledge of what works and what doesn’t. There is greater ability to share that knowledge. There are more resources available than ever before.

Although many still have their doubts, the goal of eradicating malaria became credible again last week.  The financial resources of the Gates Foundation obviously induce people to listen. But so do audacious goals, and the determination of someone with more vision than expertise, willing to take a risk and unwilling to accept the status quo.

Billy