Bill & Melinda Gates Foundation

Jim Grant's 'Child Survival Revolution'

February 17, 2011

I recently came across a book that tells the amazing story of Jim Grant, whose influence in making vaccines widely available in the developing world is credited with saving the lives of 25 million children.

Because of the work the foundation is doing on vaccine-preventable diseases, I’ve read quite a bit about the history of global immunization. But until I read Jim Grant—UNICEF Visionary (an out-of-print book available for free download), I didn’t appreciate what a remarkable visionary and results-driven leader he was. I talk more about the impact of Jim Grant’s contributions in the foundation’s annual letter.

Grant was executive director of UNICEF—the United Nations Children’s Fund—from 1980 to 1995. Prior to that time, UNICEF was already well-regarded for its global work—begun in the aftermath of World War II—preventing epidemics and malnutrition among children. In 1965, for example, UNICEF was awarded the Nobel Peace Prize.

But when Grant became head of UNICEF, he saw an opportunity to address a problem that was not high on the priority list of world leaders or international development organizations. At the time, about 14 million children were dying every year of readily preventable illnesses such as measles, tetanus, whooping cough, pneumonia, and diarrheal disease. Virtually all of the deaths were occurring in the developing world; Europe and North America had mostly conquered the diseases with low-cost means of prevention or cure developed in the first half of the 20th century.

Grant decided to focus UNICEF’s mission on halving child deaths in the developing world through a massive effort to introduce the same immunizations already available in developed countries, along with other highly-effective low-cost strategies, such as packets of oral rehydration salts for people suffering from diarrheal disease, educating women about the benefits of breast feeding, and monitoring the growth of children. Collectively, these efforts were known as UNICEF’s Child Survival and Development Revolution.

Although we still face many difficulties today getting vaccines to the people who need them, the challenges Grant faced were an order of magnitude greater. No organization had ever tried tackling a global health issue on such a large scale, and there were many skeptics, including within UNICEF.

But as Peter Adamson, who worked closely with Grant, writes in one of the book’s chapters, “…who could not be struck by the sheer unforgiveableness of millions upon millions of children dying…when the means to prevent it were at hand.”

Grant talked to anyone who would listen—political leaders, religious leaders, business leaders, educators, the media, NGOs, even the military and police. Repeatedly, he made the point that 40,000 children a day were dying unnecessarily.

In the midst of a civil war in El Salvador, Grant managed to get the government and guerilla leaders to agree to multiple cease fires so children could safely be immunized. (He facilitated similar “periods of tranquility” in wars in Lebanon, Sudan, and Iraq.) When Rajiv Gandhi became prime minister of India after the assassination of his mother, Indira Gandhi, Grant persuaded him to make the immunization of India’s children a living memorial to his mother. In Colombia, more than 800,000 children were immunized three times in a three-month period, raising that country’s immunization rate to 75 percent. In Turkey, school teachers were asked to end their vacations three weeks early so they could mobilize their villages. Immunization levels increased from 20 percent to 84 percent.

By the mid-1980s the percentage of children in the developing world who were immunized doubled to 40 percent, and prominent organizations like the World Health Organization and Rotary International had joined the effort, providing scientific advice, training, funding, and volunteers.

Amazingly, Grant’s target of over 70 percent immunization in the developing world was achieved by 1990. In that year alone, 100 million children in 150 countries were immunized six or more times. It was, Grant said, the largest effort of peacetime mobilization to that point in history.

Grant’s work is especially inspirational when you realize that he achieved success despite a world recession and global debt crisis in the 1980s. We can draw lessons from his leadership now, in our own tough economic times.

By creating a global constituency for children, getting people to focus on specific goals, and creating effective program delivery and measurement systems, Jim Grant literally saved millions of children’s lives.

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