On the eve of the high level polio summit being held in New York on Thursday, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, spoke to public health reporter André Picard. Mr. Gates is pushing world leaders to unite behind an ambitious six-year plan to eradicate the disease known as "The Great Crippler."
Here is a transcript of the conversation.
Q : What do we need to do in the final push to eradicate polio?
Bill Gates: We've got to raise the money – it's about $1-billion a year spent on the vaccine and getting the vaccine out there – so we need people to rededicate themselves on the financial side. We need the agencies, the World Health Organization, UNICEF and others to step-up and to bring some innovations, some new thinking to the campaigns. And, of course, there are the countries themselves that are either trying to stay free of polio, or the three where we've never gotten to zero (Nigeria, Pakistan, Afghanistan) they need to step-up and help make sure we vaccinate every single child. We have made some great advances, with some new donations, including the Islamic Development Bank, and we have some side meetings planned with each of the key groups to talk about their roles.
Q : Are donor countries like Canada stepping up, are they doing enough to eradicate polio?
Bill Gates: Absolutely, Canada has been great on this issue. We want to make sure is that they have an on-going commitment because there are budget pressures that are always there in every country. What we're looking at now is : What will it take over the next six years to get this done so we're not just coming at the last minute and trying to fund this year-by-year. What we're asking is that everybody step for the next six years. Our foundation is going to do that, and soi s the U.S., Canada, Australia, the U.K. and so on. The announcement from the Islamic Development Bank will surprise some because they're a new donor coming in at a very significant level. I think, out of the Middle East in general, we'll get several new donors.
Q : Will six years be enough to get the job done? Some believe it's impossible to ever eradicate polio, especially in those three countries – Nigeria, Pakistan and Afghanistan – where the structural problems are so profound.
Bill Gates: We need everybody to do their part – the donations, the innovation, and the execution on the ground. But, yes, with all the pieces coming together, I think there's a very high probability that it will succeed. We're also designing a long-term plan so there is a legacy : We're going to leave behind very strong vaccination systems in those countries. The mapping, the personnel, the supply chain, a lot of these things go beyond polio and will really energize the global health community. I've chosen this as the thing I spend the most time on, it's now the top priority of the foundation because we feel this is achievable and will be a remarkable, lasting success. Now, if the world doesn't prioritize this, if we don't finish the job and polio spreads back to many, many countries that would really be tragic.
Q : The end of polio has been promised many times. Do you worry about skepticism, about donor fatigue being an impediment?
Bill Gates: Absolutely. We've got to sit down, look at this plan, get input from the donors to know if they think the plan has everything it needs including funding for unpredictable setbacks. The fact that we've been coming and saying: "Hey, just one or two more years – and not really putting that into the context of how much has to be done, and how hard that will be – that has made it hard for donors. They want to know: Will it really get done this time? Also, they're not very good at putting in money on short notice. It really takes a long-term plan. In some ways, a $1-billion is a lot of money, but in some ways it's not very much money if you're going to eradicate a disease – something that's only ever been done once before. Our foundation is going to step-up with a huge commitment and we expect others to do so. This New York polio event is a big milestone, with new donors coming in and people seeing the recent progress. I think that will lead to us getting the long-term plan cemented.
Q: We know the problem areas are all Muslim countries, where there are issues with the Taliban in Afghanistan, and Muslim clerics in Nigeria and Pakistan opposing polio vaccination. Will the support of the Islamic Development Bank be enough to counter those fundamentalist religious obstacles?
Bill Gates: It's really a positive development to have additional Middle East donors. A few years ago, Abu Dhabi came in and was very generous, now it's the Islamic Development Bank with a significant gift of $227-million. And it's not just financial involvement: They're going out to Pakistan and meeting with people, talking to the religious community about how vaccination can be a positive thing. It's always tough to communicate, to deal with rumours and misunderstandings, even in rich Western countries that's a challenge, but we have to find a way. These new donors are a big help. This is not something imposed by the West. This is the whole world working together to eradicate polio.
Q: Why are only now fashioning a long-term, six-year plan? Why did we have all these one– and two-year piecemeal efforts?
Bill Gates: I think the whole community, including the Gates Foundation, needs to issue a bit of a mea culpa. We were overly optimistic and we accepted that this was the nature of government funding. Now, we're really stepping back, analyzing our efforts, looking in particular at what went incredibly well in India like mapping, and we're turning it into a plan. I'm very excited about this new plan. At the same time, we're going to be realistic, we're telling people that with the switch to IPV (injectable polio vaccine to replace oral polio vaccine), with the surveillance that needs to be done, that it's going to take some great work and some time for all the pieces to come together. No matter how great the work on the ground, we're going to need some time, we need a six-year plan. It's a new sense of realism and we have to realize this is what it's going to take and get people to sign-up for the effort.
Q: Any worries that six-years won't be enough, that we'll miss yet another target date for eradication?
Bill Gates: It's not a guarantee. There are no guarantees. I have to emphasize that everyone has to do their part – the donors, the teams that do the execution including UNICEF and WHO, the countries themselves right down to the local political level, the religious leaders, we need all these pieces to come together. But we've shown we can do it. So it's got a good probability of success. Our foundation has spent more than $1-billion on polio so far and we'll spend even more than that in the coming years. We're doing that because we see a real chance of success.
Q: Thank you Mr. Gates for your time.
Bill Gates: And thank you to The Globe and Mail for taking such an interest in this important cause and giving it visibility.