Global Pulse Blog

In response to a 2010 World Health Organization report Working to overcome the global impact of neglected tropical diseases, this week, the Bill and Melinda Gates Foundation, the World Bank, 13 pharmaceutical companies, the governments of the U.S., U.K. and U.A.E. and other global organizations committed to a new, coordinated effort to advance progress towards controlling 10 neglected tropical diseases by the end of the decade and improve the lives of the 1.4 billion affected by such diseases globally. Guiding this effort, the World Health Organization released targets and a strategy, Accelerating work to overcome the global impact of neglected tropical diseases—A roadmap for implementation.

These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

Today, the second annual International Conference on Family Planning (ICFP)  in Dakar, Senegal began. This conference is co-hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal to bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal of universal access to family planning.

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

With World AIDS Day coming up on December 1st, I had the opportunity to join in a call with Stefano Bertozzi Director of HIV and TB at the Bill & Melinda Gates Foundation.

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

As promised, today we bring you another commentary inspired by Secretary Clinton’s recent speech calling for an AIDS free generation by Matthew Basilico, Nworah Ayogu, and Arjun Suri of Harvard Medical School.

As students immersed in the study of biological sciences, and as future physicians anxious to provide care and improve lives, we can be frustrated when public health policy seems based on interests neither scientific nor beneficent. United States programs that fight global AIDS have accomplished tremendous good over the past eight years; however, recent stewardship by President Obama has been disappointing both scientifically and morally. Last fall, many of us at Harvard Medical School protested President Obama because we believed his failure to keep his promises to scale-up the fight against HIV/AIDS was proof that he was ignoring the science and neglecting his ethical obligation to save millions of lives around the world. However, on Tuesday, Secretary of State Hillary Clinton delivered an inspiring address that is at once evidence-based and morally laudable.

When we began our protests last fall, there was a growing body of research indicating that treating HIV also prevents its spread. Evidence from a localized study South Africa indicated that when people with HIV received antiretroviral treatment (ART), their partners were 92% less likely to contract the virus. [1] Initial modeling used this information to theorize that, with universal access to treatment, infections could plummet within 10 years. [2] With this growing evidence (as well as other studies), the phrase “treatment as prevention”—long used by health professionals working at the front lines of AIDS care—resonated in scientific communities. Not only does treatment save lives, but these recent studies show that treatment could dramatically reduce new infections, slowing or even halting the epidemic in the future. It was not until this year, however, that this could be said with such certainty. A multi-site, large-N, randomized control trial showed that ART reduces new infections by 96%. [3]

We have also been encouraged by the growing literature showing that investments in HIV treatment programs improve health systems and eases delivery of other life-saving interventions.[4,5]  Dr. Paul Farmer, co-founder of Partners In Health, described HIV treatment as the “battle horse” to drive the necessary expansion in infrastructure and political will for addressing other global health priorities.

The evidence is clear: now, more than ever, we know that investing in AIDS treatment will save millions of lives and reduce new infections. Yet in the first years of his administration, President Obama fell dreadfully short on campaign promises to significantly improve resources for AIDS funding.  Many fellow classmates from Harvard Medical School, as well as from colleges and medical schools across the east coast, joined in protests encouraging the administration to uphold its promises.  It is impossible to forget the numbers—a year of AIDS treatment costs less than $100, and the treatment program makes up far less than 0.2% of the federal budget.  Yet while hundreds of billions of dollars went to bank bailouts, no new money was found for the meager $1 billion dollar annual rise that was promised during the election cycle.

Secretary Clinton’s speech on November 8^th, therefore, was encouraging.  She declared that for the first time, it will be United States government policy to create “an AIDS-free generation.”  She emphasized prioritizing high impact interventions—prevention of mother-to-child transmission, circumcision, and treatment.  And she lauded the vital role of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been an innovative and transparent engine for delivering resources where they are needed most.  Secretary Clinton’s speech had much of what is needed, except for the numbers.

To transform the Secretary’s vision into a reality, we will need bold treatment targets and solid commitments to increase funding.  Six million patients on treatment by the end of 2013 would be an appropriate goal for the United States government, which is on track to have four million on treatment by the end of this year.  Congress and the administration have responsibility for the 2012 budget, while the Super Committee debates 2013 and beyond.  We eagerly await President Obama’s address on World AIDS Day (December 1^st).  Lawmakers have the opportunity to transform one of the greatest human scourges of our generation, or to be held accountable for inaction by patients, activists and history books.  As medical students, we have the ability to hold lawmakers accountable by calling and writing our elected officials, and communicating publically the cost of inaction.

-Matthew Basilico, Nworah Ayogu, Arjun Suri; Harvard Medical School

References

1. Deborah Donnell, Jared M Baeten, James Kiarie, Katherine K Thomas, Wendy Stevens, Craig R Cohen, James McIntyre, Jairam R Lingappa, Connie Celum, “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet 2010;375:2092-2098.

2. Reuben Granich, Siobhan Crowley, Marco Vitoria, Ying-Ru Lo, Yves Souteyrand, Christopher Dye, Charlie Gilks, Teguest Guerma, Kevin M De Cock, and Brian Williams “Highly active antiretroviral treatment for the prevention of HIV transmission,” Journal of International AIDS Society 2010; 13:1

3. Cohen MS, Chen YQ, McCauley M, et al. “Prevention of HIV-1 infection with early antiretroviral therapy.” New England Journal of Medicine 2011;365:493-505.

4. David Walton, Paul Farmer, Wesler Lambert, F. Léandre, Serena Koenig and Joia Mukherjee, “Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti,” Journal of Public Health Policy 2004:137-158.

5. World Health Organization, “An Assessment of Interactions Between Global Health Initiatives and Country Health Systems,” Lancet 2009;393:2137-2169.

Today’s guest blog post by Anand Reddi was originally published yesterday in The Huffington Post. Anand Reddi was a Fulbright Scholar in 2005, assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine. Here, he reflects on Secretary Clinton’s speech earlier this week and the importance and potential of a Global Health Service Corp.

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

Bill Gates and Rotarians make the “This Close” gesture on the steps of the U.S. Capitol in Washington, D.C. on World Polio Day, October 24, 2011, to promote Rotary’s End Polio Now campaign and show how close the world community is to eradicating the scourge of polio

Learn more about World Polio Day and global efforts to eradicate this disease which has been decreased thus far by 99% thanks to efforts including vaccination campaigns.

Today, September 26, 2011, marks the 5th annual World Contraception Day. This multinational campaign aims to draw awareness to the need for contraception access globally, targeting teenagers between the ages of 15 and 19, as they are often the most inexperienced in using contraception. This year’s theme is “Live Your Life, Know your rights, Learn about contraception” strives to bring attention to the right of young people to access accurate and unbiased information about contraception in order to prevent an unplanned pregnancy or sexually transmitted infection (STI) As USAID states, “every individual that wants them should have access to contraceptives and condoms for family planning and for HIV/AIDS prevention.”

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Youth Task Force: Who is who

According to the World Health Organization, approximately 2.4 million children die from vaccine-preventable disease yearly. On a domestic level, recent coverage of the largest US measles outbreak in the past fifteen years has been in the headlines with much discussion of voluntary refusal of immunization in the United States. A study in the Journal of the American Medical Association found that from 1991 to 2004, the number of unvaccinated children more than doubled in states allowing philosophical exemptions. On the other hand, children in middle- and low-income nations often do not receive immunizations because of lack of access. According to the Global Alliance for Vaccines and Immunizations (GAVI) 33% of all unvaccinated children under one-year-old live in China and India, and another 47% of unvaccinated children live in middle-income countries, with only 17% living in low-income countries.

Two studies from the Johns Hopkins Bloomberg School of Public Health were recently published in Health Affairs‘ June issue on Strategies for the Decade of Vaccines. The studies examined the impact of expanding immunization against pneumococcal pneumonia; Haemophilus influenzae type b (Hib);  bacterial meningitis; diphtheria; pertussis; tetanus; measles; rotavirus and malaria to cover 90% of children in 72 countries. They found that increasing vaccine development and delivery over the next 10 years in these 72 countries could prevent 6.4 million children from dying with an economic savings of $231 billion in the value of statistical lives saved and over $151 billion saved through reduced treatment costs and increased productivity. The issue brief audiocasts offer more insight into these and other contents of the June issue.

From the Bill and Melinda Gates Foundation website

While this looks promising, another study from the GAVI Alliance suggests that developing nations will be challenged to pay for expanded vaccine delivery without substantial outside support. In order to procure the projected benefits of increased immunization efforts, creative vaccine financing strategies will be needed. One such effort comes from the Bill & Melinda Gates Foundation’s commitment over the current decade–the Decade of Vaccines–to promote childhood immunization in the developing world.

Access, Cost, Quality

In a country like Nicaragua that is the 2^nd poorest country in the western hemisphere, poverty impacts every aspect of life especially health care.  According to the U.S. Library of Congress,  Nicaragua has a three tiered health care system where; 1) The upper 1-2% of the population receive care in private clinics and private hospitals and often go abroad for specialized care. 2) About 8% of the population has government health insurance. This includes mostly government workers, military personnel, and part of middle class who receive the insurance through their employer. 3) The remaining 90% of the population relies on the free public hospitals, health centers, and health posts. Now, this doesn’t sound so bad until you realize that the 8% of the population that has government insurance receives 40-50% of the nation’s health care budget and the public system that serves 90% of Nicaraguans, though it does provide low-cost/free care, lacks quality and access.

For example, I have been working in Nicaragua where I have had the blessing of knowing a 16 year old young woman with Ewing’s Sarcoma. One day when going to visit her in the hospital, I encountered several realities of the Nicaraguan public hospitals. The following is a personal account embedded with the perceptions of the Nicaraguan people that I spoke with about the situation and realities faced at every public hospital/health center/health post in the country.

When I arrived at the hospital her mother told me that before giving this young woman her third dose of chemo for this cycle, she became very pale and was gasping for breath. They debated intubation but instead gave her some medicine and oxygen. She was now left with her mother in a sparse ill-equipped hospital room. The young woman still had a 103 degree fever, was vomiting and was very pale.

1. The room has six patients in metal beds some with sheets, run down equipment, blank faces, no pillows, no water, no utensils with which to eat, paint chipping off the walls, and a window open to the hot air outside.
2. One of the other women in her room had traveled 2 days to get to the hospital. Many people from the area of the country she is from never see a doctor in their whole lives because they do not have the financial means, physical strength, or time to travel.
3. There was one nurse for all 60 patients in the medical and orthopedic units.
4. The oxygen that they gave this young woman was not working…there was nothing flowing through the tube!
5. Her labeled IV was supposed to be changed 5+ hours ago and the IV site was now red, warm to the touch and blood was infiltrating the tube about 5 inches!
6. Her mother told us that she had not seen the oncologist in 15 days! Somehow in these 15 days of not seeing the patient, the oncologist decided that the patient was okay to have chemo.
7. They had not run any urine tests that her mother could remember despite the fact that the young woman, who is on chemotherapy, was initially admitted with a kidney infection.
8. The young woman looked the weakest I had seen her. She quietly told her mother that she needed to go to the bathroom and her mother got the bedpan from under the bed and moved it under her to urinate. The entire process was very painful for the young woman since her hip/tumor site had to move to have the bedpan under her.
9. There is no toilet paper in the hospital.
10. I asked the residents who were about to pass into the room to wait until after she was done urinating just a moment to give her a little privacy/dignity. They, without saying anything, turned away from the room and chatted in the hall for a moment. I told them when she was done and they could pass into the room, but instead they continued to chat and then LEFT without looking at her or any of the other women in her room.
11. I asked a Nicaraguan doctor I am working with why they would just leave like that and she said… “that is what it is like here. That was the patient’s only chance to see a doctor today and they don’t care if they skip a room or not.”
12. Then, the cleaning lady came to mop the floor of the young woman’s room/hall with chemicals that were making even me nauseated. Ammonia and apple. The young woman, like most patients on chemotherapy, immediately started vomiting at the smell.
13. I tried to tell the nurse that the IV needed to be changed and that the oxygen not working. She was in the middle of preparing the medicines for her 60 patients and she didn’t have time to care.
14. Then , when I went to the social work office to tell them of her IV and oxygen, they said it was not their problem and that we needed to speak with the Medical Director of the hospital.
15. There was a long line outside the Medical Director’s office and he was not there. Luckily, the doctor I was with knew one of the doctors working there and told him of the situation with the hope that he will look into it.
16. The young woman’s mother/primary caregiver was tired and crying more and more frequently
17. The family members/friends, if patients are lucky enough to have them, are really the ones that know what is going on with the patients. They are doing the positioning of the patient, feeding, advocating, and doing assessments (not clinical ones…but still asking questions to rate/evaluate how patient is doing.)
18. The doctors rarely talk to the patient, the patient’s family and the nurses…they work pretty independently and do not look at much more than the patient’s chart to see how the patient is doing….only the super busy nurse and doctor write in the chart, so it doesn’t reflect what’s really going with the patient only what treatment was received/ordered
19. If a family member is to ask for something or offer information to a doctor such as “my daughter has vomited 10 times in the past hour” the doctor often doesn’t listen and instead is annoyed. The family member and patient are then labeled as problematic and their care if affected.
20. The longer a patient stays in the hospital the worse the patient’s care becomes…this young woman had been in the hospital for 17 days.
21. Many patient’s in the hospital die of dehydration (from not changing IVs) and hospital born infections. So many patients do not trust the hospital to help them.
22. There is even less medical care at night and on the weekends.
23. There are also many medication error and neglect and no accountability.
24. I learned that they do not require teaching medical ethics in all the medical schools here and bedside manner is rarely a topic that is taught.

There are many angles to look at the injustices of this young woman’s care, and the role of every person involved in creating an effective health delivery system. However, no matter what angle you look at or whether you are in the poorest or the richest country, the fundamental attribute of any health care system needs to be a balance between cost, access, and quality.

~Ayla Landry, BSN,RN

From the Author: Ayla Landry

My name is Ayla Landry. In May 2010, I graduated from Texas Christian University with a Bachelors of Science Degree in Nursing (BSN) and I am a Registered Nurse (RN). I have been involved in Nicaragua on a voluntary basis since 2008 originally assisting with a campaign against cervical and breast cancer, which are the #1 and #2 causes of death for Nicaraguan woman under 60 years old. The campaign is Nicaraguan-led and developed world-supported with several organizations from the US including NGOs, MD Anderson Houston, and MD Anderson Madrid supporting the efforts. I traveled to MD Anderson in Houston to learn as much as I could about the cancer care model and nursing role there. I helped set up a cancer registry, helped organized training conferences for physicians and nurses, helped in advocating the role of nurses in the pilot clinics created by the campaign, translated education materials (Spanish/English), and presented conferences in Spanish about the basics of oncology nursing care.

Most recently, for the past 5 months I have been living in Nicaragua to work/volunteer with a non-profit organization called Nicaraguan Resource Network (NRN). The organization has set-up churches in 26 different communities, 4 of which have schools, and 2 of those schools have special needs programs. In January 2011, NRN hired a wonderful Nicaraguan Pediatrician to provide primary healthcare to the nearly 1,800 children in their schools. I have been here in Nicaragua supporting and working alongside the physician in setting up a program to attend to these kids.

I dream to positively and significantly impact women’s and children’s health in the developing world and to promote global health education among nurses. While I was in Nicaragua, I was accepted into Johns Hopkins University for the MSN/MPH (Masters of Nursing/Masters of Public Health) program which will prepare me to accomplish those dreams, and I couldn’t be more excited to start the program at the end of this June.

The Gates Foundation will be holding an upcoming webcast dedicated to discussing the path to eradicating polio. The special event moderated by Diane Sawyer will feature:

• Bill Gates
• David Oshinsky Pulitzer-Prize-winning author of “Polio: An American Story“
• Helen Rees of the WHO’s Strategic Advisory Group of Experts on Immunization
• Ciro de Quadros, Executive Vice President of the Sabin Vaccine Institute

amongst a panel of experts on the fight to eradicate polio and the role and potential of vaccines. Tune in Monday, January 31st at 9:30am Eastern Standard Time at www.gatesfoundation.org to view this discussion on ways to protect populations across the globe from life-threatening diseases such as polio as experts delve into the immense progress that has been made, via such efforts as childhood immunizations, to reduce polio by 99% and attempt to eradicate the second transmittable but preventable disease in history.

This webcast coincides with the release of the Bill Gates’ third Annual Letter, in which he identifies polio eradication as one of the major priorities for the Gates Foundation. Further inspiring this quest at eradication, the Annual Letter will be launched the day after Franklin Delano Roosevelt’s birthday at the Roosevelt House, the location where this inspirational figure taught himself to crawl as a grown man struck by paralytic polio.

The event will also be available ‘On Demand’ following the webcast.