MAD Mavens Award for Best Project: The Measles Initiative

What does it take to be all out MAD? What difference does one have to make to become a prime example of making a difference? Impact. Transparency. Cooperation across disciplines. Little or no overhead. Bang for the Buck. Leveraging past successes. Encouraging partners.

Award	To
MAD Hare	Measles Initiative
Homer (Doh!) Award	Mrs. Kroc for giving such huge contributions without working them out with the beneficiaries.
MAD kids	Ryan Hreljac of Ryan's Well " Ryan has become a compelling voice for water-poor people in the developing world. His story has inspired many to take responsibility for the woes of the world, whether in their own communities, or like Ryan, in far away places. He has helped raise over $1 million and supported more than 120 water and sanitation projects in eight developing countries, seven of which are in Africa " Ryan started at age 6.
MAD Professional Association	International Coach Federation
MAD Bequests	Mrs. Buffett
MAD from the Past	Ben Franklin and Julius Rosenwald
Millionaire Next Door Award	Genesio Morlacci left $2.3 million to the University of Great Falls (Montana). He passed away in October 2004 at the age of 102. Morlacci ran a dry cleaning business and worked part-time as a janitor at the university during his retirement. After a lifetime of frugality, Morlacci left a huge bequest that will help many others obtain the formal education he never had.

The Measles Initiative effectively saves hundreds of thousands of lives per year. More than that, it creates a method, a system, a model for saving millions more. Furthermore, the Measles Initiative saves lives effectively, efficiently, and passionately. It triggers a virtuous cycle. The Measles Initiative tips Child Survival: from here on out saving the lives of children snowballs. The Measles Initiative does so much with so little. For making such an amazing difference to the children of the world, the Measles Initiative earns the 2004 MAD Mavens Best Project Award.

The Measles Initiative (MI) demonstrates many MAD Mavens strategies in action:

• Cross-specialty collaboration that takes advantage of each partners' strengths
• Improvement of existing models, relationships, and infrastructures
• Strong professionalism (and strong science too) without bureaucracy
• Extraordinary financial effectiveness
• Near total transparency via a unique financial model
• Innovation in administrative structure

The Virtual Organization arrived with the turn of the century. Its effectiveness exceeds our wildest dreams.

According to their website, http://www.measlesinitiative.org , “The Measles Initiative, a partnership including the American Red Cross , Centers for Disease Control and Prevention (CDC) , United Nations (UN) Foundation , United Nations Children's Fund (UNICEF) , World Health Organization and International Federation of Red Cross and Red Crescent Societies is a five year commitment to eliminate measles in Africa by vaccinating 200 million children, saving 1.2 million lives. The partnership was created in 2001 and as of June 2004 has vaccinated 120 million children.”

The Measles Initiative models the most important tools of all public health efforts: cooperation using the unique strengths of each partner. It accomplishes more by each party doing more of what it is great at and less of everything else. The open sharing of tasks and solving problems engages the genius of each participant.

Much is unique about the Measles Initiative: it has no employees, no building, no money of its own, nor any formal organization of its own. Every individual who works on the Measles Initiative officially works for another group such as the: CDC, WHO, UNICEF, the American Red Cross, or the International Federation of Red Cross and Red Crescent Societies (IFRC).

For example, the American Red Cross the lends an office and computer to Mark Grabowsky, MD MPh, who leads the effort. Dr. Grabowsky technically works for the CDC which ‘loaned' him to the American Red Cross for the Measles Initiative. The Measles Initiative is only one of Dr. Grabowsky's official duties, which also includes representing the CDC for the Global Alliance on Vaccines Initiative (GAVI).

When the Measles Initiative meets, each attendee pays his or her own way, all the expenses (plane fare, hotel room, taxicabs and meals). These are voluntary assemblies not corporate meetings. No one keeps formal notes of the meetings. The atmosphere of sharing and camaraderie is palpable.

The Measles Initiative formed spontaneously when the American Red Cross called together over 200 Non Governmental Organizations in Washington , DC , to deliver an analysis of Measles vaccination campaigns. Specifically, Dr. Grabowsky revealed scientific evidence that proved a mass campaign could lower the rate of measles dramatically. A methodical campaign might lower measles rates by 80% within 10 years with death rates falling accordingly. The collective conclusion: Measles probably is eradicable. The floor then quickly offered up a resolution that the American Red Cross lead the effort. A few funders stepped forward (UN Foundation, CDC Foundation, UNICEF) to provide adequate start up funds.

The experts proposed a campaign that focused on the epidemic areas of measles, especially sub-Saharan Africa , where an estimated 800,000 children died from measles in 2000. The IM site states, “The Measles Initiative strategy consists of mass vaccination campaigns for children ages nine months to 15 years during one week in a country. Such campaigns draw mothers and children from wide areas and offer one-stop shopping for free, much needed life-saving health opportunities.”

In 4 short years the death toll from measles has dropped by half to under 400,000 per year. In the next 4 years the death toll should drop by half again, at least, as the campaigns begin in the largest – and worst – areas for measles: Nigeria , the Democratic Republic of the Congo and Ethiopia . Successful campaigns of 2005 and 2006 may take the total deaths below 100,000 per year. Then measles will remain only in clearly identified places, places small enough to divide and conquer. The disease may officially be voted ‘eradicable' as early as this year (2005).

Where did the Measles Initiative get its method? “We stole it!” jokes Mark Grabowsky, MD MPh of the American Red Cross. He adds, “It worked, we applied it. We DID give it its rightful name: The Rotary Model.” The Measles Initiative explains its success from use of The Rotary Model: www.measlesinitiative.org/solution2.asp . The story goes back to the PolioPlus Campaign initiated by Rotary International Foundation back in 1985.

Participants in the Polio Campaigns, including Dr. Grabowsky, noticed how the practical minded Rotarians (volunteers) broke vaccination into 3 tasks: Social Mobilization, Logistics, and Surveillance. Social Mobilization means getting the people out to vaccine stations. Logistics means keeping the polio vaccine chilled until shortly before delivery “managing the cold chain” and managing systematic vaccination of millions of children in a single day.

Methods of Social Mobilization and Logistics work so successfully that over 100 million children have been vaccinated for polio within a 24-hour period in India . Rotary activated over 100,000 volunteers for that single campaign. Vaccinating 10 million children in a day and far more in any given week is now nearly routine.

Rotarians also noticed the need for follow up. Was a case of flaccid paralysis really polio? How could they assure good science stood behind their findings? Labs. Surveillance makes sure that no poliovirus shows up. And if it does, it triggers a Mop Up effort and its origin identified. These methods helped to drive the number of polio cases from millions per year to well under 1000 in 2004 and probably to zero sometime in 2005.

Rotarians have been involved with the Measles Initiative since August 21, 2002, when Dr. Grabowsky issued a White Paper suggesting the Measles Initiative distribute mosquito nets treated with safe insecticides (ITNs) as part of its campaign. The concept proved true. Rotarians Against Malaria (RAM) bought the ITNs for the first trial. In December 2002 the Measles Initiative distributed 14,600 nets in the remote Lawra District , Ghana . The cost per net distributed was 34 cents, the coverage rate over 80%, proving to be the most successful distribution of nets on record.

Laboratory quality science now has proven repeatedly that nets can be distributed with measles vaccines efficiently and cheaply. The lowest costs per net for distribution prior to the Lawra District, Ghana test was $3.90/ net – not counting the net! - and the highest coverage 70%. The extraordinary low costs and high coverage were repeated by the Measles Initiative in 4 districts of Zambia the following June and for the full country of Togo in December 2004. Moreover, participation in measles vaccinations improved over already high rates when they include nets. By adding other health goods the distribution for all of them decreases while inversely the positive effects aggregate.

New vaccines exist for pneumonia, diarrheal diseases (rotaviruses) which are anticipated to save at least a million and 700,000 lives annually, respectively, by the most conservative estimates. More vaccines are on the horizon, including a vaccine for child killers like malaria. Vaccine-like goods such as mosquito nets are projected to save another million lives per year. These interventions alone offer a running start on stopping the current 10 million deaths per year. The Measles Initiative makes distribution of these lifesaving goods possible and effective. Distribution of these and similar goods becomes routine. Thanks to the Measles Initiative delivery is now reduced to a matter of logistics and finance, of planning and production timing. The Measles Initiative, MAD Mavens submits, is the most successful public health campaign in the history of the world.

Map of Measles Initiative activities: http://www.measlesinitiative.org/map3.asp

Facts (from the Measles Initiative):

• An estimated 30-40 million children suffer from measles every year
• In Africa a child dies of measles every minute.
• Measles is one of the leading killers of children in Africa and is the leading cause of death among unvaccinated children
• Measles can also cause blindness, brain damage, and make a child susceptible to secondary infections such as pneumonia and diarrhea

Good News:

• Measles vaccination is the most cost-effective public health intervention available for preventing deaths
• It costs less than a dollar to vaccinate a child against measles
• Over five years, 1.2 million deaths will be prevented
• During the first year of the Initiative (July 2001-Jun 2002), mass measles campaigns have been carried out in eight African countries, vaccinating more than 20 million children and preventing more than 140,000 deaths
• The goal of the Initiative is to prevent 1.6 million child deaths in Africa over five years and to reduce to zero the number of measles deaths in Africa by 2005
• The success of the Measles Initiative and partnership strengthens other health initiatives in Africa
• Many times, coverage exceeds 100% during a campaign because children from neighboring areas or outside the age range come to receive the vaccine