Dr. Mark Rosenberg - Real Collaboration

Guest Lecture from President & CEO of The Task Force for Global Health

"Collaborative partnerships have the best chance for success when members lay the foundation in the first mile for the last mile success and take mutual responsibility along the journey for leadership, management, and culture within the partnership."

Dr Mark Rosenberg MD MPP, author of Real Collaboration, guest lectured our "Making Change through Policy" course and focused on the art of collaboration. The Task Force for Global Health works with private and public sector partners to address health issues for the most vulnerable populations. Among many things, the task force currently leads the Global Polio Eradication initiative and is credited for creating "Pharmaco-Philanthropy". There were three take aways from Dr Rosenberg's lecture that can be summarized as one story, one line, and one list.

The Story
Dr. Bill Foege MD MPH, the epidemiologist who designed the global intervention strategy to eradicate smallpox, was the first head of the task force. In 1987, Merck approached Foege about donating Mectizan, a drug whose off label use reduces morbidity and transmission of river blindness. Mectizan is better known to animal lovers as Heartguard - a common medication for dogs. Merck was making enough profits on animal sales to donate large quantities for off label use. Coalition leaders fearing the partnership and backlash of working with the pharmaceutical companies advised Foege to not accept the offer. True to what I've come to learn about Dr. Bill Foege, he did it anyway; establishing what is called "Pharmaco-Philantropy". Twenty-five years later the program is responsible for treating millions and its continued efforts have made eradicating river blindness a feasible end goal.

The Line
"Collaborations are like marriages. Easy to get into and hard to make work"

The List - "The Initial Barriers: Seven Cs"

1. Culture – corporate, religion, location
2. Conflicting Goals – need to settle on the goal, a very clear goal
3. Confusion – about roles and responsibility
4. Control – no one wants to give it up (personal and organizational)
5. Capabilities – everyone has different skills, strengths and resources
6. Competition - who is going to get the credit, who is the biggest
7. Costs – people don’t factor in the costs (money and time)

Guest Lecture by the Eradicator of Smallpox

Learning from a Living Legend

In 1796, the British Scientist Edward Jenner documented the first successful example of inoculating a person to prevent future disease. In this case, he used cowpox to protect against smallpox - an infectious diseased credibly traced back to ancient Egyptian mummies 3000 years ago. Jenner would call his work a vaccine (after the Latin word for cow - vacca), but it wasn't until 180 years later that US epidemiologist D.A Henderson led the global effort that eradicated smallpox from Earth.

A disease that plagued man all over the Earth for thousands of years was no more, surviving only in government labs in Russia and the US. The feat can be considered the golden point of science in the 20th century. D.A. Henderson's work garnered him the US Presidential Medal of Freedom, the Japan Prize, and Knighthood by the King of Thailand. Below I've listed three points that I found as takeaway messages from his guest lecture to my "Making Change through Policy Course"

1. Finding a Way
In countless examples, Dr Henderson mixed creativity or found exceptions to the rule to achieve results. After learning less than 10% of global vaccines met quality standards, Dr Henderson was told he could not mandate quality control ("it won't work"). Instead, Dr Henderson withheld World Health Organization funding unless vaccines met third party quality control standards. It wasn't a mandate, but it was one heck of an incentive.

2. Science and Evidence Trump Experts and Textbooks
There were four key examples in which Dr. Henderson and his team had to buck the stated norm or thoughts at the time. In each they set up experiments and tests to use science as their evidence against the textbooks. Each played a vital role in proving Smallpox could be eradicated. The first was proving smallpox did not spread easily meaning a vaccine campaign could work. The second was revaccination wasn't needed - a one time dose could work saving money, time, attrition, and follow up efforts. The third, smallpox wasn't stable in nature, thus eliminating it from humans could eradicate it.

3. Managing Guidelines
- Recruit good people who want a challenge
- Delegate authority and responsibility
- Adapt program to the individual country
- Get out from the desk (he mandated 1/3 time in field)
- Communicate regularly and frequently
- Harmonize practices
- Exceptions are necessary

I invite classmates to share any lessons learned or comments from the D.A. Henderson Lecture. What did you think?