{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://globalhealthchronicles.aviaryplatform.com/iiif/9w08w39s89/manifest","type":"Manifest","label":{"en":["Patriarca, Peter"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","metadata":[{"label":{"en":["Source Metadata URI"]},"value":{"en":["12834 (Patriarca_Peter.xml)"]}},{"label":{"en":["Publisher"]},"value":{"en":["David J. Sencer CDC Museum"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum.","Interviews may only be reproduced with permission from David J. Sencer CDC Museum."]}},{"label":{"en":["Agent"]},"value":{"en":["Peter A. Patriarca (Interviewee)","Hana Crawford (Interviewer)"]}},{"label":{"en":["Date"]},"value":{"en":["2018-06-13 (Created)","Unknown Date (Created)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Identifier"]},"value":{"en":["OHCDCM700 (collection call number)"]}},{"label":{"en":["Relation"]},"value":{"en":["Global Polio Eradication Initiative History Project (is part of)"]}},{"label":{"en":["Subject"]},"value":{"en":["Global Polio Eradication Initiative History Project (local term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Bill \u0026amp; Melinda Gates Foundation, CDC, Centers for Disease Control and Prevention, David J. Sencer CDC Museum, Polio, Rotary International, WHO, World Health Organization"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum.","Interviews may only be reproduced with permission from David J. Sencer CDC Museum."]}},"provider":[{"id":"https://globalhealthchronicles.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["David J. Sencer CDC Museum"]},"homepage":[{"id":"https://globalhealthchronicles.aviaryplatform.com/","type":"Text","label":{"en":["David J. Sencer CDC Museum"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/249/745/small/data?1724869773","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745","type":"Canvas","label":{"en":["Media File 1 of 1 - Peter_Patriarca__E9doLdyrj7o_.mp4"]},"duration":8563.729,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/249/745/small/data?1724869773","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/249/745/original/Peter_Patriarca__E9doLdyrj7o_.mp4?1724869934","type":"Video","format":"video/mp4","duration":8563.729,"width":640,"height":360},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938","type":"AnnotationPage","label":{"en":["content172486977220240828-559627-laqs5d.xml [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Today is Wednesday, June 13, 2018. This is Hana Crawford for the\nGlobal Polio Eradication Initiative History [GPEI] Project, and I’m with Dr.\nPeter [A.] Patriarca [MD] in the broadcast studios of the United States Centers\nfor Disease Control and Prevention [CDC] in Atlanta, Georgia. That’s a mouthful.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Thank you for being here today.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Sure.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: As we were talking about earlier, I will ask you to introduce yourself\nin a minute. But first, do we have your consent to conduct this interview and\nrecord it?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, you do.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: OK, great. To begin, would you state your name, where and when you\nwere born, and then share a bit about your early life?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: OK, so I’m Peter Patriarca. I was actually born in Oak Ridge,\nTennessee, of all places, and if you listen closely when I talk you can hear\nsome Southern twangs, right? I grew up in East Tennessee. I was very interested\nduring my childhood in science. My dad worked for the Oak Ridge National\nLaboratory and devoted his career to the peaceful uses of nuclear energy—and\nthis was during the Cold War. He was an inspiration to me.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I actually became interested in becoming a physician mainly because of the\nfather of a friend of mine, who I got to know and who I talked with quite a bit,\nwho really taught me that the most important thing about your career is your\nability to get along with other people and to relate to other people, rather\nthan what you did.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I ended up from there going to the University of Notre Dame. I majored in what\nwas then called “pre-professional studies”—essentially pre-med\n[pre-medical]—then went to Tulane Medical School. Got very interested in\npediatrics at the time, so I ended up doing a residency in pediatrics at the\nUniversity of Colorado. While I was at the University of Colorado, I became\nespecially interested in infectious diseases. There were two ex-EIS [Epidemic\nIntelligence Service] officers who I worked with very closely, Brian [A.] Lauer\n[MD] is one, and Neal [A.] Halsey [MD]. Neal Halsey is a name that’s well known\nin CDC circles.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I also, fortunately, ended up in—at that time it was called the Division of\nImmunization—in, at that time, the Bureau of State Services [Bureau of Medical\nServices, U.S. Department of State]. In particular, I was recruited by a\nwonderful gentleman by the name of [Walter A.] Walt Orenstein [MD, DSc (Hon)].\nHe recruited me, and I ended up matching there, but the reason, though, was that\nthere was a mistake in the matching process, and where I was supposed to go was\nto work with Claire [V.] Broome [MD] in the Division of Bacterial Diseases\n[DBD]. Somehow, through the mistake, I ended up in immunizations. Well, that was\nprobably the best thing that ever happened to me.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I worked initially in influenza, learned about outbreaks, learned about flu\nvaccines. It was really my first foray into immunization and vaccines. I ended\nup, for various reasons, transferring after my first year of EIS to what was\nthen the Division of Viral Diseases [DVD] in, at that time, the Center for\nInfectious Diseases. I continued my work in flu, which in the meantime got\ntransferred there. Then, fortunate for me, a couple years later, I got a call\nfrom Walt Orenstein and Alan [R.] Hinman [MD, MPH], who told me about a new\nopportunity back in the Division of Immunization that related to providing\nsupport for the polio program for the Americas. I signed up for that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What did you know at that time about polio?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: What I knew about polio was vivid memories. I was born in 1951, and\nso I remember, literally remember, how excited my mother was when the [Jonas E.]\nSalk [MD] vaccine became available, and I also vividly remember going to my\nelementary school when I was, I don't know, nine or ten years old, to get the\nsugar cubes with [Albert B.] Sabin [MD] vaccine. I remember the excitement in\ncommunities about the availability of those vaccines. From that standpoint, it\nwas actually very meaningful to me. By that time, I also knew that most of the\nactivity that was going on with polio was not so much in the U.S., of course,\nbut in areas of the world that I was very interested in visiting. This was sort\nof a perfect opportunity for me at that time, and, really, that was my foray\ninto polio. This was, more or less, about 1985 or 1986.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=0.0,1.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What would you be doing?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=1.0,1.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, it’s funny you should ask. One of the first things I did,\nbelieve it or not, is I took an intensive language course in Spanish because I\nwas going to be working in the PAHO [Pan American Health Organization] region.\nWell, that actually got interrupted soon because there was a gigantic polio\noutbreak in Brazil in 1986. I was one of the people, actually, who went to\nBrazil. They were kind enough to speak English, fortunately, with me while I was\nthere, but essentially, I spent about two months figuring out—trying to figure\nout—what happened, because this was one of the largest outbreaks ever recorded,\nand specifically for type 3 [wild poliovirus], which is one of the least common\nforms of polio.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=1.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"More importantly, this outbreak suddenly exploded after a period of about five\nyears in which there were almost no cases of polio at all in Brazil, because in\nthe early ’80s, mainly through Albert Sabin—Albert Sabin convinced the Ministry\nof Health of Brazil to initiate mass campaigns with oral polio vaccine, just as\nwere done originally in the ’60s in Russia, when these gigantic field trials\nwere done by Sabin. Sabin convinced the Ministry of Health, “Let’s do the same\nthing.” Lo and behold, if you look at the epidemic curves of cases in Brazil\nduring that time, it was amazing how well it worked.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The event that happened in 1986 was very concerning because essentially it was\nthe first epidemic, and I can’t remember how many cases there were, but I know\nit was in the high hundreds. I mean, it was very impressive, and it was\nprimarily in the northeastern part of Brazil, the tropical area of Brazil.\nNobody could understand why it happened.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Part of what I did then, other than looking at the cases and mapping them and\ndoing the usual sorts of shoe-leather epidemiology that I was trained to do,\nis—I also was interested to know whether the failure of the vaccine somehow\nplayed a role in this. Why was the vaccine, which had been so effective for so\nmany years—why suddenly is there this outbreak?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That ended up leading to a whole series of side investigations—so, for example,\nlooking at antibody levels to type 3 polio—and the net result of all that was\nthat it appeared that the vaccine, for reasons that were not totally clear, was\njust not functioning very well against type 3.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Because it wasn’t an issue of coverage?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: No, it was not at all an interest in coverage. This is an example\nthat Walt Orenstein refers to as, quote, “vaccine failure,” as opposed to,\nquote, “failure to vaccinate.” I was very intrigued by that and was trying to\nfigure it out. I was still new to polio, relatively speaking, and so I spent a\nlong time, both in Brazil and back in the U.S., reading the literature, looking\ninto things like how polio vaccine was made—what are the titers of the\nindividual components? How is that determined? I got very interested in the\nvaccine itself. One of the things I discovered was that the formulation of\nvaccines—of OPV [oral poliovirus vaccine] that was used in Brazil and, for that\nmatter, in most parts of the world was different than the OPV that was used in\nthe U.S., in terms of the ratio of the three types.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=2.0,3.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In particular, it turned out that the content, and also the ratio of the type 3\ncomponent in the vaccine used in Brazil, was substantially lower than the\nvaccine used in the U.S. One credible hypothesis, especially based on all the\nwork that Sabin had done previously with both monovalent and trivalent forms,\nwas sort of a simple idea: would it make a difference if we used the, quote,\n“U.S.” vaccine in Brazil, in a tropical area? We actually convinced the OPV\nmanufacturer located in Brazil to make a new formulation that had a higher\npotency of the type 3 component, and we then compared that in a head-to-head\nstudy with the existing vaccine. The long and the short of it was that it made a\nhuge difference in terms of seroconversion.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=3.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The way that we designed the study—and of course this is published. I can’t\nremember the citation, but it is published; all of this work is published—we\nactually also designed the study so that we could determine whether it makes any\ndifference if a child had received none, one, two, three, or four previous\ndoses. What we found was, in all instances, the seroconversion rate to type 3\nwas dramatically increased.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As a consequence of that study, not only Brazil, but WHO [World Health\nOrganization] in general, essentially changed the formulation of tOPV [trivalent\noral poliovirus vaccine] to match this new, increased potency of type 3. Now,\nwhether or not ultimately that had an effect or whether that was just the luck\nof the draw—to me, it’s very intriguing that it may actually have made a\ndifference, because if you look back at the epidemiology of polio ever since\nthen, that was the last large, large-scale outbreak of type 3, was in Brazil in\n1986. There were type 3 cases subsequently, but never an epidemic of that magnitude.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That’s what happened. That was my foray, and then that led me on to basically do\nother things similarly in the manner of trying to figure out whether we had the\nbest tools or not.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: A follow-up question: were there other formulations of OPV that you\nlooked at around 1987, 1989 as you were looking at Brazil?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, the answer is sort of yes. Here’s what I mean: as a consequence\nof what I just described—I mean, there was a lot of background work that went\ninto that. There’s an enormous literature. Dating back from the ’60s, there were\nbooks written about the manufacture of polio vaccines, both oral and\ninactivated, and how were they determined? How were they made? All those sorts\nof things. That literature, nobody had really looked at that for twenty years.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"From that literature, it became apparent, at least to me, that it was important\nto very carefully regulate not only the potency of each component, but also the\nratio. That ended up leading us collectively—CDC and also WHO and some academic\ninvestigators—to also examine other formulations of OPV. WHO ended up\ncoordinating a very large clinical trial that was patterned after the one that\nwe did in Brazil at the beginning. We did have similar results with the\nstudy—there were two studies related to that. But we did not see, for type 1,\nfor example, the dramatic difference in seroconversion that we had seen earlier\nin Brazil for type 3.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"All this work was more or less from about 1986 through, more or less, about\n1992—after that, not much work was really done. Those were really the only\nstudies that really sort of took a close look at the question of, do we really\nhave a tool that can go on and achieve the goal of eradication? Our focus was\nsort of on the front end, sort of on the research side—in a practical means, to\nbasically ask the question, do we have the tools available to us? Because there\nhad already been the declaration to eradicate polio. The question that I was\ntrying to—and it wasn’t just me; it was others who were interested in knowing\nwhether the right tool—did we have the right tool? Can we use that tool\nefficiently? What ways could we speed things up, if at all? How could we make\nachieving the goal of eradication more efficient? That was really the key thing\nthat I and some of the other people that I work with were really most interested in.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=4.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Who were some of the other people you were working with at that time?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, it was an interesting group of people, actually. One person who\nwas really behind this, completely from day one, was Walt Orenstein. Walt was\ndefinitely a champion of this: figuring out this Brazil outbreak, which then led\nto the question of, do we have the, quote, “right” vaccine to work with?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Walt was also, interestingly, involved in work related to IPV [inactivated polio\nvaccine] as a consequence of having actually investigated an outbreak in Israel.\nDuring his time there, he was also exposed to—it really was a public health\nexperiment that was going on. I mean, not experiment in a research sense, but\nsort of a natural experiment because there were areas in Brazil—sorry, not in\nBrazil, in Israel, and specifically the Gaza Strip—that actually had a combined\nschedule for polio that involved both OPV and IPV. Walt actually investigated\nthat and was part of sort of an inquiry that was led by the Israeli Ministry of Health.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The upshot of all that was that that information was not easy to ignore. That\nwas really the first really solid evidence, at least in my mind, in a\nso-called—I mean, Israel is not really tropical, but the areas of the world that\nwe’re talking about were generally poor and underdeveloped and not at all\ntypical of the U.S. or Europe. The idea that maybe there could be a combination\nschedule that would include OPV and IPV, maybe that was an idea that was worth\nconsidering. Walt Orenstein played a really important role in that, and sort of\nencouraged looking into whether or not IPV could have some role.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Related to that, one of the interesting things that we did, i.e., myself and a\nterrific IES officer, Bernard [J.] Moriniere [MD, MPH]—and I still don’t speak\nFrench—so Bernard actually ended up going to the Ivory Coast, Côte d’Ivoire,\nright, and the experiment that we designed was very simple. We asked the\nquestion, “If you took a group of kids and you gave them OPV at six weeks, ten\nweeks, fourteen weeks,”—which was the global schedule—\"so they got three doses\nof OPV, and then when they were nine months old, to come for their measles\nvaccination, what would happen if you gave them IPV?”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What year was this?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: It was either the late ’80s or early ’90s. It was late ’80s. I’d have\nto go back and look at the publication. All of this stuff I’m talking about is published.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We compared two groups of kids—so all the kids got three doses of OPV, but then\nat nine months they either got another dose of OPV, or they got IPV. When you\nlooked at the results, they were dramatically different. The kids who ended up\ngetting IPV had absolutely phenomenal responses, particularly to types 1 and 3,\nwhich at that time were problematic because Sabin type 2 is a fantastic vaccine,\nmainly because, genetically, it’s very close to the wild type. It’s really types\n1 and 3 that were problematic, and in this study, we showed that if you were to\nfollow that schedule, one dose—one dose of IPV at nine months—it would\nphenomenally improve the seroconversion rate, and essentially every child in\nthat group was completely protected.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=5.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"A lot of people, when they read that paper, thought that that was a novel idea\nor a novel finding. It wasn’t. Albert Sabin proved in the early 1960s that if\nyou follow an OPV infant and give them later on IPV, as a consequence of them\nhaving been primed with OPV, they will develop, essentially, a phenomenal\nbooster response. OPV primes for IPV.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"When you give IPV, you don’t have the problem of whether or not the child might\nhave some other GI [gastrointestinal] illness going on that would prevent them\nfrom—their cells, essentially, in their intestinal tract, from being infected\nwith OPV. That’s eliminated because you put the antigen in their arm. From an\nimmunological point of view, it also makes sense, and it was actually Albert\nSabin who first reported that. It was actually a replication, interestingly, of\na study that Albert Sabin did. Albert Sabin thought that IPV was essentially poison.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I was also around during the time—I never witnessed their debates in person, but\ncertainly Albert Sabin was not, in any way, a fan of IPV, and yet it was Albert\nSabin who made that first observation, and so we just replicated it. It’s not\nthat we were smart. We just tried—we were looking for efficiency. That’s what we\nwere doing. Because the alternative to efficiency was to try to replicate\neverywhere what Sabin did in Russia in the ’60s, what PAHO did in the Americas,\nwhich is mass campaigns—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Did you look at Cuba, as well?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: The short answer is no. I never really—Cuba never was on my radar at\nthat time. I’m not sure why, but no. I think this is right, that Cuba basically\nhad the same type of system with mass campaigns and so on, but I actually don’t\nrecall, now that you mention it, reading anything about the Cuba experience. It\nwas mostly the Brazil experience that was sort of in the front of my mind.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Did you look at monovalent OPV [mOPV] at all in the early—?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, well, that’s actually a good question, and this relates back to\nthe trial that I mentioned earlier that we did in Brazil. Your question relates\nto, actually, something very important which I forgot to mention, which is, as\npart of the control group in that study, we also administered monovalent type 3\nas a control, actually. But what we found was if you gave type 3 alone,\nsurprise, surprise, it works better, which, again, was proven by Sabin back in\nthe day and relates to the fact that if you look at the formulation of OPV, even\nin the U.S., the amounts and the ratio of those three components are different,\nand the vaccine actually works better—each component works better when\nadministered on its own.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=6.0,7.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Yes, that study ended up being sort of a more contemporary version of some of\nthe studies that Sabin and others—and in particular [Mikhail P.] Chumakov in\nRussia—did during the ’60s.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=7.0,7.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I really can’t take much, if any, credit for any of this stuff; it’s not like\nthis is a novel idea. The main thing that we were trying to do is basically\nfigure out, is there a better way to build a mousetrap? That was the question\nthat we were asking. At least in the studies that we’ve just discussed and that\nI mentioned, the answer is yes. There is, or there could be, a better mousetrap.\nThere could be a way to make it more efficient. There could be a way to achieve\neradication more quickly.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=7.0,7.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That’s what I took out of that experience, and there were a lot of people who\nbelieved that, but also a lot of people and groups that didn’t. They didn’t want\nto hear that. They essentially were wedded to what I’m going to call the, quote,\n“PAHO method.” That was sort of a—kind of an uncomfortable feeling, at least,\nthat I had, and some others in the field who were also interested in the\npossibility—we were never saying, “Do it this way.” We were examining all of\nthese questions strictly from the standpoint of research. Practical research,\nnot basic research. We were trying our best to consider all options. We tried\nnot to be biased. We did not do this haphazardly. We essentially recreated\nresults that had been generated, even by Sabin and Salk. We were just trying to\nbe very practical. We weren’t saying, “do it this way.” We were saying, “Hmm,\nwhat if you were to change your approach to do X instead of Y? Would that make a\ndifference? How would the program be impacted?” That’s very important because\nonce you start introducing an inactivated and injectable vaccine into a mass\ncampaign, well, guess what? The logistics of that are hugely magnified. That’s a\nproblem. But is there a way even to overcoming something like that—through\nresearch and development?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=7.0,8.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It was mainly, let’s do these studies. Now, this was early. A lot of this work\nthat I’m referring to was really in the early days of the global eradication\nprogram. It was not as though things were great in—epidemiologically speaking,\nall over the world. There were huge outbreaks in different parts of the world,\nparticularly in Southeast Asia at that time and also in Africa. The idea was,\nlet’s, quote, “get ahead of the curve” before the curve gets out so far that\nthere’s no turning back. Let’s look at these things now in a practical way, as a\nmeans of—as sort of an insurance policy. What if the global strategy, the mass\ncampaign strategy, what if that doesn’t work as well as it did in the Americas?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=8.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Maybe it will. Northeast Brazil, I was there during the outbreak. It’s an\nincredibly impoverished, at that time, area. That’s very typical of these\ntropical environments.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We were really developing insurance policies. Our intent was not to upset the\napplecart, or make people upset or give mixed messages. That was not our intent.\nWe were just trying to think of ways of doing things faster, number one. Number\ntwo, we thought that it would be useful to have an insurance policy. What you\ndon’t want to have happen is to put all your, quote, “eggs” into the mass\ncampaign basket and then ten, fifteen, twenty years later find that it’s just\nnot doing the same thing as it did in Latin America.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That was really our intent, and we were doing that, quote, “on the side.” We\nwere doing that as an R\u0026D [research and development] exercise, separate from all\nthe work that was going on with surveillance and improving surveillance tools\nand all the things that were going on, particularly in the lab: sorting out with\nvery fine specificity, where are these viruses coming from? Are they linked? Is\nan outbreak in one country linked to another? All these important and crucial\nthings that were going on—it had nothing to do with that. It had nothing to do\nwith the incredible logistics that are required, with the cold chain and with\nmass campaigns and getting children to come during mass campaigns, convincing\nparents that this was to the benefit of their children, all the social\nmobilization and all that stuff—all that stuff is so important.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=9.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I can’t say we were not interested in that, because we were, because it’s very\nimportant. But the questions that we were trying to address and answer were\nnarrow, and they were very simple in principle: is there a better way to do this\nfrom the standpoint of, number one, the vaccine as a tool, number two, we had\ntwo tools—would it be better if we could somehow bring them together? Maybe not—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you talk about the immunization schedule in the United States prior?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Prior to—?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Prior to bringing IPV into the schedule.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, sure. The traditional schedule in the U.S. was three doses of\nSabin OPV, which was trivalent—so this was after the monovalents got combined\ninto the trivalent. Three doses at age two, four, and six months. Why two, four,\nand six? Well, part of that was historical. Part of that is because that’s when\nother vaccines are administered, according to that schedule. That was the schedule.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Prior to that, when IPV was around, during the period between the time that IPV\nwas approved in 1955 to—I’m pretty sure it was ’61 when Sabin’s monovalent\nvaccines were approved, which they got—so during that five-year period, IPV was\ngiven, according to the same schedule.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That’s the schedule. In the U.S., and for that matter in Europe, for example,\noutside of the tropics and so-called industrialized countries, that’s a great\nschedule. Tremendous antibody responses. “Everybody,” quote-unquote, near\neveryone, develops antibody. There was never a question in the U.S., at least in\nmy mind, that polio could be eliminated in places like the United States,\nEurope, et cetera, et cetera. That was never a problem. Nobody ever had worries\nabout that because the response was so phenomenal.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But guess what? That’s not where the problem is. The problem is outside the U.S.\nThe problem is along the tropics, around the equator. The conditions are just so\ndifferent. The development of societies and the sanitation levels and the degree\nof sophistication and the cold chain and the vaccine delivery system—so I have\nno qualms at all that almost an entirely new system for delivering polio vaccine\nhad to be, quote, “invented” in order to achieve the same results.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But one of the big differences, though, was that in tropical areas, even if you\ndelivered three doses, you were still way below, from an antibody point of view,\nbeing able to show that the majority of kids would have had antibody against all\nthree types. As a consequence of that—and we actually showed this in some of the\nother studies we did where we actually looked at the seroprevalence of antibody,\nhow much antibody could we measure in the blood after one, two, three, four,\nfive, six, seven, and so on and so on and so on? All the way up to as many as\nthirteen doses. If you look at that dose response curve, it’s almost linear.\nWhat that means is, you don’t really hit the high nineties until you get past\nten doses.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=10.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"What it meant was that the U.S. or European routine schedule, it’s not going to\nwork. If you want to use OPV, you’re going to have to give as many kids as you\npossibly can as many doses as you possibly can. Every opportunity, you should\ngive them a dose. Layered on top of that are mass campaigns, national\nimmunization days (NIDs). You want to also do that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=11.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Why do you want to do that? Well, you want to do that because if you are\nvaccinated—if millions, or whatever the number is, big numbers of kids are all\nvaccinated at the same time, the vaccine virus can be transmitted from kid to\nkid, so you’re suddenly sort of awash. It’s everywhere. Poliovirus is\neverywhere. That’s another reason to have these mass campaigns. But think about\nthat for a moment. Think about giving ten doses of OPV to every kid, everywhere,\nincluding kids who are hard to reach, who don’t live in accessible areas.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=11.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Now, you have to figure out with a vaccine that’s labile, heat-labile—so now you\nhave to figure out, how am I going to get this child who lives way, way out in\nrural areas, no roads, but—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=11.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Seasonal flooding.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=11.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, seasonal flooding, you name it. How are we going to get ten\ndoses into those kids? You essentially have to end up creating this massive\nsystem of having to deliver ten or more doses to every kid, essentially every\nkid. You have a vaccine that doesn’t work very well, you have this major cold\nchain problem, you have the logistics of getting the vaccine from point A to\npoint B and making sure that it doesn’t lose its potency. Once you finally get\nit there, you have the, shall we say, social and cultural things that go into\nwhether or not that particular village or mother or whatever the case might be,\nwhether you can convince those people to have their children vaccinated. You end\nup with a massive, in my opinion, massive vaccine delivery—I hate to use the\nword “problem,” but it is a problem to have to create these different\noperational and infrastructural things in order to be able to achieve this.\nGuess what? That costs time and money, and a lot of time and money.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=11.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This relates back to what I was mentioning earlier: wouldn’t it be easier if you\nonly had to give three doses of OPV and one dose of IPV? Wouldn’t that be\neasier? I think it would be.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: To return to chronology a bit, in 1988, the resolution was announced.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: You were at CDC.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: I was.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: At that point. This is before funding came through the [U.S President\nWilliam J.] Clinton administration in the United States. Could you talk about\nthat time and what you were doing and where the conversation was, and also about\nthe artifact that you brought in?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Yes. Yes, so I have this artifact. This is a copy of the very\nfirst Consultation on Polio Eradication that took place in Geneva in September\n1988. I was there. I have the notebook to prove it. I also have here a copy of\nthe very first—literally the first Plan of Action for Global Eradication of Polio.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,12.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This was, obviously, a very incredible time because momentum was building, and\nthere were concrete discussions among many organizations—all the key global\norganizations, quote-unquote, “got on the bandwagon.” There was a lot of support\nfor this. It was really led by the success in the Americas, in particular, in\nBrazil. Even in 1988, following the outbreak that we talked about earlier about\nthe type 3 outbreak in ’86, that had all blown over. The quote-unquote “problem”\nwith the type 3 potency that was used globally, that problem had been solved,\nbecause the UNICEF [United Nations International Children's Emergency Fund]\nspecification, WHO specification, now called for higher potency for type 3.\nThere was a lot more confidence globally in all regions, and among all the\ninterested parties, the interested donors, that—guess what? We can do this.\nLet’s go.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=12.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you tell the story of how you arrived at that meeting? How were\nyou invited? Who invited you?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=13.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, yes. Part of the work I did, after having gotten, shall we say,\nmy feet wet, literally and figuratively, in Brazil in 1986 with PAHO, was they\nneeded somebody, WHO did, at headquarters level, somebody who had firsthand\nexperience with the program in the Americas. There really wasn’t anyone from the\nPAHO system that was available at that time, so I was, like, a good, shall we\nsay, second choice.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=13.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I actually started going frequently to Geneva from CDC, spending weeks at a time\nessentially organizing this meeting and preparing for this meeting within the\ncontext of the global program.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=13.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Were you working with [Ralph H.] Rafe Henderson [MD, MPH, MPP]?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=13.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Rafe Henderson was the head of EPI [Extended Programme on\nImmunization], as it was called at that time. He had responsibility over all of\nthe entire program, which included, obviously, polio. He also had various staff\nmembers who were also there. There were people involved with the potency issue,\nso in other words, on the vaccine biologic side, there were people at WHO, who\nwere concerned with that. There were also people who specialized in vaccine\ndelivery. It was really sort of a consolidation of all of those groups of\npeople, and then also interest on the part of other very important people who\nhad had experience elsewhere in the world with polio—we were essentially all\nbrought together for this meeting in 1988, and I was there.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=13.0,14.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: You were asked to comment on the draft.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=14.0,14.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Yes. I did comment on the draft. One of the comments, one of the\nmain comments I had, was that WHO in the EPI at that time was kind of an\ninteresting position in the sense that they wanted to replicate the program in\nthe Americas, which worked. They wanted to do that, but they couldn’t do that,\nbecause they didn’t have enough money or resources. Think about it. Think about\ngiving every child in every country in every region ten or more doses of OPV.\nThis plan really speaks to primarily the routine immunization of kids, which\ninvolves the typical schedule with three doses, to be, quote, “supplemented” by\nsome of these other things, like National Immunization Days, like mass\ncampaigns, like some of the things that had been done by PAHO. That was really\nthe problem with this plan: all the right strategies were there, but from a\npractical point of view, there was a disconnect. The idea that you could achieve\npolio eradication with a, quote, “routine” immunization series that was not\nsupplemented repeatedly—that was the other problem, repeatedly with mass\ncampaigns in the style of PAHO, and Russia before that, and so on and so on.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=14.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That was the main problem. They knew that, but they couldn’t. I mean, they\ncouldn’t, they couldn’t go to the donors with a grand plan that included, “Well,\nwe have to give ten doses to every kid in the world, no matter where they are or\nwhere they live.” Can’t do that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: How did you know that they knew that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: It was mostly hallway [laughs] conversations. Right? This is our\npolicy, but [whispering] this is what we think. That’s how it works.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Were there other people who you remember publicly pointing some of\nthese concerns out?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Yes. There was, and actually still is, in different spheres of\nvaccination, sort of, shall we say, the “silent minority,” or people who rattle\ncages. There were other people besides me who rattled cages, one of whom was a\nguy named [William H.] Bill Foege [MD]. Another one, who actually continues,\neven to this day, playing a critical role in polio eradication, but who was,\nquote, “blackballed” for most of his time, is [T.] Jacob John [MBBS, PhD].","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: From India?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: From India. It was actually Jacob John who showed, himself, in a\nseries of elegant studies—a long time ago, in the ’70s and ’80s, he essentially\nproved, at least in the environment of India, that there was literally no way\nyou could rely on a routine immunization schedule for children who lived in\ntropical regions such as the one that he did the studies in, which essentially\nwas in Vellore, India. His argument was, if you think that you’re going to—just\nbecause you give three doses of Sabin’s vaccine to every child, if you think\nthat that’s going to work everywhere, it’s not. He actually made that very\nclear. He also was interested in the role of IPV, in the same way that we were,\nso he also did studies looking at the combination of the two and was finding\nsome of the same things.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=15.0,16.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"At the same time, Bill Foege, in particular, was also confronted with\nessentially—in the literature and from speaking with people like Jacob John, and\nlooking at some of the data that we at CDC were generating with our own\nstudies—the three of us, essentially—another advocate, if you will, aside from\nWalt Orenstein, who publicly, I don’t think, could say that he was, quote, “with\nus,” but privately, I thought he did—but a public health official in Israel\nknown as T.A. Swartz [MD, Professor, Department of Epidemiology and Preventive\nMedicine, Sacker School of Medicine, Tel Aviv, University, Israel], who actually\ninvented the IPV/OPV combination schedule that was used in some areas of the\nGaza Strip in Israel—all of us were on the, quote, “combined” approach\nbandwagon. We were.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=16.0,17.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We weren’t saying that it should be done that way. We weren’t saying that it\nwould be easy. We weren’t saying that it would not be more costly. We weren’t\nsaying any of those things. We were saying, “If you want the system to be more\nefficient, this is a way to do it.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=17.0,17.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Once—and if—there was ever agreement for that, the rest of it becomes easier.\nWhat do I mean by that? After I left CDC, I’ve spent most of my career on the\nfront end of vaccine development. How are vaccines made? What are their\ncharacteristics? How can you make them so that they’re more stable? How can you\nmake them so that they’re more immunogenic, so you don’t have to give multiple\ndoses? Things like that. Those questions—that I actually know a lot about now\nbecause I’ve been doing it for the last twenty years, almost. Nobody knew at\nthat time—with IPV as an example, nobody knew how to make it cheaper, at higher\nyield, at lower doses, or add adjuvants, or any of the other things that are\nknown now. But they could have looked into it as a parallel R\u0026D effort.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=17.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Research and development?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, research and development. That’s the purpose of research and\ndevelopment, is not only to develop something new that didn’t exist before, but\nit’s also, how do you make something good better? The technology existed. Yes,\nthis was a long time ago, late ’80s, early ’90s, but the technology was coming\ninto being that, had there been an R\u0026D, a research and development effort to\nmake IPV more cheaply, to make it more thermo-stable, to administer it through\nother means besides needle and syringe, had somebody paid attention to that or\nthought about it other than us, this small group, the entire eradication program\ncould have been accelerated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Were there alternatives to injecting inactivated polio vaccine?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: The answer is yes, there were. It’s interesting to me that one of the\nthings that has come out recently, like in the last ten years, which could have\nbeen done thirty or forty years ago, is to administer IPV intra-dermally. What\nthat means is, you literally inject it into the skin. If you or anybody else\nwho’s listening to this have had a skin test—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: TB [tuberculosis]?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA:—for TB, that’s how it’s administered. The needle, it’s a small\nneedle, it goes into your skin—not through your skin, into your skin. You make a\nsmall bubble, a bleb. That’s how the TB skin test works. Now, there are more\nmodern TB skin tests now. There’s a blood test, all that stuff, but most people\nremember having that done. Well, guess what? You can deliver an inactivated\nvaccine in the same way, and one of the important, very important, series of\nstudies that have been conducted recently, within the last few years, have been\ncoordinated with WHO to look at the intra-dermal administration, just like a TB\ntest, with IPV.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Guess what? That could have been done in 1990. Case closed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: But where was the conversation in 1990?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, the conversation in 1990 was, “We don’t want to hear this.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you give an example of a meeting where that was communicated?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Yes, I can. There was a meeting in New Delhi, and I can’t—I\nshould know, I should remember exactly what year that was, and now I’m blocking\non it, but it was either ’91 or ’92. There was a meeting that was held in New\nDelhi to begin to talk about the possibility of having a combined schedule.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Who initiated the meeting?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, that was the problem—one of the problems. The meeting was\nprimarily financed by a drug company, Sanofi [Sanofi, S.A., Société Anonyme]. Or\nits predecessor—it’s—I can’t remember. Like, Sanofi Pasteur, or Pasteur Sanofi,\nor whatever the—but basically, it was a French company. Sanofi was—it may have\nbeen the only, but I’m not sure about this, but it was one of the main providers\nof IPV. IPV at that time was not used in very many places. India, guess what, is\na very populous country, right? Sanofi decided primarily to—and I can’t remember\nif they were the sponsor, but I know that they paid for most of the people to be\nthere. The idea behind that was to introduce—not demand; introduce—concepts of\nwhy and how IPV could contribute to the eradication program.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=18.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"For example, and following on to some of the research that I mentioned earlier\nthat we did, CDC did, and that others did—so it was intended to bring public\nhealth officials, especially public health officials in India, where Jacob John\nhad already shown that even if you give kids in India ten doses, guess what?\nThey’re still not protected. India was the ideal place to begin to talk about\nthis in public. It was.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As a result of that meeting—and to me, I mean, I remember giving a presentation\nat that meeting. My presentation didn’t consist of anything new; it wasn’t an\nargument that there should be a switch, “You must do this.” The message that I\nwas trying to convey, and actually, most of the other people at the meeting were\ntrying to convey, is that IPV could have a role. “This is how it could—,” not\n“It must.” It was presented in a way of, “Don’t you think we should think about\nthis? Think about it, not dismiss it—think about it as a tool?”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This was also in follow-up to a previous similar meeting that was actually held\nin Jerusalem that talked about a similar subject. Essentially, does IPV have a\nrole, a possible role, in polio eradication? The same people were there. It was\nessentially a replication. Those two meetings occurred in time within a year of\neach other, as far as I can remember.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"What happened after that meeting was, in one word, nothing. Nothing. Nothing\ncame of that meeting. Nothing. Well, I should qualify that. Something else\nhappened. What happened to me, what happened to Bill Foege, what happened to\nJacob John, is that, for lack of a more complete description, we were\nmarginalized—all three of us were marginalized.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Can you explain what you mean? What that looked like?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. What that looked like was being told directly, and I won’t say\nwho here, but being told directly by multiple people—not including CDC, none of\nmy supervisors, not Dr. Orenstein or Dr. Hinman. There was nobody at CDC who\never objected, as far as I know, to anything that I ever said or did. They were\nalways supportive. That never happened.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But there were other people, who I won’t name here, who basically, in so many\nwords, told me to shut up. “We do not want to hear this. We do not want to have\npeople, especially scientists of your prominence—” So we’re talking—I don’t\nreally put myself in the same category as Dr. Foege and Dr. John, but we were\nknown, we were part of the global system. I was there, OK? I was there. Foege\nwas not. Jacob John was not. I was. We were told, in so many words, to shut up.\n“We don’t want to hear this. You guys need to stop talking about IPV because we\nhave this global eradication going on, and our vaccine is OPV, and our strategy\nis what was developed originally by Sabin, perfected by PAHO.” And they had a\npoint here—further implemented in the Western Pacific Region [WPRO], so it was\nworking there, too. It’s no small task to eradicate polio in China, let me tell\nyou. That’s why. They pointed to all those examples as important. They were. Our\npoint was, guess what? India is not the same. Guess what? Sub-Saharan Africa is\nnot the same. That message was lost. They didn’t buy that. Basically, the three\nof us at least—there were probably more—me, Dr. Foege, Dr. John, forevermore\nafter that meeting in New Delhi, we were marginalized.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=19.0,20.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Does that mean not included in meetings?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=20.0,20.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. It means not included in meetings. That includes, “We don’t want\nto hear anything you have to say again anymore. Please shut up. We don’t want\nyou to write any publications; we want you to get with the program. We don’t\nwant to hear any more—any question.” It was not just an honest scientific\ndisagreement, which is what we all have. We’re all scientists, all of us. That\nwas what it was. We were asking questions—that’s all we were doing. We were not\ntelling people, “You must do this.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=20.0,20.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: But the response you got, did that suggest that someone felt like you\nwere pushing?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=20.0,20.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, sure. Because it was really that timeframe, and this was around\n’91, ’92, that people like us, people who question, who raise questions, who\nsowed any degree of doubt, who said anything that would scare off any of the\ndonors—if we didn’t shut up, then eradication—it was almost like, “If you guys\ndon’t shut up, we’re not going to be able to eradicate polio, so please shut\nup.” That was the message. The message got so loud in my ears that it—quite\nfrankly, it was one of the main reasons why I ended up deciding to leave CDC and\ngo work for some other part of the public health service, which first ended up\nbeing the National Vaccine Program Office [NVPO] for a short while, and then FDA\n[Food and Drug Administration]. That’s really the main reason why—that sort of\npushed me over the hump of deciding to leave CDC, was the marginalization and\nwhat I perceived as the, not inability, but the refusal to hear any\ncontradictory opinions or anything that could undermine or even question what\nwas going on with the global program, which was now basically in full swing.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=20.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: This would have been after 1991, after U.S. federal government\nprovided $3.1 million?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=21.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Right. All the donors were on board. There was tremendous momentum.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=21.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: When you say “donors,” who are you talking about?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=21.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, I’m talking about Rotary International. I’m not positive, but I\ndon’t think the Bill \u0026 Melinda Gates Foundation was yet engaged. I don’t think\nthey were. We’re talking about UNICEF. There were other countries, and I can’t\nremember the names of these places, but they were sort of the USAID [United\nStates Agency for International Development] equivalent type organizations with\nother countries. I mean, and I can appreciate this. All those organizations\nwanted a common theme. “We want to support the eradication of polio. We think it\nshould be done.” We collectively were all holding hands together, collectively\nthink it should be done, in essence, like they did in PAHO. “This is the way it\nshould be done. We’re behind it; we’re going to support it, and you’re\neither”—it’s like the old Ken Kesey, Electric Kool-Aid Acid Test [by Tom Wolfe].\n“You’re either on the bus, or you’re off the bus.” I decided to get off.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=21.0,22.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Was there one particular event? How much time elapsed?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=22.0,22.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: I mean, the big event was the New Delhi—if there was one event that\nreally made a big difference, it was that. It was also when the whole program,\nboth globally and within CDC—once the money started coming in that allowed the\norganization to be built, so the—at that time, the Division of Immunization, I\nthink it was called, that Walt Orenstein was in charge of that, whatever the\norganization was called at the time [Division of Immunization, Center for\nPrevention Services, CDC], it changed names—that became a program-oriented\nactivity. The research part that I was so interested in, they will tell you in\nretrospect, and even at that time, that there was still research going on. There\nwas. Research about very practical things, like vaccine vial indicators that you\ncould stick on a vial and you’d know immediately whether it was good or not. I\nmean, all that stuff is so important. But they didn’t want guys like me anymore.\nThey didn’t want people who were interested in a better mousetrap. It was, “We\nhave our mousetrap. It is good enough. Please shut up. We don’t want to hear\nabout it anymore,” in parentheses, “If you don’t like it, why don’t you hit the\nroad?” Full stop. The sort of small band of merry pranksters—me, [Robert A.] Bob\nKeegan [credential], [Robert W.] Robb Linkins [MPH, PhD], Mac [W.] Otten [Jr.]\n[MD, MPH]—this small band of people suddenly became this, relatively speaking,\ngigantic—it would get more gigantic as time goes on, this machine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=22.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The machine was program-oriented. We are now going to do our job. Our job is to\ngive as many doses of OPV to every child, every time, under any circumstances,\nany time we see them. That was the program, to flood the world by whatever means\npossible with OPV. That was the program. “If you,” they’re talking to me, “if\nyou have other ideas, we don’t want to hear it. Go away.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: At this point, were you leading the Polio Eradication Activity [at CDC]?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, I was. Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you tell the story of how that began?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. That began in—essentially around ’85, when Walt Orenstein and\nAlan Hinman asked if I would come back and do polio. I agreed to do that, so I\ncame back.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That then led to a—literally almost a one-man show, i.e., me, going to\ninvestigate the outbreak in Brazil and figuring out the type 3 program and the\nvaccine potency problem, all that stuff. It wasn’t just me; I had a lot of\nsupport from—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Susan [E.] Robertson [MD] was one person?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, Susan Robertson ended up doing important IPV work in Senegal.\nShe was actually involved with a researcher known as Philippe Stoeckel [MD], who\nunfortunately was affiliated with Sanofi. OK? Here’s the Sanofi connection\nagain, OK? Senegal was an IPV user, because of its affiliation with France. The\nwhole country, I mean.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Because those were vaccine-producers.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Or there were vaccine producers in France.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right. Susan Robertson, actually, was part of a field evaluation of\nthe clinical efficacy—not serologically—clinical efficacy of IPV.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you speak to the difference there and why that’s important?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. The difference is, when you look at clinical efficacy, you\nactually compare people who get a certain vaccine—in this case IPV, not OPV, but\nIPV—versus nothing. Placebo. You then compare the incidence of polio in those\ntwo groups, so in the treatment group versus a control group. I’m pretty sure,\nbut I don’t remember the details, I’d have to look up the publication that Susan\nhad with her other colleagues in Senegal, but I may have misspoken when I said\nit was placebo controlled. It probably wasn’t, but it was organized in such a\nway that you could compare, for example, one dose with two doses versus three.\nThen you actually look at the number of polio cases, paralysis cases, that you\nhave in these different groups. Well, she did that. What she found was that IPV,\neven in that situation—I mean, I’ve never been to Senegal, but I have been to\nGambia and some of the other countries that are close by that have similar\nconditions—and that vaccine worked by itself. OPV was not used in Senegal.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=23.0,24.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"You have the accumulation, then, of all these little different bits of pieces\nthat, depending on where you sit—so if you’re, quote, “on the bus,” you bring up\nall the OPV stuff; if you’re off the bus, you acknowledge, at least, we would\nlike to think—our little group of merry pranksters acknowledged, yes, Sabin’s\nvaccine is great. It’s wonderful; it’s fantastic. It got rid of polio in Brazil,\nwow. It’s wonderful. But guess what? It’s probably not going to work that well\neverywhere. That was our whole point. It was not “OPV is terrible, throw it\naway, we should convert to IPV. We should have a bonfire with all of Dr. Sabin’s\nwork we should just burn it to the ground.” But that’s how we were perceived and\ntreated. That’s what bothers me. It wasn’t just me, it was Bill Foege who was\ntreated the same way. That shouldn’t happen.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=24.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Was [Donald A.] D.A. Henderson [MD, MPH] also around?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. D.A. Henderson was actually the chairman of the TAG, the\ntechnical advisory group, for PAHO. Yes, he was there. It’s funny you should ask\nabout that, because I actually—believe it or not, I didn’t even think about it\nuntil now—I never once ever heard D.A. Henderson say anything about IPV, ever.\nWhether he thought it was good, bad, or indifferent. I honestly don’t remember\nhim talking about that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: That’s interesting. I remember reading a comment in my prep for this\ninterview, where Donald Ainslie Henderson said that better technology would be needed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Oh, yes. Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Had you heard that, as well?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: I think I read it in a paper by Bob Keegan.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, that’s right. Yes, thank you for reminding me. Yes, that also\nreminds me. We talked a little bit earlier about the first meeting in 1988 about\nglobal eradication. I will never forget what D.A. Henderson said. What he said\nin public at that meeting was, “We will not eradicate polio with this vaccine,”\nand “this” referred to Sabin, the oral polio vaccine. Henderson was not, I would\nsay, a member of the bus people. He was not on the bus. Now, I said a few\nminutes ago I never heard him say anything, one way or the other, about IPV.\nThat part is true. He never, unlike me, Dr. Foege, Dr. John—I mean, we actually\ntalked about it. I honestly don’t remember him ever saying anything, either pro\nor con, about IPV. I just don’t remember.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=25.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Interesting. Two follow-up questions: were people talking about issues\nwith IPV production and shortage of vaccine at all?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=26.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. That’s actually a very important thing which I haven’t even\ntalked about. The problem, one of the main problems at that time with IPV, is\nthat it is unquestionably far more expensive to produce and to commercialize\nthan the Sabin vaccine. There’s no doubt about that. That was one of the things,\nand rightly so, that the people on the bus kept talking about. “We can’t use IPV\nbecause it costs too much,” and all the other things: it’s hard to administer,\nit’s injected, all that stuff, which is all legitimate. But that’s a technical\nproblem that was eventually solved, in the not too far-distant future from the\nlate ’80s, early ’90s. There are manufacturing methods that have since been\ndeveloped that have brought the cost of IPV way down to the point where, guess\nwhat? It’s now being used. Is it still more expensive than OPV? Well, sure it\nis. It involves a lot more steps. Purification and concentration and all these\nhighly technical manufacturing things. It’s hard. It’s hard to make.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=26.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Yes, that was discussed. Yes, that was always recognized as a limitation by me,\nby Foege, John, and others. But our point was, guess what? Technology changes.\nNew manufacturing processes are developed. There are a lot of big vaccine\ncompanies that do this for a living. Maybe they’ll figure it out. If they do\nfigure it out, don’t you think we should think about it as a possibility? That’s\nall we were saying. We were not pounding drums. We were not renting those\nairplanes that you see on the beach with the big flag behind them. We weren’t\ndoing that. We were [whispering] asking questions. That’s all we ever did.\nThat’s it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Which is part of your responsibility in the profession, right?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, that’s right. Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What about mucosal immunity? What about that argument?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, mucosal immunity is important, it is. OPV is better, it is. But\nit’s a matter of degree. It matters to your perspective. What is your\nperspective? Well, my perspective, my own personal perspective, is I don’t ever,\never want any child anywhere in the future to be paralyzed. That’s what I don’t\nwant. To me, that’s my goal. Now, that’s not the same as—which may happen; I\nmean, it really is the goal to literally eradicate polio, so that it can’t even\ncause any infections. But to me, until you get there, the goal should be [that]\nno child should ever be paralyzed. To me that’s number one, always number one.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/152","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Could you eradicate polio with IPV? Probably not. I don’t think you could. It’s\nnot just me; the literature supports that one of the clear advantages of OPV,\nshown in multiple different ways—scientifically, animal models, you name it—is\nthat mucosal immunity, the secretory immunity that’s produced in the\ngastrointestinal tract, can unquestionably reduce—not eliminate, but reduce—the\ntransmission of polio from one person to the next. It’s a real thing. Is it one\nhundred percent? No. Does it mean that IPV has no effect whatsoever? The answer\nis no. It’s all relative. But to me, it’s really—that is a critical difference\nbetween OPV and IPV.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/153","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Even today, I would never advocate IPV alone until there is no wild polio\nanywhere, OK? Only then would I personally agree, and scientifically agree, “OK,\nwe’re done with OPV. It’s all IPV now, because there is zero—no, wild polio\nanymore. It doesn’t matter whether you have secretory immunity. It doesn’t\nmatter.” I never, ever once ever even thought that you could get by with IPV\nonly. That was the other thing that Bill Foege and I and Jacob John got flak\nfor, because the implication was that we thought OPV should be trashed and\nreplaced by IPV. No, we didn’t say that. We never did. Nobody ever said that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/154","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: You’re asking all of these questions. How did the marginalization\nimpact you, personally and professionally?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/155","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, the marginalization ultimately had positive effects. Here’s\nwhat happened. As I became more and more and more uncomfortable in my position\nas the, quote, “leader” of the little tiny—like, five people—group that we had,\nas I was sort of increasingly being told—not by Walt Orenstein or Alan Hinman,\nbut by the, quote, “global community”—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/156","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: In 1991, 1992?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/157","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right. Basically, the world—not CDC, the world community—basically\nsaid, “Shut up, we don’t want to hear from you anymore,” including the people in\nGeneva. Nobody wanted to hear me anymore. Then what’s the point of staying? I\nthought what I had done—not personally, but in terms of coordination and all the\nstuff we did—I mean, we did training programs, we literally developed the first\ncomputerized surveillance systems for polio. This was not the year 2018, where\nthere’s a PC [personal computer] on everybody’s desk. That’s not the way it\nworked. When suddenly people treated me as though they didn’t want me around\nanymore, OK.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/158","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: How did that feel?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/159","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, it felt horrible. It felt horrible. Ultimately, right around\nthat time, I started looking for other positions within the public health\nservice. I had just gotten remarried to somebody at CDC, who was very interested\nin getting a lab position somewhere, and there were no lab positions at CDC, but\nthere were at FDA. Bingo. Where’s my train ticket? I’ll see you later. Bob\nKeegan had a party for me, and he gave me, which I still have, a baseball,\nbecause I’m a baseball fan, with signatures of—everybody who cared about me\nsigned that ball, and I still have it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/160","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Who’s on that ball?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/161","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, Keegan was the ringleader. Everybody who respected me, and who\nI respected in turn. I mean, I have a vivid memory of my going-away party, and\nit was one of the saddest days of my life because I was not going to be able to\nwork with these people on a day-to-day basis anymore. They insisted on having a\nparty for me. I didn’t want one. I ended up telling them that I was going to\nrefuse to go, so it was actually partly a surprise party. It was a sad day\nbecause of that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/162","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"After that, guess what? I’m an R\u0026D guy through and through, so I go to FDA, and\nguess what? Guess what I do? I learn about the front end of vaccine development.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/163","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: How’s that different from what you’ve been doing?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,27.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/164","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Up until then? Well, I was on the back end. My career at CDC was\ndevoted to vaccines that already existed: they were already approved, they were\nalready used, so the focus is on, how do you use them? How do you use them\nbetter? Which is a lot of the things I was most interested in. If there is a\nvaccine that’s on the near-term horizon that’s going to be approved for the\nfirst time, how are you going to use that? Do you have the systems in place to\nmake sure that it’s continually going to be effective when it’s actually used in\nthe field under real-world conditions? Do you have an immunization system in\nplace to make sure that people know how to use it, when to use it, who should\nthey give it to, who shouldn’t they? All that stuff, all the operational stuff.\nI switch from that to the front end, which is vaccine development from square\none. Products that have never been tested in people yet, only in animals. How do\nyou get those from there to licensure?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=27.0,28.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/165","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That’s what I’ve done for the last—well, since the early 1990s. That’s all I’ve\ndone ever since.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=28.0,28.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/166","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Have you had any contact with the Bill \u0026 Melinda Gates Foundation?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=28.0,28.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/167","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. In fact, I’ve been a reviewer. As you can imagine, somebody with\nmy background has been a reviewer for some of their programs. One of the\nprograms that I was involved with is a program which, in my opinion, should have\nstarted in 1990. That has to do with literally new-generation,\nnever-tried-before ways of making an oral polio vaccine that will work after\none, maybe, dose, or two or three, and not ten or twenty. I was involved with\nthat. I’ve been involved as essentially a scientific reviewer for some of their\nother programs, including—we talked about this a little bit before—the use of\nwhat are known as microneedle delivery devices, to deliver a vaccine\nintradermally, using these needles that are so tiny that you can’t see them.\nThis literally, this thing that I’m talking about, literally looks like a\nBand-Aid. It can be administered under essentially room temperature, or even\ntropical conditions. You walk up, you hold your hand out, you get this thing\nthat’s about the size of my fingertip and looks like a Band-Aid, literally looks\nlike a Band-Aid on top of your skin. You let it sit for ten minutes, or\nsometimes five. You take it off, and you’re vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=28.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/168","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: That’s in development now?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/169","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: That is in development now. One of the developers of that is right\ndown the street from here at Georgia Tech. Georgia Tech Department of\nEngineering. You should go talk to them.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/170","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: That would be interesting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/171","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: There are other companies besides them, but yes. Any of the things I\njust mentioned, none of them are rocket science. They could have been, had\nsomebody been interested and had financial backing or a grant mechanism—all of\nthese things could have been invented twenty years ago. They could have, but\nnobody was interested.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/172","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: I’ve heard it said that the program has been shaped very much by the\ntiming of funding, and when funding has come in.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/173","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Oh, sure. Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/174","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Well, in December of 1988, there wasn’t a lot in place.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/175","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/176","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: I mean, the Rotarians had raised $247 million, and that was in place,\nbut it sounds as though it would have taken a lot more than that to launch some\nof these technologies.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/177","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Oh, sure.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/178","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: But it also sounds like that was not being discussed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/179","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: No. No. Once there was a plan, once the plan said OPV, once the plan\nsaid, “Give as many doses as you can,” once the plan said, “Give it routine,\ngive it National Immunization Days, give it,” quote-unquote, “‘mop-up.’” Boy, I\nhated that term. The PAHO term for “mop-up,” where they would essentially have\nmissed whatever neighborhoods or cities or whatever, so you’d have to go back in\nand vaccinate them again—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/180","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What makes you hate the term “mop-up”?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/181","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Well, a lot of reasons, but maybe the main ones—I just don’t like the\nterm. It almost has the term of, like, an afterthought. Like, it’s somebody who\nsweeps the floor after some big event, and what they’re doing is not really that\nimportant. I don’t like it because of that. It’s derogatory. That’s number one.\nNumber two, to mop up—I mean, the intent was to go back to places that were kind\nof hard to get immunized in the first place. In other words, people would have a\ncampaign, and some places would do great and some wouldn’t, and some of those\nareas would then go back and have polio. The occurrence of polio certainly was a\nred flag, so the mop-up places would involve things like that. But that was a\nterm that was developed mainly by Ciro [C.A.] de Quadros [MD, MPH]. He invented\nthat, he called it that, and it just continued onwards.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=29.0,30.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/182","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I just never liked it, because it never got to the heart of the matter. The\nheart of the matter is—to me, it was so simple. If you use OPV, you have to give\nten, fifteen, twenty doses, period. Is there a better way, an easier way, to do\nthat? What is it? How much would it cost? How does that cost compare to giving\nevery kid in the world ten or fifteen or twenty doses? Is there anything about\nthe product that you could change that would reduce costs in other areas? Maybe\nit could be thermostable, so you don’t have to have a cold chain, which, by the\nway, exists. Maybe it could be having Elon [R.] Musk develop all these drones\nthat could go in and do—I mean, you can think of all these crazy things, but my\npoint is, nobody talked about it except me and a few other people, and nobody\ncared about it, and nobody thought that it was worth making those investments.\n“We have everything we need. Go away.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=30.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/183","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Let’s not talk about technology.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/184","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/185","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Looking at my list here, I wanted to get some more description from\nyou of your role in the funding request in the early ’90s, and really go back to\nthe beginning of the story.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/186","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right. Yes. The people who worked on polio in the early days, in the\nmid-1980s—and I’m only talking now about Walt Orenstein’s group, the National\nImmunization Program [NIP] or whatever it was called at the time. I’m not\ntalking about the lab guys. We obviously interacted with them, but we were under\na different support structure and all that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/187","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: It was fairly fragmented, is the way Bob Keegan described it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/188","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, and it was. Uh oh, I lost my train of thought. The theme was—?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/189","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: The beginning of—the story leading up to the funding request.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/190","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Oh, right. We were a ragtag group. We were all part of the NIP—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/191","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: National Immunization Program?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/192","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: National Immunization Program. Most of the guys I worked with were\npart of my—it was called a section. It was actually a subdivision. My section\nwas called the Epidemiologic Research Section [NIP, CDC]. We had, like, five or\nsix people, and we had the best job of anybody in the whole NIP, because we were\ndoing research. Everybody else was doing program. We got to investigate\noutbreaks; we got to go out in the field; we got to go travel—we got to do all\nthe fun stuff.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/193","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The polio group did not exist. There was no money for polio. Basically, what I\ndid is I begged, borrowed, and stole from every place I could to create the\nequivalent of a polio unit. What do I mean by that? Well, there was a guy named\nRobb Linkins. Robb is basically a statistician, is what he is. He’s a computer\nguy. In those days, nobody knew how to use a computer or to do statistical\nprogramming or S.A.S. [Statistical Analysis System, S.A.S. Institute, North\nCarolina, USA] or any of that stuff, but he did. We grabbed him, pulled him\nover, talked to him real nice: “Robb, in your free time, do you think you could\ndo this, that, and the other?” “Sure.” There was Robb, there was a guy named\nRobin [J.] Biellik [DrPH]. Robin Biellik was the world’s greatest field\ninvestigator. What do I mean by that? A guy who will go out and collect\nepidemiological information and analyze it in the most beautiful way you can\nimagine. He did that entirely on his own. “Robin, there’s an outbreak of X.” It\nwasn’t necessarily polio. In one case, I sent him to Wisconsin to investigate an\noutbreak of pertussis. He did the world’s greatest field investigation of an\noutbreak of pertussis.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=31.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/194","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We had him. We had Mary [R.] Reichler [MD], who was probably the most technical\nand most sort of epidemiologically-oriented person in the group, who thought of\ndifferent ways of analyzing information that nobody else had thought of. Well,\nthat was before Keegan. We had Mac Otten. Mac Otten, his claim to fame is that\nhe is the first guy in the United States government in any agency who was\nallowed to buy a Macintosh computer.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=32.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/195","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Tell me about that. Computerized surveillance—are those connected?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=32.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/196","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, they are. Mac Otten, which, maybe that’s why you like Macs\n[Macintosh computers] was one of the first sort of natural computer aficionados\nwho I ever worked with. This was, again, back in the ’80s, when personal\ncomputers were a new thing. Mac Otten was really the only guy in the group\nof—within whatever it was called, the National Immunization Program, who was a\ncomputer whiz. This was back in the day when PCs were rare. You had to beg,\nborrow, and steal one to be able to use it. Mac was the first guy, I’m told, the\nfirst guy in the U.S. federal government who was able to procure, legally,\napparently, a Macintosh computer. Not an IBM [International Business Machines].\nBack in those days, they were only IBM. The reason why is that Mac eventually,\nshortly thereafter, would actually end up being CDC’s representative in the\nfield in China. Mac wanted a Mac computer, because he was also a graphics guy.\nHe actually figured out—he did it himself, he did not use software—but he\ncreated graphics software to map China. Every province, every district. He went\nout in the field, or he got people to bring it back, surveillance data for polio\nthat went back to recorded time. He created maps of incidence rates for polio\nthroughout China for the last, whatever it was—thirty, forty, fifty years. He\ndid that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=32.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/197","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: This is the first I’ve heard about it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/198","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. There was him. Who else? I’ve talked about the major actors,\nother than Keegan, but Keegan—my recollection, maybe I’m wrong—he was actually\non the polio payroll. I think he was. I did hire him. It’s possible that I hired\nhim when I was still the head of what was known at that time as the\nEpidemiologic Research Section. That’s possible. But now that you mention it,\nI’m not sure.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/199","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But Keegan was basically the guy who made everything happen, under any\ncircumstances, at any time, for anything. He was incredible. [Emotion]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/200","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you give some examples?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/201","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: I’m tearing up now because—because he—he was also my friend.\n[Emotion] He died from cancer prematurely, a few years ago. [Emotion] I’m sorry,\nI can’t help myself.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/202","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Not at all.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/203","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: OK. I’m sorry. What did you want me to talk about with Bob?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/204","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Some Bob Keegan stories.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/205","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/206","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: That’s OK.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/207","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Keegan. I taught Keegan a few things that he actually took to heart.\nThe main thing that I taught him was that Rotary mattered. This was before some\nof the huge—I mean, by that time, they had a lot of money in the game, but it\nended up being sort of the early days of that. But what I could recognize is\nthat they, Rotary, were really getting behind in a big way the whole idea of the\npolio eradication program, and that we, CDC, better do everything possible to\nmake sure that we acknowledge them: we know their importance; we want to bring\nthem to the table; we want to keep them in the loop. I was the one who\nrecognized that, so I made it a priority to go anywhere they wanted me to go. I\nactually gave seminars for—not only at the corporate level, which is in either\nEvanston [Illinois] or Chicago [Illinois] or someplace, but also these little\nitty-bitty chapters. I used to go on the road and do these little—essentially\ndog and pony shows on polio for Rotary.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=33.0,34.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/208","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Could you tell me about one of them?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=34.0,34.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/209","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: The one I remember most, because it was local, was in—somewhere\naround Atlanta, Kennesaw [Georgia], or something. There was this little bitty,\nalmost like a lodge that I went to. I came in, and I had my slides with me, and\nthey didn’t have a slide projector, so there wasn’t a way for me to make the\npresentation, so I had to wing it, and I had to—I hate to say this, but it’s\ntrue—I had to dumb it down. [Laughs] I had to explain in lay terms, “This is\npolio. This is what it’s all about. These are the vaccines. This is what we hope\nto do. This is why your help is so important to us,” blah-blah-blah. I remember\nthat one more than any other. I only did, I’m going to say—I mean, I’m making it\nsound like I did this all the time; I didn’t. I probably did it like five or six\ntimes. But I did convince Keegan, and he always took it to heart, that Rotary\nwas on his side, and if he ever wanted to do anything for any reason related to\npolio, he should bring those guys on board. Make them a part of this. They’re\nnot just a wallet full of money; they’re interested in this, and they want a\nstake, and we knew it at the time: they’re going to be in it for a long time,\nand they’re going to be spending a ton of money. A ton. The initial stake, which\nthey thought was huge—and it was huge—but it was nothing. Drop in a bucket.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=34.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/210","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What was your first contact with Rotary?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/211","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: It was with [Edward] Ted Trainer [DrPH, MSPH]. Yes. I like Ted. I\nmean, he was a smart guy. I could talk to him. He and I, I mean, we drank beer\ntogether. He was somebody that I could really relate to, and he was—he took his\njob seriously. I mean, he was the polio—whatever his title was, coordinator or\nwhatever it was called. He took it seriously, I took my job seriously, and we\nkind of made a good pair.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/212","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We developed a rapport, and what I knew he knew, and what he knew I knew. If I\nhad, shall we say, logistical questions for him, like, “Gee, Ted, we’re thinking\nof maybe doing x in China. What do you think about that? Do you have any\nadvice?” I may have even talked to him about some of the things that Mac Otten\nwanted to do with surveillance, essentially, computerizing all this incredible\ninformation that was available throughout China that ultimately became this\ngigantic surveillance system. That’s kind of what I remember. I don't know if\nthat’s very helpful, or if you want me to elaborate on anything.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/213","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: I’m interested in the opportunities that were available for Rotary and\nCDC to really work together at that early moment.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/214","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, so that was mostly informal, I would say. During my time, at\nleast—and that was really before—my time was before the quote-unquote “big”\noperation, with hundreds and maybe even thousands, I don't know. This was back\nin the early days.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/215","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: How did you meet Ted Trainer or know that Rotary was involved?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/216","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Even though a separate polio activity didn’t exist at the time,\nbeginning in 1985 or ’86, I was the polio guy. That means even though what I\nreally wanted to do was research, like we already talked about, guess what? I\nhad other responsibilities as assigned. I was assigned—and I didn’t mind; I\nenjoyed it. I did all kinds of different things. I had all kinds of different\nhats on. I was the field epidemiologist; I was the guy who went out and did\ntraining courses in WPRO [Western Pacific Regional Office of the WHO]. I went to\nGeneva and represented CDC at these polio meetings. Whatever you want me to do,\nI’ll do it. That’s what I did. I did the work of like ten different people until\nI could hire ten people to do all this other stuff. By that time, by the time we\ngot ten people, we also had money, and when we had money, we had the—what we\nalready talked about before, the momentum to implement—vaccinate every kid as\nmany times as you can everywhere with OPV. Once you had that system, it didn’t\nmatter what I thought anymore. I left.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=35.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/217","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Later, worked on polio as a reviewer.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/218","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Right. That’s right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/219","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Things that we have not talked about—what have we not talked about\nthat you think is important? Because we’re a bit over time. I want to be\nrespectful of that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/220","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes. Let’s see.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/221","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: You mentioned the Gambia. I was wondering if there was anything there\nto talk about.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/222","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Not really. I mean, I’ve been there. The Gambia was one of the sites\nwe had for the OPV trial, field trial, that we did with the different\nformulations that we talked about earlier. They were one of the sites. The\nGambia also had an outbreak in—I’m pretty sure it was in the mid-’80s. That\noutbreak was not handled by NIP. It was handled by the Office of International\nHealth [CDC], and it was handled by Mac Otten and Michael [S.] Deming [MD].\nThere was kind of a weird thing—you should maybe look into this. There was a\nweird thing, which I never understood, where it was almost competition between\ntwo different places at CDC. One was NIP—that was me; I was the polio guy—but\nthere was also the International Health Program Office, IHPO. I can’t remember\nwho was the head of it, but Orenstein would know. There were epidemiologists\nthere, including Michael Deming, Mac Otten, whose name I mentioned before, Steve\n[T. Stephen] Jones [MD, MPH]—that’s another name. Steve Jones was actually the\nfirst guy to go to Brazil to investigate the type 3 outbreak that we already\ntalked about, but—and I’m not knocking him at all, because he’s not a vaccine\nguy—but he actually was the first one that PAHO called, because of the\nInternational Health Program Office. The reason why I got involved was because\nSteve Jones waved a white flag and said, “Sorry, I’m not a vaccine guy. You\nshould get somebody else.” That’s how I got involved.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=36.0,37.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/223","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: That redirected it?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=37.0,37.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/224","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=37.0,37.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/225","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: The story of writing the request—is there a story?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=37.0,37.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/226","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: The story is pretty simple. I wish it was a really good story. It\nreally isn’t. The story is there was a guy named Phil [Philip R.] Horne. I don’t\nremember what his title was, but he was basically—I call him the “head honcho”\nof all the financial stuff that goes on in NIP. In a private company, he would\nbe the chief financial officer, the guy who manages the books. As I remember\nthis, there was—and I don't know the details, I don't know who asked for this,\nbut somebody in [the United States] Congress asked for a proposal from CDC to\nsupport the eradication program, and so Phil Horne, the guy I just mentioned, as\nhe always did, wrote the first draft, which basically said, in so many words,\n“Hi, we need—” whatever the number was; it was three million bucks for polio,\nand “this is what we’re going to do with it.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=37.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/227","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The reason why it came to me is that there are two—and it sounds like I’m\nbragging, but you’ll have to trust me that I’m not—there were two people in NIP\nwho were phenomenal writers. The most phenomenal is Alan Hinman. The second most\nis me. Alan Hinman was not there, I remember that part of it. He was not there\nto rescue Phil Horne. Like every other request, “This is due by 3:00 P.M.\ntoday,” or whatever the number was. I remember Phil Horne coming into my office\nand saying, “I’m sorry to bother you, but we need you to write this.” I did.\nNext thing I knew it was approved.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/228","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: What did you add to it?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/229","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: I mostly added technical stuff, like, basically in so many words, WHO\nwants to eradicate polio. CDC was in fact part of the technical support for the\neventual WHA [World Health Assembly] announcement, and whereas CDC, NIP has the\nexpertise to do this, that and the other, and whereas—I mean, I’m saying\n“whereas” as though it were a legal document. But it was all the reasons why:\n“number one, polio eradication is important; the United States needs to\nparticipate. It will benefit the U.S. in the following ways; plus, guess what,\nwe know what we’re doing; plus, guess what, we want to do this. Therefore,\nplease give us money. Thank you very much.” Essentially, that’s what it said. I\nwas good at writing. I’m not going to say that it was malarkey, but it was kind\nof, sort of malarkey is what it was. I wrote it. I don’t even remember what it says.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=38.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/230","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Where did it go from you?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/231","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: It went to Phil Horne. It went to—and I should know this, but I\nforgot who the head of CDC was at the time.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/232","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: [James O.] Mason [MD, MPH, PhD]?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/233","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/234","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Jim Mason.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/235","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Jim Mason. It went to Mason’s office. I was told that they made no\ncomments. It went to HHS [U.S. Department of Health and Human Services], and the\nnext thing I heard is—be careful what you wish for—we got it. That’s when polio\nbecame official. We had our own little group. [Stephen L.] Cochi [MD, MPH]\neventually—Steve Cochi ended up joining us, and then he took over for me. When I\nleft, he essentially took over for me. Everybody was happy, because Steve Cochi\nis most interested and does the greatest job with the two things that I don’t\nreally like. One is surveillance, and the other—I like the mechanics, or\ndesigning a surveillance system, but I don’t like the actual carrying it out and\nlooking at the data and all that stuff. I don’t really care about that, but\nCochi does. He’s great at it, too. The other is the program. How and where do\nyou get your vaccine from point A to point B? The actual deployment and all the\nprogram stuff. How do you motivate people in different countries, different\nethnic groups—how do you motivate them to seek vaccination out? How do you get\nthem to participate in national immunization days or “mop-ups?” Cochi is great\nat that stuff. He was definitely, definitely the guy to take over from me, and\nhe has done a wonderful job. Wonderful. I’m glad that he took over, because I\ndon’t really—I’m selfish. I don’t like to do that stuff.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=39.0,40.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/236","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Any final thoughts, or anything we’ve left out? Anything you would\ninclude in a second interview?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=40.0,40.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/237","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: The only thing I would include, but it’s just me, and I don't know if\nit would work, is “Where are they now?” To me this interview, in a way, was\n“Where is Peter now?” because nobody talked to me for twenty years, or whatever\nit is, after all I did. I mean, I was only brought back to CDC once before I\nleft. That really disappoints me. I thought I did enough to where people would\nvalue what I had to say, and I was brought back for a couple of things, but they\nweren’t really CDC things. They were more Task Force [for Global Health] things,\nbecause of my relationship with Bill Foege and Alan Hinman and all that. It’s\ndisappointing. I’m really disappointed by that. I’m sure there were other people\nbesides me who were part of, quote, “the early days,” in other countries, who\naren’t part of it now.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=40.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/238","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"That’s all. That’s what I would do, bring back—but it wouldn’t just be\nCDC-focused. There are other people like me who sort of came and went who were\nbig players at one time in polio that kind of dropped out.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/239","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Be interesting to find out what happened there and where they went.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/240","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/241","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: I’m so grateful to you for coming down to Atlanta.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/242","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/243","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Thank you so much.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/244","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/245","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: If it would be OK, is it OK to follow up with questions via email?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/246","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: Yes, sure.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/247","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: OK, great. We’ll close for now, but I might request a second one.\nWe’ll see.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/248","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"PATRIARCA: OK. All right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/249","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CRAWFORD: Thank you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745/transcript/69938/annotation/250","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"[END OF SESSION] ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134679/file/249745#t=41.0,41.0"}]}]}]}