{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://globalhealthchronicles.aviaryplatform.com/iiif/jh3cz33t34/manifest","type":"Manifest","label":{"en":["Kim-Farley, Robert"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","metadata":[{"label":{"en":["Publisher"]},"value":{"en":["David J. Sencer CDC Museum"]}},{"label":{"en":["Date"]},"value":{"en":["2017-05-15"]}},{"label":{"en":["Description"]},"value":{"en":["Dr. Robert Kim-Farley interviewed by Karen Torghele May 15, 2017 for the Global Health Chronicles Early Years of Polio project, The Centers for Disease Control and Prevention contributions to the surveillance, prevention, and containment of polio."]}},{"label":{"en":["Format"]},"value":{"en":["audio"]}},{"label":{"en":["Identifier"]},"value":{"en":["20170515 Kim-Farley Robert"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}}],"summary":{"en":["Dr. Robert Kim-Farley interviewed by Karen Torghele May 15, 2017 for the Global Health Chronicles Early Years of Polio project, The Centers for Disease Control and Prevention contributions to the surveillance, prevention, and containment of polio."]},"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/000/247/930/small/Kim-Farley.jpg?1727967840","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930","type":"Canvas","label":{"en":["Media File 1 of 2 - 20170515_Kim-Farley_Robert.mp3"]},"duration":4637.04816,"width":640,"height":40,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/247/930/small/Kim-Farley.jpg?1727967840","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/247/930/original/20170515_Kim-Farley_Robert.mp3?1723206704","type":"Audio","format":"audio/mpeg","duration":4637.04816,"width":640,"height":40},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452","type":"AnnotationPage","label":{"en":["2016_400_22 [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Robert Kim-Farley","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=0.0,1.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: It is May 15, 2017. I am Karen Torghele, and I'm at the Los Angeles\nCounty Public Health Department with Dr. Robert Kim-Farley, who was an EIS\n[Epidemic Intelligence Service] officer in 1981. He is now the director of\ncommunicable disease control and prevention at the L.A. [Los Angeles] County\nDepartment of Public Health, and is also at the UCLA [University of California,\nLos Angeles] School of Public Health as a professor in the Department of\nEpidemiology, and is the associate editor of the American Journal of Public\nHealth. Welcome, Dr. Kim-Farley.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: A pleasure to be here.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=33.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Yes, it's nice that you could talk with us today about your\nexperiences. Would you start by telling us a little bit about your background\nbefore you came to CDC [Centers for Disease Control and Prevention]?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=35.0,48.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yes. Actually, I started out kind of the backwards route. I started\nas an electronic engineer from UC [University of California] Santa Barbara, and\nthen on graduation went to the Food and Drug Administration--the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=48.0,60.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Bureau of\nRadiologic Health in the Washington area--in the area of protecting the\npopulation against the hazards of electronic production radiation, like x-rays\nfrom color TV sets, microwaves from microwave ovens. That kind of mixed, if you\nwill, engineering and public health, which got me very excited and interested in\npublic health. I then, actually, after two years with the Food and Drug\nAdministration, went and did volunteer work for the Bahá'í Faith--went around\nthe world for a year, mainly in Africa.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=60.0,87.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"During that time, I think that's when I especially got interested in\ninternational health and public health, realizing the great needs in other\ncountries besides in the United States. And I think that was my earliest\nintimation about being concerned about polio, too. Because I remember being very\nclearly in a village setting in Africa--this person had gotten off the bus. He\nhad a coat and tie, but he had polio, and because, of course, in the village\nthere were not any walkways or pathways for a wheelchair, he actually had to get\ndown on his hands and ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=87.0,120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"knees and actually crawl along the road in the village.\nAnd to me that was such an impact that I still remember today, about the\ndevastating effect that polio can have.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=120.0,132.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"After that I decided to go then for a master's in public health at UCLA. And\nbecause I did not have the biomedical prerequisites for medical school, I ended\nup doing not only the master's in public health in population, family, and\ninternational health, but I went ahead and did the biochemistry and other\nbiomedical courses that you needed to have for applying to medical school. I\nwent on, then, to the University of California, San Francisco Medical School and\nit was very nice because they already knew I was interested in public health.\nSo, for example, I was working with CDC at that time as a student to develop\nwhat they called a Peer Education and Prevention activity, where you brought in\nfellow students to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=132.0,180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"orient them about prevention and public health majors. So it\nwas kind of fun to do that in medical school.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=180.0,186.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I also--because of that international interest--ended up being chairperson of\nthe American Medical Student Association International Health Committee. And we\nhad the first all-medical student group go to China, so that was very exciting\nin 1978. I was used to traveling because my dad was in the Navy when we grew up.\nEvery couple of years we moved. I was in Panama for a couple of years and the\nisland of Kodiak in Alaska. In Guantanamo Bay, Cuba, I was evacuated during the\nCuban Missile Crisis when I was 14. So anyway, there was a number of things that\nhad gotten me excited about international work.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=186.0,220.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So between the third and fourth year of medical school--I had gotten married in\nsecond year--my wife and I also then took one year off and did some work for the\nBahá'í Faith. And we went around the world again, this time the other\ndirection from what I had done, mainly in the South Pacific and Asia. And during\nthat ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=220.0,239.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"time we spent one month at the National Hospital of Western Samoa, and for\nme this is really, again, suddenly another encounter with polio that I think was\nvery formative for me. I happened to be there during a time when they had a\ngroup of visiting orthopedic surgeons, very senior in their field, training the\nSamoan doctors in some of the more current techniques.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=239.0,258.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So they were letting me in the operating room and I was sewing up here and there\na few things, and one of the surgeons turned to me and he said, \"Bob, what do\nyou plan to go into?\" And I said, \"Well, actually, I plan to go into public\nhealth.\" He didn't say anything, went back to working on his patient, and I\ncould just see, you know, this surgeon is going to downplay the role of public\nhealth. But in fact, what happened is he stopped again on the patient, turned to\nme, and he said, \"You know something, you are going to have more impact in your\ncareer than I have ever had in mine.\" He said, \"Here we are working on this\nchild with polio, who should never have gotten polio to begin with,\" ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=258.0,299.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and for me,\nat that stage--again, as a formative stage of a medical student--to have someone\nwho could have been easily, you know, very much putting down public health, to\nrecognize the value of public health, was very reinforcing to me.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=299.0,311.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I realize, of course, in public health I'm never going to have the experience\nlike when that child comes off the table to say, oh, Doc, thank you so much, I\nfeel so much better now, or, I now can walk with this brace, et cetera. I'm\nnever going to see a parent come up to me and say, gee Doc, I just want to tell\nyou my child didn't get measles today, thank you so much. It's not going to\nhappen. So you have to realize that the idea of the community being your patient\nas compared to individual--but that was, again, a formative period for me. So\nafter that I came back to finish off medical school, did my rotating internship\nat the U.S. Public Health Service Hospital in San Francisco, and then went on to\nthe Epidemic Intelligence Service at CDC, which of course, brings us to the CDC\nstory part of it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=311.0,358.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=358.0,358.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So when you came to CDC you probably were interested in a number of\ndifferent areas, so how did you settle on the one that you ended up in?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=358.0,367.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Well, when you come to CDC as an EIS officer, you may have ideas and\nthoughts of where you'd like to be, but that doesn't necessarily always be what\nyou matched with. I was fairly flexible and open when I first came, and I\nmatched with the National Immunization Program and it was a very, very good fit\nfor me. Some of the other people, no doubt you'll be interviewing for the\nChronicles, that had significant roles to play, things like--people like [Dr.\nWalter] Walt Orenstein or [Dr.] Alan Hinman. Walt Orenstein, at that time, was a\nsection chief, my immediate supervisor as an EIS officer. I also remember\ntalking with Alan Hinman too, who was the division director at the time, and I\nasked him, you know, do you think there is really a career in immunization? It\nseems like we've got all these vaccines now, the diseases are going down. He\nsaid, don't worry about it, there will be a career in immunizations. He\ncertainly was right about ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=367.0,418.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=418.0,418.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Walt Orenstein was very supportive and basically had me as the polio\nsurveillance officer for the United States, including some other activities with\nvaccine-preventable diseases. I told him I was very interested in international\nhealth work and that I also wanted a variety of experience, and he certainly was\nable to provide that. So my first outbreak I ever went on was an outbreak of\ndiphtheria in the Yemen Arab Republic. We were there for six weeks, virtually no\ncommunication. We had this--couldn't even use the phone--we had these teletype\nmachines going back and forth with questions they might ask for us, because\nthere were two of us that were on the assignment. And so it was a very\nilluminating experience about working in the developing world in an outbreak setting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=418.0,465.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then, a bit later on, another encounter with polio in 1982. There was a\nmajor outbreak of polio in Taiwan, which was very interesting because the\ngovernment actually had very high levels of immunization ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=465.0,478.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"coverage and was kind\nof scratching their heads as to, why would we be seeing polio? And so myself and\nanother EIS officer, [Dr.] George Rutherford, I remember, went for six weeks\nagain to Taiwan. And what we found as we did our epidemiologic investigations\nwas that yes, on average the immunization coverage was very high, but there were\npockets of unimmunized children, and that's what the polio virus was seeking\nout, was those pockets. That was enough to keep it going in different places. So\nwe launched major national immunization efforts to be able to curtail this\noutbreak, which it responded to very quickly. But it was very interesting to see\nfor myself polio in its worst forms, if you will, of an actual outbreak going\non. And again, it caught the government by surprise. We were actually--very\ninteresting there, because the sense--at that time even, Taiwan was not formally\nrecognized by the United States as a separate national ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=478.0,538.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"entity, but rather under\nthe mainland Chinese. So basically, we actually had to go with our personal\npassports and not be able to go to an embassy. We actually had the U.S. Trade\nMission that we were reporting to. So it was very interesting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=538.0,551.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So you wouldn't be a representative of the United States.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=551.0,554.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Exactly, so you're not formal representatives of the United States,\nexactly right. And so, when we also went to the Western Pacific Regional Office\nof WHO [World Health Organization], to be able to report out our findings that\nwe had, again, they were just receiving us in an informal fashion. And it was\nvery interesting, many years later when the Minister of Health of Taiwan came to\nCDC as a visitor, again, CDC was not able to actually formally have a reception\nfor him. So they asked if I could have the reception in my home. So it was very\ninteresting--we had the reception for the minister in our home in Atlanta.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=554.0,588.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Interesting. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=588.0,589.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yeah.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=589.0,590.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: How did you identify the pockets where there was still polio?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=590.0,594.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: So what we did is we looked, again, those who were coming down with\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=594.0,599.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"paralysis--which is kind of the marker of polio, obviously. It's not everybody\ngets it. You take one hundred people that are infected with polio, and only one\nwill come down with paralysis, so it's kind of the tip of the iceberg\nphenomenon. But we went ahead and we found out where those cases were being\nreported. They actually had a very good surveillance system in Taiwan. And so\nthen we could go and find out, well, what is the characteristics of these? And\nit turns out, they were mostly not immunized. We said, well, how can this be\nhappening? So we learned that there were basically these pockets of unimmunized children.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=599.0,634.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So from that, I guess, in terms of the EIS experience, I then went on for\nadvance training at CDC. They had a system at that time where you could apply in\nyour first year of the EIS to do the preventive medicine residency, which would\nmake me board certified in preventive medicine as a medical specialty. I already\nhad the master's in public health, which is another requirement at that time, so\nI needed two years, then, of supervised ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=634.0,659.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"experience. So they let the second year\nof the EIS count for that, and then I stayed for an additional year, but during\nthat year is when I had the first assignment internationally.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=659.0,671.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Did you have other roles within immunization?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=671.0,674.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yes, I actually did a number of other diseases. I remember going on\na mumps outbreak in Ashtabula County, Ohio. That was very interesting too,\nbecause we looked at the whole issue of vaccine efficacy. Again, this was with\nWalt Orenstein, who probably is the guru of vaccine efficacy. And what we did is\nkind of interesting. We looked at what the vaccine efficacy was by reported\nvaccination of the child, in terms of what the mother had reported, or the\nfather. Then we looked at, well, what about the vaccine efficacy based upon the\nactual medical record that they had, the immunization card? And then, finally,\nwe actually did a record review of the physician offices to see, was there\ndocumentation of the actual ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=674.0,719.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccine having been given? It turns out that as you\nprogressively improved the actual definition of vaccination through these\ndifferent--whether it was understanding, or record that they had in the home\nversus in a doctor's office--the vaccine efficacy continued to increase each\ntime. So the more accurate you got, the better the vaccine efficacy.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=719.0,736.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I also was on an outbreak of measles at Indiana University, one of the first of\nthe big outbreaks we'd had in a college campus. And that was kind of funny\nbecause typically, CDC--when we go into an outbreak--we kind of have a bit of a\njoke about it, that we always come in on the downswing of the epidemic. Because\nby the time it's gotten big enough at a local level that they've brought the\nstate in--by the state time they'd say, hey, we need some additional resources\nhere--by that time, the outbreak usually is kind of beginning to burn itself\nout. So as I came into Indiana University, it was going down. But it turns out,\nall of a sudden, while I was there, it started rearing back up again because of\nthe fact you'd had your incubation ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=736.0,779.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"period for measles. In fact, they had a\nbigger second wave than we had even on the first wave. So it was kind of an\ninteresting experience, being on the ground, lots of media attention to this\nvaccine-preventable disease.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=779.0,792.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But during the time when I was there as the EIS officer, responsible for polio\neradication, I worked with all of the lab staff. And you may also be\ninterviewing people like [Dr.] Olen Kew and others as well--[Dr. Lawrence] Larry\nSchonberger. We actually put out a paper on the eradication of polio in the\nUnited States, because what happened was--although the last case had been in the\n'70s, with an Amish outbreak coming in from the Netherlands--no one actually\nsaid, \"Well, I guess it's over.\" We still had about six cases a year, but that\nwas due to the vaccine, because one in every three million doses administered,\nyou get an adverse reaction of actual polio with oral polio vaccine, the live\npolio vaccine. But that was all the disease that was happening. There was no\nwild virus. So ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=792.0,839.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"we actually wrote a paper specifically on that issue, of being\nable to declare that polio had been eradicated in the United States.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=839.0,848.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: And how long then was it until it was eradicated in the Western Hemisphere?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=848.0,854.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: It was not until '90, as I recall. The Pan American Health\nOrganization was the leading edge for polio eradication in the world. The\nregional elimination first occurred there, Dr. Ciro de Quadros was extremely\ninstrumental in that, and many others, obviously, from the Pan American Health\nOrganization. And so really that lead that they had done, I think, was what\nspurred the 1988 resolution of the World Health Organization for the eradication\nof polio by the year 2000.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=854.0,885.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I've heard about Dr. Ciro de Quadros before. Can you talk about him a\nlittle bit? Did you know him?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=885.0,893.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yes. A very passionate individual, very knowledgeable, and just\nrecently unfortunately passed away a couple of years ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=893.0,900.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"ago. But he is really\ncredited, I think, not only for polio, but did visionary work for measles\nelimination too. So I think he had that vision of the reality of being able to\neradicate disease like smallpox. He had been very active in the smallpox effort,\nand so I think he applied some of those principles to be able to move the world\ntowards thinking of eradication of other diseases.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=900.0,925.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You said earlier that you were interested in international work. When\ndid that start for you, and how was that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=925.0,932.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yes, your question about international work is, I think, very\ninteresting, because as you noted, I was very much wanting to get into this. And\nI told my boss, again--Walt Orenstein and Alan Hinman, again. They were very\nsupportive. I think I've mentioned to you about the diphtheria outbreak in the\nYemen Arab Republic, the polio outbreak in Taiwan. And then what happened was\nthat the government of Indonesia asked CDC to send an expert in diphtheria for a\nconsultation ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=932.0,960.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"on the status of diphtheria and the impact of immunization programs\nin Indonesia on the disease. And so CDC looked around and says, well, who knows\nanything about diphtheria? And they said, well, Bob knows because he was on an\noutbreak, because we just didn't have any in the United States. So I suddenly\nbecame the resident expert on diphtheria, having been on an outbreak.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=960.0,982.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I went there for six weeks as well, and we were able to show the impact of a\nvaccination program on diphtheria. And then what happened was that the World\nHealth Organization requested that CDC station a medical officer in the\nSoutheast Asia Regional Office of WHO, which covers about ten countries in\nSoutheast Asia, located in New Delhi. And so they had a little mini-competition\nwithin CDC for this position, because always the international positions are\nsomewhat plums. And it turns out that--a couple of things, because oftentimes,\nat that time, they had a very strong international health program office that\ntechnically they might draw from for ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=982.0,1020.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a person to be selected for that. But I\nremember Don [Hopkins], who was heading up that, was very open to the idea of\nothers being able to be considered for this position. And because I was already\nworking with immunization programs, and this medical officer position was for\nthe expanded program of immunization--the immunization program--that that was a\ngood match.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1020.0,1043.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then the other thing that was interesting--and I sometimes tell this to\nstudents that I'm mentoring or advising about who have international health\ninterests, because typically, how do you get international health positions\nunless you've had international health experience? But how do you get\ninternational health experience unless you've been hired for those positions? So\nthat kind of catch-22 exists, and I think sometimes personal travel can make a\ndifference. So the fact that I had actually travelled with my wife to seven\ncountries of the region--we actually spent one month at the National Institute\nof Nutrition in ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1043.0,1080.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Hyderabad in India and we made our own WHO study tour, so I had\nactually been at the regional office for about a week, meeting with the\ndifferent people in several of the country offices. So I could show on my resume\nand my interviewing for this position, Southeast Asia Regional Office, that I've\nactually been to many of the countries of the region. You can definitely count\non me to able to go there and not run back, because I've lived in India itself\nfor over a month. And so I think that all helped to be able to be assigned to that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1080.0,1115.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So that was in 1983. We went for basically five years--my wife and my daughter,\nwho was at that time two years of age. So we went off to Delhi. And it was a\nvery exciting time for me because we were at the stages, in the immunization\nprogram, to be able to start expanding on measles. For example, in India,\nvaccine--they had just recently introduced this into their program on a national\nscale. The ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1115.0,1140.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"efforts of working with a very highly international group--this was a\ngreat opportunity for me to learn that experience with WHO and how to handle that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1140.0,1150.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Also, it was very interesting to me--it was right away a good lesson for me in\nterms of, how does CDC operate within a United Nations framework? And the issue\ncame up very early on, because about three or four months into the assignment,\nCDC asked me, well, where is your quarterly report? And I said, quarterly\nreport? We hadn't actually talked about a quarterly report back to CDC. And I\nsaid, but you know, that's fine, I'll be glad to go talk to the regional\ndirector and say that, you know, I'd like to have a quarterly report. And I\nremember it's Dr. U. Ko Ko from Myanmar, Burma, at that time--very nice guy. I\nreally considered him a mentor in terms of helping me learn about United\nNations. And he turned to me and said, \"Bob, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1150.0,1200.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"you're going to have to make a\ndecision, are you working for WHO or are you working for CDC?\" He says, \"If\nyou're working and sending quarterly reports to CDC, then that's not\nacceptable.\" So it was very interesting. So I went back to CDC. I said to them,\nwell, you know, this is what the regional director says, you know, if you loan\nme to WHO, then really I'm in WHO's hands now. And so CDC said, well, great,\nokay, we accept that and everything was fine. And then about six months into\nthis they said, well, you know, it's time for your personnel evaluation, but we\ndon't really know that much of what you're doing because you're not sending\nquarterly reports. So I could see this little dilemma was going to be an\ninteresting one. And so what I did is I discussed again with the regional\ndirector and we decided this: I would write the regional director a quarterly\nreport of my ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1200.0,1260.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"activities, and he had no objection for me to share that with CDC.\nSo, problem solved. But it's very interesting sometimes how these come up.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1260.0,1271.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There's another one, if you'd like me to share, too. I remember another subtle\npoint of working internationally from CDC was in Indonesia--we'll come to\nIndonesia a bit later in the interview. But we had a situation where the\nPresident [Muhammad] Suharto, the collapse of that regime--the United Nations\nwas evacuating all nonessential personnel, women and children, but they were\nrequiring that heads of mission--which I was at that time, their country\ndirector for Indonesia--to stay. On the other hand, in parallel, the United\nStates government, the ambassador to Indonesia, was doing a parallel activity.\nHe was having all nonessential American staff return back to United ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1271.0,1320.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"States, and\nhe had listed me as being nonessential--which I was to the American government\nat that stage, to the embassy--but I was essential.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1320.0,1330.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So here we had a situation. And I brought it up with WHO, and I had the\nsituation of, I'm liable to a court martial, because I'm a commissioned officer,\nif I don't obey the ambassador. And I'm liable to dereliction of duty to WHO if\nI left the post. So we got WHO and lawyers talking to the State Department back\nin Washington about, what do we do about Kim-Farley here, because we both have\nclaims to him? It turns out then there was released a memo from the State\nDepartment to WHO that no one had ever seen before. And basically it was an\ninternal memo at that stage, saying that any U.S. government staff assigned to\nthe United Nations was under the United ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1330.0,1380.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Nations authority in purview during that\nassignment, except for the situation of an evacuation. And under that exception,\nthe person must follow the ambassador. So then they started--and this was news\nto WHO and the United Nations, because they said, well, look, we can't put your\npeople at high levels in our organization if we have that concern that they\nsuddenly might abandon the post right at the time when we need them the most. So\nwhat happened was lots of conferring going on, together with the ambassador, and\nthey finally decide, okay, that the U.S. ambassador would declare me an\nessential personnel. And so we resolved that little bit of crisis. However, it\ngot to where they had a million people in the street. They were going to try to\noverthrow the government. And the aircraft carrier was standing off the coast.\nThey were about ready to even evacuate the ambassador. Luckily the situation got\ndiffused. But we never got to that point where it turns out that all\nAmericans--I think ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1380.0,1440.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"by that time, all United Nations staff had probably been\nevacuated too. But anyway, it was an interesting situation, a study in\ndiplomacy, shall I say.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1440.0,1450.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So that was--going back now to the issue of in my course of duties in Southeast\nAsia Regional Office--working as a medical officer, working in different\ncountries of the region during immunization coverage surveys and looking at how\nwe could improve immunization programs in the different ministries of health.\nAnd also, we were able to have a very good collaboration among the different\ncountries working together--I was very pleased with that. We'd have WHO meetings\nwith immunization programs so the immunization program directors would come\ntogether. And we'd try to make policies and strategies for the region that would\nmake sense and have collaboration.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1450.0,1489.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We tried to work on surveillance issues. For example, in the past it used to be\nthat there was this border town in India that had a case of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1489.0,1500.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"polio. Well, they\nhad to report that to their provincial level, and the provincial level had to\nreport it to state central level in Delhi, and then that would go over to the\nWHO, and it would then go over to the other WHO office on the other side, and\ndown again through this to finally the border town in the other side in Nepal,\nbut it could be weeks before that happened. So we then were able to work on\ncross-border communications, so that someone in a local health department in the\nborder town could actually communicate to their fellow border town in the other\ncountry next to them. So you wouldn't have a problem with delays because, again,\nwe know these diseases know no boundaries and, you know, don't need visas to\ncross over countries. So that was an exciting part of it as well.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1500.0,1549.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Then about three years into the assignment in SEARO [South-East Asia Regional\nOffice], my boss was actually from the Soviet Union at that time, [Dr] Rafi\nAslanian. He was very nice. I ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1549.0,1560.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"remember we had a good collaboration together. And\nat that time, the Soviet Union would not allow their employees to stay longer\nthan five years in United Nations at any one time. So they recalled him, and I\nwas able then to become the regional advisor for immunization programs for\nsoutheast Asia region. So that's how I ended the situation in program. Then what\nhappened is that CDC, at that time, kind of had a limit on amount of time\noverseas, about five years at that time. So they said, well, we'd kind of like\nyou to come back to the mothership. But at that stage, the person who was\nactually Walt Orenstein's boss, which was [Dr. Kenneth] Ken Bart, he had gone\nand was in charge of the Bureau for Child Survival activities for USAID [United\nStates Agency for International Development] in ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1560.0,1620.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Washington. And so when he heard\nthat I was coming back to the United States he said, well, why don't you come to\nwork with us? So he was able to get permission, since it was still coming back\nnow into the United States, for CDC to loan me to USAID for that year. I was\nexpecting to be there for a long time, but what happened actually is that the\ndirector general then called the very next year and asked if I might come and\nhead up the global immunization program in Geneva.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1620.0,1659.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So while I was at USAID, I was a child survival specialist. So I dealt with\nthings like immunization programs including polio, control of diarrheal\ndiseases, acute respiratory infections, that sort of work. And then what\nhappened was [Dr. Ralph] Rafe Henderson, another name that's certainly well\nconnected with immunizations and polio, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1659.0,1680.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"was promoted to the assistant director\ngeneral in WHO. And so the director general, he asked if I could come then and\nlead the global program. And although it had only been a short time back in the\nUnited States, I think the CDC realized the importance of that position and what\nthe prestige for the United States would be to have someone that was from the\nCDC and U.S. there, so they agreed to that loan. And so that started another\nfive-year period approximately, until 1999, and so I was basically in charge of\nthe global program.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1680.0,1719.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We were majorly involved with polio eradication by that time. And so we worked\non things like improving the surveillance system--the Acute Flaccid Paralysis\nSurveillance System, for example--for polio, and the policies and strategies to\npromote polio eradication. So at that time we had what was called the Global\nAdvisory Group, or GAG for ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1719.0,1740.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"short--we now have the Scientific Advisory Group of\nExperts, SAGE, was taken over for that now--and we would convene this group once\na year to establish policies for both polio as well as other vaccine-preventable\ndiseases. A number of CDC people were involved with that. You had also [Dr.\nDonald Ainslie] D.A. Henderson was involved, Alan Hinman at one time the\nsecretary for it, and also Walt Orenstein served as the secretary for the Global\nAdvisory Group as well. And in that we prepared things like, for example, we\nwere able to introduce the first new vaccine into the expanded program\nimmunization since its creation after the smallpox eradication. And so that was\nhepatitis B vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1740.0,1785.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It was a big step because at that time, the hepatitis B vaccine cost was the sum\nof all the other components of the vaccine program, so it was a big step\nforward. It was requiring a lot of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1785.0,1800.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"new efforts too. How do we promote more\nindigenous manufacturers of the vaccine, too, in addition to just being able to\nhave the vaccine manufacturers in Europe and UNICEF [United Nations Children's\nFund], which were great partners in terms of being able to get vaccines into\nchildren? But we also saw India come up and Indonesia come up to do vaccine\ndevelopment during that time. It was also in 1993--another major polio\nresolution brought to the World Health Assemblies, World Health Assembly\nResolution 46.33. And it was, again, reiterating the priority to the global\ncommunity for polio eradication. And I remember, just kind of as an effort that\nI did on my part was to go to as many country delegations as I could, to\nactually have them become cosponsors of this resolution. I think it's had the\ngreatest number of cosponsors that they had had. I'd have to go back and take a\nlook at the total number, but it was really--I ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1800.0,1860.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"mean, it was going to pass, but\nit was nice to have all these countries signing in as actual cosponsors to the\nresolution. And I think that gave, again, another impetus to the work of polio,\nreframing it, again, as a global priority. We also, at that time, used the\nopportunity to present the director general's Health-for-All gold medal to\nRotary International, that had been a major instigator and player and partner in\nthe polio eradication effort. And so that was very exciting, to have that\nopportunity to have the director general give that award at that stage, in\nrecognition, again, of the work towards polio eradication. So that kind of puts\nus through to the time in Geneva, at least, and the headquarters.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1860.0,1906.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Your role expanded into a global role, and there are also, at the same\ntime, issues around OPV [oral polio vaccine] versus IPV [inactivated polio\nvaccine], and decisions that were made around those and which to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1906.0,1920.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"use. Can you\ntalk a little bit about that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1920.0,1924.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yeah, I think the whole issue of oral polio vaccine and inactivated\npolio vaccine is a good one. Obviously, the first vaccine developed was by Salk,\nthe IPV--had tremendous efficacy. We saw tremendous drops in the United States\non its use. And then was subsequently developing with the OPV, with oral polio\nvaccine, with Sabin, and there was a transition then over to oral polio vaccine\nin the United States. I think there was a number of reasons why that I would say\nfor early phases in an eradication effort, oral polio vaccine has some benefits.\nSo for example, inactivated polio vaccine, its administration requires the\ninjection, which means a licensed professional. Whereas oral polio vaccine,\nbecause it's given by drops--or as you probably may have heard about in the\nUnited States, we called Sabin Oral Sundays, SOS, when they give it on ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1924.0,1980.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a sugar\ncube to children--It makes the administration much easier to get large numbers\nof people.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1980.0,1987.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Secondly, the fact of the type of immunity that you get from these vaccines. So\nprimarily the inactivated polio vaccine, being given by injection, gives you\nantibodies or protection in the bloodstream. Oral polio vaccine, when it's given\nby mouth, gives not only the immunity in the bloodstream but also gives an\nimmunity in the gut, in the intestines, because there's an infection going on\nthere, and you get this other type of antibody, called secretory antibodies, in\nthe gut. So what this means, again, for the eradication is very important.\nBecause if, for example, someone who has been vaccinated with inactivated polio\nvaccine gets exposed to the wild poliovirus that's caused by disease, they're\nprotected, because, again, they have the antibody in the bloodstream. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=1987.0,2040.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But that\nvirus can grow in their gut and they can excrete it. Fecal-oral spread is how\nthe disease spreads out. And that then means that they will not be a barrier to\ntransmission from wild disease. Wild disease can come to that person. They won't\nget the disease, but they can be a transmitter of disease. So again, the benefit\nof oral polio vaccine under that setting. So, basically, this ease of\nadministration, the type of immunity being developed by oral polio vaccine were\nall really important for the eradication effort.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2040.0,2077.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"However, what happened is also the recognition of vaccine-associated polio, and\nthis was noted in the United States, about one case for every three million\ndoses distributed. You'd get about six cases or so a year in the United States\nwhere you give the vaccine to the individual--and two-thirds of the cases of\nvaccine-associated disease were ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2077.0,2100.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"not in the individual who received it, but in\nfamily members or others surrounding them. Because--and what's happened is that\ntypically, when the polio vaccine is taken orally and it grows in the gut, it\ncan mutate a little bit. So what's being excreted by that person is not the same\nas what they took, and it can revert to being more neurovirulent, we call it,\nwhich can affect the nervous system. So the fact that we were, in the late '70s,\n'80s, recognizing that the only polio really occurring in the United States was\nthe vaccine-associated polio, that the risk was not there really for wild\ndisease, so that we switched then from oral polio vaccine to inactivated polio\nvaccine. So we continued to keep the immunization guard up, but we didn't have\nto have that concern about that side effect of the rare case of actual\nvaccine-associated polio. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2100.0,2160.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Again, when you have lots of numbers of polios going\non, that is just a miniscule risk compared to what the wild disease risk is. But\nwhen you have no wild disease going on, then that comes out.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2160.0,2173.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I think that that's really one of the things that happened in the Global\nAdvisory Group, the discussion between oral polio vaccine and inactivated polio\nvaccine that was going on. There was some concern about, what happens at the\nlate stages of the eradication effort, will we need to use inactivated polio\nvaccine? And so some wanted to have more research being done in its use. Others\nfelt that, well, we know all the research that we need to have, but if we start\nemphasizing at all inactivated polio vaccine, of having any role, that it could\ndistract from the emphasis we're trying to place on oral polio vaccine. So there\nwere some tensions surrounding that. But I think now we're seeing that, in\nfact--again, when we're down to just forty-two cases, I think, last year in 2016\nin the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2173.0,2220.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"world and Afghanistan and Nigeria and Pakistan--that the\nvaccine-associated disease becomes more of a concern. And the idea is, how would\nyou know when you really wiped out polio--perhaps then to switch over at the end\nstages to inactivated polio so that there's no circulating virus of any type,\nwild or vaccine-associated. So that was one thing that I think was the driving\nfactor for oral polio vaccine, which I think was the right choice for the major\ntool for eradication. But when you're talking about the endgame strategy, there\nmay be roles here for the inactivated vaccine to come into play.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2220.0,2262.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There was also another tension that I think existed in what I would call the\neradicationists versus the integrationists. The eradicationists, the hard line,\nwould say, don't bother me with any other vaccines or any other things, let me\nget this done as ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2262.0,2280.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"fast and expeditiously as I can, because ultimately, we can\nstop vaccinating for polio and save billions of dollars. The opposite extreme is\nwhat I would call the integrationist, and would say, well, you know, this is our\nwhole portfolio of vaccines that we have, and we shouldn't do anything more for\npolio than we would do for BCG [bacillus Calmette-Guerin] vaccine. And you know,\nwe need to be doing all of these at the same pace and the same route. What I\nthink we ultimately have done, and I think was the right course, is to say, yes,\nwe recognize both of those polarities exist, but let's recognize that polio has\na priority, but let that priority help drive the other vaccine antigens that we\nuse. So for example, if we're going to build, to reach out to the periphery of\ncold chain, to be able to deliver the polio vaccine, let's make sure that the\ncold chain is big enough to handle the other vaccines that also need to be in\nthat cold chain. If we're going to go ahead and develop a surveillance system to\ndetect acute flaccid paralysis for ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2280.0,2340.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"potential polio cases, let's make sure that\nthat surveillance system can be used for other things of high public health\npriority. For example, it was used in the Americas for cholera surveillance. If\nwe're going to develop what we call a reverse cold chain--that is, to be able to\ntake stool specimens from children who have paralysis and be able to keep that\nunder cold conditions, then bring it back to a laboratory to be able to check,\nis this paralysis due to actual poliovirus--let that reverse cold chain, let\nthat reverse mechanism for getting specimens back from the periphery to central\nlaboratories, be used again for other diseases of high public health priority.\nSo I think that that balance we finally were able to get was an important one,\nbut there's always those who had felt were doing too much for this disease or\nnot enough for the other diseases. But I think that ultimately got resolved, and\nI think we're moving forward in a balanced way, but recognizing that polio has a\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2340.0,2400.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"priority from it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2400.0,2401.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I remember that supposedly Salk and Sabin, they said they agreed on one thing;\nthat is, that their vaccine was the best. So anyway, they both had difficulties\nwith each other to be able to accept those roles. And it would have been nice, I\nthink, for them to see, again, this phase where we realize, gee, there's a role\nfor both to play, and both have important contributions to make to public\nhealth. And let's make sure that we all recognize we're on the same team and\nmaking it happen.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2401.0,2434.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I would think it would be appropriate at this time to talk about the use of\nacute flaccid paralysis--I've mentioned a couple of times is an indicator for\nthe surveillance systems. Actually, we're fortunate, in a sense, with polio,\nbecause we had one difficult problem. And that is, again, mentioning that if you\nhad a hundred people infected with polio and maybe only one would come down with\nactual paralysis. So as compared to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2434.0,2460.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"smallpox, where virtually everybody who came\ndown with smallpox had visible pox that you could see and you could ask people\nabout, again, ninety-nine of your cases in polio for every hundred are going\nwithout anyone knowing about it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2460.0,2475.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So what happens is, it turns out that if you look at a population, that there\nare other things that can cause paralysis. They can be Guillain-Barré syndrome,\nthere can be other Coxsackie viruses or enteroviruses that can cause paralysis,\nusually more transient in nature. But on average, at least one per hundred\nthousand population will have some paralysis. And so if you can start looking at\nyour surveillance system as you're trying to improve it for the polio\nsurveillance, if you choose--rather than just polio as your surveilling\nactivity, you actually choose acute flaccid paralysis, of which polio is one of\nthe types of flaccid paralysis you can have--you know that, if you can get a\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2475.0,2520.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"surveillance system capable of giving you over one per hundred thousand cases of\nacute flaccid paralysis, that if there were polio there, you should be able to\nfind it. And so that's one of the success stories that we use. We look for acute\nflaccid paralysis. We do stool samples on them to be able to see whether or not\nthis was actually due to poliovirus. And if we had that level of surveillance\ngoing on, we knew we should be able to detect it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2520.0,2548.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So these are the types of things that this Global Advisory Group dealt with,\ntrying to understand and promote surveillance practices, immunization practices,\nthe issue of having national immunization days and also having the ability of\ndoing what we call mop-up operations. And maybe I'll discuss that a little bit\nas we move to a next chapter that happened in my life.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2548.0,2569.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It was then, after about five years of being in the global program, the director\ngeneral asked if I would like to go and be the country director--or WHO\nrepresentative, as it's called--to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2569.0,2580.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the government of Indonesia, which is our\nsecond-largest country program in WHO. And so, my whole family decided that this\nwould be something very nice for us to do. I remember our daughter was in the\neighth grade at the time, and so we decided we'd make this a family decision.\nAnd so we sat down, writing pluses and minuses and kind of expecting her--you\nknow, it's Geneva, nice school, et cetera--to say, well, Mom, Dad, I'd just as\nsoon stay here. But she actually said, \"I know I remember being in India a\nlittle bit.\" And she said, \"I'd like to maybe have one more experience in a\ndeveloping country before I go on to college.\" And so she was all in favor. And\nI think because the fact that she was in international schools all her life,\nwith students coming and going, it wasn't quite the same thing as what you might\nsee in the United States, where, you know, you're suddenly the only one going\nand everybody else is staying. So she had friends that were going and coming all\nthe time, so it was not that much of a problem from that point of view.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2580.0,2635.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So we all went to Indonesia. We took intensive language training together. I got\nto where I could speak Bahasa ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2635.0,2640.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Indonesia, which is the language, pretty fluently.\nI was actually giving television interviews in Indonesian, because basically--as\ncompared to India, where most of the senior folks could speak English, or\ncertainly in the United Nations people were speaking English--in Indonesia,\nreally, mostly people spoke Indonesian, and so you really needed to have that\nlanguage facility. And they were always so kind, you know, they were saying, \"Oh\nyou're so fluent,\" and I said, \"I know I'm not that fluent,\" but at least they\nreally appreciated people making an effort to it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2640.0,2671.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So it was a very fascinating story in Indonesia, because when I arrived, I was\nmet by the UNICEF representative and the Rotary International representative.\nAnd they had talked about how, over the last year, they had been really striving\nto work with the Ministry of Health--Professor [Achmad] Sujudi, who was the\nminister at the time--to be able to embark on the major polio eradication\ninitiative for Indonesia, but it wasn't happening. So they asked, you know,\nwell, maybe I, as the new representative on the block, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2671.0,2700.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"could be able to help on\nthis. So I went and talked to Professor Sujudi, who was a microbiologist by\ntraining, and so he was very knowledgeable of polio. And he just basically had\nvery much concern, scientifically, about the issue. Was polio really eradicable\nin the sense that he knew about, that only one per hundred cases showed? And,\nyou know, is this really possible? So what I did was go ahead and we convened an\ninternational meeting in Bali, in Indonesia--brought actually Ciro de Quadros\nover to be able to share his experiences in the Americas. And by the time that\nthat meeting was finished, Professor Sujudi was very convinced, yes, actually,\nthis is doable. And he was very supportive of that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2700.0,2743.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, I said, \"Okay, well then, are we ready to go?\" And he said, \"Well, no.\"\nHe says, \"You know, we have to get the president, President Suharto, to be able\nto agree to this.\" I said, \"Okay, well, that's good.\" He said, \"I will go and\ntalk to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2743.0,2760.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"President Suharto and let you know the outcome.\" So after a week or two,\nhe came back to me and he said, \"You know, Bob, I am so sorry, but the president\nhas not agreed to go forward with polio eradication, with national immunization\ndays and things in Indonesia.\" I said, \"Well, why, what did you say?\" He said,\n\"Well, I talked to him about the fact that I'm now convinced that it can be done\ntechnically, and, you know, that we could do these efforts in Indonesia and\nreduce the cases and ultimately eradicate. And the President asked me, 'Do you\nthink we should do it?'\" And of course, if I was there I would have been saying,\nyes, of course you should do it, you don't want to be exporting the polio out of\nthe country and things like this. But in Indonesian culture, for those who may\nbe familiar with it, they never say no. And so the fact that the president just\nasked the question, \"Do you think we should do this?\" was, to the minister, a\nstatement that he was not in favor of it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2760.0,2816.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I said to him, \"Well, what do we do now?\" And I ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2816.0,2820.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"said, \"Well, how about this?\"\nI said, \"What if I had the director general\"--it was Dr. [Hiroshi] Nakajima at\nthat time--\"come to Indonesia, and he will meet with the head of state,\" because\nthat's the usual protocol for the head of the WHO to do when they visit a\ncountry. \"And then we could ask the same question, but maybe we could say\nsomething more.\" He said, \"Well, you're foreigners, you could do that, there's\nno problem with it.\" He said, \"I can't go back at this stage.\" So we did that.\nAfter about three or four months, the director general came. And we're meeting\nwith President Suharto, Professor Sujudi was there too, and we brought up the\nsame issue. I said, gee, we're embarked in a global program of polio\neradication, it would be wonderful for Indonesia to be a part of this. And the\npresident said exactly the same words that Professor Sujudi had mentioned, you\nknow, well, \"Do you think we should do this?\" But we were able, at that stage,\nto say, \"Yes, we think it's a very good thing to do, because you don't want to\nhave your polio going to Malaysia. You don't want to be the last country in the\nworld still having polio. Think of, again, the burden to your ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2820.0,2880.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"country and the\ncitizens,\" et cetera. And so, it didn't take any convincing, really, in my mind.\nPresident Suharto said, \"Well, yes, then. We should do it.\"","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2880.0,2890.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And in Indonesia, which was such a command and control country at that stage,\nvery centralized in its functioning, when the president said something,\neverything cleared away and it happened. So he had the army and the navy and the\nair force all at Professor Sujudi's disposal. And with six thousand inhabited\nislands in Indonesia, you needed all of those things to get to remote places.\nThe only thing Professor Sujudi asked me was, \"I know that they call this\nNational Immunization Day,\" he said, \"but look, with all of these territories,\nagain, the six thousand inhabited islands, I just don't think it can be done in\na day. So can we call this Pekan Imunisasi Nasional, which means National\nImmunization Week?\" I said, \"Sure, you can call it anything you want to call it,\nas long as we're moving and doing ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2890.0,2940.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"it.\" And so we did all this. They prepared the\nday--they had all the instructions going down to even just village level,\nbecause, again, the command, the central command, just everything was at their\ndisposal. And later, the minister of health and I laughed because we probably\ncould have called it National Immunization Hour, because that first day, all the\nchildren--even before the immunization thing opened up--were all lined up in the\nvillage to get their vaccine. And so within about an hour, I think probably 70%\nof all the children had been immunized. It was just incredible. But the amount\nof--and I would go with them on helicopters to places, we went on navy ships to\nplaces, and things like this.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2940.0,2984.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So everything was opened, and it was a very exciting time to actually see us go\nto zero cases of polio. And I remember back then about that incident we talked\nabout back in medical school, when the orthopedic surgeon was saying, \"You're\ngoing to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=2984.0,3000.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"have more impact in your career than I ever had in mine, because here\nwe are working with this child with polio who should never have gotten it.\" And\nhere I was thinking, oh my goodness, we've gone to zero cases of polio, this is\nwhat this surgeon was prophesizing twenty years earlier. So it was very exciting\nto see that come to fruition. But I think that again, that issue that no one was\nin charge, in the sense of being solely responsible for the eradication--it was\nreally a team effort, from village levels up to UNICEF and Rotary and WHO and\nUNDP [United Nations Development Programme] and World Bank, all working together\nwith ministries of health to make this possible. And this was happening all over\nthe world. And so I think that it was a very exciting time to be able to see\nthat effort being able to get to actually zero cases of polio.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3000.0,3054.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"After six years in Indonesia, the director general asked if I could go to head\nup the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3054.0,3060.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"country program in India, so we went back to New Delhi. This time, as\ncompared to being in the regional office, I was actually in the minister of\nhealth's offices--Nirman Bhavan, it's called--and heading up the country\nprogram, which is our largest country program of WHO. And in it we had people,\nagain, working with the polio eradication area out of the regional office also.\nJon Andrus is another person that is a CDC, U.S.-trained, very involved with\nPAHO most recently--but he was there, and he was working with a team that we had\nof 750 staff in India, three hundred of which were professionals, and others\nbeing drivers and things like this. They were actually working with the\ndifferent provincial ministries of health and the central government in terms of\nbeing able to do the acute flaccid paralysis. The national immunization days--we\nhad a big launch in 2001 with Prime ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3060.0,3120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Minister Vajpayee himself delivering the\nvaccine. I've got a picture that I can show you on that. And the efforts were\nsuch that it really mobilized the country with over a billion people. It was\nreally something to see, all the zero to fives [ages].","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3120.0,3136.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And not only that--then, of course, we still had cases of polio occurring in\nIndia, and we would do what we call the mop-up operations. This is where, when\nyou actually detect cases of polio going on--in addition to the national\nimmunization days, which were happening three times a year--you actually then go\nin and what do what we call mop-up operations, where you go door-to-door making\nsure that all children under five were receiving oral polio vaccine in those\nareas we actually had cases. And these were the strategies that were being used,\nnot only national immunization days, but mop-up operations and the routine\nimmunization program. Those three things together--like three legs of a stool,\nso to speak--was really the platform of which the polio eradication effort ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3136.0,3180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"was\nfounded on, including, then, of course, the surveillance to be able to detect\nand then be able to focus our program operations to those areas of greatest need.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3180.0,3189.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We also had to do sophisticated epidemiologic work too; for example, to make\nsure that our vaccine was still a potent and strong and working well for us. And\nin fact, it turns out it was a very interesting experience--we started to notice\nthat the vaccine efficacy for type III vaccine--the vaccine has three types in\nit because there are three types of polio--was not at the levels we would have\nanticipated. And so we were looking at different things that this might be due\nto. Do we have breaks in the cold chain? Do we have breaks in the way in which\nthe vaccine is being administered in the field? What could possibly be causing\nthis? And we were scratching our heads about it, and finally we said, well, why\ndon't we also bring in some experts from Geneva to talk about--to go over to the\nvaccine manufacturer here in India and look at what they're doing. And it ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3189.0,3240.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"was\nvery interesting because they knew the WHO standards, and it required a certain\namount of titer of each of the components of type I, II, and III in the vaccine.\nAnd in the vial, as it was going out the door, it was meeting those standards.\nBut kind of unbeknownst to them, it was the fact that the standard actually goes\nbeyond just what is it like as it goes out your door, but it's also supposed to\nbe able to meet those same minimum standards two years in storage.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3240.0,3273.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The vaccine manufacturers in Europe recognized that this type degraded over\ntime, so what they did is that when it goes out the door of their plant, it's at\na much higher titer, so that after two years, it's still above the standard. But\nwhat was happening in India was that it was going out the door at the standard\nand over time it was degrading. So it was a simple fix. The vaccine\nmanufacturers went ahead ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3273.0,3301.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and upped the titer in the vaccine, and we didn't have\nthat problem again. But it was kind of, again, showing where the role of\nepidemiology, the role of looking and testing and seeing--how is your vaccine\ndoing in the field, where are you seeing disease, why could these people be\nhaving this level of vaccination but still coming down with disease--how that\nworks. It's a very exciting part of sleuthing, if you will, in the epidemiology\nworld about vaccines.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3301.0,3331.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so I think, also--I might digress on one thing that you might find of\ninterest--is that I also had the concept that looked at, as the WHO, as the\nMinistry of Health, we should be practicing what we preach. And I don't know if\nsome of the folks that are listening to this and hearing this and seeing this\nhave seen sometimes government buildings in India, but oftentimes they are not\nso well kept up--abandoned furniture in the stairwells, things like ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3331.0,3361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"this,\nunclean bathrooms, et cetera. And the Ministry of Health is no different. So\nbecause my offices, though, were in the Ministry of Health, not in the regional\noffice, I said to the minister, I said, \"Look, how about if we had a project?\nWe'll call it the Healthy Public Building Project, and we'll start here. And a\nhealthy public building should be at least safe and reasonably clean.\" And he\nagreed, he said, \"Okay, that sounds good.\" And so what we did, we started having\na group of us go around once a month--and we had people from the general\nservices and from the Department of Public Works and from the electricians, et\ncetera--and we said we'd start by identifying things.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3361.0,3401.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So the first thing we identified was just these abandoned file cabinets and\nfurniture that were in the stairwells and the hallways. A safety hazard for\nfire, but they said, \"No, we can't take it out, because we tried that once and\npeople would come out and say, 'Oh no, that was my valuable file cabinet you're\ntaking away. You can't take ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3401.0,3421.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that.'\" So we said, \"Okay, we'll write all five\nthousand people in the building\"--it was a big building--\"and tell them that in\ntwo weeks' time, if there's something important to them that's in the hallways\nor the stairwells, put it into a room.\" So then after two weeks, we just took it\nall out, and no one could complain, because they had been given a warning about\nit. So that was kind of nice. You saw a little bit of space now to walk. Then we\nhandled the bathrooms because it smelled. The building smelled the minute you go\nin. So it was a matter of communication, that the general services people\nthought the Department of Public Works is supposed to take care of that. Public\nWorks said, \"No, no, we'll take care of something broken, but the general\nhygiene and maintenance has to be done by general services in your building.\"\nAnd so with the two of them together, the fact is that half the fans weren't\nworking. So that was Public Works, so they got the fans working in the\nbathrooms. And then, at least, a modicum of cleaning going on by general\nservices. And within about four or five months, there was no longer any smells\nin the building.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3421.0,3480.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So now people ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3480.0,3481.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"were being kind of interested about this. So we said, what are we\ngoing to tackle next? And then--it was a major problem, and it happens in some\nbuildings in India, is we had these small monkeys that come in at night and\nthey're really vicious. And I had one of my staff members bitten, in fact, by\none of these. They'll just have monkey doo all over the place, and anything\nthat's in the hallway they'll just rip up and tear apart. And so one of the\npeople in the group that we had going around once a month said he had heard\nabout hiring an animal trainer with a langur, which is a big monkey, that this\nguy could walk around and that the little monkeys are the--their natural\npredator--the big one is the natural predator of the small ones, and that they\nare scared. So I said, \"You know, it's worth a try.\" Incredibly, in one day's\ntime, with this guy walking this monkey around, there were no monkeys to be seen\nin the building, and not even the parking lot, because they used to tear off\npeople's mirrors in the cars and all that sort of stuff. And although we had to\nhave him go by once every ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3481.0,3541.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"day, but it completely solved the problem. So it's\nkind of an interesting situation where again, by just slowly and methodically\nbeing able to address it, we actually came up with a clean and healthy building.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3541.0,3553.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I think again, in India, one of the things that we learned is, again, the\nimportance of being able to communicate about vaccination and the vaccination\nprogram and the polio eradication program. We had some setbacks--and remember,\nthis has happened in other countries, Nigeria as well, where sometimes rumors\nstart to spread that the vaccine is somehow sterilizing children or something\nlike this. And I know this happened in a few of the Muslim villages--it was\nhappening in India. And so how we best dealt with that was to be able to, again,\nreach out to the influencers, the imams and the mosques, and be able to talk\nwith them. And they understood then, and then they were able to preach in the\nmosques about the importance of the polio program, or they themselves would give\nthe polio vaccine, or their children would come and receive the polio ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3553.0,3601.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccine,\nso you could see that that trust and nature of it. And I think that 2000\nNational Immunization Day launch with Prime Minister [Atal Bihari] Vajpayee also\nhimself giving the vaccine was another powerful message for people to see that\nwas widely circulated in the country. I think those are some of the things that\nwe were trying to do.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3601.0,3623.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think that this whole issue about concerns about the side effects of vaccines,\nwe often see it less, actually, in developing countries, because parents see the\ndifficulties of the wild disease occurring. They see children dying of measles.\nThey see children becoming paralyzed from polio. So usually it's not such a hard\nsell, if you will, to say, hey, we've got vaccine here. There's usually a clamor\nfor it. They want to have that vaccine. And I think, actually, it's been more of\na situation that occurs in the developed countries, like back here now in the\nUnited States, where what's happened is that ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3623.0,3661.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"there's a complacency that's set\nin. That parents look around and they don't see these diseases, and so they hear\nabout side effects, some of which is false, some of which is exaggerated. Of\ncourse, we always try to recognize that vaccines are safe and effective, they're\nnot perfectly safe and they're not perfectly effective. But they're a lot better\nthan the wild disease. And I used that. Recently there was an editorial I put in\nthe American Journal of Public Health, and I called it \"The Dangerous Curve and\nthe Guardrail: Disease and Vaccination,\" in the sense that you have a situation\nthat occurs if you look over a dangerous curve in a road--so over the last year\na hundred people died going over this dangerous curve. That's like having the\ndisease, okay? Now what do we do? Well, we put up a guardrail. Well, that's like\nhaving the vaccine as a safety feature. Now the next year, the statistics show\nthat nobody was killed going over this dangerous curve. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3661.0,3721.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"However, three people\nwere hurt hitting this guardrail. And some people would say, oh my goodness,\nwe've got to take down the guardrail because it's injuring three people a\nyear--just like the side effects, you know, very rare, but it happens on\nvaccines. So some people would say, oh my goodness, we've got to take down this\nguardrail, we've got to stop vaccinating, when of course what will happen is\nthat you'll go back to the pre-guardrail era of a hundred people dying going\nover the curve, or pre-vaccine era where we had--like in polio, you know, fifty\nthousand cases a year occurring in the '50s. So people have to understand that\nproblem that we face. So sometimes that analogy helps groups to understand that\nI can't compare side effects of vaccine against current levels of disease, which\nare low because of the very success of our vaccination programs. I have to\ncompare of what would happen in the absence of vaccination.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3721.0,3774.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I think that in India also, we again recognize the importance of lots of\npeople working together in a partnership. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3774.0,3781.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Again, it was with UNICEF, Rotary\nInternational, WHO, UNDP, Asian Development Bank--all of us working together\nwith the Ministry of Health in a partnership. And that's really the only way you\ncan achieve these sorts of goals and strategies. It was in 2002, actually, that\nI left India after a little over three years. My wife, unfortunately, had\ndeveloped breast cancer. Fortunately, she's done well, but at the time the U.S.\ngovernment wouldn't let us stay in India if she was on chemotherapy--concerns\nabout decreased immune status, susceptibility to infection. And I'll always be\ngrateful to CDC, they were able to accommodate me as a career field epidemiology\nofficer, stationed here in Los Angeles. My wife was able to go to the Revlon\nUCLA Breast Center. And I was then stationed at the--half-time at UCLA and\nhalf-time here in the Department of Public Health in the area of bioterrorism\npreparedness, because that's of course where the funds are. I had to develop a\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3781.0,3841.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"smallpox plan for Los Angeles County at that time. I also prepared a course on\npreparing for a smallpox at a bioterrorist event at UCLA.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3841.0,3850.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then this position of director of communicable disease control prevention\nopened up. And it was just the right timing in my career to be able to leave, at\nthat time, government service, because I had up to thirty years' retirement as a\ncommissioned officer, and so a second career here in this capacity. And I've\nbeen able--because one of the five programs that I had administered overseas,\nthe immunization program--I've been able to keep involved with\nimmunization-related activities. And so again, this issue of looking at vaccine\nconcerns and relationships to community groups, to be able to develop stronger\nvaccination for new vaccines, like our human papilloma vaccine, things like\nthis. It's been a very nice, opportune time to be able to stay very much\ninvolved with immunization programs while looking at an even wider portfolio of\ncommunicable disease programs as ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3850.0,3901.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"well.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3901.0,3901.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think, in reflecting back on lessons learned in polio eradication, I think a\nnumber of things in my mind. Firstly, for CDC itself, the recognition it is a\nglobal leader and a global player in this field, that it gives prestige to the\nUnited States government as well as to just CDC itself. To have its staff\ninvolved in these activities providing expert guidance, providing reference\nlaboratory--the CDC that really developed some of these techniques of what we\ncall oligonucleotide mapping, which is like fingerprinting of the poliovirus to\nbe able to detect, where did this actual polio virus come from? As you get more\nand more polioviruses typed and oligonucleotides mapped, you can actually have a\ngeographic map and figure out where these things have come from, and will help\nyou then in your detection of how to stop the spread of disease. I think that\nbeing able to provide ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3901.0,3961.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"epidemiologists--and for persons involved with the\nimmunization program at high levels in the organization--has been able to\nprovide CDC with a visibility that even though, yes, I had a UN hat on or a WHO\nhat on, everybody realized I was CDC. In reality--which is that we didn't try to\npromote this--we were trying to promote the fact that we were now under a United\nNations flag at this stage and all of us were partners in this. And with now the\nGates Foundation and others that have become involved with private sector even\nmore, I think that again, it's important that we understand CDC is often one of\nthose drivers, together with WHO, for the research that's necessary to help\ndevelop the strategies, and to fine-tune the strategies that are necessary for\nthe eradication effort like we're doing now with this role of IPV and OPV at the\nend role. The ability to detect this vaccine-associated polio and what is its\ncontribution to the remaining polio in the world and how to be able ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=3961.0,4021.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to\nultimately use, perhaps, IPV to be able to stem that problem as we move to a\npolio-free world.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4021.0,4027.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think that the CDC has been very generous with its time and expertise, and I\nthink, again, it just has been to the betterment of CDC and the United States\nand its perception in the world. And I think that all of us who have been\ninvolved at one time or another in the polio eradication effort, it's like the\nnext generation that came after the smallpox, which was, again, a cadre of\npeople that were very much involved with a global worldwide effort that resulted\nin success of the eradication of smallpox. And we're right in the middle of the\nend stages, now, of those who were involved with the polio eradication to see\nthat goal finally coming to fruition. And that again, will be, I think, probably\none of humanity's greatest achievements in the twenty-first century, is going to\nbe the eradication of polio. I know we have kind of a friendly rivalry with\nthose that are ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4027.0,4081.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"working in Guinea-worm or dracunculiasis eradication, which is\nanother great story to be told. Each side was saying, okay, we're going to reach\nit first, and then each side had just a little bit more to go. So it's still a\nlittle bit up in my mind which one is going to actually get to eradication\nfirst, but obviously the polio is a much wider-spread problem. But it is a\nhealthy competition. And again, CDC, [Dr. Donald] Don Hopkins and others have\nbeen very, very influential in that effort. And it's been kind of nice to see\nthe cross-fertilizations occur that way in a safe, healthy competition as well.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4081.0,4116.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I think, in summary, certainly the polio eradication initiative has been one\nof the defining aspects of my own career, something that I take great pleasure\nin having been a part of. And again, I emphasize being a part of it. I don't\nthink anyone can ever say, you know, they own it. But I think all of us working\ntogether--we're much stronger than any of us as an individual. And I think that\nis ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4116.0,4141.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"really, perhaps, the real lesson learned in this, is that partnerships,\ncollaborations, and cooperation can achieve things that no individual could ever\nexpect to.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4141.0,4157.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: That is a perfect way to end. Thank you so much. You gave such good\nexamples of using creative ways to overcome problems that were effective. And\nyou were able to maximize use of all your resources that other people will be\nable to then use in the future.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4157.0,4190.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: Yeah. I'm glad it served what you needed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4190.0,4196.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Thank you so much.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4196.0,4199.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/transcript/70452/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"KIM-FARLEY: My pleasure.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=4199.0,4201.0"}]},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544","type":"AnnotationPage","label":{"en":["2016_400_22 [Index]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544/annotation/149","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Education/Background","format":"text/plain","label":{"en":["Title"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=43.0,361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544/annotation/150","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Dr. Kim-Farley introduces himself and discusses the events that led him to pursue medical school. Kim-Farley shares traveling was part of growing up with a father in the Navy as well as his experience of being evacuated during the Cuban Missile Crisis. Kim-Farley also describes his early experiences in international public health at the National Hospital of Western Samoa, and a mentor who introduced him to the idea of public health the community as your patient. \n","format":"text/plain","label":{"en":["Synopsis"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=43.0,361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544/annotation/151","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Would you start by telling us a little bit about your background before you came to CDC [Centers for Disease Control and Prevention]?","format":"text/plain","label":{"en":["Partial Transcript"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=43.0,361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544/annotation/152","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Africa","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"American Medical Association","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Asia","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Baha’i Faith","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Centers for Disease Control and Prevention (CDC)","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"China","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Cuban Missile Crisis","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Epidemic Intelligence Service (EIS)","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Food and Drug Administration (FDA)","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"San Francisco, California","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"South Pacific","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"the Bureau of Radiologic Health in Washington area","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"U.S. Public Health Service Hospital","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"United States","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"University of California Los Angeles (UCLA)","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"University of California San Francisco Medical School","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"University of California Santa Barbara (UCSB)","format":"text/plain","label":{"en":["Subjects"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930#t=43.0,361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/132947/file/247930/index/85544/annotation/153","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"biochemistry","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"biomedical","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"child with polio","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"community","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"crawl","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"devastating effect","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"didn’t get measles","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"electronic production radiation","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"family","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"formative period","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"Guantanamo Bay, Cuba","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"he had polio","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"impact","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"individual","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"international health","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"International Health Committee","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"Kodiak, Alaska","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"master’s in public health","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"medical school","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"National Hospital of Western Samoa","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"patient","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"Peer Education","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"polio","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"population","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"Prevention activity","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"public health","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"public health majors","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"Samoan doctors","format":"text/plain","label":{"en":["Keywords"]}},{"type":"TextualBody","value":"visiting orthopedic 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Orenstein; secretary; new vaccine; expanded program immunization; smallpox eradication; hepatitis B vaccine; big step forward; indigenous manufacturer; children; vaccine development; 1993; major polio resolution; World Health Assembly Resolution 46.33; country delegations; cosponsors; resolution; greatest number; global priority; Director General’s Health-for-All; gold medal; Director General; award; Geneva; headquarters\nSubjects: Global Advisory Group (GAG); Scientific Advisory Group of Experts (SAGE); CDC; Europe; United Nations Children’s Fund (UNCIEF); India; Indonesia; World Health Assemblies; Rotary International\nSegment Synopsis: Dr. Kim-Farley discusses improving polio surveillance systems with the aid of the Global Advisory Group [now Scientific Advisory Group of Experts] and working towards global eradication. 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