{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://globalhealthchronicles.aviaryplatform.com/iiif/n29p26rw0j/manifest","type":"Manifest","label":{"en":["Jafari, Hamid"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","metadata":[{"label":{"en":["Source Metadata URI"]},"value":{"en":["12824 (Jafari_Hamid.xml)"]}},{"label":{"en":["Publisher"]},"value":{"en":["David J. Sencer CDC Museum"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum.","Interviews may only be reproduced with permission from David J. Sencer CDC Museum."]}},{"label":{"en":["Agent"]},"value":{"en":["Hamid S. Jafari (Interviewee)","Hana Crawford (Interviewer)"]}},{"label":{"en":["Date"]},"value":{"en":["2018-02-23 (Created)","Unknown Date (Created)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Identifier"]},"value":{"en":["OHCDCM700 (collection call number)"]}},{"label":{"en":["Relation"]},"value":{"en":["Global Polio Eradication Initiative History Project (is part of)"]}},{"label":{"en":["Subject"]},"value":{"en":["Global Polio Eradication Initiative History Project (local term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Bill \u0026amp; Melinda Gates Foundation, CDC, Centers for Disease Control and Prevention, David J. Sencer CDC Museum, Polio, Rotary International, WHO, World Health Organization"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum.","Interviews may only be reproduced with permission from David J. Sencer CDC Museum."]}},"provider":[{"id":"https://globalhealthchronicles.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["David J. Sencer CDC Museum"]},"homepage":[{"id":"https://globalhealthchronicles.aviaryplatform.com/","type":"Text","label":{"en":["David J. Sencer CDC Museum"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/250/510/small/2016.400.6HamidJafari_EpxLDM7yMC4_.mp4_1726185076.jpg?1726185078","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510","type":"Canvas","label":{"en":["Media File 1 of 1 - 2016.400.6_Hamid_Jafari__EpxLDM7yMC4_.mp4"]},"duration":6036.515,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/250/510/small/2016.400.6HamidJafari_EpxLDM7yMC4_.mp4_1726185076.jpg?1726185078","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/250/510/original/2016.400.6_Hamid_Jafari__EpxLDM7yMC4_.mp4?1726185071","type":"Video","format":"video/mp4","duration":6036.515,"width":640,"height":360},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449","type":"AnnotationPage","label":{"en":["Jafari_Hamid [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: It is July 5, 2016 and I'm here with Dr. Hamid Jafari who until\nrecently was the Director of the Global Polio Eradication Initiative at the\nWorld Health Organization, and has just last week been appointed the Principal\nDeputy Director for the Center for Global Health at the Centers for Disease\nControl and Prevention [CDC] here in Atlanta. So welcome, Dr. Jafari. Thank you\nfor agreeing to be interviewed today for the Global Health Chronicles. My name\nis Karen Torghele, and I'll be talking with Dr. Jafari about his polio-related\nwork here and overseas. So to begin, Dr. Jafari, would you please tell us a\nlittle bit about your background? And how you came to be involved in polio work\nand came to be at CDC in the first place?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=0.0,50.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: So I did most of my growing up in Karachi where I was born, Pakistan,\nbut in fact, I did my first three grades ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=50.0,60.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in Tehran [Iran] where my father was in\nthe Pakistan embassy as the Press and Cultural Attaché. I come from a family of\nmostly educators. My father started his career as an educator, but he then ended\nup being quite a celebrated poet, a satirist in Pakistan and India. And so I\nalso went to medical school in Karachi, Sindh Medical College and graduated in\n1983, did what in the British system is known as a house job which is sort of an\ninternship and I came to the U.S. in 1984, and as they say, came off the boat in\nBoston. And it was a time when it was very difficult for foreign medical\ngraduates to be accepted into a residency training ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=60.0,120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"program. I was interested in\ntraining in pediatrics, but it took some time. It actually took me two and a\nhalf years before I could get into a residency training program. But that sort\nof turned out to be good because for the first year I worked in a basic cell\nbiology lab at St. Elizabeth's Hospital in Boston, where I learned to do basic\nscience wet bench research, something I'd never done before. And that was very\ninteresting, and I learned a number of new laboratory techniques, which enabled\nme then to get a research fellowship at Harvard Medical School at\n[Massachusetts] Mass General Hospital. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=120.0,168.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I worked there for a year, and it was\nreally, again, new techniques I was learning, like cell culture and protein\nbiochemistry, and was working on ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=168.0,180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a growth inhibiting factor from malignant\neffusions of patients with cancer. So after these two years doing basic science\nresearch in Boston, I got accepted in a residency training program at Dartmouth\n[College] and there--also what is called the national resident matching program.\nSomehow, that year, Dartmouth had a vacant position they were not able to match\nfor. So I ended up interviewing the program director --in, actually, the\nlibrarian of Boston University --who was, I think, doing his MPH [Master of\nPublic Health] at the University of Boston. So that's where I was interviewed.\nAnd I was offered the job, and I accepted that sight unseen. I hadn't even gone\nto Hanover to look at the hospital and the medical school, because I was quite\ndesperate to get ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=180.0,240.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"into residency training. So the lab that I was working at Mass\nGeneral, they immediately threw a party. They knew that I was interested in\nreally looking for a residency training program, so-- and there were all of\nthese fellows and medical students going to Harvard [University], and for them\nit was obviously unimaginable that someone would accept a residency training\nprogram without having even looked at the hospital or the training program. So\nthey said, \"Look\"-- a couple of them really expressed surprise that you haven't\neven gone up to Hanover and you've accepted the position. So my mentor at Mass\nGeneral, he said, \"Look, he comes from a culture where they get married without\nhaving seeing the bride first. This is only a residency training program.\" So it\nwas kind of like an arranged marriage, and it really worked out well. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=240.0,295.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I learned\na lot in that training program, and as I was ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=295.0,300.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"training, I realized that I have a\nreal interest in infectious diseases and so I was accepted in a pediatric\ninfectious disease fellowship program at University of Texas Southwestern\nMedical School, which was one of the best pediatric infectious disease\nfellowship programs in the country. Lucky that way. So did some good research,\nlearned a lot of good clinical pediatric infectious diseases. Then as I got into\nmy third year -- senior year of the fellowship-- I wasn't really sure where I\nwould go next. And [Dr. Gregory R.] Greg Istre, EIS [Epidemic Intelligence\nService] 1980 was at that time the state epidemiologist for Oklahoma State. He\nwas changing careers and wanted to leave the administrative work. He loved\npublic health, but he said, \"Look, I am doing less and less public health and\nmore administration.\" So he decided to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=300.0,360.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"do a clinical infectious disease\nfellowship for a year. So as a senior fellow, I took him around, showed him the\nprogram. We had lunch at the faculty club, and he asked me what I was planning\nto do. And of course my plans were vague, other than to say I like infectious\ndiseases, I like international work. And he said to me that, \"You have an EIS\nofficer written all over you, but you don't know it.\" So it was actually Greg\nwho got the application forms for me from CDC, and I applied. And at that time,\nin sort of the confusion of the next move I was interviewing with the\npharmaceutical industry -- and clearly I was very clear that I didn't want to go\nthere, but the options were not very clear whether I wanted to stay in academia\nor try this CDC thing, you know, this EIS training program. And Greg said to me\nthat those two years were the best of his ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=360.0,420.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"career, and he assured me that I would\nfind those two years the best in my career as well. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=420.0,429.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I applied, was called for\nan interview. I interviewed in the immunization program and meningitis and\nspecial pathogens here at CDC, and at the end of the interview, everybody would\nask me, \"How do you know Greg?\" So clearly, Greg had talked to all of the people\nI was going to interview. So anyway, I was very fortunate. I was offered a slot\nin the class of '92 EIS, and so I started my training in meningitis and special\npathogens [Dr.] Anne Schuchat was my immediate supervisor and [Dr.] Jay [D.]\nWenger was the branch chief. So we started off there. And after I finished my\nEIS, I ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=429.0,480.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"joined the National Immunization Program [NIP] and Dr. Walter [A.]\nOrenstein was the director of that national program. And I started working on\nHaemophilus influenzae type b [Hib] surveillance. In fact, I had already started\nto work on that while I was in meningitis and special pathogens branch. But I\nvery closely watched the debate at that time between the use of the inactivated\npolio vaccine [IPV] and the oral polio vaccine [OPV] in the U.S. An issue that\nhad gone all the way up to the debate in ACIP [Advisory Committee on\nImmunization Practices], but also discussions at the Institute of Medicine. And\nfinally, those discussions led to U.S. going to a full inactivated polio vaccine\nschedule from the oral polio vaccine, with a transition period of '96 to 2000\nwhere both vaccines were being used in the infant schedule in the U.S. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=480.0,503.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I\nworked in the NIP from '94 to '96, and I saw the small sort of activity begin to\ngrow which was called the polio eradication activity led by Dr. Steve [Stephen\nL.] Cochi and his deputy Bob [Robert A.] Keegan. And at that time, I was\nlearning that these CDC epidemiologists and Public Health Advisors were helping\nwith establishing polio eradication programs in partnership with WHO [World\nHealth Organization] and Rotary International. And UNICEF [United Nations\nChildren's Fund] was also gradually getting on board, but these epidemiologists\nwere really setting up the eradication effort in Africa, in the Southeast Asia\nregion that included India. Many of them worked in key countries like China. And\nthose two regions were considered particularly challenging. The eastern\nMediterranean region of WHO that has all of the countries of the Middle East and\nnorthern Africa, but also Afghanistan and Pakistan and Iran. And in the\nSoutheast Asia region that has India, Nepal, and Indonesia, some large\ncountries, Bangladesh, many of these densely polio-endemic countries. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=503.0,531.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I sort\nof became interested in this. And my wife and I we discussed that maybe it would\nbe good to go out overseas and see what international work is like overseas. I\nwas doing domestic immunization work here, and she agreed, and we said, \"Let's\ntry it for a couple of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=531.0,540.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"years and see where that leads.\" So I applied and was\nselected. And both Bob and Steve advised me that I should be located to\n--seconded to the Eastern Mediterranean region of WHO, and that office was\nlocated in Alexandria, Egypt, and it covers twenty-three countries. As I said,\nall of the Middle East, North Africa and Pakistan, Afghanistan, and Iran. And so\nI was selected in summer, but I volunteered for the summer Olympics in 1996. So\nthey were very gracious. They allowed me time to work as an envoy in the Atlanta\nOlympics. So it was in September that we moved to, September '96 -- to\nAlexandria, Egypt. We didn't know anybody in that city. So my wife and I and our\ntwo and a half-year-old son, we landed in Alexandria, Egypt. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=540.0,600.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I worked with that\nregional office for six years, and four years later, we moved to Cairo, and then\na year later to Pakistan--Islamabad--for almost a year. And that was a very\nimmense learning experience. Got to work with the government and partners in\nthat region. Fascinating countries, very challenging countries, and got to\nreally play a role in establishing polio eradication programs in some very, very\ndifficult and challenging environments-- countries at war, countries with\nprolonged, complex emergencies, culturally challenging countries. But then we\nlearned a lot about those countries and learned a lot about how to set up public\nhealth programs, surveillance programs, vaccine delivery programs in such\nsettings. So that was a very good experience in that region. And we can talk\nabout that more when we come to specifics of polio eradication and lessons we've\nlearned. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=600.0,640.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Then I came back-- in fact, we were evacuated from Pakistan. We were\nposted to Islamabad three weeks before 9/11 happened. So our household goods had\nnot even arrived in Islamabad, and 9/11 happened so we were evacuated. Then\nwe're allowed back in December of 2001. And kids started going back to school,\nand we were starting to settle down in our house in Islamabad. There was a\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=640.0,660.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"suicide bombing in a church in the diplomatic enclave in Islamabad, and we lost\na staff from the U.S. Embassy and her child in that, and then Pakistan became a\nnon-family duty station, so we were evacuated, and we came back to Atlanta in\nmid-2002. And I came back as polio eradication branch chief. And by that time,\nthat small polio eradication activity had become the Global Immunization\nDivision [GID]. And so within that, there were two branches, and I came back as\nthe chief of the polio eradication branch. And then after two years, I was\nselected to be the director of the division of global immunization, and so did\nthat for two years, and then another itch. My wife and I--we discussed, and\nthen we said okay, let's go out again on an overseas assignment. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=660.0,692.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And a position\nwas available in the Southeast Asia regional office of WHO, to support polio\neradication in the region in New Delhi. So I stepped down as division director,\nand this is the interesting part. This is what I really like about CDC that you\nhave these options that you could be on a leadership track or you can choose to\nswitch that track and go into program work. And so that's what we sort of\ndecided that I step down as director of Global Immunization Division to go and\nwork closer to polio eradication in the Southeast Asia region. And so we arrived\nthere in, again, August of 2006. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=692.0,718.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And by March of 2007, the regional director\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=718.0,720.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"then asked me to basically go and lead the polio eradication program in India.\nAnd there were some significant uncertainties about that decision. While it was\nthought quite feasible that I could be posted to the regional office of WHO in\nNew Delhi, India, there were some concerns that my origins being from Pakistan,\nhow would I be accepted in India? But the regional office, since it covers about\neleven countries, that was okay. But when I was asked to go and take up the\npolio eradication program in India, which was at a very intense phase-- there\nwas a polio outbreak going on in Northern India--very visible, very public. The\ngovernment was making funding ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=720.0,780.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"decisions to put more and more of its own domestic\nresources into the eradication program. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=780.0,787.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I was concerned at how I will be\naccepted by the Indian government, by the large project-- more than 2,000 staff,\nmore than 250 medical doctors from India, you know, what would that be like? And\nI think a couple of things were very interesting in that regard-- that I was\nfirst seen as an expert from CDC, and it didn't matter where I came from. I\nthink it speaks to the credibility of the agency the scientific excellence, and\nthat's what I think the government and the other technical experts in India. I\nsuppose, looking at is that they knew that I was assigned to WHO ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=787.0,840.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"from the CDC,\nand that's what I think brought a great deal of credibility to my assignment\nbeing there in the first place. And secondly, I think it really speaks to the I\nthink the sense of diversity, plurality, in India, that we had all kinds of\nchallenges during the eradication program, and some very tough periods of\nnegotiation and discussion with the government-- both the central government and\nat the state level-- but never where I came from was an issue. It was always\nfocused on the program issues, the challenges, and such. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=840.0,892.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So that turned out to\nbe an absolutely fantastic assignment. One that I was ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=892.0,900.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"extremely anxious and\nnervous about, and just had a fantastic team, fantastic partners, very strong\ncollaboration with the government, and an outstanding public health workforce in\nthe National Polio Surveillance Project that I led for five years in India. So\nthen India was, as you know, successful in stopping transmission of wild\npoliovirus and the last case occurring in January of 2011. So in February of\n2012, we had confidence that we might have stopped transmission, because all of\nthe surveillance data, all the laboratory tests from cases of acute flaccid\nparalysis and environmental surveillance-- which is the sort of sewage ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=900.0,960.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"surface\nwater testing--had tested negative for a period of twelve months. So India was\nofficially removed from the list of polio-endemic countries. And so one day, it\nwas a Saturday evening, and I was at a dinner party with my wife, and there's\nsome music playing, and my cell phone rang, and I saw it was a Geneva number.\nAnd I picked up, and, of course, I had over the years had many friends working\nin the polio program in WHO Geneva headquarters. So there was this lady on the\nline, and she said, \"Hamid, this is DG calling.\" And I thought that one of my\ncolleagues was playing a prank on me, that it's unimaginable, 10:30 Saturday\nnight ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=960.0,1020.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"directly my phone rings. So I started saying, \"Yes, yes, all my friends\nsay that when they call me.\" So it actually did take Dr. Margaret Chan\n[Director-general of the World Health Organization] a couple of sentences to\nconvince me that it was in fact her. So I said, \"Okay, let me step out, the\nmusic is loud here.\" And basically, she said, \"Look, I want you to come to\nGeneva as director of polio eradication next month,\" basically. And I tried to\npersuade her that, look, India is not out of the woods, we still have to\nconsolidate on the gains we've made. And she said, \"Look, others can do this--\nyou need to come to Geneva.\" ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1020.0,1065.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So that's how I moved to Geneva in March of 2012\nand led that program there until end of January this year. So I hope that\nsummary gives you a sense of how this has evolved.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1065.0,1079.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: It ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1079.0,1080.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"does. That's very thorough and interesting how you got from\nstarting out in Pakistan and ended up in Geneva at the World Health\nOrganization. And in between, you were at CDC in different positions.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1080.0,1099.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: That's right I've been with CDC for now exactly twenty-four years, and\nof those twenty-four years, sixteen have been spent overseas on assignment to\nWHO. Seconded to WHO, which has been a totally fascinating experience--to have\nthe benefit of the best of the two agencies and also manage the challenges of\nthe two agencies, because I think all public health agencies have their\nstrengths. So it's been a very, very good experience in this regard ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1099.0,1140.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and to have\nworked in two regions that have two very different sets of concerns. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1140.0,1148.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The Eastern\nMediterranean region, in terms of population, is medium-sized, one would say 400\nmillion population, but countries like Somalia and Sudan and South Sudan used to\nbe part of that region until very recently. Afghanistan, Pakistan, Iran, Syria\nand Iraq and being able to help establish eradication programs in that region,\nand the lessons learned there, and innovations in that region were very\ninteresting. On the other hand, Southeast Asia region only eleven countries but\nyou have the diversity of Thailand, which is a middle income, good\ninfrastructure, well-developed country and you have of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1148.0,1200.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"course more than 25\npercent of the population live in these eleven countries. India 1.2 billion\npeople, Indonesia more than 250 million, then you have Nepal--and then some of\nthese small countries are tiny in terms of population size, like Bhutan and\nTimor-Leste and Maldives. And there again, unique challenges particularly in\nplaces like India, in particular, the population size and the density and the\nbirthrates and the conditions, very favorable for poliovirus. The virus has been\nentrenched there for thousands of years, and the conditions were rife for its\nsurvival and propagation. So important experiences and learnings.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1200.0,1254.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So when you had your training, you had your cellular ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1254.0,1260.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"biology training,\nand you also had your residency, and you had your EIS training, all those\nthings. Can you talk about how the training led to what you later did, and how\ndifferent parts of your training led you to do the jobs you did?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1260.0,1282.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: I often wondered in the beginning, that this basic science work that I'm\ndoing, how is that going to work later on? I was thinking of having a career in\nclinical infectious diseases, but that evolved, as I mentioned, into really more\npublic health work and less and less clinical work. But in the end, it's all\nconnected and interrelated. And so a very important part of the eradication\nprogram, of course, is laboratory surveillance and understanding laboratory\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1282.0,1320.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"methodologies and techniques. And as they evolve over time, you get a much\nbetter and clearer understanding of how the lab diagnostic methods and\ntechniques, how do they work, how to interpret the data? And as the technology\nevolved, you are in a better position to keep up, because you have some\nlaboratory background. So it really doesn't go to waste. In fact, it really\nhelps you understand, even understand the problems labs are having because of\nthat background. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1320.0,1359.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Similarly, the clinical training for surveillance, and talking\nto your peers, pediatric associations, or convincing physicians or senior\nfaculty to make sure that cases are reported from the institutions. It all comes\nin very, very handy to be able to have a ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1359.0,1380.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"conversation with clinicians, with\nexperts in the field because you can speak their language and you can\nunderstand, and also to interpret the clinical data that comes out of\nsurveillance and classification of cases. And being able to explain the merits\nof a vaccine--the adverse events of a vaccine-- to not only your peers,\nphysicians, and doctors, but also to the community and to the public at large,\nto politicians, to policymakers. So all of this comes into great use actually.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1380.0,1424.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You had a unique set of qualifications and skills from all of your training.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1424.0,1432.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Yeah, I mean, I think what I've learned is that it's so important to\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1432.0,1440.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"have--in public health. I think it's one of those in some ways almost like a\nunique career where you certainly need technical credibility of what you're\ndoing--to have credibility to the training and the support of an agency like CDC\nwhere scientists are supporting your programmatic work. We've had fantastic\nsupport from scientists at CDC. Particularly we've had two giants here in\nenterovirus laboratories, [Dr.] Olen Kew and [Dr.] Mark Pallansch. I learned so\nmuch of polio virology from them and having their support which is directly on a\ncritical pathway to setting up laboratory surveillance network, laboratories\ninterpreting surveillance data, molecular epidemiology, sequencing of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1440.0,1500.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"poliovirus\ngenome. Tremendous work. So you need to establish that scientific credibility of\nyourself as a leader but also the credibility that's given to you by the\ninstitutions that support you in that work. So that's very important in public\nhealth. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1500.0,1527.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The other, I think which is very important, is to have the cultural and\ndiplomatic credibility. And that really comes from being able to understand\ncultures and have the ability to understand other people's perspectives, because\nthat's the sort of art and diplomacy of public health, is to getting people\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1527.0,1560.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"onboard making political commitments, making financial commitments, putting in\ntheir technical resources into a program. And one has to have that credibility\nas well, where people can trust you, and you are accessible to them, and you can\naccess them. And, you know, in many parts of the world, the real business gets\ndone over a cup of tea or on the margins of a formal meeting. So I think for our\nemerging public health leaders, it's not all about technical leadership. I think\nit's also about the credibility that you establish in terms of understanding\ncultures, understanding people, being empathic, being able to see things from\ntheir eyes, understanding partnerships, and in the end having your personal\nintegrity, that people can trust you, people from other ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1560.0,1620.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"cultures can trust you.\nSo those are some of the important insights I've sort of gained in this journey.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1620.0,1631.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You got the technical training, and we know some about that. But how\ndid you learn the diplomatic skills that you had to have had?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1631.0,1645.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: See, partly, I mean, as I said, I grew up mostly in Pakistan, but also\npart of my childhood in Tehran in the early '60s. And part of it, I think, comes\nfrom some of the watching your family first, but also some of the colleagues\nhere at CDC, and understanding how they navigated some difficult meetings where\nyou also can't sugarcoat ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1645.0,1680.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"things but also having the cultural sensitivity of\ncommunicating and conveying and thinking always win/win. Clearly I learned a lot\nfrom Bob Keegan, who recruited me, and also he was my deputy director when I was\ndirector of global immunization division, but I kept learning from him during\nthat period. Certainly from Steve Cochi, who was the division director\ninitially, in the initial period when I was in global immunization\ndivision--from him. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1680.0,1725.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But also, I think having sort of a broad cultural background\nlike the family I come from, and what was important in our family. I ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1725.0,1740.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"mean, in my\nextended family a person's worth is not measured by how much they make or what\nthey own or what they have. It's always seen as, how many people can you help.\nThat's the metric that's always used. So that kind of aligns with the public\nhealth training you get at CDC. How many lives are you saving? How many diseases\nare you preventing? It's a very bottom-line metric, and it sort of aligns well,\nthat it's all about results, it's all about impact. So I think those things,\nsort of, I feel were important in my career development.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1740.0,1767.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: When you came to CDC, smallpox had already been eradicated. Were there\nlessons learned from that effort that you took with you in your efforts with polio?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1767.0,1775.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Absolutely. I think there were these eight points by Dr. [William H.]\nFoege that we were all given before we were put on that flight to overseas\nassignments, and those were absolutely jewels. The importance of expecting that\nit would be more difficult than you think, but can be done. Always maintaining\nthe faith, not giving up in the face of adversity. The importance of local\ncommitment, the government's commitment, and making sure how you get to that and\ndeserving that. Some very important lessons were conveyed. Of course, Dr. Foege\nis not ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1775.0,1800.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"only a sort of mentor and hero for all of us in polio eradication, but\nalso he was a hero for many of the people who were my mentors. So those were\nimportant lessons and, of course, no shortcut for hard work. It's just tough out\nthere, and it's just not going to be easy, but just not giving up and just\nkeeping at it. And polio eradication has lasted much longer than it was\npredicted to, and the program has had almost every possible difficulty that\ncould have been imagined, either at the technical level or the programmatic\nlevel or political level. But its perseverance and the faith that it can be done\nthat has kept this program going. And I think it was many of those important\nlessons ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1800.0,1860.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that we learned from our predecessors who had worked in smallpox\neradication that have motivated us to keep going.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1860.0,1871.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Just stepping back a little bit to clarify a little bit about what you\ndid and when. During your EIS years, can you talk about some of the work you\ndid? Those two years from '92 to '94?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1871.0,1894.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: So I would highlight in three or four specific areas that my EIS\ntraining was focused on. One area was, this was a period when the U.S. was\nhaving a number of outbreaks in various pockets, some based in college campuses\nof ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1894.0,1920.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"serogroup C meningococcal meningitis, and so I was involved with the\ninvestigation of one of those outbreaks right here in western Georgia, in\nCarroll County. But also I helped draft the guidelines for prevention and\ncontrol of meningococcal disease-- that were finalized, of course, based on the\nrecommendations of the ACIP, but I drafted those during my EIS training. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1920.0,1957.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I also\nwas very much involved with the surveillance and the disappearing of Haemophilus\ninfluenzae type b invasive disease because it was really sort of around 1990\nthat the new Hib vaccine, the conjugate vaccine was ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1957.0,1980.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"introduced in the infant\nimmunization program and that led to precipitous decline in invasive Haemophilus\ninfluenzae type b disease. So I was involved in looking at that surveillance\ndata and documenting that decline, and looking at the populations where the\ndisease was still surviving, the sort of disadvantaged low socioeconomic\npopulations where the visible disease was still persisting. So I was looking at\nanalysis and publication of surveillance data for invasive Hib disease. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=1980.0,2027.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then\nI was also involved in the development of guidelines for prophylaxis against\nneonatal group B streptococcal disease, group B ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2027.0,2040.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"strep. And so, Dr. Anne Schuchat\nwas leading that work at the national level and she was my supervisor, so I\nlearned a lot from her including--we did a survey of obstetricians about what\nsort of screening practices they use for screening for group B strep. So that\nsurvey helped with the final guidelines that were adopted across the country for\nscreening of pregnant women for group B strep. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2040.0,2082.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Then I also did a project in\nKenya for three months in Western Kenya, based out of CDC's malaria's research\nstation in Kisumu, where we were looking at the sick ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2082.0,2100.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"child assessment algorithms\nthat could be used by clinical officers in the absence of a fully trained\npediatrician. So we were comparing the performance of that evaluation algorithm\nwith that of an expert pediatrician. And that work informed WHO's guidelines in\nwhat is called Integrated Management of Childhood Illnesses, IMCI. So I did some\nof that work there, and also shot some videos that were used for training of\nclinical officers in recognizing severe anemia, respiratory distress in\nchildren, signs of pneumonia, and such.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2100.0,2122.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You had an interesting two years.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2122.0,2124.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Oh, very interesting, yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2124.0,2125.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: And then tell us again where you went next.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2125.0,2128.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: So next I went to the national immunization program, and there I\ncontinued with the--because since Haemophilus influenzae type b vaccine,\nconjugate vaccine, had become part of the infant schedule, then I continued to\nanalyze and publish surveillance data on invasive Haemophilus influenzae type b\ndisease, and worked with state and county health departments as to how they\ncould further improve detection of invasive Haemophilus influenzae type b-- Hib\ndisease basically. So I worked on that. I then also got involved with pertussis\ncontrol in the U.S., and in fact investigated a pertussis outbreak in Yuma,\nArizona, and also then ended up analyzing a lot of the data that was coming out\nof these several trials that were being ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2128.0,2160.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"conducted for acellular pertussis\nvaccines, because at that time the schedule around the world included whole-cell\npertussis vaccines. So there were a number of studies done in Europe of various\ntypes of acellular pertussis vaccines, so I helped analyze those studies and\ndata. That eventually then ended up informing the ACIP deliberations on making\nnational recommendations on the introduction of acellular vaccines in the U.S.,\nSo I was one of the co-authors on the first set of ACIP recommendations on the\nacellular pertussis vaccines.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2160.0,2180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And it was at that time was my first brush with polio, because as I said, the\npolio debate had started at that time--of inactivated polio vaccine and the oral\npolio vaccine used in the U.S. And then I was invited for a couple of\npolio-related training activities for surveillance in Pakistan, and was --in\nfact in 1995 went and investigated a polio outbreak in Punjab Province of\nPakistan. In fact, that was my entry into polio eradication really, while I was\nstill with the domestic program. Then, having done this from '94 to mid-'96,\nthat's when I moved to the polio eradication activity.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2180.0,2205.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I wondered how your past had gone, exactly, that led you to polio. But\nthere must've been something, too, that really piqued your interest specifically\nabout polio. Can you remember when that happened, or how?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2205.0,2214.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: I knew of this eradication effort ongoing, and I was hearing about\nchallenges in setting up the program in India at the time but also ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2214.0,2220.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"challenges in\nPakistan and Afghanistan. Egypt still had a lot of polio then, and Sudan, and\nmany of these countries--Somalia--were sort of the tough challenges. So I was\nhearing about those. But I think what might have sort of at an emotional level\npushed it was when I investigated the polio outbreak in Punjab. And this is in\n1995. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2220.0,2235.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I was invited by WHO to go, and it was a pretty nasty outbreak. And as\nI started to go and see patients--you know, you hear about diseases and\nillnesses and you see them in clinical medicine, in a clinical setting--but as I\nwent to the homes of these patients to talk to the families to understand the\nconditions, the environment in which this was happening, it was quite--it really\nmade an impression on me. The one or two instances that a three-month-old baby\ngirl and the mother knows that this doctor has come from America, and she's\ndressed her all up in her best clothes, and she feels that this doctor has come\nfrom America and maybe he'll heal her and maybe she'll be able to move her legs\nagain. And there you are looking at a three-month-old girl and a lifetime of\nparalysis. And in many of these countries, and particularly for a young girl,\nthat's a death sentence, right? I mean, how do you talk to a mother and explain\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2235.0,2280.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"this in a way that does not take away all hope, but it's realistic that there is\nno cure for this? And to think that this can be prevented by just a few drops of\nvaccine. Right? A few doses of vaccine, this could have been prevented. And\nwe've had this vaccine for decades. So that's pretty powerful. And you go to\nsome of the poorest areas, people in Shanties, they can hardly make their ends\nmeet, and they offer you best hospitality. They'll offer you a bottle of Pepsi\nor Coke, saying that you've come from America and that you won't be able to cure\ntheir child, but they're still giving you their best hospitality. Part of their\nday's wage is going into that hospitality. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2280.0,2333.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So it's sort of--you have to connect\nthe dots that all of this training in medical ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2333.0,2340.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"school, all of this training in\ninfectious diseases, all of this training in CDC, what does it translate to?\nWhat can you do with that? That it actually translates into making a difference\nto people. It's something that is not rocket science. It's making sure that\nchildren get vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2340.0,2348.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So it sounds like you maximized all the parts of your training and\nyour education to come to this effort of eradicating polio.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2348.0,2352.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Yeah, I suppose it must be that sometimes all your energies and\neverything sort of gets focused on--like a convex lens focusing on a tight, and\nsort of it burns. And maybe that's probably what happened with polio, and that's\nwhy--a very deep sense that you can't give this up. It has to get done no matter what.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2352.0,2361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I'm interested in, especially your time in India and how you got there\nin 2006. Five years later they were having their last of--wild poliovirus was\ngone you said. It was only five years. So what happened between 2006 and 2011 to\nmake that happen?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2361.0,2368.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: You know, a number of things happened. I mean, I think first I should\nsay that a lot of good work had already happened in India, because, you know,\nyou stand on the shoulders of those before you. You don't start from a clean\nslate. So a lot of good work had already happened. My CDC colleagues and\npredecessors had done a fantastic job of setting up and running the surveillance\nprogram and what came to be known as the national polio surveillance project in\nIndia. They set up great partnerships with Indian Rotarians, a good working\nrelationship with the central government, but also with the key state\ngovernments. By the time I arrived there, most of the indigenous virus from\nalmost all the states of India had already gone. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2368.0,2388.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There were only two states\nwhere polio had remained endemic, and it used to break out of there to other\nparts of the country, and these were Uttar Pradesh and Bihar. Of course, these\nwere the two most challenging states in terms of development, their population\nsize, and these were the most densely polio-endemic states. And Uttar Pradesh\nthe size of 200 million population, and Bihar 100 million population. Just the\nbirth rate of Uttar Pradesh was nearly 500,000 per month. So you ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2388.0,2401.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"have 500,000\nnewborns every month, and in a condition where virus travels very fast, because\nit's fecal-oral transmission. The hygiene and sanitation conditions are very\npoor in these states, and the newborns are being born at that pace. And so it's\na race with the wild virus, which is fitter, faster, and much better adjusted to\nthat environment than the vaccine we were using. And we had to get to these\nchildren before the wild virus could get to them, and get to them with vaccines.\nSo it required a number of elements to be in place for us to succeed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2401.0,2451.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In immunization, you generally have one or the other issue, which is either\nvaccine failure--the vaccine is not working, so you ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2451.0,2461.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"have to change your tool--or\nthere's a failure to vaccinate, and you have to improve your program so that you\nget everybody. In India, we had both of those challenges in these states. The\nvaccine we were using was not performing as well, because it was under\ntremendous pressure-- and I'll explain that momentarily--but we were also\nmissing critical populations, and we had to reach these children as well. So we\nhad to optimize the tool as well, and also find ways to identify who we were\nmissing, and then to find ways and innovations to reach them. So one important\nlesson we learned in India is that you have to really go back to the drawing\nboard and establish a full research program.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2461.0,2513.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Okay, so one important insight is that even you may think you know everything,\nand you're in advanced stages of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2513.0,2521.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"an eradication program--never think that you\ndon't need to do research again. So we had to actually establish a research\nplatform in India, and in some of the most difficult areas, some of the most\nmistrustful populations to do research in those communities. And we were able to\ndo that research to identify how different vaccines would work, how does polio\nimmunity work in those communities, so that we could optimize our vaccination\ntool and strategy. On the other hand, we had to establish a very robust\nsurveillance system to understand the epidemiology in detail at the micro level,\nbut also a very intense program monitoring mechanism real-time data and capacity\nto analyze those data to know who we are missing, why we are missing them, and\nwhat's the solution that allows the front line to actually innovate and come up\nwith solutions that are specific to the reasons we are missing children. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2521.0,2552.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So\nthere were a variety of reasons. For example, we went through a phase where\nthere was a great deal of vaccine hesitancy, resistance, refusal to vaccinate\nbecause there was lack of trust, particularly in minority communities in India.\nAnd we had to establish--and UNICEF took the lead in that--but we had to\nestablish a program of communications, community engagement, to build trust. And\nagain at the micro level. Thousands of workers deployed in some of the key\npockets of refusal and resistance. Then we learned through our data that we\nmissed newborns because there is a custom that you don't bring out a newborn for\nthe first forty days. When the vaccination team goes to the house and knocks on\nthe door, they don't walk up to the door because they're too tiny to do that. So\na whole newborn-tracking strategy was ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2552.0,2581.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"developed where they would register each\ntime every house was visited in these states. So the scale of operation was\nenormous. More than 60, 70 million houses were visited several times in a year,\nand each time you visit you have to register a newborn and then make sure that\nin the next eight rounds that particular newborn gets vaccinated. So a specific\ntracking strategy for that. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2581.0,2610.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We also learned that at any given time, a proportion\nof children are on the move. So a very elaborate mobile and transit strategy was\nset up in place. At bus stations, train stations, in moving trains. In Uttar\nPradesh and Bihar five million children were vaccinated during a vaccination\ncampaign in moving trains and buses and children on the move, just five million,\nbecause the total target combined together was ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2610.0,2641.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"over 60 million children under\nfive years of age that were vaccinated repeatedly in these mass vaccination\ncampaigns. About 5 million of those were vaccinated when they were on the move,\nthrough this transit strategy. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2641.0,2654.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We would also have periodic outbreaks of polio in\nother parts of the country, and what we found out towards these later stages,\nthat there are certain types of migrant population--economic migrants--that were\nparticularly at high risk of being missed during vaccination campaigns, who were\nvulnerable to getting polio. And then as they moved around, polio spread with\nthem. So they became a very high priority population for us to cover. These are\nvery underserved populations. They were construction site workers. India was in\na construction boom in the Mumbai area, Delhi area, other parts of the country\nthere was industrial construction, and many of these workers came from\npolio-endemic states of Uttar Pradesh and Bihar. So tracking them and then\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2654.0,2701.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"mapping them where they go, mapping their communities where they settle and then\nhaving special vaccination programs to reach them were very important. There was\na certain parts of the year bricks are produced in parts of countries, and these\nworkers move. Their children were being missed because they live in these very\n--sort of outside settled areas, where they make bricks so that we had a special\nstrategy for brick kiln and agricultural workers. And so towards the late\nstages, before we interrupted transmission, we had mapped more than 400 migrant\nsites across India, so that each time we did a campaign in Uttar Pradesh and\nBihar, those settlements were also vaccinated, those areas were also vaccinated.\nAnd there was special timing for them because they had different work hours, so\nthat the vaccination teams, the monitoring, and even the hours of vaccination\nwere tailored to this population. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2701.0,2758.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So it was really identifying, again, through\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2758.0,2761.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"rigorous evaluation of data, assessment of data, why we were missing, who we\nwere missing, what other characteristics of that population, and then what's the\ninnovative solution to put in place to do this? So to summarize this, we had a\nsystem whereby what I call is a critical triad for success in an eradication\nprogram. We had motivated government officials right from the central\ngovernment, to state government, and particularly at the district level, and\nthese were district magistrates and chief medical officers. District magistrate\nin the Indian civil service is the chief executive officer for district. All\nline ministries, departments report to the district magistrate. So in these\nendemic states, the district magistrate was in charge of the quality of the\npolio program, so they were very motivated to take corrective action. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2761.0,2815.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But\ncorrective action cannot be taken in a vacuum. That corrective action was based\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2815.0,2821.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"on good-quality surveillance data--where the poliovirus is, how it's moving,\nwho's affected, which is the vulnerable population and who we are missing--the\nprogram immunization monitoring data. So good monitoring evidence, right, that\nthen linked to accountability. Who is not performing, who is not doing their\nbit. Roles and responsibilities are defined across the partnership. What WHO is\nto do, what UNICEF is to do, what government workers have to do, what are the\nresponsibilities of Rotarians, local partners. And then making sure why children\nare missed, so they were tracked from round to round. Who is missed, why missed,\nwhat did not happen here, what needs to happen? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2821.0,2866.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And this started to work really,\nreally well. Accountability based on good objective evidence, so there is no\nargument. It's not a war in opinions, right, it's evidence-based, and committed\nofficials who are empowered to take corrective ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2866.0,2881.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"action. And this circle of\ncontinuous optimization, and a pursuit for who's being missed, and then\ncontinuous optimization of vaccination. There was no magic bullet. It's about\ngetting it right and making sure that you cover and you vaccinate everybody. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2881.0,2896.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And\nthere were times when it was really tough because polio is an epidemic-prone\ndisease. As long as you have virus circulating, it will find vulnerable\nchildren, and over time susceptibles accumulate-- those that are missed or those\nwho do not respond to the vaccine--and you will get an outbreak. And convincing\nthe government who-- in the later years, the government of India was putting in\nmore than $250 million a year into the immunization program, and it was a very\nvisible program constantly in the media, constantly in the press. The cases were\nbeing reported in the press in the later years, and you would have these\noutbreaks, and the press would write about that, and there was always ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2896.0,2941.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a risk\nthat the state and the union would sort of argue about this. But we always had\nto explain why the outbreak is happening and what's the way forward. So that the\npolitical commitment and the financial commitment does not go away. Because it's\nnot a straight road line down to eradication. It sort of goes like this, you\nhave outbreaks, you have to explain those outbreaks, why they're happening, and\nstill have a clear path as to what is the path to success here, still, so that\neverybody can see that and come along with you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2941.0,2981.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So you were essentially trying to hit a moving target with multiple,\nmultiple factors, but what you did it sounds like it went to where they were\ninstead of having them come to you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2981.0,2995.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Well, that's exactly right. I mean this workforce, this\nproject--national polio surveillance project--complemented by ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=2995.0,3001.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"these district\nmagistrates, the government commitment, and the work of Rotarians and the work\nof UNICEF in social mobilization and engagement of communities for us--I mean,\nit was constant optimization. And having the field workforce empowered to\ninnovate is very important. You can't micromanage them. In fact, a lot of my\neffort was for them to focus strategically, collect less data, the more\nimportant data, take time to analyze the data, rather than-- what I used to say\nto them, \"Don't work like robots. You're medical officers. Look at the data.\nTake one day of the week--just look at the situation you're in. Prioritize and\nput 80 percent of your time in 20 percent of the places which pose the greatest\nrisk.\" They felt they were responsible for their entire district or entire\nstate, and would lose ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3001.0,3061.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"focus. And I said, \"I will take responsibility for what\ngoes wrong in 80 percent of the low-risk areas. You're responsible for putting\n80 percent of your time in the 20 percent of the areas that pose most of the\nrisk.\" It's easy to say that, but it's very hard for managers on the ground to\ngive up these other areas, where they feel, what if a case happens there? What\nwill happen? And to sort of get them focused on that this is the source of the\nproblem, the key blocks in your district that you know are under-performing\nwhere repeatedly polio circulates. That's where you have to stop it, and that's\nwhere your efforts have to be concentrated. Give them the tools. They have such\nrich data but teaching them how to analyze and how to apply it in prioritization\nand the innovation they did. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3061.0,3116.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I mean, most of the innovations--the ones that\nsurvive and are meaningful--are ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3116.0,3121.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"all the ones that come from the ground. You\ncan't innovate from outside. One of my early learnings were that when we first\ndid trainings to set up acute flaccid paralysis surveillance so that all cases\nof acute flaccid paralysis are identified and reported, and stool specimens\ncollected within two weeks of paralysis onset--for laboratory confirmation if\nthe cause of paralysis is polio or not poliovirus. Setting that up in\nAfghanistan--and this is during the time when the Taliban were controlling one\nhalf of Afghanistan and the Northern Alliance, and we did trainings on both\nsides. In the areas controlled by Taliban in Jalalabad, we did trainings, and\nalso in Mazar-e-Sharif, we trained the areas that were under control of the\nNorthern Alliance at the time, in '97. And what we did was that we engaged our\nAfghan colleagues in designing the system. Our job was to give them the\ntechnical rationale, what we are trying to do, and then the programmatic\nobjective. This is how we want cases to be-- these kinds of cases need to be\ndetected and identified. Our objective is to collect stool specimens from them,\nand then the specimens have to be transported and then shipped through these UN\n[United Nations] flights from different parts of Afghanistan to the reference\nlaboratory in Islamabad in Pakistan. So we had to give them the outlines of what\nour objectives were. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3121.0,3169.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It was the Afghans who actually designed the operational\npart of the system, and it was beautiful. It's still working, and it continued\nto work through all wars in Afghanistan because it was designed locally. And in\nfact, that was such a strong surveillance operational design that we actually\ntook it and then had a similar discussion ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3169.0,3181.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with local health workers in Somalia\nand in South Sudan, and in other war-affected areas and other parts of Africa\nthat were war affected and those principles were applied there. But again, the\ndesign work is done by the local health workers. They understand the conditions.\nThey know what works. They know what the information systems are, both formal\nand informal. So that was very rewarding, to have that partnership. And once the\ninnovation is at the local level, when the system is managed and handled at the\nlocal level, that's where a program is at peak performance.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3181.0,3219.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So you didn't ever go in and tell them how to do things and what to\ndo. You listened to them and got their ideas.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3219.0,3229.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Absolutely. And really it's really mentoring. Take the time to analyze,\ntake the time to think. Thinking saves time. Don't react to everything. And\nagain, highlighting what are ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3229.0,3240.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the important parts of their job, but let them do\nthe problem solving locally. I couldn't have solved problems from Delhi. My job\nwas to mentor them and then ask the questions. That helped all of us to find the\nanswers together.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3240.0,3256.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Can you think of some examples of some solutions that people came up\nwith that maybe surprised you, or that you wouldn't have thought of yourself,\nthat worked?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3256.0,3267.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Two or three things really stand out. One of the other areas--we thought\nwe were getting very high coverage in Bihar in the later stages, and still wild\npoliovirus type 1 kept sort of occurring and surviving in a part of Central\nBihar. What we learned was that this is an area that gets annual flooding, And\nwe had figured out how to vaccinate children during flooding, but what we had\nnot realized that what happens after the floods are gone? These are the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3267.0,3300.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"snows\nthat melt in the Himalayas in Nepal. The rivers surge, and there is flooding\nof-- large parts of Central Bihar gets inundated. It's an annual phenomenon.\nPeople move to higher grounds--you vaccinate them there. But once the floods go\naway, this is very fertile land. And there's a land grab, and then there is very\nactive cultivation in this basin. And what happens is that parents take their\nsmall babies and set up these small shanties called Basas. So when teams would\ngo to vaccinate in villages, they would only find some of the children--but not\nthe children that were living in these basas where their parents had found this\ntemporary shelter while they were cultivating the land.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3300.0,3344.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And this is a very difficult place to move. No roads, motorbikes could only go\nsome distance, places--it took you like eight hours to walk to some of the\nvillages in thick mud and such because it's all like a flood basin really. Very\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3344.0,3360.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"fertile land. So we actually had to completely change the planning paradigm for\nthis area. And, again, it was the local staff that came up with a grid planning,\nrather than using administrative boundaries for planning vaccination. They came\nup with a grid planning approach with satellite mapping, and then established\nnight shelters with water and food, because there's no electricity there, and so\nthat medical officers and supervisors could actually go and spend the night.\nBecause once you go, you can't come back in the same day to the main towns. So\nshelters were established, logistics were put in place in some villages so that\nwork can continue without people having to come back to capitals or the major\ntowns. So we found thousands of children that were being missed, and that's what\nexplained the persistence of virus. A virus doesn't persist in ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3360.0,3420.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccinated\nchildren. No matter what kind of innovative ideas you come up with--but that's\nwhat reinforced that lesson. So a lot of this grid planning was done by officers\nand workers in central Bihar. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3420.0,3435.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Another innovation was the strategy in India--was\nhouse-to-house vaccination. And so the vaccination was fixed to a child living\nin the house. It was not how many children here? The focus was always, who's not\nthere? So when you go to a house, the first job of the team was to establish how\nmany children are in that house on that day. Whether those who live there, those\nwho are visiting, or a newborn, somebody who's coming spending the night. How\nmany children on that day? They have to write that, and then how many of those\nthey actually were able to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3435.0,3480.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccinate. And if they were not able to vaccinate all\nthose--so that by itself was a process of learning, as to how you ascertain how\nmany children are in the house. It's not a simple process. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3480.0,3492.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"First of all, you\nfind out how many households in a compound. A household is defined by a separate\nkitchen. You can have several kitchens in one large space. And then ascertaining\nhow many households, how many children, how many newborns. You ask different\nways the question--any guests visiting? daughter visiting her parents with a\nsmall child? All of those ways of asking questions. You do the micro-census and\nthen see whether you were able to vaccinate all of them. If any child was\nmissed, then you have to record that, and the reason why missed. Not there, or\nwhere the parents refused vaccination or was the house locked? And was the house\nlocked because they had just gone to the market and will be back, or have been\ngone for weeks and won't be back during the days of the campaign? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3492.0,3539.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so the\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3539.0,3540.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"team started noting this for the reason why a child was missed and then would go\nback to that house with a strategy that would address the reason they were\nmissed. So if the reason was that the family was reluctant to vaccinate--was\nrefusing vaccination because they'd had enough or felt the vaccine was not\nsafe--then that team already had names of local influencers who had influence in\nthat community, who would go back to the house with the influencer to engage\nthem in a discussion and persuade them to accept the vaccine. If the child, they\nsaid is sick and we feel is not well enough, a local doctor would go and talk to\nthe family, assess the child and see if the child could be then vaccinated. Or\ngo back and see if the child may be back at the house because they were just\ngone to the market and the house was locked. So it was according to the reason,\nand the conversion from non-vaccinated to vaccination was tracked by-- ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3540.0,3573.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This is a\nlocal innovation. It's the local field volunteers, and the medical officers came\nup with this tracking strategy. And so the district magistrates were tracking\nthis conversion from round to round. That's the level of detail that this was\nbeing done. As I mentioned for migrant workers, they figured out in Mumbai that\nwe go--they leave very early for work, and they're gone all day, and they take\ntheir children with them. So they started vaccinating, and there were night\nvaccination teams. They would go at night to those neighborhoods and then find\nchildren and vaccinate them. And only local people know these issues and can\nsolve them, as long as they know what you're monitoring. And they have to tell\nyou why they are missing and who they are missing.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3573.0,3598.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: How did you know which children had been vaccinated?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3598.0,3600.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: So this ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3600.0,3601.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"also was an innovation early in the program--was that there was\nfinger marking done. So if a child was vaccinated, there was indelible ink that\nwas put on the finger that was good for a few days. So it was through finger\nmarking that it was checked. But even there was a check for that. That there\nwould be monitors, who would go and check if there is false marking going on.\nThat parents had said no to the vaccine but convinced the vaccinator to mark the\nfinger. We had examples in countries, including in India and Nigeria. That was a\nbig issue, where in Nigeria, they had to implement what is called directly\nobserved OPV [oral polio vaccine] vaccination. So that they would be under the\nobservation of a supervisor--that children in those particular compounds and\ncommunities would be vaccinated, where there was a history of where they had\npersuaded the vaccinator to just mark the finger but not give the vaccine. But\nthat's how basically this was. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3601.0,3632.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then, validation. I talked about house\nmarking, to see whether the house was marked appropriately, whether the child\nhas been missed in this house or not. A supervisor would come and do a sampling\nof these houses behind the teams, to validate, is the house marking appropriate\nor not? In India, they used to call it a false P. If a house had a marking of P\nmeans that all eligible children had been vaccinated in this house. But if a\nsupervisor found an unvaccinated child there, this would qualify as a false P,\nand false P's were tracked for the area by the supervisor, by the team. So this\nis the level of detail at which this program had to operate. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3632.0,3655.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I've talked mostly\nabout missed children. But we, in India had to go from trivalent vaccine oral\npolio vaccine, which wasn't working as well because the type 2 component in the\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3655.0,3661.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccine was competing with the type 1 and type 3 attenuated vaccine virus. And\ntype 2 had been eradicated and was last seen in India in 1999--last seen in the\nworld anywhere in India in 1999. So we were vaccinating against the virus which\nhad not been seen for several years. So then we shifted to the monovalent type 1\nand monovalent type 3 vaccine. And there we ran into the problem where we were\nprioritizing eradication of type 1 virus because that was causing more outbreaks\nbecause that virus behaves differently from type 3 virus. Type 1 has a higher,\nor lower, rather, infection-to-paralysis ratio. So an average of 200 children\nwould get infected, and one of them developed paralysis with type 1 wild\npoliovirus whereas type 3 could be at 1,000 to 1 ratio. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3661.0,3721.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So it was more dangerous\nthat way and more virulent virus and it also had a tendency to spread further,\nso most of the outbreaks within India were spread from India to other countries\nwas actually of type 1 wild poliovirus and not type 3. So we prioritized\neradication of type 1 virus, so we used type 1 vaccine preferentially,\nmonovalent vaccine. It was more effective than the traveling vaccine against\ntype 1, which had all the three types of viruses that are presented in the\nvaccine. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3721.0,3756.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But then we started having resurgence of type 3 polio outbreaks. And\nthen how do you explain that to parents, to the policymakers and decision\nmakers, that this is a cost we are incurring? For a parent, it is polio. And\nthen we had to optimize the type 3 vaccine campaigns and type 1 campaigns. And\nthen we moved to the use of the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3756.0,3781.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"bivalent vaccine, which we also first studied in\nIndia, as I said when we established the research platform. And we studied the\nperformance of the bivalent vaccine compared with trivalent and compared it with\nmonovalent 3 and monovalent type 1, and it was non-inferior to those. So then we\nwent with bivalent vaccine that addressed both the type 1 and type 3 remaining\nwild polioviruses in India. And then that was the optimization of the vaccine\ntool. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3781.0,3798.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So this all came together, that vaccine alone would not have done it if\nyou were still missing children. You have to vaccinate children for the\ntransmission to stop. But then we were able to optimize our vaccine delivery so\nthat we're missing very, very few children. And then we were also in parallel\noptimized the vaccine itself.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3798.0,3811.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: It almost sounds impossible.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3811.0,3812.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Many people actually said that the conditions on the population size, as\nI said--birth rate, the environmental and climatic conditions in India were such\nthat there is such efficient transmission of poliovirus in those conditions that\nthis will overwhelm the capacity of polio vaccine to interrupt transmission, so\nit can't be done in India. And that's why the success in India was such an\nimportant turning point in the global polio eradication because it removed sort\nof this--a lot of experts questioned the biological and technical feasibility of\npolio eradication because of what we were faced with in India. But once India\ninterrupted transmission, I think these arguments of technical and biological\nfeasibility was removed. And the strategies are solid-- that you have to have\ngood surveillance, you have to vaccinate all children, and transmission will\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3812.0,3842.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"stop. So any place where transmission is persisting, it's because children are\nbeing missed. And they're being missed either because there isn't enough\npolitical commitment, not enough financial commitment, not enough\naccountability, the quality of micro-plans for local planning is not good, they\ndon't understand fully who they are missing, and that's why they can't find\nthose children and such. And that's how this was a major push, then, in the\nremaining endemic countries of Nigeria, Pakistan, and Afghanistan to optimize\nthose programs.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3842.0,3875.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so a lot of lessons learned from the India program were actually adapted by\nthe program in Nigeria, Pakistan, and Afghanistan. And in fact, waves of the\nmedical officers from the national polio surveillance project of India--the\nproject I was heading in India-- actually spent months in Nigeria, and sort of\ntransferring those lessons learned and helping with the adaptation of those\nlessons by the local workers and local ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3875.0,3902.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"officers in Nigeria itself. And so many\nof these best practices around accountability and corrective action and\nmicro-planning and tracking of migrant and mobile groups were applied in these\ncountries based on the lessons we learned in India. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3902.0,3911.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So Nigeria succeeded. They\nhad their last case of wild poliovirus in July of 2014. So this is getting to be\nnow two years with no wild polio in Nigeria. In fact, in the last wild polio\ncase in North Africa, in fact, was in Somalia, which was following an\nimportation from Nigeria for wild poliovirus type 1. So the last case in\nSomalia--all of Africa--was in August of 2014. So all of Africa, in a month or\nso, would be without any case of wild poliovirus for two years. And now Pakistan\nand Afghanistan are making very, very good progress, and there is likelihood\nthat they will succeed this year in stopping transmission of wild poliovirus. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3911.0,3938.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Of\ncourse, we had very unique challenges in both Nigeria and particularly in\nPakistan, where in Nigeria many of the polio vaccinators died as a sort of\ncollateral damage to attacks on health centers and such as part of the armed\nactivities of Boko Haram. And in Pakistan, this is sort of a truly unprecedented\nchallenge in public health, where the polio vaccinators were killed and\nassassinated in cold blood because they were, for political reasons, in the\ncountry. So tremendous lessons have been learned in Afghanistan, Pakistan,\nNigeria and many countries, and Somalia also, when we faced these outbreaks\nwhere there was some extremist ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3938.0,3962.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"elements in Somalia also that were not allowing\nand have not allowed vaccination of children in areas that they were\ncontrolling--the al Shabaab in Somalia. But program has learned very important\nlessons as to how there could be, again, operational innovation to vaccinate\nchildren in areas of conflict or areas where the program has no physical access,\nokay, and in some of the most insecure areas, how you can still maintain\nsurveillance--as well as strategies with cooperation of appropriate security\nplanning, and vaccination of mobile populations that are moving in and out of\nsuch areas, so that you get to them and provide vaccination as they're on the\nmove. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=3962.0,4019.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Very important lessons for public ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4019.0,4022.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"health in general--how to reach\npopulations that up to this point, I think, in public health were considered,\n\"Let's wait for the conflicts to get over.\" We were entering a global situation\nwhere there are so many active areas of conflict and extremism and insurgency\nthat you can't just wait and leave women and children non-combatants in areas\nthat are affected by such conflict and say, \"Okay, we're not going to give them\nany services, because let's just wait for this to get over.\" Don't know when\nthat's going to happen.\" But we've learned enough that we can now think of\nproviding essential services to women and children, non-combatants in these\nareas, largely through the lessons we've learned. Some very hard way-- by losing\na lot of our workers on the ground--but important lessons have been learned on\nhow to vaccinate children from such communities. TORGHELE: How do you get\nworkers in when there's a war situation?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4022.0,4080.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: The first and foremost ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4080.0,4082.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"is building trust and engagement of communities,\nthe non-combatants in these communities because what often you find is that they\nalso are held hostage by the extremist elements in those areas. Okay, everybody\nwants to protect their children. So what if this is in areas controlled by a\nTaliban faction or some other militant faction. You know, those women and\nchildren, you know those parents still want their children to be protected and\nso one has to find the local leaders, religious leaders, community leaders,\nengage them, build bridges with them. Get them to implement the program, empower\nthem, empower communities, empower community leaders, give them the resources to\nprotect their own children. And once you build that bridge, then the communities\nbecome the biggest protectors of the program. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4082.0,4137.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And in parts of Pakistan, for\nexample, we've had enough leverage to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4137.0,4142.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"take young women from those communities,\nget the endorsement of community leaders and religious leaders for them to be\ntrained so that they can go and vaccinate children in their communities and in\ntheir neighborhood and that obviates a lot elaborate security arrangements and\napparatus. In other areas, you create corridors or zones of security so areas\nare cordoned off in a way that with careful security, planning and coordination\nof security and vaccination campaign operational planning that you can create\nthese safe zones where vaccination teams can move and these are vaccination\nteams largely made up of local people. So there's not outsiders coming in-- they\nhave the language skills, they understand the community leaders so that there is\nacceptance of these teams when they're moving in these areas. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4142.0,4161.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/152","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The third area, as\nI mentioned, is to set up vaccination posts in critical transit points where\n--people move. So as they move, you can engage these communities and vaccinate\ntheir children as they're moving in and out of these areas. And then fourthly,\npolitical situations change. Leaders change. Different leaders take different\npositions. You can actually negotiate access to some of the leaders because\nthere's not one opaque body. Afghan Taliban have always been supportive of polio\nvaccination when they were in government and even when they've been out of\ngovernment. So in areas that they're largely controlling Afghanistan, they still\nsupport the polio eradication program. The program has to engage intermediaries,\nneutral parties to negotiate the program. But they identify workers in their\nareas, and they get trained, and they provide vaccination to their children.\nThey're not philosophically against vaccination of children. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4161.0,4182.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/153","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So this can't be\npainted with one brush. As I said, even in Afghanistan, there are different\nfactions who deal with it differently. Different in the south, different in the\neastern region next to Pakistan. So it all has to be tailored and customized to\nwhat the local challenges are and who are the people on the ground. Where there\nare problems, the solutions are always there.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4182.0,4192.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/154","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: If you empowered the people to help and promote their solutions along\nwith you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4192.0,4194.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/155","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: That's correct. That's exactly right. You can't parachute programs, and\nyou can't parachute ideas and such. I mean I think this is becoming an important\nlearning, right? I mean we would have an important lesson learned in the Ebola\noutbreak also is that we didn't have good bridges with communities. We were not\ntalking to them well enough, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4194.0,4203.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/156","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"right. And this was a surprise, but now I think in\npolio we learned this lesson that when there's a polio outbreak, you don't just\nsend an epidemiologist. You send in a logistician. You send people who can plan\nadministrative and operational aspects, the logistics, movement, communication,\ndata, you know, the whole multidisciplinary team. That must include a\ncommunications expert--how to engage the affected community, get people engaged\nfrom those communities. Are we listening to them? How are they processing this\npolio outbreak? What does it mean for them, and how are they perceiving the\nthreat of this outbreak, and how do they perceive people who've sort of come to\nhelp them? So that's now a part of the package of the outbreak response that\nit's just not a uni-dimensional outbreak response.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4203.0,4233.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/157","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So what's your prediction about polio eradication? When and --","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4233.0,4236.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/158","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: My first prediction is that it will happen because I think that maybe\nsome people who still think that maybe it can't be done but I think after India\nand Nigeria we should--you know, there's just no way this can be given away at\nthis time and so it will happen. It's really a matter of are we getting to these\nfinal pockets of under-vaccinated populations. Are we getting there or not? And\nif we are, it can go like this. An indication in Pakistan and Afghanistan we are\ngetting there. All the data seem to suggest that but there are also complex\nplaces with complex security, you know, conflict situation and there could\nalways be a setback. But these ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4236.0,4264.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/159","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"programs, as I said, have learned very important\nlessons. They've come a long way from where they were even two years ago, and\nthose learnings are not lost. So if there are any pockets left this year, I mean\nI think that they are pretty close of getting done this year. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4264.0,4283.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/160","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But even if they\ndon't get done this year, I think they're on their way. They're on their way,\nand I don't think we should hold people's feet to a calendar year. Polio has its\nown seasonality, and if not this year maybe the next low transmission season\nwhich will be the early part of 2017. But I'm hoping. I'm keeping my fingers\ncrossed and really rooting for the team to do this year, to interrupt\ntransmission in Pakistan and Afghanistan. These are the only two countries left,\nand it's not even--in other words, these countries are tiny pockets in\nAfghanistan and pockets in very well circumscribed pockets in Pakistan as well.\nI ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4283.0,4324.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/161","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"mean more than 95 percent of the population lives and has lived in areas that\nhave been without wild virus transmission for years. It's, again, who is it that\nwe're missing and how to get to them.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4324.0,4340.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/162","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Before we go, can you just say a little bit more about how Rotary\nInternational and UNICEF and CDC and WHO, World Health Organization, all worked\ntogether and what that was like?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4340.0,4354.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/163","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Fantastic partnership. I think the Global Polio Eradication Initiative\n[GPEI] is one of the most enduring. We didn't plan it that way-- it's lasted\nlonger than we thought, but in some ways, it's been a kind of exemplary\npartnership that many other programs have tried to emulate. And it's worked\nreally well, and it's not formal. There's no legal entity like GPEI, but it's a\nvery effective partnership. It works well ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4354.0,4384.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/164","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"together. WHO, UNICEF, Rotary\nInternational, Bill and Melinda Gates Foundation and, of course, U.S. Centers\nfor Disease Control and Prevention. The roles and responsibilities are clearly\ndefined, which is very important in a partnership. Understanding each other's\npriorities and strengths and weaknesses is important, and everybody brings\nunique strengths to this partnership. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4384.0,4408.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/165","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And Rotarians, in particular, have been\nabsolutely outstanding and I've had the privilege of working with the Rotarians\nboth at the local level and National level particularly in India and Egypt and\nin Pakistan and other countries, and they are just tremendous partners. I mean\nyou come to a block, whether it's a financial block or a political block, there\nis lack of commitment or even outside health sector, if you need the help of\nanother ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4408.0,4444.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/166","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"ministry, Rotarians will engage, and they'll open the doors for you and\nvery effective. Clearly, Rotary volunteers bring a lot of passion to\neradication, and they are the voice of the people, the civil society in this\npartnership. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4444.0,4462.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/167","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CDC is a scientific organization. The CDC experts work in this\norganization. We get paid to do this work. So is WHO, so is UNICEF, similarly\nGates Foundation, although with some important differences. The leadership Mr.\nGates brings to the partnership, giving away, and tremendously effective leader,\nbut Rotarians are the voice of civil society. They give their time, and they\ngive their money to this all on a volunteer basis, and they bring tremendous\nleadership in their countries and at the global and international level. And ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4462.0,4504.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/168","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"so\nthey are in a unique position to hold all of us accountable because they're\nputting in their time, their money and they have the voice of civil society, so\nthey can hold the GPEI partners accountable, and they can hold their own\ngovernments accountable for what they're doing for polio eradication. Among all\nof us partners, they are the most uniquely positioned to ask their governments\nthe questions. Whether they're a government that is polio-endemic or polio\ninfected or if it's a donor government. So I've worked with Rotarians in Europe\nand accompanied them, advocating with their parliamentarians, with their\nministers of development, going in with Rotarians who, German Rotarians and\nSwiss Rotarians, talking to their leadership and saying we need your funding\nsupport to finish global eradication. It's a global public good. So they're\nenormously effective. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4504.0,4528.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/169","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I think clearly the scientific and technical\ncredibility and excellence of CDC is enormous. The work of the CDC virologists,\nI mean they're the ones that have set up more than 145 labs around the world\nwhich are the poliovirus laboratory network on which other vaccine-preventable\ndisease laboratory networks have been set up. The measles labs and measles and\nrubella labs and yellow fever labs in Africa have been built on this poliovirus\nnetwork, and our scientists here have been instrumental in building those\nnetworks and CDC leaders, of course, public health leaders and our scientists\nhave been key. As I said, in four of the six WHO regions the CDC experts were\ninstrumental in establishing polio eradication programs in those regions-- the\nSoutheast Asia region, the European region, the Eastern Mediterranean region and\nthe African region. And then in other region also CDC has been very engaged, CDC\nhad a very close working relationship with China when China was polio-endemic,\nand so we had a lot of Chinese scientists here. A lot of exchange programs. So\nthere's enormous scientific exchange between CDC China and CDC US. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4528.0,4561.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/170","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So the role\nof CDC in polio eradication evolved over time as WHO built more capacity and\nmore leadership in polio ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4561.0,4565.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/171","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"eradication. The sort of gap-filling work and the early\nprogram establishing work that CDC had to do was called on less and less as the\nglobal program expanded and more and more staff were recruited by WHO and\ndeployed for this work. But without that bridging and the early foundational\nwork and program establishment work of CDC, we would have never made that kind\nof progress. And where we go from here, CDC will have to stay engaged and\nprovide that leadership of transition planning how global public health, the\nworld of immunization, the next set of eradication programs, global public\nhealth security--programs benefit from all we have learned and all we have built\nfor polio eradication. So I think CDC is engaged in that and will remain engaged\nin that sort ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4565.0,4625.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/172","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the next set of benefits because I think most donors and the\npublic health world looks at the global public good of polio in two ways. One\nis, of course, the eradication of wild poliovirus and poliovirus altogether\nforever as a cause of paralysis of children. They'll be gone forever. So\nbenefits accrue forever just like they do for smallpox. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4625.0,4654.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/173","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But the other benefit is\nthat what can we build on this tremendous workforce, this lessons we've learned\nof reaching the unreached populations and putting populations on the map that\nwere not on anybody's maps and being able to deliver services to those\npopulations. Amazing surveillance system, field surveillance system that has\nability to detect cases of acute flaccid paralysis is almost every district\naround the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4654.0,4685.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/174","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"world. And being able to collect stool specimens and have them tested\nin a WHO accredited laboratory. What more can we build on that? I mean a lot has\nalready been built but what more can we build onto that? So the many donors look\nat that as a return on their investment as well in this eradication program so\nthere are direct benefits and then there are enormous indirect benefits of polio\neradication. And CDC is also involved with and must stay involved with this kind\nof transition of work because it involves other parts of CDC as well. Global\nHealth Security Agenda is an important U.S. government and an agency priority,\nand there are links between polio transition and how global health security can\nbuild on top of the assets built for polio eradication.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4685.0,4745.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/175","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4745.0,4745.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/176","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Well, this has been an amazing discussion. And when you talk about\nlessons learned, you've communicated the lessons learned in polio eradication so\nwell. I can't imagine them being communicated any better. So it's been an\neducation, and it'll be very valuable to have your input for these oral histories.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4745.0,4777.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/177","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: Thank you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4777.0,4779.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/178","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So I really want to thank you so much, Dr. Jafari, for coming and\nsharing your experience and your skills and your knowledge and your insight.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4779.0,4796.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/179","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"JAFARI: It's been a pleasure. Thank you for the opportunity.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4796.0,4802.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/transcript/70449/annotation/180","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Okay. Thanks very much.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=4802.0,4805.0"}]},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543","type":"AnnotationPage","label":{"en":["Jafari_Hamid [Index]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/181","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Background ","format":"text/plain","label":{"en":["Title"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=39.0,547.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/182","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Dr. Jafari discusses his educational background and explains how he became involved with the CDC. ","format":"text/plain","label":{"en":["Synopsis"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=39.0,547.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/183","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"So to begin, Dr. Jafari, would you please tell us a little bit about your background and how you came to be involved in polio work and came to be at CDC in the first place?","format":"text/plain","label":{"en":["Partial Transcript"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=39.0,547.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/184","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"ACIP","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Advisory Committee on Immunization Practices","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Boston University","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"CDC","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Centers for Disease Control and Prevention","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Dartmouth College","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"EIS","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Epidemic Intelligence Service","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"haemophilus influenza type B","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Harvard Medical School","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Hib","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"India","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Institute of Medicine","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Mass General Hospital","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Massachusetts","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Meningitis and special pathogens","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"National Immunization Program","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"NIP","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Oklahoma State","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Pakistan","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"Sindh Medical College","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"St. Elizabeth’s Hospital","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"U.S.","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"United States of America","format":"text/plain","label":{"en":["Subjects"]}},{"type":"TextualBody","value":"University of Texas Southwestern Medical School","format":"text/plain","label":{"en":["Subjects"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=39.0,547.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/185","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"A. 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countries.","format":"text/plain","label":{"en":["Synopsis"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510#t=547.0,1510.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134289/file/250510/index/85543/annotation/188","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"So I worked in the NIP from ’94 to ’96.","format":"text/plain","label":{"en":["Partial 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