A Mighty Purpose (32 page)

The summit schedule, drawn up with military exactitude, allowed each head of state between three and five minutes to speak during the afternoon session. Anybody who overran their time would be chastised with a red flashing light and the slam of a gavel. Since he was not a head of state, Jim Grant had initially not been permitted to speak at all. When the possibility was broached during the planning process, several diplomats were adamant: Grant cannot speak. The man behind the summit would have to keep quiet. “This made many of us really sad,” Gautam says.

After a concerted lobbying effort, resistance yielded: Grant would be given four minutes—the same amount of time allotted to some heads of state. But four minutes was only enough time for a quick exhortation; Grant wanted to make a case for investing in a range of specific opportunities to advance child survival. To buy more time, Adamson suggested including a fifteen-minute video, arguing that the meeting couldn’t be all speeches. The summit organizers agreed but said it could run no longer than eleven minutes. “We stretched it,” admits Adamson, who added one more minute to the film. Adamson purposefully
wrote the video script and Grant’s speech to comprise one continuous presentation. So now, Grant essentially had sixteen minutes, instead of four.

The video followed remarks by the secretary general, leaders of several of the “initiator” countries, and President George Bush. At the last minute, the State Department had confirmed Bush’s attendance. But the US president would have to cut out early.

To the annoyance of many, Bush skipped the entire afternoon session, when most other leaders spoke and when substantive discussions took place. This compounded an already widespread frustration with the United States over its refusal to sign the Convention on the Rights of the Child (a position stemming, in part, from conservatives’ fears that the treaty prohibited capital punishment for minors and that it might limit parents’ disciplinary options). But Bush’s brief appearance would do what Grant had hoped—bolster media attention for the summit and help convey the magnitude of the event. It did something else, too. According to the
New York Times
, his presence “forced the Bush administration to focus on the problems of children in a way that the United States Government has not done in a decade.”

As his bespectacled image hovered on the two large television screens on either side of the stage, Bush reiterated his call for a “new world order” and for improving the well-being of children “who will live in and lead this new world.” He was eloquent, but his words sounded pat and tailored for this audience.

After Bush’s speech, the giant TV screens flashed a white title:
341: A Film for the World Summit for Children
. Photos of
babies were accompanied by a few eerie, sparse piano notes. The babies’ faces then morphed into the faces of leaders in the audience, including Bush. Then Peter Adamson’s crisp, somber, British voice floated into the General Assembly Hall: “We were all children once …”

His narration continued: “But some children never grow up to their potential. And some never grow up at all.”

Forty-five seconds into the video, as children’s faces faded in and out, white numbers start flashing. With each number came a loud, clicking noise. The unmistakable sound of a clock ticking.

The meaning of the numbers was soon made brutally clear by Adamson’s serene voice: “forty thousand a day … a quarter of a million a week … a child every two seconds.”

Each of those white numbers was a tombstone, marking a child’s death. And they kept flashing every two seconds, a jolting, flinch-inducing reminder. By the end of the film—which went on to explain how the deaths could be stopped—the grim counter had reached 341. Three hundred forty-one young lives extinguished just in the last twelve minutes.

As the video vanished from the two screens, Jim Grant prepared to start his speech. The grandiose congregation was silent as he began.

The World Summit for Children is widely considered UNICEF’s finest moment—a watermark in the history of the UN and international development. It landed in the
1992 Guinness Book of World Records
for being the “largest meeting of heads of state and heads of government” and spurred many other such global “summits” over the years. The gathering’s time-bound, specific targets for fighting child mortality, poverty, and other ills set a new standard and would eventually inspire the creation of the UN’s Millennium Development Goals (MDGs). These eight antipoverty benchmarks, which have accelerated progress in many areas of health and development, are also time-bound: on December 31, 2015, the world decides if they have been met.

Grant did not bask in the summit’s glow for long. At a post-summit meeting with his staff, a beaming general congratulated his weary foot soldiers, telling them: “You should all feel very good … on a scale of one to ten, it was certainly an eleven!” He said the gathering’s success had represented many “can’t be dones … that were done.” He then told them he was going to sleep more than he ever had since World War II.

After that brief respite, he would start pestering, pushing each leader who had signed the pledge to craft a “national plan to action.” Over the next four years, he would meet with more than one hundred presidents and prime ministers to check on their progress. He wasn’t about to let anyone wiggle out of anything.

By the summer of 1991, they finally had the numbers. And those numbers added up to more than 80 percent. Though WHO and UNICEF would not officially certify it until a few months later—at a strange, stilted UN ceremony hosted by Audrey Hepburn—Grant and Nyi Nyi were now confident that the world had achieved universal childhood immunization. They could now say they had done what so many had pronounced impossible.

A total of sixty-four developing countries had actually made the target, and many others had come close (though some in Africa still trailed badly behind). Among developing countries, it was reported, immunization coverage rose to 90 percent for tuberculosis, 85 percent for DPT, 83 percent for polio, and 80 percent for measles.

An estimated three million young lives were being saved each year through vaccines against six killer diseases and as many as one million more were being saved through the increased use of oral rehydration salts—four million lives that had once been considered dispensable, four million cataclysms of grief unnoticed by the Western world. But now, those deaths had been prevented, and many people had seen it happen. Once it was widely known that impoverished children did not have to die in mass numbers, it was a lot harder to ignore those children. It was a lot harder to duck behind the comfortable cloak of fatalism—that cloak was in tatters.

The summit may have been Grant’s crowning accomplishment, but universal childhood immunization was, by far, his most significant triumph. He had sparked a movement involving millions of people in every corner of the world, mobilizing whole societies. He dubbed it “the largest single peacetime collaborative effort in world history.”

His “grand alliance for children” had included governments, hundreds of NGOs (such as Fazle Abed’s Bangladesh Rural Advancement Committee), other UN institutions (such as the World Health Organization and World Bank), relief organizations, development agencies (including USAID), a wide range of donors (governments, corporations, and others), foundations (most importantly the Rockefeller Foundation), and service organizations (like Rotary International). It also comprised churches, mosques, synagogues, schools, media organizations, parents, doctors, nurses, Boy Scouts, volunteers, police officers, soldiers, and trade unions. The imperturbable Dr. Bill
Foege—a former director of the US Centers for Disease Control and Prevention, who led the Atlanta-based Taskforce on Child Survival—had helped Grant secure and maintain critical links among many organizations and funders. The once recalcitrant World Health Organization had provided critical technical assistance, monitored results, ensured vaccine safety and quality, and dramatically improved cold chain technology. (The WHO’s Ralph Henderson, who led its EPI program, deserves considerable credit, including for some of the initial gains made in the late 1970s and early 1980s before GOBI was launched.)

The “real heroes”—as Audrey Hepburn would later note during the immunization certification ceremony—were the government health workers and volunteers who administered the vaccines. Many had braved bombs and land mines, negotiated treacherous mountain passes, and risked the threat of gunfire and abduction. In Turkey, two government immunizers who had been traveling by donkey to remote, blizzard-prone areas to deliver vaccines had frozen to death.

In Grant’s mind, the true significance of UCI went far beyond immunization, says Jon Rohde. “Jim really wasn’t about immunization,” he says. He “was about reaching everybody and then doing more.”

Indeed, the immunization campaign marked the first time a basic lifesaving service had been made available to so many on such a wide scale. “Never before in history had something been done for everybody,” Rohde says.

But they had to keep reaching everybody, year after year. They had made a ragged, breathless, flat-out sprint to the finish
line—but now that they had crossed it, they couldn’t stop running. And it wasn’t just UNICEF staff—countries that had funneled resources and energy and manpower into breakneck immunization drives would have to keep doing it (and some simply weren’t equipped to). How were they going to maintain all this? What was the next move?

Grant hoped the summit goals might help. Many staffers knew that the one thing, the only thing, that would keep everything moving was Jim Grant himself.

Another pesky fear pulled at the seams of the otherwise celebratory mood: Would the numbers hold up? Would the entire enterprise be called into question? Grant never gave voice to any of these concerns, though they quietly nibbled away at some other staffers. India was the biggest quandary. Without the vast country, of course, the global goal would not have been achieved. It was reported in the 1992 edition of
The State of the World’s Children
that India had exceeded the 1990 target, reaching 97 percent coverage for the tuberculosis vaccine, 92 percent for DPT, 93 percent for polio, and 87 percent for measles. But many UNICEF staffers were suspicious. Those figures seemed stratospherically optimistic.

Dr. F. Marc LaForce, a revered global health pioneer and veteran of the smallpox effort who would later oversee a review of the UNICEF immunization campaign, thinks the India results were questionable. “C’mon, give me a break, Jim,” LaForce says now with a chuckle, in reference to India’s
sky-high statistics. “What happened was, in the end, it was clear he wasn’t going to be able to make it unless India came in at a pretty high number.”

And if India didn’t make it, then the world wouldn’t make it either.

“I’m surprised more people didn’t come out and pull the rug out from under him,” says one former high-level UNICEF staffer. “Because … I don’t think we really did reach 80 percent … I think we were talking about somewhere in the 70 to 80 percent range from most people, and they were trying hard.”

UNICEF and WHO depend upon countries to supply them with immunization data, and all of these figures are estimates that are subject to error and manipulation. The data have improved significantly over the last two decades, and the two agencies have developed more comprehensive and rigorous ways of measuring it. In 1999, UNICEF and WHO harmonized their respective processes for collecting and analyzing immunization information, coming up with a joint reporting system. In 2000, they conducted a retrospective review of immunization estimates going back to 1980.