Chris Elias, MD, MPH, president of the Global Development Program at the Bill & Melinda Gates Foundation, was recently a featured guest for Conversations in Global Health, a seminar series that spotlights leaders in global health. In conversation with Stanford Medicine's chief communications officer Paul Costello, Elias reflected on lessons learned from the Foundation's efforts in polio eradication and the crucial role of collaboration in addressing current and future public health threats.

Less than 30 years ago, wild poliovirus was endemic in more than 125 countries. Today, that number is down to three, with another hopefully soon to be crossed off the list. As President of the Global Development Program at the Bill & Melinda Gates Foundation, Chris Elias, MD, MPH, oversees the Foundation’s Polio Eradication portfolio. Speaking to a packed audience at Stanford University, Elias reflected on lessons learned from polio and the crucial role of collaboration in addressing other current and future public health threats.

“Few things actually get done by one person or organization these days. It’s a collaborative effort,” said Elias. “It’s not always achieving greatness, but we get there by giving talented people the tools and support to do great things.”

Polio is a top priority at the Bill & Melinda Gates Foundation. The Gates Foundation made its first significant contribution in 2007 and since then, has joined with the Global Polio Eradication Initiative (GPEI) mission to eradicate polio worldwide. The Foundation has dedicated significant technical and financial resources to GPEI partners to accelerate efforts, focusing specifically on the three countries where wild poliovirus remains endemic – Nigeria, Pakistan and Afghanistan.

These programs have been particularly successful in Nigeria, where there has not been a case of polio in more than ten months. Elias attributed that success to strong political leadership and the formation of emergency operation centers bringing Nigerian public health officials together with the technical assistance provided by WHO, UNICEF, CDC, Gates Foundation and other global partners.

“We now think we have seen a recipe for what works,” said Elias. “It’s that coordination, coupled with an independent evaluation of the quality of the vaccination campaigns and enough staff to confidently execute and improve the performance.”

The infrastructure and protocols established in the creation of the polio emergency operation centers is ultimately what enabled the Nigerian government to respond quickly and effectively when Ebola entered the country in July 2014. Elias explained how this type of system is crucial to ensuring all key players were working in the same incidence command, analyzing the same data, and getting real-time feedback to respond to the crisis.

As Nigeria is home to the largest population in Africa, and one of the most mobile populations in the world, the spread of Ebola to Nigeria could have fueled a much larger outbreak had a strong response system not been in place. In the end, the Nigeria Ebola outbreak was controlled to 20 total cases.  

“Ebola was a wake up call, but having now woken up [the global community], we need to think about the variety of threats that may face us in the next epidemic,” said Elias.

When thinking about future threats to global health security, Elias warns it’s less likely to be a war, but more likely to be a microbe – an emergent infection or bioterrorism event.

In this context, he cautioned that Ebola is likely not the worst global health threat that we’ll face and in order to be prepared, we need to start asking the “tough questions” now.

What will it take to build a global outbreak alert and response capability? What do we have to do to organize and strengthen surveillance to prevent the next outbreak?

To get there, we’ll need to get out of a complacent view, break down barriers and silos, and invest the resources necessary to build up biosurveillance capabilities and strengthen health systems.

In closing, Elias challenged the next generation of students, fellows, and individuals working in global health and development to “think bigger.”

“Let’s take that wake-up call and think about it. We shouldn’t miss this moment to set the world’s sights higher for outbreak preparedness.”