Speeches and Testimony

Remarks by Dr. Ezekiel J. Emanuel, Special Advisor on Health Policy to the Director of the White House Office of Management and Budget, on receipt of the Malaria Vision Award

Malaria Champions Breakfast
Malaria No More
March 17, 2010

Thank you, Mark.

When Ron’s kids, my nieces and nephews, heard about this award, they thought I won it because I am good at killing mosquitoes with my hands. I know that is not why you selected me, but I also know that I do not really deserve this award because all of the success was in place long before I was selected by the President, actually by Peter Orszag, to actually oversee this. It was put in place by Admiral Tim Ziemer and by people at USAID and by many of NGOs, represented in this room, who have been working in this space a lot longer than I have.

In January 2009, when we were reviewing the budgets, Peter leaned over to me and said, “Would you think through our goal of the health strategy and make sure that we are doing the right thing?” Then, I initiated a whole series of review of [USG’s] health programs for my own education. Having worked in Africa, particularly in Mali, Malawi, Uganda and Tanzania, I knew we were making a lot of success against Malaria, but I also knew about the ravages of Malaria, having visited many of the places and working with teams, mostly with many of the research teams.

But, when I asked the Admiral to come in and present on PMI, I have to say, despite working for nearly a decade in this area, I was incredibly amazed; mostly amazed because it seemed to me that PMI had to be the best kept secret in Washington.

In a few short years, we had achieved so much, and yet here I was, someone who I thought knew something about malaria, had no idea how much success we were having, and I was sure everyone else in Washington, who didn’t even know about global health, had no idea the tremendous achievements we were getting. It seemed to me, more importantly, the more I heard and the more I looked at PMI, it really was the model of what we needed to do in the President’s Global Health Initiative.

I just want to go through the tremendous success PMI has had and how it has really informed what the President has laid out in his agenda. The first, as you have heard over and over again, is they have identified core strategies [and] core interventions and brought them together for synergy: the bed net, the residual indoor spraying, the treatment and the intermittent treatment for prevention of pregnant women. You have things that work; you do not do them individually; you bring them together so you get the synergy of those effects. They are:

• The focus on mothers and children is clearly important. It is a disease that ravages pregnant women and children, and that has been a high priority for the President.
• The integration of the interventions with other programs, not having a stand-alone program, but trying to treat everyone when they come, is strengthening the healthcare systems.
• Working to train the healthcare workers
• Ensuring there are no stock outs; that we have all the drugs that we need and all the malaria nets that we need, where we need them, when the season erupts.

About two years ago, I was in very rural Mali having to drive to a site the day they were distributing bed nets and condoms for HIV family planning in one facility. We went around to the huts to see, and there was a bed net in every single hut we had gone to [see]. It was pretty amazing arrangement of collaboration and coordination with our other partners, many of the NGOs, but also companies and many others.

PMI has been a model on how to work with all those organizations that the Admiral mentioned. Country ownership is another very important principle that we want to include in the GHI and make sure that it’s not just our imposing our vision on countries, but [their] adopting their own plans and [our] supporting them, so that these things are sustainable over time and get woven into the fabric of the healthcare system. Again, PMI has been a model of that.

And the last one, as the Admiral has mentioned, as you know Emanuels are pretty impatient, and we don’t just like good efforts. Touching people and counting the number of bed nets that we distribute, those are all good things, but they are not good enough in our opinion. What I especially liked about the PMI program was the fact that they could offer really hard outcomes, precise outcomes, that we care about. As you have heard, the decline in malaria positive blood smears, declines in under-five mortality, declines of malaria prevalence and empty beds, which you can now begin to see, and declines in the severe anemia of children are the things that we really care about. We want to improve health; bed nets are fine, number of people treated is fine, but actually making a difference so that people are living longer, living healthier, that is really why we are in this game.

When I reviewed the program, I think I said this to the Admiral the first time, we have to get this out; we have to get the message that we have an incredibly successful program out. But, it made it a lot easier for me, especially on the inside, to champion the fact that we have a successful program and that we can do even more by funding it at a higher level.

Let me say that there were two other factors that made it incredibly easy for me to champion this program and for the President to support it and make sure that it got increased in funding. First, that all these interventions, that all these things that you people in the room are doing on the ground everyday have an unbelievable, terrific return on investment (ROI). Nothing else we do has such tremendous returns. And let me just say last week Senator Kerry had a private breakfast in the foreign relations room in the capital for Bill Gates, and there was a discussion round table, and someone in that room said that he was very happy about the Gates Foundation getting in because he thought private industry and private philanthropy were really efficient, by implication slighting the U.S. Government’s role. And I piped up giving my situation, you know there’s almost nothing the U.S. Government does, and I can’t think of a single thing that has such a tremendous return on investment for every dollar spent that we have; we can save lives for hundreds of dollars and almost nothing else can do that. And, Bill Gates said you’re right; this was absolutely the best ROI that he had ever seen. That makes it incredibly easy to support this in a time when, as you know, we have huge budget deficits, when there’s real good justification for focusing on domestic programs; when every dollar spent in foreign aid has to be justified one, two, three, four times; when we have a freeze on the discretionary program. Having that ROI really really helps.

Second, having a program run efficiently; having a really small staff that does the job with no scandals, and such tremendous success in such a short time shows and makes it easy to justify what we’re doing here. When you have a program of this success, when you have it operating so efficiently you have such a high ROI, it makes it (pause) it sells itself. It makes it easy to get the 36 percent increase in funding we got a couple of years ago and the 13 percent increase we have put in the President’s budget proposal. Why is that? These kind of programs are not just good policy for us wonks, but good politics; good politics in foreign affairs, and they’re good. They sell themselves, and all we have to do is sit there and be the cheerleader.

Thank you for all your tremendous work in making these malaria programs successful and for keeping it up. We do look forward, as the video said, to wiping this disease out and really making it a minor, bothersome issue and not a major health threat anymore. Thank you very much.