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Meeting Problems with Solutions
India day 1: getting better all the time
Halfway through the first day of my India trip, TV personality Prannoy Roy told a story I think really highlights the progress of India’s long journey to better health.
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New Delhi, India

Halfway through the first day of my India trip, TV personality Prannoy Roy told a story I think really highlights the progress of India’s long journey to better health.

We were filming a question-and-answer segment in front of a studio audience for his show on New Delhi Television, one of India’s largest news networks. Prannoy was asking me and Bollywood star Aamir Khan about philanthropy, health, and India’s development when he recounted a discussion he had about 20 years ago. A former prime minister asked him and a group of other people what India could do to be a better country. Prannoy said his answer – provide better toilets for women – was met with nothing but laughter.

Things have really changed. Just before seeing Prannoy, I had spent several hours in meetings with Indian parliamentarians and ministers. Our wide-ranging conversations about health and vaccines almost always returned to how to stop the spread of diseases through better sanitation and, specifically, toilets.

I was glad: the toilet is one of my favorite topics. At each meeting I got to talk about how flush toilets (ones that use water to clear the waste away through plumbing) won’t make it anytime soon to much of the world, including rural India where infrastructure is poor and water is scarce. Instead, we need to invent a better toilet, one that doesn’t use water yet eliminates harmful microbes and gets rid of any smell. Last year our foundation sponsored a “re-invent the toilet” fair where 14 universities submitted innovative answers to that problem. None were perfect but they all were a step in the right direction.

After several meetings it was clear there was strong interest in holding a similar “re-inventing the toilet” event in India early next year. We set some follow-up meetings to start figuring out how to make it happen. We agreed that applying India’s many creative minds to the sanitation problem could speed the path to a breakthrough.

In my post, “Why I’m Going to India,” I wrote that the country is an ideal place for understanding both the problems and the solutions in areas that our foundation focuses on. In my meetings yesterday, the sanitation discussions were just one example of the great optimism I felt from government leaders and health experts for overcoming the problems. I also heard about several new solutions.

A group of polio experts updated me on how India’s focus on ridding itself of that disease is paying dividends to broader health efforts. After a lot of hard work, India has been polio free since January 2011. India will be certified polio-free if there isn’t another case by next January. I’m confident we can get there. Yesterday the experts walked me through how they are using satellite mapping to not only see where they need to provide the polio vaccine but also to expand the country’s system of routine vaccinations (the vaccines children get in their early years). With satellites and cellphones we are getting far more detailed health data on hard-to-reach places. I’m convinced those tools, pioneered with polio, will be a game changer for expanding routine vaccination.

I also sat down with some of India’s top scientists, public health experts and pediatricians. This group was celebrating amazing progress of the phase 3 trial of Rotavac, India’s first home-grown vaccine for rotavirus, the world’s main cause of diarrheal disease—which, after pneumonia, is the second leading killer of children under age five. I touched on rotavirus in yesterday’s post but it’s worth emphasizing again. The work the group did to create the vaccine, and run a very high quality trial is nothing short of phenomenal. Rotavac is a rare global collaboration among the Indian government, vaccine manufacturer Bharat Biotech, and others including PATH, the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. Our foundation provided grants to support the work. The next milestone is to get the vaccine licensed by Indian authorities.

Dr. M.K. “Raj” Bhan, former secretary of India’s Department of Biotechnology and a pediatrician who shepherded the vaccine’s creation, told me that he expects the vaccine to clear India’s regulators by the end of the year, an estimate the country’s minister of health echoed later in the day. That means that India could start introducing the vaccine next year and start saving tens of thousands of kids’ lives a year.

In answering the prime minister two decades ago, Prannoy, our TV interviewer, pointed to a health problem that India still hasn’t fixed. Yet things are absolutely getting better. Since that time, India’s child mortality has dropped 45%, better than 35% for the world as a whole. With every visit to the country I see how India will drop that further as it gradually solves its health issues. An official I met at India’s Planning Commission yesterday described how India is “slow and deliberate” and ultimately successful in working through challenges. “That’s what this country is all about: finding a way,” she told me.

Today I’ll see another example of how India is finding a way when I visit a research center using old and new technologies to help boost agriculture productivity and fight malnutrition.

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