BRUCE AYLWARD, A CANADIAN FIGHTING TO RID THE WORLD OF THE WORST DISEASE

Last fall, after nearly three years of turmoil, chemical attacks and the slaughtering and scattering of millions, the situation in Syria suddenly got bleaker: polio was back.

In late October, the first 10 cases were officially confirmed. To Syria, the devastating and once-eradicated virus had returned after 14 years. For polio fighters, it also meant a potential spark for a wider outbreak — and the latest threat to the biggest, costliest and most ambitious public health campaign in history.

That morning, however, a bespectacled Newfoundlander was setting a plan in motion. Bruce Aylward, a 51-year-old doctor and epidemiologist with the World Health Organization, had taken a red-eye to Oman, where he was quickly pulled into a meeting with worried health ministers from across the Middle East. 

“What I needed to do then was convince the 22 ministers in the room that we were dealing with an emergency,” said Aylward, the WHO’s assistant director-general for polio eradication and humanitarian response. “(I said) ‘We are going to need, within four weeks, to start vaccinating 23 million kids — from Egypt right up through Syria, southern Turkey and all of Iraq’.”“This is not about Syria. This is a Middle East outbreak".

 

By the following week, the region’s largest-ever immunization campaign was underway — several rounds of vaccination for millions of children across seven countries and territories. Today, the crisis is far from over. Syria now has at least 39 cases and the outbreak recently spread to Iraq, where a baby boy in Baghdad tested  positive.

 

The WHO has been criticized for not acting sooner on an outbreak many feared would come. But the disaster surely would have spread farther and wider by now, if not for that early push.“A big part of the job is finding the way forward in environments like that,” Aylward said. “Getting everybody to say ‘yes,’ basically.”

Aylward has been getting people to say “yes” to tackling polio since 1998, when he took charge of the WHO’s fight against the virus. Polio is a highly infectious virus that mainly affects children, some of whom are left paralyzed or dead.

In the 26-year, multibillion-dollar crusade known as the Global Polio Eradication Initiative, Aylward is just one of many players. The initiative is a sprawling partnership of governments, international organizations, health workers and volunteers, many of whom risk their lives on the front lines. Canada has contributed volunteers and millions of dollars.

But the complicated effort also needs a driver and Aylward is among the few who hold the keys.“I think many people would consider Bruce Aylward the key figure in polio eradication,” said retired U.S. ambassador John Lange of the UN Foundation, who co-chairs an advisory body for the initiative. “He is, in many respects, a linchpin for the program.”

Those who work alongside Aylward often use the same adjectives to describe him: energetic, charismatic, wickedly smart — and an extraordinary communicator. “He could make a rock care about eradicating polio,” said Dr. Carol Pandak, director of the polio program at Rotary International, a major partner in the effort.

Aylward lives in Geneva with his Italian wife Elisa Rapiti, a cancer researcher, and their 14-year-old son, Nico, but he is almost always leapfrogging the globe — jet-setting to Japan for a day of meetings, or flying to Pakistan where he and the WHO’s director-general recently sat down with the prime minister.

But long before Aylward’s peripatetic lifestyle took flight, he was a kid in Atlantic Canada. Born in St. John’s in 1962, Aylward is one of six children raised by a Haligonian woman and her lawyer husband, who eventually became a judge in Newfoundland’s Supreme Court.

Aylward studied medicine at Memorial University. By 1984, he had his sights set on becoming a surgeon and went to Uganda through a school program, working in a hospital for six months.While in Africa, an acquaintance at UNICEF roped him into also working on a measles vaccination campaign. Aylward loved it.

“Part of your day, you’re spending in surgery trying to help on an individual level. And then you’re actually dealing with whole populations (while vaccinating),” he said. “That was one of the things that really whetted my appetite. I started to think: what part of my day am I enjoying the most?”

After graduating, Aylward studied internal medicine in British Columbia before pivoting full-time toward public health, studying in the United Kingdom and then at Johns Hopkins University in Baltimore.

But no matter where he landed, Aylward managed to get back on a plane. “Every time I had enough money in the bank, I would pack up whatever practice I was in and head off to Africa or South America,” he said. “I spent a lot of time banging around the developing world when I went through my training.”

His wanderlust was bemusing to his parents and a deal breaker for many girlfriends (“I got a lot of ‘Dear John’ letters when I was on the other side of the world,” he laughs). But at Johns Hopkins, he met the Italian woman he would later marry. After graduation, Elisa Rapiti moved home and Aylward found himself routing his travels through Rome at every opportunity. After years of “dating in at least 20 different countries,” the couple married in Geneva, where they also had their son in 2000.

When Nico was born, Aylward had already been based in Geneva, where the WHO is headquartered, for nearly a decade. But it has always been a home base only — soon after being hired by the WHO, he managed to get transfers to Egypt and Cambodia.

When Aylward landed in Phnom Penh in 1993, the global polio eradication campaign was in its fifth year. In 1988, a year that saw an estimated 350,000 people infected by polio, the World Health Assembly passed a resolution to eliminate the virus by 2000. If successful, it would become only the second human disease to be eradicated; the first was smallpox, which was vanquished in 1979.

Aylward’s job was to organize Cambodia’s first mass immunization campaign. The task was daunting. “Cambodia was a pretty messed up place,” said Chris Maher, a WHO epidemiologist who worked with Aylward in Phnom Penh. “So many people had been killed by the Khmer Rouge and it was still a very active conflict.” Aylward showed up in Cambodia and hit the ground “running around all over the place,” Maher recalled.

“He’s like the Energizer Bunny. Someone presses the on button and he just rattles around until the batteries run out,” Maher chuckles. “He’s very capable of working very, very long hours in a day, and still producing quality work.” Those frenzied weeks of preparation were full of surprises — like when Aylward ordered a million posters to publicize the vaccination campaign, only to have them come back saying “Happy birthday polio.”

He woke up anxious on the first day of vaccinations and climbed into a jeep with his colleague, driving for hours to the outermost reaches of the campaign. As he watched the sun rise over the quiet, green rice fields, he was suddenly overcome with doubt. What had he been thinking? Did he really believe this campaign would work?  “But then we see women coming out of the fields with little kids,” he remembers. “And as we got closer and closer to this shack . . . these people were coming. Dozens, hundreds, in the middle of nowhere, the most rural place you could imagine.”

In 1998, the WHO asked Aylward to come back to Geneva and run its contribution to the Global Polio Eradication Initiative, which is spearheaded by the UN health agency along with UNICEF, the U.S. Centers for Disease Control and Prevention and Rotary International. Aylward agreed, under the condition that major changes would be made. The initiative was stalling and the original eradication deadline was only two years away — but some 20 countries had yet to even start immunizing. “There was no way the world was going to stop transmission by the end of 2000. But you know, you couldn’t say that,” Aylward said. “My goal was to make sure that by the year 2000 every country in the world had started eradication programs.” He succeeded. In 1999, Sierra Leone and the Democratic Republic of Congo became the last countries to join the polio fight.

Aylward realized the program would need to run like a business if it was to expand and his first hires were young MBA graduates and communications specialists. Major funders, like the Gates Foundation and the UN Foundation, also started coming on board. Aylward’s push for dramatic change ruffled some feathers in Geneva but within two years, he saw his staff expand from four people to dozens. More crucially, his team in the field ballooned from about 80 to 2,500, with operations rolling out in difficult countries such as Somalia and Sudan. Over the last decade, Aylward and his partners have brought polio to its knees. When he first joined the effort in 1998, there were 10,000 cases worldwide; last year, there were only 403. India — once considered the hardest place on Earth to eradicate polio — has gone three years without a single case. Last month, the WHO declared a significant milestone: the entire Southeast Asia region is now polio-free.

But polio has a knack for finding weak spots and it recently popped back up in Cameroon and Equatorial Guinea. The virus also continues to be endemic in three countries — Afghanistan, Nigeria and Pakistan — and these last refuges will prove the most difficult battlegrounds. These days, the eradication effort is more of a political challenge than a technical one. Organizers have honed their vaccines and logistical strategies; they now need to figure out how to stop extremists — driven by ideology and anti-western conspiracies — from killing their polio workers. Polio workers have been particularly targeted in Pakistan, the country Aylward says is the furthest off track. As long as polio survives there, it will continue to be a threat everywhere.

The latest deadline for polio eradication is 2018. Will the world hit it this time? “Hell yeah,” Aylward says. He has been similarly optimistic about past deadlines that have come and gone. Some think the eradication goal should be abandoned, replaced by a strategy for controlling the disease. But abandoning the cause no longer feels like an option. Not only will more children be paralyzed and killed by a preventable illness, billions will have been wasted and major public health agencies will lose credibility in the eyes of donors, policy-makers and the wider public. To Aylward, stopping would signify an even deeper failure: that for some children, the world cannot provide the most basic of health interventions. This fight is about more than just polio, he believes. “It’s about equity. It’s about social justice and making sure every kid’s got a better shot at a better future,” Aylward said. “The day you walk away is the day you say some kids aren’t worth it.” 

Jennifer Yang 

in the Star.com through Sunilkzach