Unheralded but saving lives

Drive past the nondescript brick building on Commerce Drive in Decatur and you wouldn't give it a second glance. Leafy trees line a parking lot next to a Kroger. A sign out front says "Decatur Housing Authority."

Nothing hints at what's on the fourth floor.

That's where a little-known nonprofit with a global reach marshals troops from around the world to combat threats to public health, such as traffic deaths and deadly forms of tuberculosis. With 45 employees and an $8 million budget, the Task Force for Child Survival and Development has for 22 years quietly assembled coalitions to confront large-scale health threats, cajoling experts from rival agencies to set aside egos, forget about turf and work as a team.

About 120 experts in one such coalition meet in Decatur today to refine a battle plan against drug-resistant tuberculosis, which kills tens of thousands and sickens half a million each year. The experts work for agencies such as the World Health Organization and Centers for Disease Control and Prevention in countries including Brazil, China and Russia.

The task force helped secure a $45 million grant from the Gates Foundation several years ago to forge a consensus among various agencies fighting drug-resistant tuberculosis. The agencies worked out differences and opened a unified front that has treated 12,000 people in Peru, the Philippines, Estonia, Latvia, Russia and other countries.

During a three-day conference beginning today at the Holiday Inn in downtown Decatur, the task force hopes experts from different parts of the globe will learn from counterparts which tactics have worked best against a nasty strain of tuberculosis. It's the kind of unglamorous, behind-the-scenes work that has become the task force's hallmark --- and it has saved thousands of lives, said Howard Hiatt, former dean of Harvard's School of Public Health and a task-force board member.

"The tuberculosis program alone has saved many, many lives," he said.

Yet Dr. Mark Rosenberg got blank stares when the task force executive director spoke to a Rotary Club in Decatur.

"They said 'My God, you're two blocks away and we don't even know you exist,' " he said.

The low profile is by design.

Dr. William Foege, part-time Atlanta resident and senior health adviser at the Gates Foundation in Seattle, founded the task force with several colleagues in 1984. He's well-known in public health circles as the man whose strategy eradicated smallpox and as director of the CDC from 1977 to 1983 and executive director of the Carter Center from 1986 to 1992.

Foege inspired a culture of humility at least in part on the grounds that letting others take credit encourages them to keep up the good work.

"That was very much Bill Foege's philosophy --- that you ought to shine the spotlight on your partners instead of yourself," Rosenberg said.

Tangible progress

Foege and colleagues who co-founded the task force sought first to get UNICEF and the World Health Organization to join forces to increase the 20 percent childhood-immunization rate in the developing world.

"It struck him that they were mainly competing with each other for money, fame and glory," Rosenberg said.

With support from those two agencies plus the World Bank, United Nations Development Program and the Rockefeller Foundation, the task force championed an effort that raised $1 billion in six years, compared with about $35 million that UNICEF and the World Health Organization had been spending each year to immunize children, Rosenberg said.

"It was an unbelievable success story," Rosenberg said.

Since then, the task force has evolved to focus on other projects. Most seek to tackle large-scale health problems by bringing representatives from various agencies to a neutral meeting ground to form a coalition.

"When everyone works independently, problems just don't get the same level of attention," said Margaret McIntyre, senior program associate director. "A neutral middleman can help bring together people who would otherwise find themselves entrenched in a non-collaborative relationship."

Yet it isn't easy.

"A coalition is very much like a marriage --- very easy to get into and very hard to make work," Rosenberg said.

Two programs benefit

His background as a psychiatrist may give him an edge in gauging people's motivations for participating in a coalition and playing to those motivations.

"Some may do it for fame. Some may do it because it advances their career. Some may do it because they believe deeply in social justice," he said.

The bulk of the task force's expenses support two programs. One has to do with mass distribution of a drug to treat two diseases while the other seeks to design health information systems.

The task force's Mectizan Donation Program reviews and approves applications from nonprofit organizations and government health ministries that would like access to Mectizan, a drug donated by the pharmaceutical giant Merck. The program employees make their decisions in consultation with a seven-member panel of independent experts.

Merck pledged in the late 1980s to donate Mectizan "to all who needed it for as long as needed." The company says its Mectizan reaches 45 million people a year, mainly in Africa but also in some Latin American countries and the Middle Eastern nation of Yemen.

Mectizan treats people suffering from River Blindness, the world's leading preventable cause of sight loss, and lymphatic filariasis, an infectious tropical disease that can result in massive swelling of limbs.

The task force's Mectizan Donation Program approved 70 requests last year to distribute 62.2 million doses of the medicine, said Mary Allen, an associate director of the program.

Data under scrutiny

Another major initiative at the task force involves computer technology of value to local and state public-health agencies.

About a dozen employees in the Public Health Informatics Institute talk with health workers nationwide to determine the kind of data they need to collect while investigating problems such as a disease outbreak, when such information is as vital to medical workers as fingerprints and blood evidence are to police detectives.

After Sept. 11, 2001, in the wake of the anthrax scare, the task force assembled local and state public-health lab managers to outline the kind of computer system that would best track and share information about anthrax. As a result of those discussions, the computer industry is designing software that could help labs get and share answers more quickly the next time they are overwhelmed with samples to test, said Dave Ross, director of the institute.

It signifies to Rosenberg the value of a coalition.

"There are things that we can do together that we cannot do alone," he said.