companies simply shoved it down their throats anyway, Davis insists that’s not the case. The deaths in the demonstration project, Davis says, were considered unrelated to the vaccine. Still, Indian officials are conducting an inquiry, and have imposed a moratorium against use of the vaccine in public programs.
That means that girls from wealthy families can get the vaccine on the private market, while poor girls who need it can’t get it, Davis says. The only thing PATH or any other organization can do now is patiently explain its position to activists and opposition media, answer everybody’s questions during the government inquiry, and hope that the decision is made to lift the moratorium.
“India has one of the highest burdens of cervical cancer in the world, many people never diagnosed, and the poor girls can’t get any treatment,” Davis says. “They die these horrible deaths without any painkillers. It’s a national tragedy, it’s increasingly recognized, because we have a safe and effective vaccine.”
Davis has learned about how rowdy democracy can be in a place like India. PATH has to explain it is on a public health mission, and isn’t some kind of front group for a Big Pharma agenda. At the same time, there’s a balance to be struck, because PATH believes deeply in working with commercial partners like Merck and GlaxoSmithKline that are among a very small group of organizations on Earth with the money and manpower to discover, develop, manufacture, and distribute something like a cervical cancer vaccine. (The companies are obviously not pure innocents here. Merck has had its controversies here in the U.S. including pushing for mandatory cervical cancer vaccinations in Texas, but that’s another story.)
Getting the public health officials rallied around an idea isn’t as simple as just calling the Indian equivalent of U.S. Health and Human Services Secretary Kathleen Sebelius or convening a meeting of agency heads in Washington D.C. Much of the day-to-day public health work is conducted at the state level in India, and each state can be vastly different in terms of its urban/rural dynamics, socioeconomic status, and health infrastructure. Of course, there are lots of other players in the mix too, like the local point people for the United Nations, USAID, Bill & Melinda Gates Foundation, and more. PATH itself has every single one of its strategic programs at work in India, with five offices, about 85 staff, and more than 20 consultants there.
One key advantage Davis has that he knows PATH’s Seattle operation inside and out from his nine years on the board. He’s spending about half of his time these days in Seattle (much of it at odd hours on Skype talking to people in India). The other half of his time, he’s actually on the ground in India, about two weeks per month. He’s gotten the hang of the brutal flight—26 hours door to door from Seattle, through Newark, to New Dehli is his favored route. “I’ve found you’ve just got to buck up, take a sleeping pill and deal with it,” Davis says.
The learning curve has admittedly been steep, Davis says. He sure sounds like he’s reveling in all of it—the frustrations, and the potential to do something good. It’s given him a whole new perspective on what Chris Elias calls “the innovation pile-up” in which important innovations like the cervical cancer vaccine get developed, but then stall at the delivery stage, so that the maximum benefit sometimes doesn’t get to the people who need it.
“Sometimes an interesting technology gets created and we haven’t cracked the code on how to implement it,” Davis says. “You can get a lot of technology and a lot of smart people and a lot of money organized around a problem, but if you can’t figure out the uptake issues, you’ve got a problem. I’m seeing it front and center in India.”
