by Adam Fifield
When working with autocratic governments, Grant had reminded staff that UNICEF “is not Amnesty International.” You are, he told them, in the business of “making a difference, not making a point.” Staff were encouraged to work with human rights groups like Amnesty and to discreetly provide them with information, but to leave the boat rocking to others. That was generally not UNICEF’s job.
Ultimately, Mengistu was yet another devil Grant had to deal with. According to Paul Ignatieff, who served as UNICEF Ethiopia’s representative several years after the 1984 famine, Grant would “romance” the autocratic ruler. The two men “got along like a house on fire,” he says. As a result, claims Ignatieff, Mengistu eventually gave UNICEF critical access to rebel areas to deliver badly needed relief.
During the height of the 1984 emergency, UNICEF staff, including Alan Court, were racing the clock to save as many lives as possible and working with NGOs to distribute high-protein food biscuits, medicines, and oral rehydration salts. At any given time in the Korem camp, you would see children hours away from death. “You felt like if you turned your back, the child was going to die,” says Padmini, who was the UNICEF Ethiopia representative during the famine. Cholera would soon erupt in some camps—though the government forbade the use of the word “cholera,” for fear it would hurt foreign trade. The combination of starvation and dehydration became so rapidly lethal that people died while standing in line, waiting to receive ORS, according to Padmini.
In New York, Court was chatting with a colleague, Manou Assadi, when Grant popped into Assadi’s office. Assadi introduced them.
Grant extended his hand and said hello. He asked how Padmini was. Then he asked the question that stunned Court: “So how are you doing with your immunizations?”
Court had expected the executive director to ask about the famine, how the staff was faring in an impossibly daunting situation. But immunization? Now?
So he replied with jarring honesty: “Well, if we focused on immunization, the people we’re immunizing would be dead, because they don’t have food.”
Grant was unmoved. “That’s not our job,” he said. “That’s the World Food Program’s job.”
Court shot back: “I know, but they’re not doing their job … so we have to step in.”
This snagged Grant’s attention.
“Tell me about it,” he said. “Come and see me after you finish here.”
Later, after evening had drained light from the windows, Court went to Grant’s corner office overlooking the East River and the southern tip of Roosevelt Island. The large room was basically neat. Photos of Ethel and his three sons stood on his desk. Gifts and awards Grant had received from all over the world were set out around the room; these would eventually include a collection of papier-mâché dolls from Japan. A series of clocks were arranged on top of a bookshelf. A dark Turkish Kilim rug lay on the floor. On the wall hung a stark photo of a girl standing alone on a street in Beirut, Lebanon. Reports and files were usually scattered across his desk.
Court sat down and described the situation in Ethiopia in detail. People were migrating into the camps in phenomenal numbers, from everywhere, abandoning their homes in a last-minute attempt to find food. In some cases, a lack of food was not the problem—they simply did not have the money to pay for it. So, Court explained, UNICEF had started a cash-for-work program, giving people cash stipends in exchange for one or two days of work per week on community projects. (This was not news to Grant—the cash payments had actually been his idea, according to Padmini.) But he listened as Court described the program and how it had helped staunch the migration.
Finally, Grant said, “Let me talk to the head of the World Food Program about this.”
Court was relieved, but then Grant returned to his original question.
“I’ll take care of this.” he said. “But I want you to take care of immunization.”
Then he gave Court a new assignment: “Go to Colombia and see what they’re doing there.”
Court agreed he would. When he returned to Ethiopia, he learned some surprising news: the World Food Program representative was being transferred to Zambia, and the secretary general had appointed a new UN emergency coordinator to handle the famine. He was a Finnish man named Kurt Jansson, an able UN field veteran who had worked for UNICEF in Cambodia. Grant had recommended him.
According to Court, Jansson helped turn the tide in Ethiopia. “He was transformational,” he says. “It was the result of Jim Grant taking ownership.”
Jansson was indeed lauded for pulling off a startlingly difficult and thankless task, but he was also later criticized by Africa Watch for allegedly condoning government abuses and lies; some, if not all, of this may have been beyond his control. Either way, a troublesome burden had been shunted away from UNICEF.
The next time Grant was in Ethiopia, he approached Court after a staff meeting. He again asked how immunization was coming along. Court agreed that they would aggressively pursue immunization—as long as the hunger problem had been addressed. (UNICEF would continue to provide a variety of aid for famine victims in Ethiopia.)
“That’s been taken care of,” Grant said.
Then he asked, “Have you been to Colombia yet?”
“No,” Court said. “Not yet.”
“Go.”
Grant went to Ethiopia several times, starting in August 1983. During a visit to the Korem camp, one detail stood out for him: the coughing. It was a harsh, hacking bark, a sickening ambient sound, in many cases a wasted body’s final protest against the ravages visited upon it. He later remarked to UNICEF’s eastern Africa regional director Mary Racelis: “You know, from all these tents and bushes, all you can hear is coughing … What are we going to do about it?” He decided that the answer was blankets. Already sick and weak, many people had nothing to guard against the fatal creep of the night cold. On his next trip to Japan (one of UNICEF’s most consistently generous donors), Grant asked the government for a donation of blankets for Ethiopia. The answer was no, recalls Racelis, but a government minister suggested he approach the Japanese Red Cross. He did, and they agreed—they would raise money to provide the blankets. When the blankets arrived, many of them were used for the grim purpose of wrapping dead children for burial.
Even before the BBC report, Grant had been urging the world to pay more attention to Ethiopia. He had begun to significantly increase UNICEF’s resources and staff presence throughout Africa; in August 1984 he launched a $67 million fund-raising appeal for Ethiopia and twelve other countries. Grant likely miffed many at the UN when he told reporters that Western donor governments and relief agencies—including UNICEF—had been woefully slow to respond.
“The international community, preoccupied with other things, did not respond,” he told PBS news host Robert MacNeil in November 1984. “Sometimes it takes things to get darker before the world community will respond. We remember in Kampuchea that it really had to get very bad, and then the world community responded, and we saved a people from disaster.”
Kampuchea, or Cambodia, was still raw in Grant’s mind. Though he pushed for a bigger, bolder emergency response in Ethiopia, he certainly did not want UNICEF to lead it—not this time. After the draining vortex of Cambodia, he could feel “the alligators snapping at my heels.” Those alligators could drag him into a swamp and mire GOBI in the muck. He lobbied for the creation of a special UN body exclusively tasked with handling emergencies in Africa.
The “opening shot” of the child survival revolution was fired at about eight a.m. on June 23, 1984, at the presidential palace in Bogotá, Colombia. It did not come from a gun, but rather a small dropper bottle containing oral polio vaccine. The country’s avuncular president, Belisario Betancur, aimed two drops from the bottle into the mouth of a baby, the first to be inoculated. The launch of Colombia’s immunization crusade was an unparalleled national event involving 120,000 volunteers—teachers, priests, Boy Scouts, nurses, health workers, Red Cross members, police offic
ers, and soldiers—working at ten thousand immunization posts around the country. By seven that evening, as many as 800,000 Colombian children would be inoculated against polio, measles, diphtheria, tetanus, and whooping cough. The crusade would continue on July 28 and August 25, as the children received the second and third doses.
In a photo from the first or second vaccination day, Colombia’s first lady, Rosa Helena Betancur, is positioning a polio dropper carefully over a baby girl named Lina Margarita, whose cheeks were likely squeezed together to keep her lips open. The first lady is leaning forward and gently holding the baby’s arm, as her husband stands nearby, grinning approvingly. Peering over a scrum of people gathered around the baby was Jim Grant, his face glowing with luminous delight.
The result of the Colombia campaign was important in and of itself, of course: these children were now protected from deadly and debilitating illnesses. But the symbolic victory was just as critical. What had happened in Colombia showed that what Grant envisioned—reaching the majority of a nation’s children with basic health care—could be accomplished.
Colombia was an ideal test case, because it was a middle-income country with a fairly robust health infrastructure and immunization rates that were already comparably quite strong. In 1983, coverage for the measles, polio, and the DPT (diphtheria, pertussis, and tetanus) vaccines were all between 42 and 43 percent, while tuberculosis vaccine coverage hovered at an impressive 79 percent (for this reason, the campaign did not include the tuberculosis vaccine). The country was also already embarking on ambitious health and immunization programs, and it had a competent leader who seemed capable of delivering on his promises.
A lawyer and former dean of the law school at the National University of Bogotá, Betancur was a popular conservative who had earned widespread praise for reconciling with guerrilla groups in Colombia. One of his first actions as president was to offer amnesty to guerrillas and welcome them back into the Colombian “family.” But the peacemaker could wield a sharp tongue. At a December 1982 luncheon for President Reagan, who was visiting Colombia, Betancur delivered a surprise toast in which he criticized America’s efforts to “isolate” and “exclude” some Latin American nations (presumably Cuba and Nicaragua) from peace efforts, according to a New York Times account. “Why shouldn’t we do away with the exclusions in the inter-American system?” Mr. Betancur asked.
At their first meeting in November 1982, Grant and Betancur talked over cups of tinto, a black Colombian coffee drink, in Betancur’s office. They sat on couches, in a circle, the first lady and the minister of health flanking Betancur. In settings such as this, Grant usually leaned forward, hands folded together, getting as close as he could to his host. With each leader he met, he slightly honed his pitch. Would he appeal to a head of state’s self-interest (saving children can win you votes)? Would he try to stoke a sense of rivalry with a neighboring country? Or would he make a moral argument?
Betancur was genial, almost benign-looking, with glasses and a double chin. He seemed like an empathetic man, and Grant chose the latter tack.
He made a stark, pointed, emotional appeal, and Betancur listened attentively, according to UNICEF’s former Colombia representative, Jorge Jara.
“Forty thousand children die every day,” Grant said, his eyes probably boring into Betancur’s. “That is the equivalent of one hundred twenty jumbo jets crashing … ev-a-ree day!”
Betancur stared at his guest wordlessly.
Grant likely warned of a “silent emergency.” At some point, he declared: “It is unethical not to do anything. We need to break the inertia.”
Then finally: “This is obscene. We cannot do business as usual.”
Jara recalls an astonished expression claiming Betancur’s face. “When Jim said, ‘This is obscene,’ that hit Betancur,” he says.
The grim information must not have been a complete surprise to Betancur. He had grown up in a large, poor family, the second of twenty-two children. All but five of his siblings had died young.
After a pause, the president nodded his head. “Yes, yes,” he said. “Definitely, it is obscene. We cannot do business as usual. We need to break these tendencies.”
Then he said what Grant wanted to hear: “We need to provide the political support for these ideas.”
Still reeling from Grant’s plea, the president went on to say how incredible it is that so many children are dying “when we already have the vaccines to prevent these deaths.”
Betancur’s minister of health, Jaime Arias, who was in that meeting, had already been planning an offensive on child mortality and ill health. He was developing three interlinked campaigns: immunization, an antidiarrhea initiative, and a program to tackle respiratory diseases. But he was having trouble getting the immunization campaign to move. He needed more propulsion, and he knew who could supply it.
“I needed the support of Mr. Grant to convince the Colombian government to do this,” Arias says. “We had to mobilize all the main forces of the country.”
Betancur’s decision was not a facile one. There was a “big risk of failing,” says Arias. If the goals were not reached, the president would suffer significant political embarrassment and would have a hard time building a consensus for other health initiatives.
Arias characterized Grant as a “very alive person … [who] transmitted a lot of energy.” The UNICEF leader’s enthusiasm was contagious, he says. “He transmitted that feeling to everybody. That was very important.”
The entire country pulsed with that energy. Colombia was where Grant was able to try out his strategy of “social mobilization”—engage every sector of society by showing them that they all have a common interest: protecting children. The desire to immunize all the kids in Colombia was pushed by citizens, “not by epidemiologists or doctors,” says Jara. It was, in that way, a “bottom-up” initiative—the exact opposite of what many of Grant’s critics had alleged GOBI would become.
The Catholic Church asked all its priests to support the campaign. On the Sunday before each immunization day, the sermons in all 2,280 parishes were devoted to the importance of vaccination. Some pastors reportedly went as far as telling parishioners that if they wanted their babies to be baptized, they had to promise to get them immunized. A major bank did its part, printing thousands of free calendars, reminding its customers to get their kids inoculated. The country’s two main media outlets, the daily newspaper, El Tiempo, and the national radio network, Caracol, agreed to promote the immunization crusade for free. With results from each province broadcast every hour by Caracol, the campaign took on the feel of an election day. Rather than wondering who would win, everybody wanted to know: Would we make it? Would Colombia, as a nation, succeed?
A local advertising agency created a cartoon mascot for the campaign: a doughy, smiling, obviously healthy little boy named Pitín (pronounced “Pee-TEEN”). His jovial image, with big, horseshoe-shaped eyes and a lick of hair sticking up, ran in El Tiempo and other newspapers throughout the country and was usually accompanied by basic health advice.
Pitín was part of a strategy to convince the most crucial stakeholders of all: the parents. Some were wary of immunization, especially since the injections could cause fevers. It was also a huge hassle, particularly in remote rural areas, to lug kids several miles to an immunization post. They had to be persuaded it was worth it.
Organizers tried to make the experience easy and even enjoyable. In urban areas, a carnival-like atmosphere pervaded the streets on each of the three days: musical troupes, theatrical performances, fireworks, and puppeteers entertained the kids and parents waiting in line.
The immunizers were government employees or volunteers, deployed by the Ministry of Health. The vaccines, syringes, cold chain equipment, and promotional materials were supplied by UNICEF and other UN agencies, including the WHO’s regional arm, the Pan-American Health Organization (PAHO). PAHO was pivotal and became one of UNICEF’s most dynamic partners in the years ahead, in large
part due to its dogged immunization chief, Ciro de Quadros; the Brazilian epidemiologist would play a seminal role in the eventual eradication of polio from the Americas.
In the lead-up to the crusade, resistance percolated from medical and technical staff at health centers. Some resented being told to alter their procedures and panned the idea as unrealistic. Many cited weak cold chains as a reason the campaign world never work, says Jara. UNICEF had to prove them wrong and show that a cold chain would hold, even across formidable geographical terrain.
The vaccine’s journey started at the site of the manufacturer and had to snake its way across the globe to the airport in Bogotá and then to a government storage facility and then to the regional health center and then to the local health outpost and then into a syringe (unless already in a dropper) and then into an often wailing child—and all the while, it had to be kept cold. But not too cold—between 36 and 46 degrees Fahrenheit, to be exact. If the temperature strayed too much above or below this range, the batch of vaccine could be ruined. The doses were stored in refrigerators (many powered by kerosene, in case of electrical outages) and transported in insulated Styrofoam “cold boxes” lined with ice or ice packs.
The country’s civilian air patrol was a crucial link in the Colombian cold chain, lending its planes and helicopters to transport the doses to the hardest-to-reach places in the Andean mountains. Once they reached the airfields, the cold boxes were immediately unloaded and strapped to mules. They then began the next leg of the journey farther into the mountains. When the vaccines finally made it to their designated villages, health workers immediately had to test the temperature to make sure they had not spoiled. In some of the country’s Amazonian areas, cold boxes were transported on boats.
On the second day, when officials in a town in northeastern Colombia heard via radio that a plane carrying forty thousand doses of vaccine was on the way, they realized they had a problem: the plane would be arriving after dark, and the small runway had no landing lights. The town was flanked by mountains. So they sent a radio message to local residents: please bring your cars and trucks to the runway right away. More than one hundred drivers responded, parking their vehicles in even rows on each side of the runway. They turned on their headlights. The last-minute, makeshift landing lights allowed the plane to land safely. The vaccines were unloaded and the plane immediately climbed back into the murky sky.
