The Imaginations of Unreasonable Men

by Bill Shore

  Table of Contents

  Title Page

  Dedication

  Introduction

  CHAPTER 1 - WHEN GOOD IS NOT GOOD ENOUGH

  GOOD IS NOT GOOD ENOUGH

  MOST FAILURES ARE FAILURES OF IMAGINATION

  IRRATIONAL CONFIDENCE: THE VISIONARY’S DILEMMA

  THE IMAGINATIONS OF UNREASONABLE MEN

  CHAPTER 2 - WHATEVER IT TAKES

  AN UNSTOPPABLE FORCE

  “AND THEN THERE’S THIS WILD THING STEVE HOFFMAN IS DOING”

  CHAPTER 3 - STRANGE BEDFELLOWS

  MOSQUITOES MORE DANGEROUS THAN MORTAR ROUNDS

  FROM IMMUNE RESPONSE TO VACCINE

  FROM COLLABORATORS TO COMPETITORS

  CHAPTER 4 - THE BIO-HAZARD LEVEL 3 STRIP MALL

  HOW MANY TECHNICIANS DOES IT TAKE TO UNSCREW A MOSQUITO?

  MAN, NOT MYTH

  THE “SPACE RACE” OF THE TWENTY-FIRST CENTURY

  CHAPTER 5 - TROPICAL LINEAGE

  THE PRIESTHOOD OF TROPICAL MEDICINE

  THE “GRAND OLD DAYS” OF TROPICAL MEDICINE

  CHAPTER 6 - BATTLEFIELD GENERAL

  JOURNEY TO THE CENTER OF THE MOSQUITO

  WHERE THE WILD THINGS ARE

  A MASTER SPY’S MICROSCOPIC TRADECRAFT

  A CLUB MED FOR BUGS

  “VACCINE MAKERS, LIKE OIL MEN AND GOLD DIGGERS, NEVER STOP DREAMING”

  CHAPTER 7 - THE E WORD, ONCE AGAIN AND AT LAST

  A CHANCE TO SAVE THE WORLD—TWICE!

  HITTING THE HIGH NOTES

  “HOOKWORM HAS ONLY PETER HOTEZ”

  THE BILL AND MELINDA GATES FOUNDATION

  CHAPTER 8 - SANARIA HAS ITS DAY IN THE SUN

  A GATHERING OF MALARIA ROYALTY

  “THE LIVER IS WHERE THE WAR WILL BE WON”

  CHAPTER 9 - ECOSYSTEM OF MARKET FAILURES

  VENTURE CAPITAL FOR VACCINATIONS

  “AT WHAT POINT WILL WE TREAT IMMUNIZATION THE WAY WE TREAT UTILITIES?”

  CHAPTER 10 - MOMENT OF TRUTH

  ONE STEP FORWARD AND ONE STEP BACK

  CAREFULLY CHOREOGRAPHED CLINICAL TRIALS

  TRIALS AND TRIBULATIONS

  CHAPTER 11 - PHILANTHROPY’S SHIFTING TIDES

  THE EMERGENCE OF MARKET-DIRECTED ORGANIZATIONS

  LESSONS LEARNED: SIX PROBLEM-SOLVING STRATEGIES

  CHAPTER 12 - MORAL IMAGINATION

  WHEN MAN AND MOMENT INTERSECT

  WHAT WE SEEK TO KNOW

  Acknowledgements

  NOTES

  INDEX

  Copyright Page

  For Rosemary, first, last, and always.

  INTRODUCTION

  AT MY DINING-ROOM TABLE, the glow of two flickering candles illuminates the photograph of a beautiful young woman. In the image she is thirteen years old and sitting attentively at a polished wooden desk. Her skin is coffee brown, her eyes bright and searching, and her dazzling smile and gentle expression hold the promise of a limitless future.

  The picture was taken in an Ethiopian village called Yetebon, about a three-hour drive south of Addis Ababa. I was there in 2002 with a delegation of business and philanthropic leaders who support Share Our Strength, the anti-hunger organization my sister and I founded in 1984 following one of Ethiopia’s most devastating famines. We started the organization with the belief that everyone has a strength to share in the global fight against hunger and poverty, and that in these shared strengths lie sustainable solutions.

  Project Mercy is a U.S.-based nonprofit that seeks to educate and supplement healthy lifestyles for impoverished communities around the world. Its first and main campus is located in Yetebon, where Project Mercy had built schools and kitchens and helped to plant community gardens. In the wake of a famine, the group was in the midst of a new construction project—a hospital. Share Our Strength had gone to Yetebon to partner with Project Mercy and to generate more awareness and resources for its work.

  At one point in our trip, a few of us stepped into an English class in the Project Mercy campus school. The teacher asked one child after another to stand and tell us what they wanted to be when they were older. After each child had spoken, and after I had thanked the class for allowing us to visit, one girl said something so quietly that I could hardly hear her. She was the only person who spoke without being called upon. I walked over and knelt down to ask her what she had said. She repeated so that I could hear it: “God bless you.”

  Like any child, she was shy, but unlike many she did not look away. Something about her presence set her apart. She told me her name. I asked her to write it down for me so that I would know the correct spelling. She searched her notebook for an empty space and carefully formed the letters of the English alphabet she had learned in school, writing “Alima Dari.”

  We talked for five or ten more minutes. I told her where we were from and why we’d come to visit. I complimented her on her English. She told me about her brothers and about her walk to school, and where her family lived.

  Eventually, I rejoined the Share Our Strength group to tour the cattle shed, the gardens and kitchen, and the partially built hospital. When finally it was time for us to leave, all of the children, hundreds of them, lined the road from the school to the main gate. As I walked toward them, I scanned the faces for Alima’s. There were close to three hundred children, standing three rows deep. It should have been impossible to find her. In fact I soon realized that it was impossible not to find her. She beamed at me, and I waved and yelled “Alima!” I reached across the first row of children and we shook hands again.

  On my way back to Addis Ababa, and to the United States, I asked myself why one young woman among so many had made such an impression on me. I didn’t fully understand it then, nor do I claim to understand it now. I just knew that it moved me. I was simply delighted to have met Alima. I was struck by the sense that anything was possible for her—or for anyone who was so ready to live life to the fullest. From that day forward I followed her progress. For a little over a year we exchanged letters. I received pictures of her reading her graduation speech. I have had many different experiences in my travels for Share Our Strength, but never have I connected with anyone quite the way I did with Alima.

  The following summer, when my colleague Chuck Scofield returned to Ethiopia, I gave him a handwritten letter to deliver to Alima. Though Chuck and I keep in close touch, I didn’t hear from him for weeks. Then one morning I received this email:Dear Billy, I have not called because I have been avoiding sharing bad news that I learned with regard to Alima. She died a couple of months ago as a result of TB and cerebral malaria. All at Project Mercy were and are extremely sad about losing such an amazing person. Evidently the hospital in Butajira only treated the TB without realizing that she had the most deadly form of malaria. By the time they got her to the hospital in Addis it was too late. I hate like hell to share this news with you.

  I was stunned. I have often been moved by the work Share Our Strength carries out. The organization has frequently worked in difficult circumstances in the aftermath of tragedy and disaster. But this was the first time in nearly two decades that I’d felt a sense of loss that touched me personally. It was the first time I’d experienced the brutal impact of poverty and disease on someone I knew and whom I had come to care for. This one small catastrophe had taken place not in a ravaged landscape but, ironically, in a setting of optimism and hope. With all the new building and progress at Yetebon, it was cruelly incongruous that Alima should have died.

  It is tempting to describe Alima’s death as senseless, but in a terrible way it makes perfect sense. Nearly 3,000 children die from malaria every day, almost 1 million each year. Malaria is the leading cause of death f
or children in Africa. Global spending on malaria control at the time of Alima’s death was $200 million a year—a drop in the ocean. Perhaps Alima’s death was inevitable. Treatment within twenty-four hours of the onset of malaria symptoms is essential. Unfortunately, lack of sufficient funds had prevented the hospital at Yetebon, a short walk from Alima’s classroom, from being finished before she contracted malaria. Although Yetebon now has its hospital, many African towns and villages do not.

  Such thoughts swirled in my head in the wake of the news about Alima. They were somewhat despairing. In time, though, I became convinced that Alima’s short life was long enough to show that action and inaction each have consequences, that lives hang in the balance when it comes to the generosity and commitment with which we pursue our work. It was long enough to make me aware of the fact that Alima and her classmates were among the most voiceless beings on the planet. Children in their situation around the world are so nearly silent and invisible that there is no economic market for delivering to them the basic goods and services that we take for granted and that they desperately need just to stay alive. Given the huge up-front investment that drug and vaccine development require, there’s no profit to be found on a continent where people—potential customers—earn less, on average, than $2 a day. When economic markets fail, the gap is sometimes filled by political markets, or governments responding to a need. When economic and political markets both fail, as they have failed Africa’s children, only charity or philanthropy remain as a last resort.

  While I was thinking about the lessons that Alima’s life signified, I began to wonder who, in the developed world, might be trying to help children like Alima and her classmates. Was there anyone dedicated, determined, or driven enough to want to try to cure a parasitic disease like malaria, which ravages not New Jersey and California but countries and peoples continents away, who have neither the money to pay for treatment nor the ability even to ask for it? Was there anyone who was possessed by the idea, as I had become, that malaria had to be defeated?

  Victory in such a battle does not come easily. Drug and vaccine development requires a huge amount of investment in both time and money, and even those who have both must overcome an incredible number of obstacles.

  It was in 2004 that I first began to really think about the teams of researchers working on the malaria vaccine and the specific hurdles facing them. The more I learned about the nature of the disease, the more I realized that conquering it would take more than just time and money, more even than a sense of purpose and persistence. It required a moral vision and imagination: a person or a team stubbornly dedicated to the idea that no child’s death should ever be ignored as “inevitable” or “senseless,” and abundantly blessed with practical wisdom to tackle a problem that has baffled others.

  I asked myself what kind of people, with what qualities of character, would take on a challenge as daunting as climbing Mount Everest was before Tenzing Norgay and Edmund Hillary, or walking on the moon before Buzz Aldrin and Neil Armstrong. Ending malaria may be less visually dramatic than a moon landing, and the beneficiaries—people like Alima’s classmates—are less conspicuous. That’s exactly why it takes a very unusual person to take on a challenge like this one.

  But beyond that, the quest for a malaria cure became emblematic for me of humanitarian endeavors in general, especially those that presented such huge challenges that success had eluded us time and again. The more I discovered about malaria research, the more I became convinced that it held clues to how any quest of this magnitude, with so many attempts and failures behind it, could finally succeed. And the more I looked for answers, the more I came to believe that it is the character of the people doing the work that is the key. Their methods can be baffling and surprising, and sometimes they can even be unreasonable. They are different from the rest of the crowd. And I wanted to understand how they were different.

  This book is inspired by Alima’s memory. But beyond being a celebration of her, it is a tribute to the quest undertaken by a small number of heroic idealists. It is a tribute to the imaginations of unreasonable men.

  CHAPTER 1

  WHEN GOOD IS NOT GOOD ENOUGH

  Federal officials announced today that scientists had cleared the last major hurdle to development of a vaccine against malaria. . . .

  . . . It should now be possible [officials and scientists] said, to mass produce a vaccine that will stimulate immunity against at least one stage of the major form of malaria.

  M. Peter McPherson, administrator of the Agency for International Development, expected that a vaccine would be ready for trial in humans within 12 to 18 months and widely available throughout the world within five years.

  —Philip M. Boffey, “Malaria Vaccine Is Near,

  U.S. Health Officials Say,” New York Times, August 3, 1984

  IN THE FALL OF 2009, I was invited to speak at a gathering of foundation and nonprofit CEOs from Massachusetts. I’ve spoken to many such groups over the years, usually about nonprofit effectiveness and strategies for reaching scale and sustainability. This was different, a setting unlike any I’d encountered, as was the theme I was asked to address. It became a turning point in my thinking about the ingredients needed to succeed at the kind of work in which we engage.

  The invitation came from the Pucker Gallery in Boston, which was showing the work of a renowned potter, the late Brother Thomas Bezanson. His pottery includes tea bowls, vases, and large decorative plates known for their elegant glazes. His work has been collected by the Metropolitan Museum of Art, Boston’s Museum of Fine Art, the Smithsonian’s Renwick Gallery, and many other prominent institutions.

  I know little about pottery and ceramics and had never heard of Brother Thomas. But the gallery owners, Bernie and Sue Pucker, are active in Boston’s philanthropic community and we had mutual friends and interests. They asked me to speak on the connections between the spirituality of Brother Thomas’s art and spirituality in social justice work. It was virgin territory for me, requiring more than the usual amount of preparation. I visited the gallery several times to learn more about Brother Thomas and his work.

  I prepared my talk at the same time I was working on this book. Science and pottery might seem to have little overlap, but what I was finding most exciting in my research for the book were the qualities of character and entrepreneurial strategies that led to discoveries and breakthroughs. They had relevance beyond any single project. They were pertinent to my own life’s work of trying to end hunger and to a plethora of seemingly impossible-to-solve issues, such as climate change, education, human rights, and health care. Such qualities and strategies are not always as obvious and familiar as the more concrete external resources we reflexively seek, such as money, technology, expertise, and political support. But that doesn’t make them less essential. Like diamonds deep beneath the surface, their scarcity and invisibility make them all the more valuable to capture and bring to light. As Antoine de Saint Exupery’s fox said to the Little Prince, “what is essential is invisible to the eye.”1

  Character qualities are especially critical for tackling problems that affect people so politically and economically marginalized that there are no market incentives for solving them. My dozen years on Capitol Hill and in presidential politics, and quarter century in the nonprofit sector, taught that those problems seem never to go away and are the toughest of all to solve: poverty, disease, ignorance, inequality. Traditional approaches always fall short. People who devote their careers to such problems are simultaneously admired and dismissed as idealists. In the absence of a new way of thinking, the frustrating cycle of finding and allocating hard-won resources, whether public or private, toward problems that resources alone can’t solve, futilely continues.

  Such pathology is discouraging to the increasing number of people who desire to make a difference. They want to give something back, but are not sure how to do so most effectively. The nonprofit sector is growing rapidly and is increasingly diverse. But it see
ms perennially hobbled by shortages of money and talent and by old traditional ways of doing things. Too often, good intentions stand in for transformational thinking and disciplined strategy. Many well-meaning organizations, efforts, and movements fail to live up to their full potential.

  But what is full potential? And how can we discover it? Here, the detour of trying to understand Brother Thomas through his art was profoundly revelatory.

  GOOD IS NOT GOOD ENOUGH

  To read the basic biographical facts about Brother Thomas Bezanson, you’d think he’d lived an ordinary monastic life. He was born in Nova Scotia in 1929, graduated from the College of Art and Design there at the age of twenty-one, and then earned a degree in commerce from St. Mary’s University in Halifax. He’d entered the Benedictine Monastery in Weston, Vermont, by the age of thirty, and earned a doctoral degree in philosophy at Ottawa University in 1968. Brother Thomas became artist-in-residence with the Benedictine Sisters in Erie, Pennsylvania, in 1985, and he died, at the age of seventy-eight, in 2007.2

  But Brother Thomas was far from ordinary. His work has appeared in dozens of public exhibits in some of the most prominent museums in the world, as sought after today as it was during his lifetime. And then there is this curious fact: Of the first 1,200 pieces he created, Brother Thomas broke 1,100, a ratio he adhered to throughout his life. He routinely destroyed hours’ and days’ worth of solitary creative effort and disciplined craftsmanship.

  Brother Thomas lived by a unique set of standards. Even when his pots were good, they were not good enough, begging the question: Not good enough for whom? Would the flaws even have been noticeable to anyone but himself? Yet, no matter how good they may have been, they were not good enough for Brother Thomas. As much as others may have admired them, they did not represent the version of himself that he was determined to express. They were not true to what he believed to be his highest potential.