The Search For Solutions

A doctor, a banker, an engineer and a scientist are working separately—and together—to bring lifesaving vaccines to children around the world. How inspired individuals can take on and conquer some of the world's biggest problems.

In medicine there are three kinds of good ideas: the obvious ones, the not-so-obvious ones and the sort that Dr. Edward Jenner came up with in 1796. He had heard from his neighbors in rural Gloucestershire, England, that people who caught cowpox didn't get the more-lethal smallpox very often, and he suspected the first disease was triggering the body's defenses against the second. The notion must have sounded preposterous to his colleagues. At the time they didn't have words for the "immune system" and "germs" because they hadn't figured out either concept. Nonetheless, Jenner believed in his idea, and so did a mother who let him test it on her 8-year-old son, James Phipps, when cowpox broke out on her farm in the spring of that year. The doctor collected pus from an infected milkmaid, shot it into the boy, and waited. After six weeks he injected the boy with smallpox. He waited some more until he was sure James wouldn't get sick. Then he announced the dawn of an era. He had invented the vaccine. No doubt Jenner sounded crazy when he proposed his idea. Revolutionaries often do.

Vaccines have transformed the entire world by eradicating smallpox, and they have largely rid the developed world of polio and measles. If vaccination is one of the most important medical innovations of the past two centuries, it is also one of the most cost-effective. Vaccines do not cure disease; they prevent it, which is better. Immunize 100 people and you not only keep them healthy, you stop them from infecting thousands more. Each year, vaccines save uncountable numbers of lives, uncountable because in the West it is impossible to imagine life as we know it without them—which makes it all the more confounding that millions of people still can't get them. When it comes to immunization, much of the developing world is still stuck in the 18th century. In vast parts of rural Africa, Asia and Latin America, kids don't get any of the basic vaccines available in developed countries; they die because of that fact. And no one anywhere gets routinely and effectively immunized against the big global killers—HIV, tuberculosis and malaria, which together take 6 million lives each year—because, even with all the technological prowess of modern medicine, good vaccines for those diseases do not exist.

Why this grim reality? There are challenges at every level. The science is hard: doctors struggle to run clinical trials in the shambles of the developing world, and biologists can't always outsmart bacteria and viruses. The logistics are hard: the path a vaccine takes from the lab to the patient is fraught with difficulty. The financing is hard: cost-effective though they are, vaccines are still too expensive for most poor countries to afford, and experience has shown that it doesn't work when rich countries just throw money at the problem. Considering the obstacles, it's kind of amazing that people get immunized at all.

And yet, 211 years after Jenner treated his first patient, those obstacles are starting to look a little more surmountable. The basic idea behind vaccines hasn't changed much; they work the same way, and the goal is still to use them to wipe out the world's worst diseases. But something else has changed: Jenner has a large new group of heirs, and they share his doggedly optimistic attitude. They include a doctor who's making it easier to do high-tech science in low-tech environments; a biologist who has spent 23 years failing to defeat HIV and trying, trying again; an engineer who thinks patients can ward off disease with a cheap inhalable powder, and a banker who has improved the health of poor people by getting rich people to invest in bonds. All four are given to unorthodox thinking. Put more bluntly, sometimes they sound a little crazy. But if they're crazy like Jenner, that's probably a good thing.

Dr. Fred Binka, 54, was standing at a hospital bed one day two weeks ago, looking down on a sleeping 4-month-old girl. Her name was Jennifer Mansua, and she had spent most of this day in the Kintampo Health Research Centre, in central Ghana, in the dark—the power kept going out. The nurses gave her blood transfusions by candlelight and tried as best they could to keep mosquitoes away from her. The mosquitoes, however, had already won. Jennifer had malaria. Her mother, Cecilia Nakabu, had tried to cure her with methods that didn't involve a costly hospital visit—over-the-counter meds, TLC, prayer. Now Jennifer was soothed and on her way back to health, but Nakabu still hovered near Binka, looking worried. Binka, meanwhile, was thinking about saving not just Jennifer but millions of other kids. "Imagine the stress on the whole system," he said. "If you could just develop a vaccine to prevent this disease, malaria, then, well, it would be fantastic."