In a rural village in Malawi, families gather under shade trees to learn how to save their eyesight. They hear from an older man who wasn’t so lucky; he suffers from a bacterial disease called blinding trachoma that causes his eyelids to flip inward, scratching his corneas. The man serves as Exhibit A for why health workers are asking all the villagers—sick or not—to swallow an antibiotic.
Some 8,300 miles away, a few blocks from the Decatur Square, sits a red-brick building, the headquarters of the Task Force for Global Health, a nonprofit whose imprint is all over that village. They’re the ones who trained the health workers; provided the meds; and collected the data that will be aggregated and pored over by governments, drug companies, and nongovernmental organizations around the world. The endgame is not simply stopping the spread of blinding trachoma in that village or even all of the surrounding villages. It is eliminating the disease from the planet by 2020, a formidable goal that the Task Force, together with other public health entities, is working hard to achieve, along with vanquishing several other diseases. So why haven’t you heard of them?
Atlanta is a world capital for public health. But unlike some of the other big players based here, including the Centers for Disease Control and Prevention and the Carter Center, the Task Force for Global Health has operated largely out of the public spotlight—and done so by design, since it was founded in 1984 by former CDC director Dr. William Foege with a mission to boost childhood immunization rates in the developing world. At the time, nearly 12,000 children, mostly in the world’s poorest countries, were dying every day from vaccine-preventable diseases such as measles, pertussis (whooping cough), and diphtheria. The Task Force brought together leading health and development agencies—including the World Health Organization, UNICEF, and the Rockefeller Foundation—to focus on improving immunization coverage. Six years later, the percentage of kids receiving at least one vaccine had shot up from 20 percent to 80 percent.
Today the Task Force reaches populations in 154 countries. It’s the largest nonprofit in Georgia and the fourth largest in the country, according to Forbes. Even so, the Task Force always has worked by the credo that “credit should be infinitely divisible,” says Dr. David Ross, the nonprofit’s president and CEO. In other words, the organization prefers to work behind the scenes, letting its public and private partners get the glory.
But in August, it was the Task Force that grabbed the spotlight after being awarded the 2016 Conrad N. Hilton Humanitarian Prize, which at $2 million, is the world’s largest such award given to organizations that have “made extraordinary contributions toward alleviating human suffering.” Previous recipients include Doctors Without Borders and the International Rehabilitation Council for Torture Victims.
“The Task Force has accomplished some very powerful things without fanfare and without looking for a profile for themselves,” says Peter Laugharn, president and CEO of the Conrad N. Hilton Foundation, which is based outside Los Angeles and was established by the Hilton Hotels founder. “It’s pretty amazing that they are not all that well-known [locally].”
That may change. The Task Force and DeKalb County officials are currently exploring ways to improve the lives of residents who are living in areas where the health picture resembles that of developing countries. “We do hope that with the prize, we’re able to help the Task Force come a little more into the limelight,” Laugharn says. “Not to change the way it works, but to the make the public more aware of what a gem you have in Georgia.”
Stamping out diseases
In her second floor office in downtown Decatur, Katie Gass is at her standing desk, poring over health data coming in—in real time—from the field in Tanzania. It won’t be her office for much longer. The nonprofit is putting the Hilton Prize money towards the purchase of a former DeKalb County government building that will serve as its new headquarters. The Task Force’s 120 employees have outgrown their current space, and there are plans to double the staff over the next few years.
Gass is an epidemiologist whose job entails studying how diseases spread and coming up with ways to control or even eliminate them. For the past year, she has been designing survey tools for the World Health Organization to help health workers in places like Malawi and the Philippines and Honduras measure the percentage of people receiving antibiotic and anti-parasitic drugs.
“The big mechanism for controlling and ultimately eliminating disease is what’s called preventive chemotherapy, or giving medicines to people in an endemic area whether they are sick or not,” Gass says. “We know that a certain threshold of the population needs to swallow the drugs in order to stamp out these diseases.”
Gass, who first came to the Task Force as a public health graduate student in 2008, works for the Neglected Tropical Diseases Support Center, which concentrates on a handful of diseases that afflict people living in extreme poverty in developing countries. Gass spends 15 to 20 percent of her time in those countries advising government officials and training health workers in the field.
The job has its challenges. While traveling, she often goes long periods without hot water or Internet. She has stared down dangerous hippos in Malawi. Still, she isn’t afraid, she says.
“I totally trust my colleagues in the field,” says Gass, “and I’m willing to accept the risks for the thrill of getting to know new places and improving the lives of the people who live there.” The hardest part of her job, she says, is seeing the day-to-day suffering caused by debilitating health conditions. “At the same time, I have a sense of awe. There is so much to learn from these cultures and their strong sense of community and support. These people are survivors.”
Gass’s division is one of eight at the Task Force. Another Task Force program called TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) supports field training programs for health workers on the front lines to recognize and respond to outbreaks of viruses like Ebola and Zika. The organization’s Public Health Informatics Institute helps developing countries and nongovernmental agencies improve health by using data-driven approaches. Their expertise recently earned the institute a spot in a new Bill & Melinda Gates Foundation–funded initiative to address the causes of serious illness and death among young children in Africa and South Asia.
“We expect those models to be replicated in lots of places,” says Ross, who founded the Informatics Institute and took the helm of the Task Force this past May. “This is a viral strategy, if you will.”
A pioneering approach
In tackling enormous public health challenges, the Task Force has, since its beginning, relied on collaboration. But while similar organizations have long partnered with universities, hospitals, or other public health groups, the Task Force was among the first to partner with drug companies—a strategy that has changed the way that public health work is carried out around the world.
It began 30 years ago with the Mectizan Donation Program. Mectizan, known in the U.S. as ivermectin, was developed by scientists at Merck & Co. in the 1970s to treat parasites in animals. A decade later, scientists discovered that the drug could also treat and prevent another disease that afflicts people: river blindness, which not only claims eyesight but also causes relentless itching. At that time, it was considered taboo for public health entities to partner with big pharma, but Foege took Merck up on its offer to donate the drug for as long as it was needed to eliminate the disease.
“A lot of public health people felt like, ‘How could you really trust a for-profit enterprise?’” Ross said. “Now we see that you can make this a win for all parties.” The partnership launched what is now known as pharmaco-philanthropy. In 2015 pharmaceutical companies donated $1.6 billion in medicines to the Task Force to treat or eliminate diseases.
Today the Mectizan Donation Program reaches more than 250 million people a year, and two years ago the scientists who discovered the drug were awarded the Nobel Prize for their work on river blindness. Still, big challenges remain, says the program’s director, Dr. Yao Sodahlon. One is getting the drugs to people who live in hard-to-reach places: remote pockets of rain forests or areas upended by conflict. Another is convincing people who don’t feel sick to take the drugs.
“That is one of the biggest challenges and it is very, very tricky,” Sodahlon says. “It is a matter of convincing, convincing, convincing, which means making a lot of noise that they can be infected without showing [signs of] the disease, or they can be free of the infection now, but that doesn’t mean they won’t be infected in the future.”
Sodahlon stays motivated by the successes. River blindness was eliminated in Colombia, Ecuador, and Mexico by 2015. As of December, Guatemala is free of new infection.
In 2016 the World Health Organization verified that another disease, lymphatic filariasis, had been eliminated in six countries, thanks in part to the Task Force’s work. Sodahlon’s home country of Togo in West Africa is soon expected to follow suit. Lymphatic filariasis is also known as elephantiasis because it causes the arms, legs, and genitals to swell to gross proportions. “It is truly disfiguring,” Sodahlon says, “and those who suffer from it [often] exclude themselves from society.”
Gass describes elephantiasis as both tragic and fascinating. “We all have our favorite parasite, and I cut my teeth here on this one,” she says. The complex disease is triggered by microscopic, thread-like worms that live only in the human lymph system. After the worms mate, they produce baby worms that circulate through the bloodstream, where they can be picked up through mosquito bites and spread to other people.
Until recently, testing for elephantiasis meant drawing blood in the middle of the night because that’s when the baby worms enter the bloodstream. “Can you imagine going to a rural village in Africa at midnight and saying, ‘I want your blood?’” Gass says. But diagnostic advances now make it make possible to test in the light of day, expediting the disease’s ultimate end. Gass says “we’ll throw a party” when that happens.
Bringing global health home
The work that the Task Force is doing in the developing world has major implications right here in metro Atlanta. “Caring about global diseases is important because we are only going to see more and more of them inside our borders,” Gass says. “Zika is a prime example.”
Going forward, the Task Force also plans to tackle noncommunicable diseases such as cancer, diabetes, and heart disease that claim the lives of many people in Georgia. The Task Force has been exploring ways to help identify and address health problems that are widespread in certain pockets of DeKalb county. The work begins with collecting and analyzing data on any number of factors that have been shown to impact health, including income, education level, and access to transportation.
“Public health workers are inherently in the information business,” says Ross, who currently serves on the National Committee on Vital and Health Statistics. “Imagine a dashboard that could readily tell county and city leaders, neighborhood by neighborhood, the forces that are causing health problems and what they can do about it,” he says. “We want to bring that technology innovation. We’ve been doing some pretty neat stuff in some pretty faraway places. We feel an obligation to bring that experience and expertise home.”
This article originally appeared in our January 2017 issue.