11 minute read

A Shot in the Arm

Saving Lives Through Vaccination Takes Global Action & Local Solutions

Violaine Mitchell ’81 off-handedly remarks that she was on the phone with the Vatican the other day, talking about vaccines with a cardinal. She realized later that perhaps she had used a loaded word when she called inoculations “miracles” during their conversation. “But I do believe vaccines are pretty miraculous,” she says. “They have so utterly transformed the world we live in.”

Mitchell ought to know. Working for the Bill & Melinda Gates Foundation as the director of health funds and partnerships, she oversees a team of 20 Seattle-based staff who work to improve healthcare systems and access to routine childhood vaccines for preventable diseases, such as polio, pneumonia, measles, and rubella in more than 20 countries, including Afghanistan, Pakistan, Central African Republic, Ethiopia, India, and Mozambique. She’s been part of the Gates Foundation success story that has, since 2000, reduced by 50 percent the deaths in children under five from preventable diseases. This includes time spent working in northern Nigeria, helping to eradicate wild polio in Africa. She’s also had a hand in campaigns to provide meningitis vaccination in sub-Saharan Africa and to end maternal and neonatal tetanus and yellow fever in 57 countries.

Since the coronavirus pandemic hit, Michell has shifted gears to finding ways to improve access to coronavirus vaccines in developing countries. Her projects revolve around the Gates Foundation-funded organization, Gavi, the Vaccine

VIOLAINE MITCHELL SPEAKING AT THE GATES FOUNDATION.

Mitchell is among the global players of the world in community health and vaccines, providing expertise during one of the most unprecedented times in our history.

Maternal education is the most powerful indicator for child survival and Mitchell advocates for increased investment in this area to save lives.

Alliance; its global coalition, COVAX, which fosters the development of new COVID-19 vaccine candidates; and the COVAX Facility, which negotiates pricing for the vaccines and makes sure they are distributed equitably around the world. These entities have played an essential role in getting the AstraZeneca and other approved vaccines into developing countries, especially those places that don’t have ready access to cold storage, such as many countries in Africa.

Her high-stakes work is challenged by international politics, vaccine shortages, and various technical issues in delivering vaccines at the individual country level. She also must navigate the fact that the coronavirus pandemic has caused routine immunization and other healthcare services to be suspended in more than 30 countries, leading to otherwise-preventable outbreaks. There’s also the problem of developed countries prioritizing their own populations for coronavirus vaccines ahead of poorer countries, which she calls “vaccine nationalism.” And at the same time, she must overcome vaccine skepticism; she explains that many people don’t appreciate how important vaccines are. “The better you are at delivering them, the harder it is to convince people to take them, because they don’t see the disease,” she says. “Pretty much every doctor under the age of 40 has never seen a case of tetanus in infant meningitis. It’s hard to get people to believe that you need to vaccinate to maintain this level of immunity.”

As a practitioner and advocate of public health, she looks at vaccines as “a community responsibility, as what we do for others, so we can protect those who really cannot take a vaccine.” Of the importance of vaccinating everyone, no matter where they live, she says, “No one is protected until everyone is protected.”

The arc of Mitchell’s life seems to have led to this moment. She grew up on a 5,000-acre beef cattle farm in Kenya, where some of her formative experiences included seeing children succumb to diseases other countries had already found a way to manage. “I knew kids who died of measles, tetanus,” she explains. “These were things that are just so preventable with an easy vaccine.” She also gained a global perspective from a young age, attending an internationally diverse and multiracial school in Nairobi, while also being influenced by her parents’ work—her father worked at the Ministry of Tourism and Wildlife in Kenya, involving international development, and later at the World Bank in Washington, D.C., where the family moved when she was 12. Her mother ran the International Institute for Education in Nairobi, helping to place Kenyan students in U.S. universities.

Though her work with the Gates Foundation has taken her around the world, her life today is centered, physically, on a 200-acre farm in Metchosin, British Columbia, on Vancouver Island. Yes, she carries a heavy load of responsibility for life and death at a global level, but at Stillmeadow Farm, she is also responsible for life and death—of her 100 sheep, 400 pigs, and 1,000 chickens, along with the grains she grows for bakeries and breweries in the region and the native wild plants she is cultivating to restore wildlife corridors. She works on the farm in the evenings and on weekends; every Sunday she helps her husband load pigs for market and sell pork chops; and every Christmas she takes time off to lamb. “Lambing,” she explains, “involves getting up every three hours, so basically being a nurse midwife to the lambs”—which she loves.

She’s had a relationship with animals from the beginning—especially riding horses. One of her early claims to fame was becoming a riding double in the Born Free television series. She remembers being chased by a waterbuck while on her pony and coming across a Somali lion. Later in life, at Brown University, she became interested in the transmission of diseases between animals and humans. There, she was awarded the Arnold Fellowship, a stipend that allowed her to work in Egypt with an NGO, observing real-life problems, understanding people’s needs without judgment, and finding cooperative solutions. She brought together Catholic Relief Services, Oxfam, and other organizations to start an animal health center after identifying several problems concerning communities and their domestic animals that resulted in huge—and preventable—losses to local economies and incomes.

Another issue in Egypt that led her to pursue vaccination work was when she noticed infants with tetanus and realized they were contracting it because midwives were using old razor blades to cut umbilical cords. Again, she used her skills in problem solving and connecting resources to bring UNICEF into the fold and started a midwife training program to give the women the skills they needed for disease prevention.

Perhaps the moment that led her directly into the coronavirus pandemic role she plays today is when she noticed diarrheal diseases in kids who were living with livestock in the area of Egypt where she was working. She delved into the work of a scientist at Harvard who specialized in zoonotic diseases and began corresponding with him. He in turn encouraged her to come to Harvard, where she obtained her master’s degree in tropical public health.

From experiences at the Institute of Medicine in Washington, D.C. (now called the Academy of Medicine), working on issues of international vaccination for children and malaria prevention, she realized that, generally, not many other people were interested in vaccines, even while vaccines are among the most cost-effective health interventions available in the world. She found her calling, and, she says, “I never looked back.”

Successful vaccination campaigns are about more than science, cost, and distribution. They involve a collection of moving parts, with different solutions that fit the needs of different countries, cultures, and communities. Part of Mitchell’s success in her field comes from her ability to connect

with people. She is warm and forthright and laughs easily, with a big toothy smile, and she spends a great deal of time fostering relationships and building partnerships at the global level and the country level. On any given day, she might be talking with a country’s minister of health or foreign affairs office, leaders at the World Bank, or the Biden-Harris administration; at the same time, she and her team have spent time in the field, talking with local people in communities, learning about their lives and needs.

She stresses the importance of listening to and empowering others—“really trying to understand people’s context and the challenges people are facing, and resisting the urge to jump to solutions before you’ve really understood the challenges, working collaboratively with people to develop programs.” She worked hard in Nigeria, for example, developing the trust of traditional leaders so they could encourage people in communities to get immunized against polio, an approach that helped overcome hesitancy and even hostility to vaccines. These types of personal interactions can make all the difference; in both India and Nigeria, she explains, polio eradication happened “when governments and communities really took charge, owning the program” in their own way.

Woven throughout her global vaccination and health care work, one of Mitchell’s biggest ongoing interests is empowering women. She mentions that maternal education is the most powerful indicator for child survival and advocates for increased investment in this area to save lives. She also says that “Eighty percent of health care workers in the world are women, and less than three percent are in leadership positions.”

When she considers programming or staffing at the Gates Foundation, she finds herself always asking, “How is this affecting or how is this drawing in women? What are the barriers and constraints that women have? Not all women are facing the same issues.” For example, she says, in many countries where Gates works, women who are divorced or are the single head of a household might need help setting up a bank account. In other situations, making sure health clinics are open during hours that working female heads of households can come to a clinic is essential to ensuring basic healthcare.

She recalls back to when she got accepted at her graduate program at Harvard—she was the only woman in the program, and the only person without a medical degree. At first, she felt like she might not belong there or that other faculty didn’t think she belonged there. Her mentor was encouraging, however, and now she’s among the global players of the world providing expertise during one of “the most unprecedented times in our history,” as she describes it.

Mitchell wants to encourage young women at Holton and elsewhere as well: “Go for it,” she says of their ambitions and goals. Don’t get caught up in doubt. “Follow your heart, believe in yourself, and support each other. You can do this.”

When she recalls her own Holton days, it seems Holton is where she first practiced the art of failing, learning, and persevering. She tells the story of how, after losing the election to become 10th grade representative, she solicited feedback from friends, classmates, and teachers to learn how she was or was not presenting herself as “someone who would listen and represent others’ views and perspectives.” She reflected, she recalibrated, and she ran again, winning the position of 11th grade representative and later, Representative Assembly director. Through this process, she internalized a message that she has carried with her throughout her life: “Everything is possible.”

This is the mantra she uses when talking about eradicating wild polio in Africa. “It was an incredible feat that nobody thought was possible. And yet it was possible.” And it’s the mantra she is taking with her in all her next steps: strategizing a plan to eradicate polio throughout the world within the next five years; working with partners on finding a new path forward to “re-envision health care services” altogether, to battle the “huge pockets of inequity in the world that are extraordinary”; and ushering in a vaccine revolution. “We’re on the precipice of moving into a new world, thanks to science and innovation,” she says. For example, she explains that opportunities are brewing for modular vaccine manufacturing, which would help make vaccines available faster by increasing the number of manufacturing sites, building modular or prefabricated manufacturing plants or adapting existing facilities for this purpose. At the same time, she says more vaccine manufacturers are emerging in developing countries, all of which she finds “very exciting.”

Making the impossible possible shows up in Mitchell’s life in everything she does. Back at the farm, she has calculated that she must put the rams in with her ewes 154 days in advance of the end of the annual December Gavi board meeting so she can be home in time for lambing. With her seemingly endless energy and enthusiasm, she also organizes a free local community fair each fall that involves a pet show, hayrides, a salmon and lamb barbecue, and local bands. She’s delighted by how much her community of about 5,000 people enjoys it, but she also says it’s “madness.” She explains how she might find herself in Geneva at a meeting, discussing the latest issues in global vaccination, for example, and someone working at the fair might call her about needing to order three more toilets. She laughs at the juxtaposition of her two different lives.

But, really, all the elements of her life are connected, her past and her present, people and animals, community and cooperation, and “global action with local solutions,” as she likes to advocate. In her life at the farm and abroad, she cites humility as being one of the greatest lessons—and the one that together with possibility, perhaps leads to lasting change. When ideas and solutions—whether a way to keep bears and cougars away from her sheep, or how to transform the outcome of a fatal disease—don’t initially work out, she pounds a few fence posts at the farm, while turning over in her head the limitless options for moving forward—and then she tries something new.