On June 20, 1983, Chris Elias was a newly minted MD from the Creighton University School of Medicine driving west out of Omaha to post-graduate work at the University of California, San Francisco.
“I was driving into the front lines of an epidemic,” Elias, BS’79, MD’83, HON’09, recalled Feb. 4 during the Dr. Robert G. Townley Keynote Address as part of the Global Health Conference Midwest hosted by Creighton. “A week later, on June 27, 1983, the Omaha World-Herald reported the first case of AIDS in Nebraska. No one mentioned AIDS when I was in medical school. And yet, a month later and for the next three years, about a quarter of the patients I saw were young men with AIDS, all of whom died because we didn’t understand what the larger science was.”
In an address titled, “Beyond Medicine: How Markets, Data and Partnerships Shape Global Health,” Elias, now the president of global development at the Bill and Melinda Gates Foundation, recounted his experiences on front lines extending from the AIDS crisis to the worldwide fight to eradicate polio, detailing how science, innovation, markets and compassion coalesce around a common goal.
In the epicenter of the American AIDS crisis, Elias said it was enough to try to stem the tide of daily diagnoses and death in the midst of an ongoing epidemic.
“It was a pretty dark time in medicine,” he said. “We could prolong life a little bit, but we didn’t understand the underlying immunology of AIDS at the time. We didn’t understand the associated illnesses and cancers. I was very focused, spending 100 hours a week with patients and I saw medicine through a very narrow lens. My patients were very sick. People were dying every day. What I missed was the broader social context of the AIDS epidemic.”
But it wasn’t until he had left UCSF for a two-year stint with the American Refugee Committee, working in a refugee camp on the border between Thailand and Cambodia that he came to a fuller appreciation of what was at work in his Creighton education and in what he had seen in San Francisco — a more global and social outlook on health and disease.
While working in the camp, someone sent Elias Randy Shilts’ seminal work on the AIDS crisis, And the Band Played On: Politics, People, and the AIDS Epidemic. The book told the stories of several men whom Elias recognized as patients he had treated.
“I met them when they were terminally ill and I didn’t know their lives outside of the hospital,” Elias said. “The book woke me up to that social context in which illness is constructed. It opened me up to my future career course and future studies.”
In the refugee camp, Elias said the medical staff were treating manageable diseases like pneumonia and diarrhea in children. But these were also easily preventable illnesses and in Elias’ second year in the camp, the American Refugee Committee began shifting to a focus on preventive and public health.
Elias, too, pivoted away from the clinical medicine he’d been pursuing and completed a master’s degree in public health from the University of Washington. From there, he set about working in nonprofit organizations aimed at disease prevention, encouraging healthy practices and technological development.
Prior to joining the Gates Foundation, Elias served as president and CEO of PATH, which oversaw the interaction of global markets, science and technology in helping create an inexpensive, widely distributed vaccine for meningitis. The vaccine was deployed to great effect in 22 countries in sub-Saharan Africa that, until 2009, experienced annual and devastating epidemics of the disease, with upwards of 250,000 cases reported annually causing 25,000 deaths, mostly in young people aged 1 to 29.
The effort required a massive undertaking between PATH, the national governments and industry, all of which combined to share technology and resources so that a vaccine could be produced at a cost of less than 50 cents per dose. The upshot has been the prevention of some 1.3 million cases of meningitis, staving off 130,000 deaths and 250,000 cases of disability. The vaccine has also freed up public health resources and removed a major financial drain on families and communities.
Burkina Faso, a central African nation hit hard by the annual epidemics, reported just three cases of meningitis in 2016.
Coming to the Gates Foundation in 2012, Elias is now overseeing the philanthropy’s project to stamp out global polio.
In 1988, when the World Health Organization announced a plan to combat the disease on an international scale, there were more than 100 countries around the world still suffering annual polio epidemics.
Since the Gates Foundation’s advent into the project in the last decade, the leaps have been exponential, especially in areas where the disease was most persistent: Nigeria, Pakistan, Afghanistan and India. But partnerships with industry and a revolution in how those on the front lines are getting vaccines out have managed to turned the tide such that there were only 37 cases of polio worldwide in 2016.
Elias said he is optimistic we could see the last cases of polio in the world this year and the disease could be declared eradicated as early as 2020.
“These are very complex agreements,” Elias said. “Scientists in industry are like scientists in academia. They want to make a difference. It’s finding a way to lower the cost of partnership. Not that the companies need a large profit, but they at least want something, or to break even. There’s no one template, it’s working with different companies, doing a lot of analysis to figure out how to reduce cost of goods, investing in science to find easier ways to produce, easier ways to manufacture, working on getting costs down so that it makes it at least not financially unattractive to each participant.”
Elias, who was appointed to the Creighton Board of Trustees in 2016, said his Creighton education has been a mainstay in his present career and has helped him seek to better understand the relationship of people with disease and with science, but also of people with one another. To be giving the inaugural Dr. Robert G. Townley Keynote, he said, was a great honor, for Dr. Townley was an integral component of what Elias has done with his life and career.
“What I really recall from meeting Bob as a medical student was how much he interacted and cared about the students,” Elias said. “He would ask you more questions until you found your own way into better inquiry into med and science. One of the great things the Creighton medical education gave me, in addition to the great values, the humility about what we know in medicine and what we don’t know. We have to be prepared to keep learning constantly. Our understanding of medicine will constantly evolve, our understanding of biology is constantly evolving. But it’s putting that into the people perspective that will remain crucial.”