prime minister of pakistan and said we need your help in holding people accountable to get the job finished. and he asked for a map showing where the problem was. it was a district map but it was all green. 95% of children were getting vaccinated in every district of pakistan. he said i don't understand a problem, supposed to do anything with this? we obviously were not properly managing the program. we went back and said it doesn't count if you say you were vaccinated. you need to have a purple mark on your finger, we marked the fingers of the children and we look at that and see whether or not they are truly being vaccinated. we brought in and put in place truly objective measures as to whether or not children were being vaccinated. by february this year, the prime minister had announced his action plan to hold of the ship of each district accountable to reaching their children with the

most basic of health services, then he put in place, on the bottom you can see the polio control room, they ran a trecker across the bottom of it showing this district leader failed to vaccinate his children, and by district leader isn't either and very quickly things started to change. and n basic management processes have to be in place and you have to hold people in place and we don't do that enough in public health. i tried to pull out some of the things that are, if not controversial, not being practiced. the second thing you need to do at this point, with the experience we have, you have to invest heavily in on the ground technical assistance. we all want to buy bed nets, we all want to buy vaccines, we all want to contribute that way. in many places where we operate, those children being missed, it is because the basic capacities

are not there to manage the resources you are putting at their disposal and you need to invest in building that capacity. polio eradication is the easiest task you're going to have, drops, even i have done it successfully, and we still need to put a lot of people on the ground. here is what we did in the polio eradication program. guess what year i was tired? when i arrived in geneva and looked at what we were trying to achieve globally, it was quite clear that we simply did not have the personnel, the expertise on the ground, to put in place the basic management processes. this is something i discussed with malaria people and everyone who uses these 3,000 people we now put on the ground because there seems to be a terrible distaste for it. but without people on the ground to manage the resources, build

the capacity, you're going to learn by trial and error very slowly with a lot more air than trial. this is the current distribution. you not only need to put people on the ground, this is a big challenge, you have to have the right distribution mix, you need to be able to move people. as you can see here, the distribution of people reflects the epidemiology and the risks of the program to the program. the other thing you need to do is to be flexible and be able to respond with your human-resources to where your problems are. this is the last reservoir, we believe, of type i polio, this is the kosi river through the northern part of the country and this is the ganges river and this is where they meet. this area around the river is a massive flood plane. every time you see in the of

flooding and people standing on their roof, you're looking at this part of india on tv. this, also, is where polioviruses are right along this area. when you look at what was in place to serve these people, to manage the program, there was one primary health care center within the flood zone area if i remember correctly, for an area of 100 kilometers, 20 kilometers wide, ten million people during the flooding periods. you need to be able to put in place if you want to reach these children, you have to put in place the infrastructure to do it and this is what our team in india did. they laid down very quickly a whole infrastructure to deliver not just the polio vaccine, routine vaccinations, other basic interventions. you have to put that

infrastructure in place. the third thing, speaking to the memory of bathwater, you have got to establish robust capacity for all aspects of communications. this has become one of the biggest, most diverse parts of our program which i am not going to go through in detail. just to give you detail of the point class a, i spoke to this team in india who sent this out, i asked for his reflections on a roll of communications in polio and you can see what he said here, it has required us to think differently about the communities, especially the muslim communities where the disease predominated, to understand the structures, the networks, and deeply penetrate that and engage with that community, develop the trust to make real change. we learned a lot of other lessons. toward the bottom, something we

had not been good at, a lot of the above, we could have read from a textbook. one of the things we learned from the polio program was the importance of scale when it comes to the communications side of what we're doing. you scale of the technical assistance, the refrigerators, vehicles, everything else, and we try to run the communications on a pittance. as an afterthought, what is very clear is certainly to finish eradication to reach these populations, we had to invest heavily and we had to make sure it was data driven. everywhere we build our communications capacity it had to be in response to we had to reach and when we were seeking to achieve theire. this is how we had to reach the muslim communities in seeking

not just polio vaccine but any vaccine. they were vaccinated against polio, and we put nearly 5,000 part-time people on the ground, these were people within the communities, we trained them on social mobilization, interpersonal communications, begin the process of building the community engagement needed to eradicate polio to get the population of to the levels that would stop transmission. as we work with communities to engage them as well, this required use of another tool we were not used in immunization or the areas i was working in, that was widespread use of social mapping to figure out how do we reach these populations. for those of you know, communications is second nature for those of us who are doctors, and use to approaching medical problems. lot of this is, to a certain

degree, new. this is an example from the tribal areas of pakistan and afghanistan, they have mapped out along the different parts of this trial agency, fm radio, they will need to have taliban meetings, to engage the communities. increasingly, more sophisticated social mapping to figure out where the people are and what they will respond to. the other thing is bringing in professional management, accountability, and we're doing in the area of communications. this is just an example of using indicators to monitor what is happening in terms of social mobilization impact in august and july. we began investing heavily in terms of community mobilized errors in this area and you can see over time what happens in

terms of refusals. finally, the need to developed special strategies for specific issues. as you can see here, not everyone and not polio eradication was a wonderful idea. we had to adapt our strategies as we went forward to deal with these issues, to ensure the communities were fully engaged. using locally appropriate mechanisms with community dialogues in northern india to achieve that. this brings me to one of the 4 big lessons we learned, this is the lesson in terms of advocacy. we are getting extremely good in the world of international health at national advocacy, the advocacy of rock stars and heads of state. but the reality is that will raise awareness of we're trying to do and raise resources for we are trying to do but will not necessarily get the children

vaccinated. in the federal republic's where we are working, federated republics, we need to be operating at the sub national level and this is an area we are not very good at. if you look at where polio exists in india, 2 northern states, there are 2 achieve ministers who between them head what would be the sixth biggest country in the world if it was an independent country, a population of three hundred fifty million people. to engage with people like this, to affect change, you have got to advocate at a sub national level. we engage in the national level, rock stars worked at the national, international level. what has been impressive when we look at one of the lessons has been our ability to work, to

learned to work at the sub national level. these are the most impressive photographs from the eradication program. you have the director general of who, not meeting with the prime minister because that was not the key eradication but the chief minister travelling out to where she was based to understand the challenges and how do we help. in the bottom picture, here she is on the border with pakistan with the governors, the leadership of that key province. this is a picture of mr. gates's trip to nigeria, he went up north, met with the leaders of the traditional leadership, the sultan of sikoto, and he met with the nigerian governors who led the true believers to the vaccination of children in those areas. not just advocates, we talk about advocacy but advocacy at

the level where it is going to make a level of getting kids vaccinated. you have to get to the subnational level and there are not a lot of mechanisms for doing it, we are not good at mapping that politically or planning out who can advocate with those players effectively to engage in international and national goals. it can make a big difference. one of the major milestones of eradication initiative recently passed when the governor of kano stopped polio vaccine for 12 months, leading to the biggest international outbreak of polio we have seen in 60 years. for reasons related to concerns and public confidence in the safety of the vaccine, in january of this year, he vaccinated his own child of polio using oral vaccine to restore community confidence and get this moving faster.

this effective advocacy at the sub national level, this was 5 years after the national leadership came back on board. this may difference, we have seen a drop by 75% in proportion of mist kids in the first quarter of this year as a result of direct engagement and leadership on it. there are many myths about the polio eradication program, anything that runs this long and his wife is going to generate myths, but one of them is the fact the we don't do research. one of the most important lessons has been the need to maintain an active research program, and that is very much what we have done. the lesson we would suggest in terms of the title here is to maintain the active research program especially if you think you know all the answers. with the polio eradication program, it began with great fanfare in 1988 saying we prove

folio can be eradicated. all you have to do is apply the same strategy everywhere and the disease will be eradicated. people are different in different places, the approaches are different in different places and you need different solutions. you will constantly be surprised, especially in eradication, and as we go for universal coverage of anything, as you get out to the periphery, geographically, culturally and epidemiologist plea -- babbitt genealogy -- epidemiologically you will be surprised. after the initiative was launched we were introducing new tools. vaccine for introduced in 2005 after a 6 months development process, thanks to our friends in sanofi who took on a fifty million dose order, and you decided to help us do this.

was that procedure implemented in 2006 that half the time we needed to eradicate polio. look at the application of these tools, on the left-hand side, we see the maps of pradesh and the one area of india that never stopped polio, this area of pradesh of 3 year, this area of the country, every other fires we have seen is genetically linked, this has been the key reservoir whe never stopped folio. we have gone two months without polio, we are still trying to clear it out but the research generated the solutions very

late in the game to solving that problem. three other big lessons we learned along the way, the most self-evident is we need a lot of money to reach the last 20% in particular about what might not be as obvious is the need for truly sophisticated fund-raising and financing. we need just -- not just the money but a diverse funding stream. we look at the polio program financing, this shows a breakdown of where the $7 billion spent on polio have come from. you can see 49% from the multilateral sector, 15% is a little higher now. private sector, 20%. domestic resources, actual cash into the program, about 14%, and

others, 5% of the resources. quite a diverse mix. if you rich look to this program of the financial sector at any time, a 5-year period, you will see it changing dramatically to adjust to the realities of who can pay for what and who is willing to pay for what. there's still a substantial financing as you can see, $345 million despite the generosity of these players, in particular, in this big orange block, rotary international which has played an extraordinarily special role in this program not just as one of the initiators but in bringing financial resources, political advocacy and volunteerism on the ground to getting the job done. the importance of having a diverse range of funding is reflected in this graphic.

this shows the trend in g 8 contributions in polio eradication. not since 2005, it shows the period from 2003 through 2013, the reason 2005 is important is that was the year of the gleneagles summit in which the g 8 made a commitment to sustain or increase its contributions to polio eradication until the job was finished. that was in 2005. you can see the proportion, they made that commitment as a proportion of the contributions to the program. as you can see they went from a peak in 62% with the overall funding to 43% of overall funding, down 20% to what is confirmed in the current period for the program. you have to have in place not just a very aggressive advocacy agenda to maintain your funding,

but also other funding streams to adjust for problems like this. the seventh lesson we learned was protect your gains. as we move forward, we have a terrible habit of moving on to the next thing and taking our attention away from our successes only to see them dwindle again and perhaps the most striking example of this in polio eradication is we have not been able to protect a lot of the polio free areas because of chronic gaps in routine immunizations services. you can see the spread internationally of polioviruses from india and nigeria in the past 25 years, this resulted in over 30 countries getting reinfected at one point or another. and cost $50 million in outbreak

response activities alone. many people say why don't you continue polio campaigns in these areas? we did. four countries, sudan, chad, chronically polio infected, cleaned out, reinfected. they have done 150 polio campaigns in the last 7 years. looking forward we have strategies for continued trying to campaign the highest risk area to keep it polio free but we need to see real progress on routine immunization and need to be part of that solution. the final lesson we learned the hard way and completely obvious to everyone who might have remember the original target

date, planned for the contingencies because it will take longer than you think and is going to cost more money than you think. one of the things we learned through eradication is it doesn't end with just interrupting the polio virus. taking a timeline for the post eradication period, you can see once we stopped the last wide poliovirus, we have a multi-year program at work to make the world free of polio altogether which would include stopping the use of the oral polio vaccine and eventually verifying the elimination of that which you alluded to in your comments in vaccine derived polioviruses. that summarizes the big lessons we learned in the eradication initiative. i didn't speak to the ones that are the most obvious, but it has been the issues of management, on the ground technical expertise, communications, national advocacy that have really made the difference in

getting polio vaccine to the children that are being reached. i have 4 or 5 slides to show you where our emphasis is. this is where the countries and areas affected with polio over the last 6 months, the dots are in red for type i polio and type iii, type ii has been eradicated, we saw the last case in 1999 in india during the wild polio virus. we have that associated with tight ii and outbreaks due to the vaccine derived poliovirus that this is what the picture looks like with wild viruses. the northern part of india, pakistan, afghanistan and nigeria, have never interrupted their indigenous polioviruses but in addition to that we have another group of countries that are infected as a result of

spread from nigeria as well as shad and the sudan, those are the key countries that affect the spread in this area and in addition we have the challenge we are facing because of the spread of polio from in the and angola. i don't want to be late for everything we want to do to get the job of the revocation published. it is not the topic of today's discussion but i have touched on a lot of the things we are doing over the course of my presentation. the key thing will be sustaining implementation. we have an independent evaluation on going of the major barriers to interrupting transmission. hopefully we get a fresh look at what we're doing in each of the remaining infected areas. we are assessing a number of new approaches, we are evaluating a new vaccine with type i and iii to augment the tools we have, taking additional strategies to limit international spread.

to give you a sense of the scale of the international response to the outbreaks that are ongoing, the scale and the complexity of the coordinated outbreak response in the horn of africa and west africa to get this finished. when we speak of the new approaches we are trying, one of the things we just had agreement with the nato forces in afghanistan, of of southern zones of afghanistan is to work on the highest districts that seem to be sustaining transmission of polio in afghanistan, to reach sufficient children in a safe enough environment to get the job finished. from a technical perspective, we are -- the data are brand-new, can we accelerate the eradication initiative with of polio vaccine that targets the type i lira and the type iii in one vaccine? we are taking the time ii

component out. this is a picture of me making the vaccine. you can see in this graphic how promising this might be. the final push to limit eradication. you see on the far left, this is the response after two doses of a bivalent vaccine and  similarly, a similar result for type iii, this is data we got last week, looked superior to the trivalent vaccine, type i and takes iii and not in theory to the monovalent vaccine, there's not a statistical difference but this may simplify the logistics of reaching kids in sub-saharan africa with more efficacious vaccines and also in the conflict affected areas of

afghanistan and pakistan to get the job finished more quickly. you can see from this map the complexity of the situation we are facing. many countries are still affected with polio. very few districts in the world have polio as you can see. the challenge of these practices and outbreaks in west africa, with the range of new tools, political commitments, etc. i believe we can indeed accelerate the progress we're making to reaching all children and eventually eradicating this disease forever. if there is one last lesson i might close the presentation with, it is this one. if we have learned one thing, it has been that in this battle as in any, no plan is going to survive contact with the enemy, you have to constantly be revising it as necessary to reach the kids, which indeed we can as shown through this

program. thank you. [applause] >> coming up on c-span 3, house hearing on regulating the insurance industry, particularly in the financial sector. we will hear about efforts to craft regulation in preventing events like the collapse of insurance company aig. that is live at 10:00 a.m. eastern on c-span 3. the senate energy and natural resources committee is in the process of wrapping up its work on an energy bill. next, the panel's top republican, senator lisa murk s murkowski , shares her thoughts with reporters. this is just over an hour.

>> good afternoon, i am barry worthington, executive director of the united states energy association that it is my pleasure to welcome to our newsmakers series, senator lisa murkows murkowski. this is all on the record, as all of our briefings are. she is the senior senator from alaska, only the sixth senator from alaska and the first born in the state. she was elected to three terms before joining the united states senate in 2002. she is with us today because she is the ranking republican on the senate energy and natural resources committee, she is also a member of the senate appropriations committee, health education, labor and pension committee and the senate indian affairs committee. we know and understand how busy she is, particularly these days. we appreciate you taking time from your schedule to be with

us. we normally ask our guests to speak for 15 or 20 minutes or however long she prefers and open up for questions and try to be done in an hour. >> i appreciate the opportunity to be here with you. timingwise it works out pretty well considering we are talking about energy this afternoon. that has been the focus of my life for the last 3 months as we have worked to advance an energy bill. i was at a gathering of few days back and somebody commented that the energy bill coming out of the senate energy committee was the longest, most torturous markup that they had participated in, and that was a good thing. was interesting that they framed it that way. complaining that it