CDC EARNS EDELMAN AWARD

Centers for Disease Control and Prevention receives coveted prize for its ongoing, optimized, worldwide efforts to eradicate polio once and for all.

By Peter Horner

Members of the 2014 Edelman winning-team, headed by CDC’s Mark Pallansch (second from right).

Thanks to the longstanding, widespread and effective use of vaccines, the United States hasn’t had a reported case of polio in 35 years. The dreadful disease has been nearly wiped off the face of the Earth since then, but the threat isn’t over, at least not yet. The virus remains active in small pockets of Pakistan, Cameroon and Syria and a few neighboring countries, and until polio is eradicated worldwide, any country is just a visit away by an infected person from having polio potentially re-introduced within its borders.

“Scenarios for polio being introduced into the United States are easy to imagine, and the disease could get a foothold if we don't maintain high vaccination rates,” explains Centers for Disease Control and Prevention’s (CDC) Dr. Greg Wallace, National Center for Immunization and Respiratory Diseases. “For example, an unvaccinated U.S. resident could travel abroad and become infected before returning home. Or, a visitor to the United States could travel here while unaware that they are infected. The point is that one person unknowingly infected with polio is all it takes to start the spread of polio to others if they are not protected by vaccination.” [Source: CDC website]

To underscore that point, on May 5 of this year the World Health Organization (WHO) issued a warning of the possible spread of highly contagious wild polioviruses (WPVs) and imposed restrictions on travelers leaving the three countries mentioned above, requiring those travelers to get a polio vaccination and carry a card attesting to the fact that they did.

Ironically, or perhaps fortuitously, just over a month prior to WHO’s announcement, INFORMS bestowed its most prestigious prize, the Franz Edelman Award, on the CDC for its ongoing, worldwide efforts to eradicate polio.

Following a series of presentations by a half-dozen Edelman finalists at the INFORMS Conference on Business Analytics and Operations Research in Boston on March 31, a panel of judges headed by Edelman Award Committee Chairperson Peter Bell deemed CDC the winner. INFORMS President Stephen Robinson made the dramatic announcement that evening at the Oscar-esque 2014 Edelman Gala before a ballroom full of conference attendees. The winning entry, titled “Using Integrated Analytical Models to Support Global Health Policies to Manage Vaccine Preventable Diseases: Polio Eradication and Beyond,” outlined the CDC’s and its partner Kid Risk, Inc.’s optimized efforts to eradicate polio from the planet once and for all.

“This work has been fundamental to so much of what’s happened in the polio eradication program over the last few years, and it has helped to support many of our decisions over the last decade and to bring the world much, much closer to one where future generations will never know the terror of this disease,” says Dr. Bruce Aylward, WHO assistant director-general of polio, emergencies and country collaboration.

In accepting the award on behalf of the winning team, Mark Pallansch, Ph.D., director of the division of viral diseases at CDC, thanked a host of people, including the Edelman judges and team coaches Sid Hess and Pelin Pekgun; Kim Thompson and Radboud Duintjer Tebbens, president and vice president of Kid Risk, Inc., respectively; as well as additional partners and colleagues from the CDC and elsewhere.

“This has been a long journey,” Pallansch said. “Certainly there have been many colleagues in addition to those on the stage tonight who contributed to this work over a long period of time, and it has been a pleasure to work with all of them … working for the goal of polio eradication.”

Pallanach went on to note that when the collaboration began, everyone involved had much to learn about each other’s area of expertise, including Kid Risk about polio and the CDC about operations research.

The Project

Thanks to extensive vaccination, India has been polio-free for three years.

Thanks to extensive vaccination, India has been polio-free for three years.

As described in the Edelman Gala Program, the CDC, a spearheading partner of the Global Polio Eradication Initiative (GPEI), annually contributes more than $100 million of its budget and significant human resources to polio eradication activities for which it maintains high standards for developing evidence-based policies and expectations of cost-effective use of its resources.

In 2001, the CDC launched a collaboration with Kid Risk, Inc. to use a range of operations research and management science tools combined with the best available scientific evidence and field knowledge to develop integrated analytical models for the evaluation of the global risks, benefits and costs of polio eradication policy choices. For example, as world leaders began to consider the end game that would follow the successful eradication of wild polioviruses (WPVs), questions emerged that demanded rigorous answers, such as: “What vaccine (if any) should countries use after WPV eradication?” and “What risks will need to be managed to achieve and maintain a world free of polio?”

The team systematically developed each of the components required to support integrated analytic models, including clarifying the policy options using a decision analytic approach, developing a dynamic disease model for polioviruses using a system dynamics approach, and characterizing the risks and costs of the options with sensitivity analyses. By providing both analytical structure and a synthesis of the existing evidence, the team effectively engaged a wide range of stakeholders with diverse perspectives and values. The ability of the team to help decision-makers visualize and quantify the expected impacts of their options encouraged effective dialogue and shared understanding of critical issues and uncertainties.

The analytical results from the collaboration significantly furthered polio eradication in many ways, including more rapid response to outbreaks and reaffirmation that pursuing eradication instead of control is the “best buy” to prevent cases of paralysis and to save lives and money. The results also supported global policies to coordinate global cessation of the use of oral poliovirus vaccines after successful WPV eradication and awareness of the challenging dynamics associated with ending the use of a live virus vaccine.

At a time of increased skepticism about the potential for achieving polio eradication in India, the collaboration demonstrated through modeling that success depended on the degree to which India intensified its immunization efforts to increase population immunity and the problems associated with a wavering commitment. Remarkably, the government of India successfully stopped endemic WPV transmission in early 2011, and recently celebrated three years of polio-free status.

The collaboration estimates that between $40 billion and $50 billion of net benefits by 2035 will be associated with the GPEI. Recognition of polio eradication as a major program in need of stable financing helped support a fundraising effort in 2013 that raised $4 billion from donors to finish the job.

The team foresees increased integration of operations research and management science tools to perform simultaneous probabilistic and dynamic modeling for other complex global health challenges, including other vaccine-preventable diseases such as measles and rubella.

The Edelman presentation also noted that while the key to polio eradication – universal vaccination, follow-up surveillance and treatment and supportive public health policies – has been known for decades, the global effort to achieve the goal has been hampered in some countries by politics, poverty, ignorance and misinformation.

The Team

As part of the U.S. Department of Health and Human Services, the CDC serves as the primary federal agency for conducting and supporting health protection activities in the Unite States. According to the CDC website, the fight against polio has been part of CDC’s mission since the 1950s, and the global push to eradicate polio is just the latest chapter in CDC’s polio efforts. CDC’s Global Immunization Division leads the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI).

Kid Risk, Inc. according to its website, “strives to empower policy-makers, parents, kids and others to make better decisions for children and recognizes that managing risks and resources well represents the key to realizing the best possible futures for everyone. Kid Risk, Inc. researchers focus on bringing a diverse set of operations research and management science tools to high-stakes challenges that involved risks to children.”

“The global eradication of polio involves not only all the countries in the world, but also many, many stakeholders that have put in a great deal of effort over a very long period of time,” the CDC’s Pallansch said after the award presentation. “This includes the World Health Organization, Rotary International, UNICEF and the CDC as spearheading partners, as well as recent contributors such as the Bill and Melinda Gates Foundation.”

Pallansch, a biochemist, said he has always had an affinity for operations research, and his appreciation for O.R. has only grown stronger given his experience with the Edelman-winning project over the past decade.

“There are opportunities in the government sector to utilize more effectively operations research,” he says. “In fact there are processes and activities within the government where we can indeed improve what we do, but at the same time in the public health sector in particular, I think there are opportunities for broadening the perspectives of operations research to include things that are prevention oriented. It’s the harm that is not done that is increasingly difficult to quantify going forward.”

The Judges

Widely considered the “Super Bowl” of operations research, the Edelman Award involves a nearly year-long, international competition that begins with nominations, continues with a vetting process and concludes with a selection of finalists capped by presentations before a panel and judges at the INFORMS spring conference and the ultimate selection of a winner. As is the case almost every year, the Edelman judges this year faced a difficult decision differentiating between the six finalists, half of whom were active in the healthcare sector.
The other finalists included:

  • Twitter, with Stanford University, for “Who to Follow System at Twitter: Strategy, Algorithms and Revenue Impact”
  • The Energy Authority for “Hydroelectric Generation and Water Routing Optimizer”
  • Grady Memorial Hospital, with the Georgia Institute of Technology, for “Modeling and Optimizing Emergency Department Workflow”
  • Kidney Exchange at the Alliance for Paired Donation, with Stanford and MIT, for “Kidney Exchange”
  • NBN Company, with Biari, for “Fiber Optic Network Optimization at NBN Co.”

Along with Bell, this year’s judges included Srinivas Bollapragada, Debra Elkins, Don Kleinmuntz, Russell Labe, R. John Milne, Patricia Neri, Leon Schwartz and Michael Trick.

“It was an interesting year because there was only one private sector finalist, Twitter, two non-profits and three healthcare finalists,” said Edelman Chairperson Bell, who has served the Edelman competition in many capacities for many years. “Any one of the six would be a worthy winner.”

So what made the difference?

“You are looking for a high-impact piece of work that is theoretically sound, that has changed the way people do things, one that has had an impact on a strategic level,” Bell added. “The CDC certainly met those criteria, and who could argue with eliminating polio as a project worth attacking?”

Schwartz, an Edelman judge for 25 years, agreed that the decision was a difficult one, given the quality of the six finalists’ work and presentations. “It was a very difficult decision,” Schwartz said. “The CDC had something that would have a lasting impact on the entire world – the eradication of polio. You might think, who cares, it’s eradicated in the United States, but then you look around the rest of the world, particularly in places like Afghanistan and Pakistan where war is going on, and polio has not been stopped completely.

“This work started in 1988. Since then, India, which was a problem area, just celebrated three years without polio. The amazing part of it to me is it involved so many different organizations and countries, and they had to convince all these different people to change their whole way of thinking about how to approach the disease and that made a difference.”

Peter Horner (horner@lionhrtpub.com) is the editor of OR/MS Today and Analytics magazine. Sources include Barry List (director of communications for INFORMS) and the CDC. For more on the 2014 Edelman Award, including a video of the award presentation, visit https://www.informs.org/Recognize-Excellence/Franz-Edelman-Award.