The Childhood Survival Revolution: How James P. Grant Convinced The World To Save Its Children - Forbes
James P. Grant was one of the greatest visionaries and social entrepreneurs of the 20th century. ... [+]
Bill GrantHe was one of the greatest visionaries and social entrepreneurs of the 20th century. This week marks the 25th anniversary of the passing of James P. “Jim“ Grant, the father of the Child Survival Revolution and legendary executive director of Unicef. Still way too unknown for the magnitude of his impact, Grant transformed the global health care sector, saving the lives of 25 million children during his lifetime, and preparing the ground for many more afterwards.
Under his leadership, within only a decade (1980-1990), vaccination rates for the six major killer diseases responsible for childhood deaths went from 16- 21% to 80% worldwide, a logistical and cultural masterpiece.
Similarly, Grant fought the number one cause of childhood deaths, diarrhea, thanks to a cheap solution: little sachets filled with glucose and salt, otherwise known as oral rehydration therapy (ORT), and effectively took on the fight against mental impairment in children by promoting iodized salt.
Ashoka’s Konstanze Frischen spoke with Jim Grant’s youngest son William (Bill) about key elements of Grant’s work, his impact and what drove him. Like his father, Bill has a passion for and has been working in development, and thus had the chance to sometimes professionally accompany his dad during the 1980s.
A Bold New Idea
Jim Grant saw an opportunity hidden in plain sight to solve a tremendous problem. At the time, an estimated 14 million children under the age of 5 were dying annually in the developing world — mostly from diarrhea or malnutrition, as well as from polio, tetanus, measles, tuberculosis, or diphtheria. Solutions existed — vaccinations and even remedies like adding 1 teaspoon of salt and 8 of sugar to 1 liter of water to stop dehydration from diarrhea. But they were only used in small pockets of the world, despite being cheap and simple, and for the most part didn’t reach those most affected. Grant set out to change this scenario. “Morality must march with capacity,” he said. He wanted to make these low-cost solutions available to communities everywhere in the world. The proclaimed goal: to cut the childhood deaths in half.
In an extraordinary marketing tour de force, Grant traveled the globe, forging alliances with a wide range of groups, from the World Health Organization to the International Pediatric Organization to religious leaders to grassroots organizations, and convincing governments, dictators, and royals alike to vaccinate their children and promote the fight against diarrhea. “The word impossible did not exist for him,“ says his son. “He was a relentless optimist.“
Unicef gave Grant the platform he needed to act on this bold vision but it required transforming the organization into a major global policy and implementation force — a change that would initially cause a lot of opposition. “Unicef had an impeccable reputation and had won the Nobel Peace Prize, but they had a modest budget and small impact, working with clusters of villages here and there. They delivered school books to some kids and Land Rovers to school inspectors,” remembers Bill. “And then came my dad and said: I want you to not double your impact, but to increase your impact 100 fold, and reach children everywhere.” There was almost a revolt. It took Grant two years to build up his internal team. Under his leadership, Unicef’s budget would eventually grow from $313m to $1 billion.
But over and beyond that, it was the alliances he forged with states and institutions, and the resources these partners put behind his cause, that led to the global breakthrough.
The Power of Marketing, or: Changing Mindsets
Grant had a rare talent for marketing. “Dad’s friends used to say that he could sell anything. But he chose to sell development. And he was brilliant at it. He knew what made people tick.” He won the arguments internally at Unicef. But more importantly, he won them externally. His son saw it up close — for instance, during a lunch with the governor of Casablanca that he attended alongside his dad. Not even halfway through the starter, Jim Grant asked for the salt shaker, pulling out a iodine dropper from his pocket to test the salt. “You could see that the governor was thinking: what is this crazy guy doing,” laughs Bill. “Ha!” he remembers his dad shouting out to the dazzled governor. “You’ve got a problem!” And he started to explain that the salt had no iodine, which was a problem because Iodine deficiency would lead to goiter, the major cause of mental impairment in children. “And on it went from there. By the end of our luncheon, the governor had dictated that all salts sold in the province of Casablanca had to be iodized.”
The story was no outlier. Grant was a showman, and he was obsessed. He would never miss an opportunity to convince and enlist those he regarded as most influential to change people’s habits. He would talk to kings, dictators, presidents, archbishops, imans — about diarrhea, polio or goiter, pulling out iodine testers and ORT sachets, and showing pictures of other heads of states with their grandchildren getting vaccinated.
Making the case that more children got killed by vaccine-preventable diseases than by bullets, he convinced leaders, rebels and religious leaders in El Salvador to halt the civil wars so children could get their immunization shots. These “Days of Tranquility” were later repeated in countries like Lebanon, Sri Lanka and the Democratic Republic of Congo. Through “Corridors of Peace” he helped get humanitarian supplies to people in Sudan, Uganda and Iraq. He also convinced Islamic leaders in Egypt to issue an edict recommending the education of girls.
What drove it home for the powerful? “If you do good things for the children in your country, parents will support you. They will vote for you, they will like you.” Grant knew it was important that leaders could harvest the praise. “Perhaps one of the reasons my dad is relatively unknown is that he always gave others the credit.”
Focus on Key Data to Stir up Competition
Grant was obsessed with statistics. And measurement. To be able to track success, he narrowed his focus to essential data sets. “At Unicef, he didn’t say let’s do these 60 things,” explains Bill. “He said we’re going to focus on the four that are most important.” These 4 — growth monitoring to fight malnutrition, oral hydration therapy against diarrhea, breastfeeding and immunization —would become known as GOBI, then later just “I” for iodine. Grant developed a flash index to compare countries, and would communicate weekly rankings and set targets. He would produce the State of the World’s Children Report every year.
This made progress powerfully measurable, and he would never miss an opportunity to let the powerful know how they were doing. “He would go to the president of Turkey, and tell him about the latest numbers from Colombia. Oh, did you know… he would start. I always saw him measuring and counting and tracking. It was what helped him get things done.”
In 1990, Grant convened the World Summit for Children, which he had been planning towards over 5 years. It celebrated the 80% global vaccination goal, and saw over 100 countries committing to reach further, specific, time-bound goals on child survival, health, nutrition, education and protection — the first time a U.N. conference had achieved such an agenda.
Grant had tested earlier how effective it could be to stir competition via data. In the late ‘60s, when he was leading the Overseas Development Council, he developed the Physical Quality of Life Index, which eventually friends of his from The World Bank took and turned into the human development indicators. Grant focused on three numbers: infant mortality, life expectancy and education. And then he started calculating and comparing countries and cities. He loved to point out that Sri Lanka got a higher PQLI index than Washington D.C. back then. No one believed him at first, so he would explain: ‘Well, more people are literate, they have a lower infant mortality and life expectancy is longer.’ It stops and wakes you up when you hear statistics like that.”
Entrepreneurship and Creativity Throughout his Life
Grant was born in China in 1922 to American parents and lived there until the age of 15. His grandfather was a medical doctor and built his city’s first major hospital. His father was the first doctor of public health in China. Jim went on to pursue a degree in economics from Stanford, and a law degree from Harvard, and became a public servant early. “He always took on responsibility. And he was always in key places,” remembers Bill. By the age of 25, he became the head of the U.S. foreign assistance to China. Shortly after, he negotiated multilateral agreements between Pakistan, India, Nepal and the U.S. government. And then he just kept going — e.g., senior positions at USAID, and becoming the founder and CEO of ODC. “He always went in and set policy. He hated wasting time.” That would also show in his personal life. He used to wake his children up at 6 a.m. on Sundays to take advantage of the full day to do projects — building a fort, going on a hike, an excursion. He used to show up not 2 hours, but 15 min, before a flight would take off. (“My mother didn’t like that,'' remembers Bill.)
And Grant was always hands on. When stationed in China with the military during WWII, he set up a restaurant and started selling food to American soldiers. Why? “He hated the food they were getting at the base,” explains his son. “So he hired some local Chinese cooks, got a restaurant going and fixed the problem.” When moving to New York for Unicef, he was challenged with finding an affordable place to live. “So he got this idea to build a house on top of a building; and then he went about building a house on top of a building.” He got the permits, found a contractor, and set to work. Nobody had ever done this before in Manhattan. “He was careful to never call it penthouse,” remembers his son. “He didn’t want to create wrong impression. And it wasn’t a penthouse. It was his roof house.”
What Would He Say Today?
In 2019, the WHO warned of a record breaking number of measles outbreaks following lower vaccination rates due to misinformation about side-effects. What would Grant say about the growing anti-vaxxer movement? “Oh, naturally, he would be against it,” says his son, “But he would never say these are evil people. He would say: How do we change this? He would figure out who the key decision makers are, the key influencers, and then he would go and talk to them, he would try to understand them. And then he would show them why it would make sense to start vaccinating. He could build bridges with anybody. He would seek and find common ground.”
Sometimes, he would come under criticism. “People didn’t always appreciate at first that he would talk to dictators, for instance. They would say, ‘how can you work with this person?’ And my dad would say: ‘Well, this person has the power to change the lives of the children in his country. And he will, because it is his country.’”
Sources and links:
William Grant. Interview notes. January 2020.
David Bornstein: How to Change the World: Social Entrepreneurs and the Power of New Ideas. (New York, Oxford University Press, 2001)
Adam Fifield: A Mighty Purpose: How Unicef’s James Grant Sold the World on Saving Its Children (Other Press, New York 2015)
Peter Adamson: Postscript and Dedication of The Kennedy Moment. (Myriad, 2018)
U.S. Committee for Unicef, press release (not yet published)
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