Leadership and progress

In some stories of progress, a key factor is a leader who serves as a driving and integrating force towards a techno-economic goal. Individual inventors may solve particular technical challenges, but sometimes what is needed is a mind that can grasp both the technology and its business potential, and pull them together and make them meet.

Arkwright seems to have played this role for textile mechanization: systematically seeking out inventions relevant to the process, completing half-finished innovations or adding improvements, and generally putting the whole thing together into a business enterprise. Westinghouse played a similar role for electric power. But these days I am thinking particularly about the field of diseases and how they are conquered.

One example is Harry Weaver, director of research at the National Foundation for Infantile Paralysis—“infantile paralysis” referring to the disease now better known as polio. The National Foundation was a well-funded and highly influential private charity that sponsored almost all research on polio, as well as paying for the medical care of polio victims.

Here’s how historian David Oshinsky describes what happened after Weaver came on (from Polio: An American Story):

After talking to a number of grantees, he told [foundation director Basil] O’Connor what both men already suspected: “only an appallingly few [are] really trying to solve the problem of poliomyelitis in man.” There was truth to this. The grand outline set forth by Thomas Rivers in 1938 for the conquest of polio had failed to light a fire. No one seemed to be in a hurry to move things along. Indeed, as the brilliant David Bodian later admitted: “The fact is that most of us [then] doing research on poliomyelitis were motivated mainly by curiosity, and by the challenges of the many unsolved problems concerning the interaction of virus and host, rather than by the hope of a practical solution in our lifetime.” Weaver had a plan.

The plan was to focus efforts on a vaccine. This was correct, because like the new coronavirus we are facing now, no other technique would work: as a viral disease, antibiotics were useless; and since it was transmissible between people, it could not be eliminated with water sanitation or pest control.

Weaver brought a sense of focus and urgency to the polio efforts. Oshinky writes:

As director of research from 1946 through 1953, he successfully harnessed the diffuse, free-floating energy of these fifteen polio specialists, among others, and focused it—too narrowly, some complained—toward a single goal. It was the charismatic O’Connor who led the national crusade against polio. It was the coldly efficient Weaver who provided the scientific blueprint for success. Weaver did not have imposing academic credentials. … What distinguished him, most agreed, was his “wonderful quality of being bold.” … “In research,” said Tom Rivers, “you often need a person like [Harry] around, you know, someone … to encourage people to see what the grass is like on the other side. In other words, a catalyst. Harry Weaver performed that function beautifully.” Weaver saw polio research as applied science—seeking a specific solution to a particular problem. For him, the solution to polio lay in a successful vaccine, and the problem in developing one lay in the foundation’s obvious failure to lead. For years, its grantees had been inching along on disparate, often esoteric projects, ignorant of each other’s findings, and painfully slow to challenge the accepted truths about the disease. Not everyone fit this mold, but there were too many who did, Weaver thought. It was time for a change.

One problem to be solved, for example, was to determine how many distinct strains of polio there were; a vaccine would have to protect against all of them. This “typing” work was routine, monotonous, and not prestigious. But it was absolutely necessary. Weaver launched a program to get it done, funded it, and put someone in charge who would complete it. Later, he helped launch the large-scale clinical trials of the polio vaccine, when many researchers associated with the foundation were against the idea. At every point, he kept up the forward momentum, until there was a vaccine.

Another example is D. A. Henderson, who led the effort by the World Health Organization to eradicate smallpox. As I wrote in my history of smallpox, Henderson gave energy and drive to the project, even with little support from within the WHO: regional directors were often uncooperative, and the WHO director-general at the time was actually against the project and expected it to fail. (!)

Henderson had to coordinate over a hundred thousand volunteers across dozens of countries. He and his team had to solve practical problems, such as: what tool would they use to administer vaccines? After some success with an air-powered jet injector, they ultimately settled on a simple two-pronged or “bifurcated” needle that could be used with little training, was very efficient with dosage, and could be sterilized and reused. He also faced strategic challenges. One key decision was not to attempt mass vaccination of every endemic population, but to adopt a targeted containment strategy focused on identifying outbreaks and vaccinating everyone who had come in contact with known cases.

Reading Henderson’s story, I had the distinct impression that a prime reason for the success of the project—the only one of its kind in history—was the existence of a competent leader with the conviction that it was his job to eradicate smallpox. It was that combination of full-time focus and energy, together with a willingness and ability to solve any problem that got in the way, of any kind: medical, financial, logistical, or administrative.

Progress doesn’t always happen because of a single leader. Sometimes many people contribute in separate or loosely coordinated efforts. The development of railroads could be described that way, for instance.

But it seems to me that we’d be doing a better job fighting COVID-19 if there were someone qualified who believed it was their job to solve it. The solution is an integration of clinical, pharmaceutical, diagnostic, logistical, economic, and social issues. We need to ramp up both hospital and test capacity, manufacture and distribute equipment from masks to ventilators, train up medical staff for surge levels of demand, guide the public to the right level of isolation and quarantine, and minimize the economic impact of all of this even as we do it. The plan has been outlined by experts such as Scott Gottlieb and Amesh Adalja, but unfortunately neither of them have the authority or the budget to lead the full implementation.

Such a person could be part of a governmental or quasi-governmental organization, like Henderson; or a private charity, like Weaver; or a university; or even a for-profit company. The key is possessing intelligence and competence, credibility and authority, probably at least a modest budget, and a full-time focus and commitment to the goal.

Relevant books

Polio: An American Story

Smallpox: The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer

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