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The Fight Against Malaria: Lessons for the Nonprofit Sector

Bill Shore, founder of Community Wealth Partners and the national anti-hunger organization Share Our Strength, has spent the last year researching and writing about the fight against malaria, which claims between 1 and 3 million lives each year, according to Malaria No More. Incredibly, the disease infects more than 100 million people each year and is responsible for more childhood mortality than any other single infectious agent, according to Sanaria. Shore’s soon-to-be-released book, The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria, follows the story of two audacious scientists who have been racing each other for 30 years to develop the malaria vaccine. He uses the narrative to broach the question, “How do you solve the problems of hunger, disease, and other critical social problems with no natural market?”

The challenge to end malaria lies not only in finding a vaccine to kill the often mutating parasite, but in finding entrepreneurial strategies to sustainably scale the scientific discoveries. Shore asserts, “The solution to a malaria vaccine is not a matter of scientific discovery, it’s a matter of biotech industry; it is not a matter of finding it, but scaling it.” This challenge of scaling a service and making it affordable to those who need it is one of the greatest problems social sector organizations face today. Community Wealth Vanguard spoke with Shore to discover what the story of malaria teaches about sustainability, growth, and innovation—Community Wealth Partners’ areas of focus—and how to apply these lessons to the social sector today.

Ensuring Sustainability

Building in Economics: Shore discovered that the most vital element of sustainability is to build the economics into the project at the beginning, not the end. Often nonprofits develop new and interesting solutions to problems, but do not consider the economics of the solution until the end, retrofitting the product or service to match the cost only after development. In his book, Shore argues that “it is incumbent upon social entrepreneurs to not only develop solutions but to make them affordable” (p. 255). He cites Dr. Peter Hotez of George Washington University, who explains that if an organization cannot make its product affordable to the target population, it is not worth making the product at all. For malaria, therefore, the solution lies as much in markets as in science.

Ambitious Vision: At a malaria conference years ago, one of the scientist heroes in Shore’s new book recommended that he and his fellow scientists should strive to make a malaria vaccine, despite prejudice that this idea was utterly impractical. No one at the conference thought this idea was reasonable. The scientist, Stephen Hoffman, persevered with this unreasonable vision, dedicating much of his life to finding a scalable vaccine. Hoffman currently is chief executive officer of Sanaria, a Maryland-based biotech firm that is testing a scalable malaria vaccine—an idea that supposedly couldn’t be done.

Shore mentioned an example of a shifting vision that was closer to home. The nonprofit that he founded, Share Our Strength, originally sought to feed hungry children in the United States. More recently, the organization has changed its focus from feeding children to ending childhood hunger. Although the former is more popular with funders, it will never make the need go away. Ending childhood hunger can be less gratifying to funders in the short term, because the goal takes five to ten years to accomplish. However, it will have lasting results that can, as Shore says, “solv[e] the problem once and for all, not just ameliorat[e] it by placing Band-Aids on its symptoms” (p. 258). Since changing its goal, Share Our Strength has seen more growth than ever before. Firms that set ambitious goals will inspire people to fix—not bandage—social problems.

Taking Care of the Organization: In addition to championing a strong vision, Shore also promotes organizational awareness. Steve Hoffman left a large biotech company to start Sanaria in 2002. Although this company had no bureaucratic red tape, it also had no money. By 2007, Hoffman’s research had outgrown Sanaria’s previous office space. Through building capital, including a large grant from the Bill and Melinda Gates Foundation, Hoffman was able to move his company into a biotech office and use the much larger space and better equipment to make the vaccine.

Nonprofits have a tendency to serve their clients before taking care of themselves, sometimes putting their own organizations at risk. While it is commendable for nonprofits to focus their energy primarily on their constituents, an organization will maximize its long-term impact if it shows financial savvy. An organization must invest in itself to increase its capacity to serve its stakeholders in the long term. Sanaria’s move has proven vital to moving the vaccine closer and closer to the finished product.

Effective Growth Techniques

Shore shared three tips about effective growth in the fight against malaria that he feels are vital for nonprofit growth.

Precise Measuring: The first tip is to measure impact with great precision. Shore observes that measuring with precision is a powerful practice in science. Scientists raise most of their funding based on their outcomes, so they measure well and share their results. Nonprofits are more attractive to funders when they put systems in place to consistently measure their outcomes.

Healthy Competition: For many years, Stephen Hoffman and fellow scientist Rip Ballou both worked in the military, at the Naval Medical Research Center and the Walter Reed Army Institute of Research, respectively. They were the two leaders in developing a promising malaria vaccine. By 1987, they were so hopeful about one vaccine that they inoculated themselves with it . . . and became very ill. Though they fully recovered, they realized that the vaccine still had a long way to go. Ballou retired from the military in 1999 and Hoffman did so in 2001.

Both men continued developing the vaccine in the private sector, and began the competitive race to see who would develop the vaccine first. Ballou chose to work with large organizations, working for GlaxoSmithKline for about five years, then for the Bill and Melinda Gates Foundation for about a year, only to return to GlaxoSmithKline in 2009. Hoffman, on the other hand, chose a lonelier road. At first, Hoffman also worked at a large biotech firm, then left it to develop his own small start-up. With Sanaria, Hoffman eventually won the race. In The Imaginations of Unreasonable Men, Shore states, “Though in the beginning Hoffman and Ballou were more collaborators than competitors, as the stakes grew higher their rivalry grew sharper and ultimately fierce. Each had something to prove” (pp. 49–50). Surely both men expedited their work, knowing that the former collaborator was working hard to beat him to the vaccine and that millions of lives depended on the vaccine’s success.

Often nonprofit organizations resist the notion that they should be competitive; it seems almost countercultural to the sector. Shore says, “[Nonprofits] want to do things with volunteers. Not with the best resources, but with the best leftover resources or donated resources. Such choices are based on noble intentions, and . . . may be economical in the short run, but it completely undermines one’s long-term competitive strengths” (p. 261). Nonprofits will have better capacity to serve clients when they make themselves competitive by hiring the best people, delivering the product at a reasonable price point, and showing a strong return on investment that aligns with the organization’s mission.

Fostering Innovation

In Science, In Distribution, In Production: Shore cited innovation as the most important attribute in winning the fight against malaria. Malaria has approximately 5,300 genes. When any one of those genes mutates, the vaccine must be altered. Since the disease mutates constantly, scientists must bring innovation into the lab and implement different ways to attack the disease.

Organizations trying to prevent malaria have instituted huge campaigns to distribute bed nets, since mosquitoes would typically bite at night. Now mosquitoes also tend to bite earlier in the day, requiring additional innovation.

Producing medication affordably is another challenge, since there is no natural market for the vaccine. One solution has been to use a plant in China which can make synthetic derivatives of the vaccine. Another option is to consider alternative markets, such as tourists and military personnel, who may purchase the vaccine and thereby provide enough funding for organizations to distribute the vaccine to those who otherwise can’t afford it.

One of the most exciting innovations cited in The Imaginations of Unreasonable Men is the only nonprofit pharmaceutical organization in the world, the Institute for OneWorld Health. Founded by Victoria Hale, the firm uses venture philanthropy dollars to develop and produce drugs to serve poor populations who suffer from diseases foreign to our country, and to our radar, such as leishmaniasis, diarrheal diseases, malaria, Chagas disease, and chronic gastrointestinal infections. The Institute has been a significant funder for Hoffman.

Shore’s book takes an in-depth look into the journey to eradicate malaria, illuminating insightful lessons about sustainability, growth, and innovation. The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria will be released on November 23, 2010 by PublicAffairs.

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About Community Wealth Partners

At Community Wealth Partners we dream of a world in which all people thrive. To realize this dream, we help change agents solve social problems at the magnitude they exist. As a Share Our Strength organization, we bring the successful practices of one of the nation’s leading anti-hunger, anti-poverty organizations to hundreds of change agents nationwide.

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