Public Health: Carol Bellamy

By Aaron J. Sender, Jeff Minton|Thursday, November 25, 2004


executive director, Unicef, since 1995


Began her public service as a Peace Corps volunteer. She was elected a New York state senator in 1972 and was elected city council president of New York City in 1977. She ran for mayor of New York City in 1985. 

Biggest accomplishment:

“The last 10 years. I hope I’ve led Unicef well. One leads by knowing when to be behind sometimes. One leads when one has to be ahead. One leads when one has to be next to someone. I hope I have provided good leadership for Unicef. It’s by far the most extraordinary opportunity I’ve had in my life.”



RICHARD FEACHEM, executive director, Global Fund to Fight AIDS, TB, and Malaria

RICHARD KLAUSNER, executive director of global health, Bill and Melinda Gates Foundation

DAVID NASH, professor of health policy and medicine, Jefferson Medical College, Thomas Jefferson University

FREDERICA P. PERERA, director, Columbia Center for Children’s Environmental Health, Columbia University 

Now in her 10th year as executive director of Unicef, Carol Bellamy has been a corporate lawyer, an investment banker, an elected representative in city and state government, and the director of the Peace Corps. “Zigging and zagging,” as she puts it, between public service and private enterprise prepared her to run not only one of the world’s largest bureaucracies but also a corporate-public partnership that strives to increase immunization in developing countries against a host of preventable scourges. The Global Alliance for Vaccines and Immunization (GAVI) is a collaborative effort of large pharmaceutical companies and Unicef, the Bill and Melinda Gates Foundation, and other governmental and charitable organizations. In April 2001 Bellamy joined Bill Gates Sr. in Boane, Mozambique, to kick off the project with 1.3 million doses of a vaccine that protects against diphtheria, pertussis, tetanus, and hepatitis B. Since then GAVI—which Bellamy chaired for the next two and a half years—has inoculated 35.5 million children in 40 developing countries against the liver-damaging virus. And millions more have been protected from Haemophilus influenzae type B, yellow fever, and other childhood killers. By the time she finished her term, the alliance had committed more than $1 billion for work in 70 countries. Her philosophy: “I don’t think do-gooder organizations need to be any less well run than the private sector.”

What changes in public health have you noticed since you got to Unicef?

B: Over the last 10 years, there has been, in some parts of the world, continued improvement—but certainly in sub-Saharan Africa probably a deterioration for a variety of reasons. Some of the efforts at health reform were well motivated, but they were aimed at decentralization. But unless you decentralize and with the decentralization send the authority, the resources, and the capacity, you aren’t really making sure health care is functioning at a more local level. So very often, while well motivated, the decentralization didn’t lead to that.

What were the goals of GAVI?

B: GAVI wasn’t my idea or Unicef’s idea alone. It grew out of the very significant commitment by the Gates people [the Bill and Melinda Gates Foundation] initially. The initial discussions were around the introduction of new and underutilized vaccines more rapidly in developing countries than history had shown this happening in the past. These were vaccines that were already in use in the developed world. Measles is an example—[although] not a GAVI example. But measles vaccine—and measles is a disease that kills—was around for more than 20 years in the developed world before it really started getting introduced in the developing world.

The initial focus was helping to accelerate or close that time frame, particularly around a couple of vaccines: hepatitis B and yellow fever. We’ve been intimately involved because we are the largest purchaser of vaccines for the developing world. And so GAVI vaccines are purchased through Unicef, in conjunction with the vaccine fund, but we are actually the purchasers because of our relationships with the pharmaceutical industry—business relationships.

What personal traits or strategies did you use to lead GAVI successfully?

B: We have good staff. My view is that just because you’re doing good doesn’t mean that you should put down your interest in making sure you try to squeeze out as much as possible, and that you don’t squeeze it all out through bureaucracy, or that you should take longer, or that you should be more accepting of fuzzy thinking—although we have some fuzzy thinking.

You seem to have a knack for cutting through bureaucracy and getting things done. What’s your secret?

B: If you want to make things move in a multicultural environment, you have to understand that there are different pushes and pulls and different pressures. So what might work in a unified group of people who all generally come out of the same background isn’t necessarily going to work somewhere else. It’s very important to understand. More and more things are global in nature. Not just the U.N. More and more businesses are global in nature. Even more and more nonprofits and foundations are global in nature.

What personal trait is most helpful in your job?

B: I think honesty is really important. Whether people agree or disagree, that at least they feel there is an element of fairness is very important. And I think humor is always critical. Being prepared to laugh at yourself is really important. You have to take some care with humor, though, because humor will be different from place to place. For me, it’s really more internal.

Where do you draw your inspiration?

B: If I had to pick two things, it would be coming of age in the ’60s. It was a time that said the world was open. You might succeed or not succeed, but you had to give it a try.  The Peace Corps was the most important thing I ever did—being a volunteer.

What time does your alarm clock go off?

B: It goes off at four.

What’s the biggest public-health crisis right now?

B: I’m reluctant to answer this, but I’m going to say HIV and AIDS. My fear in saying this is that it shouldn’t just be put into a health portfolio. In fact, I worry when I go to a country and find that the senior person in government in charge of their AIDS response is the minister of health. I worry that the government is not taking it on fully, because it’s limiting it by seeing it only as a health matter. In terms of poverty and in terms of public health, I would say that the catastrophe of HIV and AIDS, and the implications of that—not only in people dying but the implications of health workers dying, the implications on systems functioning, the implications on the stability of whole societies. The multifaceted implications of HIV and AIDS, not just as an infectious disease, is the major public-health crisis that we are confronting in the world.

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