Leadership in global health: the case of Ciro de Quadros, a testament to values, valor, and vision

ABSTRACT

[ABSTRACT]. When Dr. Bill Foege wrote “When Words Fail,” he was referring to how difficult it was for him to describe adequately, in written words, all the effort that is involved from the scientific conceptualization of a new vaccine, to eventual bench discovery and development, to the training and supply chain logistics, and ultimately to the moment the needle pricks the skin to save a life of a child (1). He called it the “chain of perfection”. He was “at a loss” to describe this cascade of events with due justice. I have been asked to describe the leadership attributes of Dr. Ciro de Quadros as a case study in best practice and lessons to be learned. Similarly, I too am at a loss. Simply put, Ciro broke the mold. I should disclose that what I am about to write is influenced by decades of either working directly for Ciro, as was the case during the polio eradication era in the Americas, to collaborating with Ciro more recently on various projects that included measles and rubella elimination, the introduction of new vaccines, and surveillance of infectious diseases. The work evolved into a relationship that bridged from professional mentorship, to actual friends with a deep sense of admiration, love, and mutual respect. In global health, leadership is somewhat like the “self-actualization” of public health practice. The “leader” must have all those attributes that embodies a fully realized individual, positioned in the system to make things happen, such as in Ciro’s case, to help create a world of equitable access to life-saving vaccines. Ciro always kept such a vision in mind. He was unrelenting when seemingly unsurmountable forces impeded his way. Like a hurricane, he would uproot naysayers, but with a clear sense of knowing exactly where he was going. I will attempt to describe what made Ciro this “force of nature”, including, perhaps, what arguably may have been some of his deficiencies. The three “V’s”, values, vision, and valor, have been used to describe broadly the attributes of effective leaders. For Ciro, volumes could be written on each, especially if we think of his career in its entirety, spanning more than four decades.