Kenneth Warren and the Great Neglected Diseases of Mankind Programme (book review)

I stumbled across Conrad Keating’s biography of Ken Warren, a tropical medicine and philanthropic pioneer at the Rockefeller Foundation, by chance and was immediately intrigued.
Kenneth Warren and the Great Neglected Diseases of Mankind Programme-The Transformation of Geographical Medicine in the US and Beyond covers many interesting aspects of my research interest in (auto)biographies and historical accounts of and from seminal figures in the context of global development. It also tells us a lot about the academic, research and international aid industries from the 1950s until his death in 1996 and invites the reader to reflect about all the changes that have happened-and the stability of some discourses that surround us today.

Warren, ‘a scientific investigator ahead of his time’ (p.7) pioneered research on tropical diseases at the interface of medical and what we today what call ‘public health’ research and as program manager at the Rockefeller Foundation he was instrumental in creating a unique long-lasting network for research and capacity building and shaped policy and practice of international organizations such as the WHO or UNICEF.

As you probably know by now, I will approach my review from a communication for development perspective-focusing on what the story of Ken Warren’s life can tell us about today’s approaches and practices when global academia, transnational policy and local aid work meet.

A life in the #allmalepanel lane
Laurie Garrett’s review of the book in the Lancet is entitled When Big Men ruled global health and the absence of women in the narrative or on most of the photos in the book is striking. It ads to the clear top-down, North-South dynamic somewhere between lavish dinners in Oxford, UK, retreats in Bellagio, Italy or scientific research training in Woods Hole, Massachusetts. It is not the total opposite of the Chambers’ian notion of ‘putting the last first’, because there was a genuine passion about improving the lives of millions of poor people, but the ‘success through (male, American) ego’ narrative certainly has participatory, bottom-up blind spots.

Working in an age of grand strategies
There is a certain appeal to read about an age before work-life balance debates, tenure track worries and laborious grant application writing. Lead by Warren who ‘pushed himself, pushed the future and pushed the people who came within his gravitational pull’ (p.9) his ‘autocratic, peremptory management style (which) certainly forced a high tempo and high productivity’ (p.12) reminded me of similar colleagues of his age: UNICEF Director Jim Grant inspired many followers in a similar way and managed to achieve some incredible successes in global well-being in the 1970s and 1980s. It was not only the age of leap-frogging successes around ‘neglected diseases’, but also a time of Universalgelehrten-the German expression for polymaths: 

Warren’s fascination with schistosomiasis, communication theory, and information systems led him to write two major scholarly bibliographic works chronicling the entire literary history of the disease over a 100-year period (p.22).

He was also good at self-promotion and advocating for his research area turning mainstream attention to tropical diseases.

The Rockefeller years-before philanthropy turned into philanthrocapitalism
Responsible for Health and Population at Rockefeller, Warren became a ‘scholar-activist’ cornerstone working towards the next big thing after the Green Revolution for which program staff Normal Borlaug had received the Nobel Prize in 1970.

Warren emphasized ‘collaborative and interdisciplinary research’, advocated for long-term funding for 8 years, included ‘young investigators’ and started a ‘global network for communication’ with an annual conference often at Bellagio as the highlight, in short ‘the Great Neglected Diseases of Mankind Network was born’ (pp.33-34).

Of course, there was no peer-review committee and no consensus; the entire group was selected single-handedly by Warren. (…) He prided himself on his personal network, on knowing everyone (p.34).

Warren work illustrates well how different those ‘good old days’ were for grant recipients, the foundation’s standing and scientific progress:

the project involved 161 scientists and clinicians and 360 trainees, of which 150 were from the developing world, and resulted in the publication of 1800 papers. This was all accomplished at the cost of approximately 15 million USD (55 million in 2015 values)-a prodigious rate of return on the investments by any standard (p.40).

It was an age before conferences and many other aspects of the world turned into neoliberal commodities.

And how much better are our digital, over-networked and constantly measured approaches really?!
Another ‘big man’, Halfdan Mahler of the WHO led ‘the philosophical redirection away from the curative toward preventive care’ (p.56) clashed with Warren’s vision, but by collaborating with yet another ‘big man’, Robert McNamara of the World Bank, Warren’s efforts on evidence-based selective health care culminated in the 1993 WDR Investing in Health.

When Jim Grant joined the Warren-Mahler-McNamara circle a window opened ‘to launch one of the most audacious international health projects ever attempted-to protect the world’s children from 6 killer diseases in 100 countries’ (p.69).

In the end, all good things most come to an end. Warren’s leadership and management style, including ‘perceived financial extravagances’, became more and more obsolete as Rockefeller underwent a period of professionalization as well as financial and programmatic re-orientation. His ‘ingrained sense of entitlement’ (p.112) probably did not strengthen his position in the foundation.

His subsequent work in academic publishing, ‘Warren was ahead of most health professionals in investing in the capacity to collect large amounts of accurate data and make it available to many’ (p.125), led to short-lived collaborations with controversial entrepreneurs.

I cannot assess whether ‘Warren’s legacy was being obscured by an invisible wall of historical amnesia’ (p.132).

Ken Warren certainly

had a vision for how best to align scientific discovery to the reduction of disease. Coupled with his innate excitement for science, he brought knowledge and creativity to one of the most influential positions in international philanthropy and health (p.134)

And Maybe Warren ‘would make greater efforts to ensure that more people in developing countries were doing the work’ (p.141) if he were still alive.

From my point of view the book was certainly an unexpected gem for my collection. A traditional biography which opens up some interesting reflections on how our (research, development, policy) world used to work, a glimpse into the life of a big man with big ideas and big impact-yet a subject to dominant discourses and existing power relations. A father who had little time for his children and maintained an impressive global network in the pre-digital age.

Research, philanthropy and development have certainly changed. His self-promotion must seem tame in an age of TED-talk celebrities, his all-male events would not go uncriticized and his work at Rockefeller appears to be traditional in an age of disruptive billionaires.
And yet some of his traits, his enthusiasm and vision to think big for a better world can still inspire in our age of micro-management, impact factors and uber-professionalization in many aspects of our work and life.

Keating, Conrad: Kenneth Warren and the Great Neglected Diseases of Mankind Programme-The Transformation of Geographical Medicine in the US and Beyond. ISBN 978-3-319-50147-5, 150pp., 32,09 Euro, Heidelberg: Springer, 2017.