Never in history has a killer mass disease fallen so far so fast - with as few inputs. Measles may be past the Tipping Point already. Measles is not yet eradicable, but it may be soon. The Measles Campaign sets the stage for other inputs. One such input is the Insecticide Treated Net.

See the Big Picture: The Tipping Point of Epidemics

Tipping Point on Dread Diseases
The Tipping Point is the point where something changes. Studies of how change happens give us sharp insights into how to structure programs. Once we understand change and tipping points, the more we can use it to our advantage.

Rule 1: Change happens fast. The Measles Campaign was a concept in early 2001. In less than 3 years the Measles Campaign cut deaths from measles in Africa by half, by a total of about 200,000/year. These results occurred while they were designing, testing and polishing their methods.

The 2004 Measles Campaigns is projected to lower the death toll by another 200,000, equal to all the lives saved the first few years. Change can accelerate. The first few years the measles campaign saved a couple hundred thousand lives. Now that the methods are refined, they are rolled out and campaigns can go into the harder areas to cover. In prior areas monitoring and mop up campaigns continue to lower rates ever further. Within 5 years of starting the death toll from measles in Africa should be down by over 90% and falling further.

Never in history has a killer mass disease fallen so far so fast - with as few inputs. Measles may be past the Tipping Point already. Measles is not yet eradicable, but it may be soon. The Measles Campaign set the stage for other inputs. One such input is the Insecticide Treated Net.

Rule 2: Little things make a difference. Insecticide Treated Nets are small things that have a big impact. Cover the children of sub-Saharan Africa and save a million lives per year. Every $1 put into ITNs puts $20-100 into the economy. That's impact.

Rule 3: The broken windows theory. When windows stay broken, local conditions decline. The more the graffiti, the more broken windows appear in a neighborhood, the larger and more serious the crime becomes. Deterioration snowballs.

Happily, the reverse is also true. Small things matter. Clean up the graffiti, fix the windows and the crime rates drop. In some cases, crime plummets. Positive change also builds on itself.

In 1990 New York City had over 2000 homicides. As part of an overall campaign, officials undertook a number of small things. Among other things, they cleaned up graffiti and fixed broken windows. 2003 saw fewer than 100 murders in New York City. Violent crimes dropped dramatically.

Providing mosquito nets gives the entire community a visible sign of participation in health care. We know that ITNs have a huge impact on health care within families and on the system as a whole. Put a net in every house and the hospital visits may drop by 25% or 40%.

Rule 4: The Role of Visible Leaders. The rule goes like this: when a community has leaders playing roles visible to the public, order prevails. Like broken windows, the problems arise in the absence of sightings of leaders.

Where community leaders are visible more than a particular amount, problems appear to stay under control. When the leaders don't make themselves seen or heard. Problems rise. Researchers noticed that when visible sightings of leaders fall below a particular point, then a whole raft of bad things all spiked up quickly and almost in concert. When fewer leaders appeared in the communities being studied, crime, truancy, drug usage, juvenile delinquency and teen pregnancies all changed for the worse almost overnight. The chart of the change looks like a dogleg. The change is not a continuation of earlier trends. The shift is non-linear.

What is more important than saving lives? There is little doubt that communities that receive vaccines or mosquito nets are better off with these goods. Might another 'good' that is delivered outweigh the importance of the goods? The 'good' has a double meaning here, that of seeing a community volunteer participate in a public way in activities that help the community. How about saving communities?

What messages does the Measles Campaign send to communities? The Measles Campaigns are run almost entirely by volunteers. The volunteer participants are unpaid in conventional terms, and still achieve unconventional success. The volunteers appear in public on a regular basis in visible roles that help the communities. Perhaps the most valuable payoff for the communities, the most valuable 'input' is the visible public service. The millions of volunteers provide role models for the children, youth and people of all ages in each country. The studies in the Tipping Point suggest that the visible volunteer service may be most valuable contribution to the campaigns and their country overall.