WEBVTT - Global Disease is Solvable 0:00:15.076 --> 0:00:21.596 Pushkin, I'm may Have Higgins, and this is Solvable Interviews 0:00:21.596 --> 0:00:24.676 with the world's most innovative thinkers working to solve the 0:00:24.716 --> 0:00:27.956 world's biggest problems. My name is Steve Davis and the 0:00:27.996 --> 0:00:32.556 President and CEO of PATH, and my solvable is that 0:00:32.636 --> 0:00:37.156 we can in the next couple of decades eliminate or 0:00:37.236 --> 0:00:41.196 eradicate five to ten diseases that are causing enormous human 0:00:41.236 --> 0:00:44.876 suffering today. So our solvable today is a scary one 0:00:44.956 --> 0:00:49.156 and an exciting one, eliminating or eradicating a number of 0:00:49.276 --> 0:00:52.636 horrific diseases. If you want to freak yourself out and 0:00:52.636 --> 0:00:55.156 you've got some time, you could check out the roll 0:00:55.276 --> 0:00:59.036 call of the top diseases on the World Health Organizations 0:00:59.116 --> 0:01:03.916 hit List. That list includes ebola and zeka and something 0:01:03.916 --> 0:01:08.116 called disease X, which represents the knowledge that a serious 0:01:08.116 --> 0:01:11.316 international epidemic could be caused by something that we don't 0:01:11.316 --> 0:01:14.876 even know about yet. Disease X sounds terrifying, but of 0:01:14.916 --> 0:01:17.756 course there are plenty diseases that we do know about 0:01:18.196 --> 0:01:20.916 which we can try to fight, and they're the ones 0:01:20.956 --> 0:01:23.876 you're going to hear Steve Davis talk about in this episode. 0:01:24.596 --> 0:01:27.396 These diseases are some of the world's biggest killers, and 0:01:27.556 --> 0:01:32.276 the organization Steve runs Path is working to either eradicate 0:01:32.476 --> 0:01:36.516 or eliminate them. So top of Steve's list is polio. 0:01:37.236 --> 0:01:39.996 Polio is one of the most feared diseases of the 0:01:40.036 --> 0:01:44.596 twentieth century. It can cause permanent paralysis, and it's potentially deadly. 0:01:45.236 --> 0:01:48.396 There's no cure for polio, but there is a vaccine. 0:01:48.956 --> 0:01:52.956 Successful vaccination programs mean the US has been polio free 0:01:52.996 --> 0:01:56.676 since nineteen seventy nine, and globally the number of reported 0:01:56.716 --> 0:02:00.916 cases has fallen by ninety nine percent in thirty years. 0:02:00.916 --> 0:02:04.436 But as you hear Steve say, the hardest part is 0:02:04.516 --> 0:02:07.036 getting to the last few cases to wipe out the 0:02:07.116 --> 0:02:11.116 disease for good. Another disase that is close to eradication 0:02:11.356 --> 0:02:14.836 is malaria. It can feel like a flu, or it 0:02:14.836 --> 0:02:18.156 can be a lot more severe, requiring urgent treatment and 0:02:18.276 --> 0:02:22.996 actually endangering your life. The drive to wipe out malaria 0:02:23.156 --> 0:02:25.116 is one of the best known, and the World Health 0:02:25.236 --> 0:02:30.036 Organization publishes an annual report on the disease. However, last 0:02:30.076 --> 0:02:33.756 year they wrote that after great success in reducing infections, 0:02:34.116 --> 0:02:38.036 there'd be no progress made between twenty fifteen and twenty seventeen. 0:02:38.676 --> 0:02:41.556 In twenty seventeen, there were two hundred and nineteen million 0:02:41.636 --> 0:02:44.676 cases of the illness and it kills more than four 0:02:44.756 --> 0:02:50.596 hundred thousand people. Steve also mentions riverblindness, and that's caused 0:02:50.596 --> 0:02:54.156 by a parasitic worm transmitted to humans when they're bitten 0:02:54.196 --> 0:02:59.516 by infected black flies. Riverblindness is found most often on 0:02:59.556 --> 0:03:04.796 the African continent, but it's also in Yemen, Brazil, and Venezuela. 0:03:04.956 --> 0:03:09.116 More than two hundred million people are at risk of riverblindness, 0:03:09.236 --> 0:03:13.596 the world second leading infectious cause of blindness, so obviously 0:03:13.756 --> 0:03:17.876 it can cause vision loss, but also severe skin diseases 0:03:17.916 --> 0:03:22.356 and neurological damage. There's no vaccine for it, but countries 0:03:22.356 --> 0:03:26.156 have been doing huge work to control and treat new infections. 0:03:26.676 --> 0:03:28.916 Columbia was the first country in the world to be 0:03:29.036 --> 0:03:33.036 verified and declared free of river blindness, then Ecuador in 0:03:33.076 --> 0:03:37.036 twenty fourteen, Mexico in two thousan fifteen, and Guatemala in 0:03:37.156 --> 0:03:41.876 two thousand and sixteen. Steve Davis describes himself as a 0:03:41.956 --> 0:03:46.476 transformative innovator with a passion for global health and saving lives, 0:03:46.996 --> 0:03:49.556 and he goes about doing this daily in his role 0:03:49.636 --> 0:03:53.436 as President and CEO of PATH. Now, I love the 0:03:53.476 --> 0:03:56.876 way this organization started out back in the nineteen seventies. 0:03:56.916 --> 0:03:59.876 There was a bunch of researchers in Seattle looking to 0:03:59.916 --> 0:04:04.276 help Chinese manufacturers make better quality condoms. Isn't not just 0:04:04.396 --> 0:04:08.916 classic Seattle behavior and that was it. From their start 0:04:09.116 --> 0:04:13.076 in family planning, PATH have now become a global charitable 0:04:13.156 --> 0:04:19.836 conglomerate developing devices, medicines and services. Steve says PATH exists 0:04:19.956 --> 0:04:23.516 because access to good health too often depends on where 0:04:23.516 --> 0:04:27.676 we were born, our race, gender, ethnicity, age, and class. 0:04:28.436 --> 0:04:32.556 His organization tries not only to improve individual health but 0:04:32.636 --> 0:04:37.076 also the delivery of healthcare in developing countries. That includes 0:04:37.156 --> 0:04:41.476 helping to build digital systems like mapping and data analytics 0:04:41.516 --> 0:04:44.276 tools that are used to fight ebola in the Democratic 0:04:44.276 --> 0:04:48.356 Republic of Congo. The scope of Path's work is vast 0:04:48.916 --> 0:04:52.036 now unusually as an NGEO, almost all of their work 0:04:52.156 --> 0:04:55.996 involves the private sector. That could be biopharma or digital 0:04:56.036 --> 0:05:00.396 distribution anything. They try to bring private sector assets and 0:05:00.636 --> 0:05:04.396 their ideas to bear on these huge global problems which 0:05:04.476 --> 0:05:08.876 might not otherwise seem commercially attractive. We'll hear more now 0:05:09.236 --> 0:05:13.636 this conversation with Jacob Weisberg. Okay, here we go. There 0:05:13.676 --> 0:05:18.916 are many many diseases that kill hundreds of millions of 0:05:18.916 --> 0:05:22.676 people a here that are actually preventable, that we know 0:05:23.756 --> 0:05:27.116 how to treat it and hopefully how to even prevent it, 0:05:27.556 --> 0:05:31.876 but that the problem is we're not getting enough access 0:05:31.916 --> 0:05:33.996 to the people that need it the most of the 0:05:34.036 --> 0:05:39.156 tools and the solutions. So the opportunity is now we 0:05:39.196 --> 0:05:43.476 are in this extraordinary moment in history, or we're actually 0:05:43.516 --> 0:05:46.916 pursuing to actually get rid of some of the oldest 0:05:47.116 --> 0:05:49.996 killers on the face of the earth. What's brought you 0:05:50.156 --> 0:05:55.716 to this problem? Well, I'm neither technologist by heart or 0:05:55.756 --> 0:05:59.436 a doctor, but I do know and I believe in 0:05:59.476 --> 0:06:04.676 the power of technology and human spirit together can conquer 0:06:04.716 --> 0:06:07.476 a lot of things. And we've seen that already. And 0:06:07.556 --> 0:06:09.996 what's so exciting is I think we're in a space 0:06:10.076 --> 0:06:13.796 square in a time and history where those two things 0:06:13.836 --> 0:06:17.396 have come together to actually vanish some of the world's 0:06:17.436 --> 0:06:21.116 oldest killers. And I'm very inspired by the fact that 0:06:21.316 --> 0:06:24.676 not only do we have political will and commitment at 0:06:24.716 --> 0:06:27.316 a scale around a few of these diseases that we've 0:06:27.356 --> 0:06:31.996 never seen before, we also have the technology, including both 0:06:32.036 --> 0:06:37.956 the biochemical technology of better vaccines, better medicines. But really 0:06:37.996 --> 0:06:41.396 importantly now is we have the digital tools to get 0:06:41.436 --> 0:06:45.796 to know where to go, to map, to do geospatial awareness, 0:06:45.916 --> 0:06:48.836 to all the things that it takes to actually identify 0:06:48.956 --> 0:06:51.036 where the outbreak is or where the problem is and 0:06:51.116 --> 0:06:53.396 how to get to them. And then of course we 0:06:53.436 --> 0:06:56.916 also have a lot of political commitments, so we have 0:06:56.996 --> 0:07:01.316 countries that are more capable to go after these diseases 0:07:01.356 --> 0:07:05.116 and commitments to that. But in all of human history, 0:07:05.156 --> 0:07:10.436 if I've got this right, we've only eradicated one disease, smallpox, 0:07:10.436 --> 0:07:14.436 and that was maybe forty plus years ago. So what 0:07:14.716 --> 0:07:17.876 is it about technology or what leap have we made 0:07:18.236 --> 0:07:22.676 that makes you're solvable eliminating or eradicating five to ten 0:07:22.716 --> 0:07:26.156 diseases in a few decades conceivable? Yeah, Well, it is 0:07:26.356 --> 0:07:28.756 fascinating that in all of human history there's been only 0:07:28.796 --> 0:07:32.476 one human disease that we've eradicated, and that is smallpox. 0:07:33.236 --> 0:07:37.036 And I should be sure to distinguish between eradication, which 0:07:37.076 --> 0:07:41.076 is completely eliminating the disease and really the potential for 0:07:41.116 --> 0:07:44.756 the disease versus elimination, which is seeing how that get 0:07:44.836 --> 0:07:47.276 in a region. We've really gotten rid of the problem, 0:07:47.316 --> 0:07:50.076 and it is actually so the number has gotten so 0:07:50.156 --> 0:07:52.636 low that it is it really will be very difficult 0:07:52.676 --> 0:07:55.996 for it to re enter that region. But what's happened 0:07:56.276 --> 0:07:59.076 is I think a few things. One is, human health 0:07:59.156 --> 0:08:03.356 has just improved vastly over the last number of decades, 0:08:03.436 --> 0:08:06.916 and we've produced children mortality by about forty percent in 0:08:06.956 --> 0:08:10.356 the last twenty years. We've seen a lot of other improvements, 0:08:10.356 --> 0:08:13.276 and that is actually giving us sort of a platform 0:08:13.436 --> 0:08:15.996 to actually go after the really hard stuff, which is 0:08:16.036 --> 0:08:20.236 to eliminate eradicate diseases. Secondly, there's been a large commitment 0:08:20.756 --> 0:08:23.276 in the global community over the last twenty years to 0:08:24.316 --> 0:08:27.636 global health and including what we see and in the 0:08:27.836 --> 0:08:32.396 SDGs as around human health. The SDGs are the Sustainable 0:08:32.476 --> 0:08:37.156 Development Goals, These commitments by countries around the world, including 0:08:37.196 --> 0:08:41.436 a commitment to improved human health in a significant way. 0:08:42.116 --> 0:08:44.276 I think the biggest two things really are that we 0:08:44.516 --> 0:08:48.796 have money in the system, whether it's commitments made by governments, 0:08:48.836 --> 0:08:53.756 commitments made by large foundations to actually target the eradication 0:08:53.836 --> 0:08:58.236 of polio, the eradication of guinea worm, and the elimination 0:08:58.356 --> 0:09:01.636 of malaria in many regions of the world. The elimination 0:09:01.716 --> 0:09:05.916 of rabies, elimination of river blindness. And this is a 0:09:05.956 --> 0:09:10.156 new level of commitment, including a political commitment, a funding 0:09:10.196 --> 0:09:12.956 commitment that is enabled a lot of this to happen. 0:09:13.476 --> 0:09:17.076 And then finally, I would say maybe the biggest game 0:09:17.156 --> 0:09:23.076 changer is the digital revolution that's enabled us to understand 0:09:23.116 --> 0:09:28.716 the data better, to target the communities, better to isolate cases, 0:09:28.756 --> 0:09:34.236 easier to share information better. All of that comes together 0:09:34.756 --> 0:09:39.516 to make a very powerful combination toward elimination or eradication. 0:09:39.996 --> 0:09:43.236 You mentioned a few different human diseases which I'm really 0:09:43.236 --> 0:09:45.716 interested in, But what's the next one do you think 0:09:45.756 --> 0:09:48.716 to be eradicated? Is it polio? Yeah? The likely two 0:09:48.796 --> 0:09:52.556 diseases for eradication the next few years. Actually, we're just 0:09:52.796 --> 0:09:56.516 literally in the final stages is polio, which there's a 0:09:56.636 --> 0:10:00.716 large global commitment too. It's not quite getting to the 0:10:00.756 --> 0:10:02.876 finish line as fast as we thought, but we'll get 0:10:02.916 --> 0:10:04.796 there in the next couple of years. We're down to 0:10:04.876 --> 0:10:07.756 I think about thirty cases a total in the world 0:10:08.036 --> 0:10:11.076 in three countries, and then guinea worm is very likely 0:10:11.116 --> 0:10:14.716 again given very large commitment to that effort. And then 0:10:14.756 --> 0:10:19.116 there's a suite of about fifteen diseases that the WHO, 0:10:19.316 --> 0:10:22.436 the World Health Organization, has put on a list for 0:10:22.956 --> 0:10:27.716 potential for either elimination or eradication. Some of those are 0:10:27.796 --> 0:10:30.876 quite hard to do. Probably the one we're working with 0:10:30.916 --> 0:10:34.556 the most is malaria, which is a huge problem in 0:10:34.596 --> 0:10:38.116 the world still. It kills around four hundred to five 0:10:38.196 --> 0:10:41.756 hundred thousand people a year, and yet we do have 0:10:41.916 --> 0:10:46.756 many many countries that are year by year being declared 0:10:47.356 --> 0:10:50.396 malaria free. And so just this last year, I think 0:10:50.396 --> 0:10:52.476 four countries in the last two years have been declared 0:10:52.516 --> 0:10:55.316 malaria free. And that's the kind of work we now 0:10:55.356 --> 0:10:57.716 have to keep working on. There's a kind of paradox 0:10:57.836 --> 0:11:01.956 around the effort to finally eliminate or eradicated disease, isn't 0:11:01.996 --> 0:11:04.996 there in that when you're down to just a few cases, 0:11:05.356 --> 0:11:08.076 you spend a lot of money on those few cases, 0:11:08.156 --> 0:11:10.716 and you could spend that saved money to save a 0:11:10.716 --> 0:11:14.596 lot more lives targeting a much more prevalent disease. How 0:11:14.596 --> 0:11:17.716 do you deal with that in the community and philanthropic 0:11:17.796 --> 0:11:21.796 world and the scientific world that you live in. Yeah, well, 0:11:21.876 --> 0:11:27.316 disease elimination and particularly disease eradication is not a no brainer. 0:11:27.676 --> 0:11:29.916 I mean it's obviously not a no brainer in terms 0:11:29.956 --> 0:11:32.196 of how hard it is and to pull all this 0:11:32.316 --> 0:11:36.596 together and also get the social and cultural peace right 0:11:36.716 --> 0:11:39.796 along with the technology and data peace. But it's also 0:11:39.916 --> 0:11:43.276 not a no brainer from a sort of political and 0:11:43.636 --> 0:11:49.436 financial strategy, because in fact, the last cases become astronomically 0:11:49.556 --> 0:11:53.276 expensive because either the hardest to get, and so a 0:11:53.316 --> 0:11:55.436 lot of effort needs to go into finding them and 0:11:55.516 --> 0:11:58.116 isolating them and getting rid of them. And some people 0:11:58.116 --> 0:12:01.716 could argue the money we're spending to eliminate or excuse me, 0:12:01.756 --> 0:12:05.116 eradicate polio, we could have taken that and done something 0:12:05.116 --> 0:12:08.076 else with a different disease or a different set of problems. 0:12:08.116 --> 0:12:11.236 But there's three reasons why I think make the compelling 0:12:11.276 --> 0:12:14.996 case why we need to pursue this. One is still 0:12:15.596 --> 0:12:19.876 you know, the potential to end the suffering and death 0:12:20.556 --> 0:12:24.396 of people in the world who are vulnerable at diseases 0:12:24.636 --> 0:12:26.956 that you and I aren't because we've made the commitment 0:12:27.116 --> 0:12:30.676 here to do that is the moral reason we have 0:12:30.756 --> 0:12:33.076 to We know how to do it. Let's go finish 0:12:33.116 --> 0:12:36.636 the job, and let's make sure people are valued equally. 0:12:37.116 --> 0:12:41.236 There's a second reason, which is the potential for ongoing 0:12:41.756 --> 0:12:45.796 cost saving. So the estimation is in the tens to 0:12:45.916 --> 0:12:49.116 twenty billion numbers around what it will save the world 0:12:49.516 --> 0:12:52.596 once we eliminate polio from having to treat it and 0:12:52.716 --> 0:12:55.876 manage it over the time. And then the final I 0:12:55.916 --> 0:13:00.516 think is a strong belief that we need to demonstrate 0:13:00.716 --> 0:13:03.716 to the world that we can actually get this job done, 0:13:04.156 --> 0:13:07.196 because then when we go back to the global community, 0:13:07.316 --> 0:13:12.076 whether it's taxpayers or legislators or funders, there is a 0:13:12.116 --> 0:13:15.476 commitment that we can actually set a target, get it done, 0:13:15.836 --> 0:13:18.196 and go after the next one. Yeah. I mean nobody 0:13:18.236 --> 0:13:20.636 wants to march behind the banner that says let's almost 0:13:20.716 --> 0:13:23.396 eliminate polio, right, I mean you need a level of 0:13:23.556 --> 0:13:27.596 inspiration around an ambitious goal that says people have been 0:13:27.636 --> 0:13:32.636 suffering for centuries from this, let's get rid of it forever. Yeah. 0:13:32.676 --> 0:13:38.316 That's why I think it's exciting solvable because it's eminently doable, 0:13:38.556 --> 0:13:42.276 although wildly difficult. But it's also there's a little bit 0:13:42.316 --> 0:13:46.196 like the moment is now that we haven't ever had 0:13:46.196 --> 0:13:48.916 this experience before. I mean, yes, there was one and 0:13:49.236 --> 0:13:53.916 huge success called smallpox. But the idea that we can 0:13:53.996 --> 0:13:57.116 sit at tables which I'm actually sitting at and talking 0:13:57.156 --> 0:14:00.636 about which disease and how in what countries can we 0:14:00.676 --> 0:14:04.116 eliminate it or could we take a global eradication strategy 0:14:04.676 --> 0:14:07.596 is pretty remarkable in the scheme of things. So you 0:14:07.716 --> 0:14:10.796 talked about data as the thing that really enables the 0:14:10.876 --> 0:14:15.756 breakthrough here, But for data, you need good reporting. In 0:14:16.076 --> 0:14:18.916 these countries where many of these diseases they are most prevalent, 0:14:19.356 --> 0:14:24.276 don't have developed medical systems, they don't necessarily have good reporting. 0:14:24.516 --> 0:14:26.756 I mean, I love the idea that we can visualize 0:14:26.756 --> 0:14:30.116 these hotspots and pinpoint them, but how do we necessarily 0:14:30.196 --> 0:14:34.716 know how it's happening. Well, again, getting the right data 0:14:34.876 --> 0:14:39.636 and digital capabilities and infrastructure around these problems is not 0:14:39.836 --> 0:14:43.156 trivial problem to solve. And the good news, I think 0:14:43.276 --> 0:14:46.676 is there's quite a bit of energy and again investment 0:14:47.556 --> 0:14:51.516 now know how in countries to do this. And the 0:14:51.636 --> 0:14:54.636 other is that these systems that are being built are 0:14:54.716 --> 0:14:58.556 not only being built around an elimination disease strategy, but 0:14:58.596 --> 0:15:02.436 they're improving hopefully the national health system altogether. And so 0:15:02.476 --> 0:15:06.596 the promises that we'll have improvement both around a disease 0:15:06.636 --> 0:15:09.436 area and for the whole health system. But you know, 0:15:09.596 --> 0:15:12.076 quality is always a challenge. Can we get the right 0:15:12.116 --> 0:15:15.156 tools to the right people, Can we measure and validate 0:15:15.276 --> 0:15:19.076 numbers in a correct way. But you know, we've certainly 0:15:19.116 --> 0:15:23.556 seen through the polio eradication efforts, and my group helped 0:15:23.596 --> 0:15:27.916 set up the emergency operations centers and did the geospatial mapping, 0:15:27.916 --> 0:15:31.036 et cetera for some of the recent abola outbreaks in 0:15:31.116 --> 0:15:35.076 the Democratic Republic of Congo. And while that's a very 0:15:35.156 --> 0:15:38.516 difficult problem in it, there's all sorts of complications. The 0:15:38.596 --> 0:15:42.236 data quality of what we know, where we know it, 0:15:42.356 --> 0:15:45.076 how fast we know it is actually quite remarkable how 0:15:45.196 --> 0:15:49.636 much it's improved. Who sets the priorities of which diseases 0:15:50.196 --> 0:15:52.876 we go after? There are different places in the world, 0:15:52.956 --> 0:15:57.716 they affect different constituencies. You have a quick list that 0:15:57.836 --> 0:16:00.436 it's polio, guinea worm. You seem to know what the 0:16:00.516 --> 0:16:04.636 order is. Yeah, Well, the official list is the WHO, 0:16:04.756 --> 0:16:07.596 the World Health Organization and all of the member states 0:16:07.636 --> 0:16:10.996 of the United Nations onto that. So that that and 0:16:11.036 --> 0:16:14.316 that's where my list is. Here's the numbers. But then 0:16:14.356 --> 0:16:18.556 there's you know, things that influence those selections. Certainly one 0:16:18.596 --> 0:16:21.356 of them is just the state of the science. Do 0:16:21.476 --> 0:16:24.156 we have a good vaccine do we have the right 0:16:24.236 --> 0:16:28.236 diagnostic tools. All those things will matter in terms of feasibility. 0:16:28.276 --> 0:16:31.676 And then the other is the again the funding and 0:16:31.716 --> 0:16:34.156 political commitment, and that can be at a regional level. 0:16:34.236 --> 0:16:38.356 So India recently stepped up and has committed to we 0:16:38.396 --> 0:16:42.316 are going to eliminate malaria. Zambia has recently put a 0:16:42.356 --> 0:16:46.996 declaration from their president that they're going to eliminate malaria 0:16:47.036 --> 0:16:49.796 in their region and so. And that then comes with 0:16:49.796 --> 0:16:54.316 both domestic funding and also global funding to support those efforts, 0:16:54.636 --> 0:16:58.476 and that that actually obviously influences where on those lists 0:16:58.516 --> 0:17:01.316 we end up putting our energy and time. The big 0:17:01.316 --> 0:17:06.916 pharmaceutical companies work in their profit driven enterprises, and we've 0:17:06.956 --> 0:17:09.956 had this problem with incentives that the poor people who 0:17:09.956 --> 0:17:14.156 suffer most from disease are not buyers of expensive pharmaceuticals. 0:17:14.236 --> 0:17:18.236 Are we getting better at dealing with the pharmaceutical companies 0:17:18.236 --> 0:17:21.076 and getting them to do the kind of research we 0:17:21.156 --> 0:17:25.836 need to create drugs. There's no question we're doing better. 0:17:26.036 --> 0:17:28.876 And I sit with the CEOs of many of those 0:17:28.876 --> 0:17:31.876 companies and see the progress we've made over the last 0:17:31.916 --> 0:17:34.756 fifteen years due to a lot of different efforts and 0:17:35.196 --> 0:17:38.756 leadership that we are making vast improvements, both in terms 0:17:38.756 --> 0:17:43.556 of commitments to research and development, to commitments to access, 0:17:43.596 --> 0:17:49.236 to commitments to participation in these global undertakings. That said, 0:17:49.436 --> 0:17:52.076 you know better is a relative term. We still have 0:17:52.356 --> 0:17:55.156 some work to do, and it's it's still not a 0:17:55.196 --> 0:17:58.796 slam dunk. There are several things that you're absolutely correct. 0:17:58.876 --> 0:18:03.476 The vast majority of these diseases are diseases, which are 0:18:03.756 --> 0:18:07.276 diseases are the poor, and that the reason rich people 0:18:07.316 --> 0:18:10.756 aren't getting most of diseases. I mean, for instance, HIV 0:18:10.916 --> 0:18:13.516 is not on either of those lists, but HIV is 0:18:13.556 --> 0:18:16.396 a disease that the rich and the poor world both have, 0:18:16.516 --> 0:18:19.996 and therefore there's incentive for investments in those kinds of diseases. 0:18:20.436 --> 0:18:24.116 Where there's not as much incentives, we've created mechanisms to 0:18:24.796 --> 0:18:29.876 enable pharmaceutical companies and biotech and other companies to engage. 0:18:29.916 --> 0:18:33.396 So we've either there's like the END Fund, the end 0:18:33.596 --> 0:18:36.076 E and D Fund, which has been set up to 0:18:36.116 --> 0:18:40.276 provide more incentives to go after some of diseases they're 0:18:40.836 --> 0:18:43.996 My organization works on a number of vaccines that are 0:18:44.076 --> 0:18:47.196 not there's no really market force for them, but if 0:18:47.236 --> 0:18:51.436 we can get some philanthropic money to de risk that innovation, 0:18:51.876 --> 0:18:54.396 then that companies are willing to do it and do 0:18:54.436 --> 0:18:57.356 it quite well. So we're working on a whole bunch 0:18:57.356 --> 0:19:00.316 of different ways to ensure that there's a market if 0:19:00.356 --> 0:19:03.876 somebody does invest, to find ways to subsidize or de 0:19:03.996 --> 0:19:07.236 risk some of this for some companies, and literally just 0:19:07.316 --> 0:19:09.676 to get the companies at the table able to commit 0:19:09.716 --> 0:19:13.276 to it as part of their larger scientific commitment. It 0:19:13.396 --> 0:19:16.316 must just drive you crazy to see people dying of 0:19:16.596 --> 0:19:18.916 disease in the developing world, and then people in the 0:19:18.996 --> 0:19:23.956 developed world have these superstitions against vaccination, which very much 0:19:23.996 --> 0:19:27.916 controversy right now. But why is that happening? And if 0:19:27.916 --> 0:19:31.436 they knew what you knew, would people not be resistant 0:19:31.436 --> 0:19:37.156 to vaccinating their children. Absolutely, to disconnect between being rural 0:19:37.196 --> 0:19:39.756 Ethiopian a couple of days and where you know a 0:19:39.916 --> 0:19:44.916 mother will be desperate to get her child to a 0:19:44.996 --> 0:19:49.156 vaccine campaign and to get that vaccination, and then I 0:19:49.196 --> 0:19:52.796 will fly home to my home state in Washington State, 0:19:52.876 --> 0:19:56.316 where we have measles outbreaks and all sorts of things 0:19:56.316 --> 0:20:00.236 from the anti vACC movement, And there is a concern 0:20:00.436 --> 0:20:02.516 and a great concern for those of us working in 0:20:02.516 --> 0:20:06.236 the field that the larger what's called vaccine hesitancy, that 0:20:06.316 --> 0:20:09.036 you know, kind of concern whether it's some of it's 0:20:09.236 --> 0:20:13.196 coming out of a lot of disinformation that's been propagated 0:20:13.236 --> 0:20:16.116 by social media and other plays, but some of it 0:20:16.236 --> 0:20:20.636 is coming from just more concern about in some ways 0:20:20.636 --> 0:20:23.916 a victim of success that the more we've been able 0:20:23.956 --> 0:20:27.916 to innovate, we are vaccinating against more and more diseases. 0:20:27.956 --> 0:20:31.076 So suddenly parents are like, wait a minute, how many 0:20:31.516 --> 0:20:33.716 shots of is my kid going to get? And then 0:20:33.796 --> 0:20:36.476 some of it is is simply you know, we have 0:20:36.676 --> 0:20:39.476 had some challenges in parts of the world where the 0:20:39.876 --> 0:20:42.796 vaccine didn't go well. There was corruption in China and 0:20:42.836 --> 0:20:45.836 the Philippines recently, and that doesn't help. So we're in 0:20:45.876 --> 0:20:50.476 this larger work of trying to get more people in 0:20:50.516 --> 0:20:54.356 a place. I mean, vaccines are effective, they're cost effective, 0:20:54.356 --> 0:20:58.316 they're preventable, they're great global health tool. But we are 0:20:58.316 --> 0:21:01.836 fighting another battle now, which is once we get it's 0:21:01.876 --> 0:21:04.716 hard enough to get the scientific tool and get access 0:21:04.796 --> 0:21:08.156 figured out and great demand for these and get them 0:21:08.356 --> 0:21:10.956 remain cold old until they get out to a village 0:21:10.996 --> 0:21:14.156 and get the village leaders to the commitment for social 0:21:14.236 --> 0:21:18.036 change there and then to have this larger noise about 0:21:18.316 --> 0:21:21.276 vaccines is a new problem we're actually having to face. 0:21:21.756 --> 0:21:24.196 I like that you said that the solvable is to 0:21:24.236 --> 0:21:27.516 eradicate or eliminate the range of five to ten diseases 0:21:27.556 --> 0:21:30.716 over a few decades. I noted that when Mark Zuckerberg 0:21:30.756 --> 0:21:33.396 set up his foundation, he said the goal was to 0:21:33.516 --> 0:21:36.916 eliminate all disease, and it just seemed to me so 0:21:37.036 --> 0:21:39.876 unrealistic given what we were just talking about, that there's 0:21:39.916 --> 0:21:43.996 been one human disease eradicated. It's not a miscalculation or 0:21:44.076 --> 0:21:48.036 misunderstanding on his part. Yeah, I mean, of all thes R, 0:21:48.356 --> 0:21:50.276 I don't know what Mark was talking about it. I mean, 0:21:50.316 --> 0:21:52.756 it looks good on a headline, but maybe if a 0:21:52.876 --> 0:21:55.716 future I hope the planet lasts that long. But in 0:21:55.796 --> 0:21:59.796 there's some future where maybe we understand the body so differently, 0:21:59.996 --> 0:22:03.196 or we understand sort of fundamental organic chemistry so differently 0:22:03.196 --> 0:22:06.156 that this all changes. But first of all, we have 0:22:06.316 --> 0:22:09.916 new diseases popping up. There's thousands of diseases in the world, 0:22:09.956 --> 0:22:12.196 and now most of them most of us don't know about, 0:22:12.316 --> 0:22:15.036 or rarely do we get them. And they morph and 0:22:15.076 --> 0:22:18.276 they keep changing and they keep arising. So we need 0:22:18.316 --> 0:22:21.276 to be hyper focused on the things that we can 0:22:21.356 --> 0:22:24.996 get done and not overstate the case. And I also 0:22:25.076 --> 0:22:28.316 think that we have a hard enough time actually just 0:22:28.396 --> 0:22:32.236 getting people to believe that there is the opportunity to 0:22:33.036 --> 0:22:36.236 generally improve human health, which has been proved vastly, but 0:22:36.316 --> 0:22:38.636 there's still a lot of you know, sort of negative 0:22:38.676 --> 0:22:41.796 headlines about it. It's all a waste of money. And 0:22:41.836 --> 0:22:44.356 then the second is the belief that we can even 0:22:44.396 --> 0:22:47.476 eliminate one disease. There's still some people doubting whether we'll 0:22:47.476 --> 0:22:49.876 get all across the line on polio. So I'm sticking 0:22:49.916 --> 0:22:52.876 with one, one or two at a time. What's going 0:22:52.916 --> 0:22:56.036 to happen when polio is finally eradicated? Is there going 0:22:56.076 --> 0:22:58.876 to be a ceremony? Is there going to be an award? 0:22:59.116 --> 0:23:01.676 Is there going to be a day of global celebration? 0:23:01.756 --> 0:23:04.996 I mean there should be, right, I suspect there's you know, 0:23:05.276 --> 0:23:07.836 somebody's thinking about that already. It's like they think about 0:23:07.836 --> 0:23:10.676 the queen's funeral and they've got a plan, but they 0:23:10.716 --> 0:23:13.396 can't talk about it. Look, first of all, it's a 0:23:13.476 --> 0:23:17.036 long process. So just to be clear that who makes 0:23:17.036 --> 0:23:20.836 these declarations and there's a long protocol on what it 0:23:20.876 --> 0:23:25.516 takes to declare something eliminated and then eradicated, and there's 0:23:25.516 --> 0:23:28.436 a waiting period, so it takes a number three years 0:23:28.476 --> 0:23:31.476 after the last case. So if that occurs, it's they 0:23:31.476 --> 0:23:33.756 will know at a long time and ahead and of advance. 0:23:33.796 --> 0:23:36.116 But you know, there are two things there should be 0:23:36.156 --> 0:23:39.236 if we are successful we the global community, there should 0:23:39.276 --> 0:23:42.316 be a cause for human celebration. It's a commitment to 0:23:42.396 --> 0:23:47.196 science and human suffering ending and something to celebrate. But 0:23:47.396 --> 0:23:50.596 what's actually most interesting about that is to figure out 0:23:50.676 --> 0:23:53.956 sort of how to take that energy and those assets 0:23:53.996 --> 0:23:56.356 and that political movement and that science and what do 0:23:56.396 --> 0:23:58.836 we do next with that? And so we're already in 0:23:58.916 --> 0:24:03.076 conversations about the so called polio legacy. What happens with 0:24:03.156 --> 0:24:05.836 all that capacity that it just doesn't go away and 0:24:05.916 --> 0:24:07.916 we can go tackle the next thing and the next thing, 0:24:07.956 --> 0:24:10.396 and how that's managed than the transition is going to 0:24:10.396 --> 0:24:12.676 be important. See what are some of the things our 0:24:12.716 --> 0:24:15.756 listeners can do? And I'm talking about listeners who aren't 0:24:15.756 --> 0:24:19.276 Bill Gates and who aren't epidemiologists, but who just care 0:24:19.316 --> 0:24:22.676 about this problem, want to contribute to the solvable you've 0:24:22.716 --> 0:24:25.916 been talking about. Well, I think there's three things that 0:24:26.156 --> 0:24:28.876 listeners can do in this but one is find out more. 0:24:29.116 --> 0:24:31.316 I think this is one of those areas that for 0:24:31.356 --> 0:24:34.156 some reason, I think it's got lost in the storyline. 0:24:34.476 --> 0:24:37.676 I sometimes talk about the focus on the trend lines, 0:24:37.796 --> 0:24:41.676 not always the headlines, and even though they're less interesting sometimes, 0:24:41.676 --> 0:24:43.756