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How to Meet the World’s Grand Challenges

How to Meet the World’s Grand Challenges

Bishop: So we’re ending on this big, ambitious note of what can innovation, what can tech do to solve the biggest problems facing the planet at the moment. And we’re going to do this in two phases. Firstly, I’m going to talk with Larry Brilliant, who, as David said, is now running the Skoll Urgent Risks Center, and is an expert in pandemics, and has been lately working around the Ebola issue. And then we’re going to bring on the rest of the panel to talk more broadly about what are the opportunities and challenges of actually I think fulfilling the promise that is out there that innovation can actually deliver some major progress.
So Larry, I want to start with Ebola. Just tell us briefly, how worried should we be at this point? How is the world responding and what role is tech playing in that response?
Brilliant: Well, let me start out with some good news. So about six weeks ago, Ron Conway and I got together and thought that Silicon Valley should have a kind of unified response, at least as far as the technology goes, to the needs of the Ebola response world. And the question at that time was how do you observe somebody who’s come from West Africa who’s been in the neighborhood of an Ebola case for 21 days? Every state wants to do it differently, different countries want to do it differently, WHO wants to do it slightly differently for its own staff.
So we got together several companies, particularly Salesforce and Google and Apple, and many other Silicon Valley companies and individuals, and CDC said, well, we need to have a tracing program, a contact tracking program, and Marc Benioff, who will be here tomorrow, just told everybody it’s all hands on deck, and 200 volunteer hours later, two chronological days later, we had a tracking system. And that system, along with work done by InSTEDD, a voice-response system that’s up and running right now, being used to track individuals, and WHO is going to deploy it for their staff. So there’s no money involved. Nobody made any money; it’s all donation. But it’s really something to be proud of, I think, as part of our industry, and I’m really pleased about that.
As for the epidemic, the numbers are getting more encouraging than discouraging. There’s 13,000 cases that have been reported. Most people believe that’s underreported by a factor of 2.5. So maybe we’re dealing with 25,000 or 30,000 cases. There have been 5,000 deaths. That’s probably not underreported, proportionally, as much. I don’t think we will get to CDC’s worst-case scenario of 1.4 million cases, certainly.
We have to remember that in the U.S. we have a disproportionate antigen-antibody response, anaphylactic shock—if you’re medicine-oriented, we’ve gone crazy. We’ve had precisely one unwanted importation of Ebola, four cases that occurred on our land, and the death rate from the individuals that we brought here for treatment is exactly zero. So we’ve all gotten a little bit crazy about it, from our own point of view. And let us not forget, in West Africa, the disease, the fear of the disease, the dysfunction of the response, has destroyed the economy of three countries, and they are mostly post-conflict countries, poor patients. It occurred at an area where the three countries of Guinea and Sierra Leone and Liberia come together. It’s a no man’s land. Those of you who’ve worked in the developing world know that the country is pretty much synonymous with the capital city, and it occurred in places where there’s no public health infrastructure.
So the question is can we still depend upon the cavalry coming, from CDC or from WHO or any other place, and my fear is not that we will not solve the Ebola problem. We will crush the Ebola problem, and we will do it quickly, now that we are all energized and it’s on cable 24/7. But it shows how poor we are as a world in organizing our global response, and I think that—I used to see the headline “Ebola and the End of the World.” Well that’s not a very accurate headline. But if it said “Ebola and the End of the World Order,” I think we could have some conversations about that.
Bishop:So a few years ago, you were involved in the making of this movie—was it called “Pandemic”?
Brilliant: No, it was called “Contagion.”
Bishop: “Contagion.” It was basically—
Brilliant: Prescient?
Bishop: Prescient, but also, it seemed to imply that sooner or later we are going to have one of these pandemics that wipes out large parts of America and Britain, as well—
Brilliant: This is not that pandemic.
Bishop: No? That’s a relief.
Brilliant: So Ebola is not a pandemic. Ebola is not a pandemic. It’s a terrible epidemic. It’s a tragedy for the individuals involved. It has risen to heroic status. Médicins Sans Frontières and other organizations—
Bishop: But are we at the point where we’re any closer to being able to say we can protect the world against this pandemic threat?
Brilliant: Yes. I think we’re much closer to being able to say we can protect the world against this pandemic threat, and I’d like to say that since—over the last 30 years there have been 30 novel viruses that have jumped species from animals to humans. So outbreaks are inevitable. But pandemics are optional. If we can get there fast enough, if we can identify the organism and we can put a ring around them by reducing the percentage of people who are susceptible, by isolating cases, we can stop a pandemic in its tracks.
We gave this virus an eight-month head start. Everybody in business understands exponential growth. You want some, right? But that’s for revenue. But exponential growth for a virus is a bad thing, especially one that has an incubation period of eight or ten days. We gave this virus an eight-month head start. It’s a surprise to me only that there are so few cases. Because if you gave measles an eight-month head start, there’d be 2 billion cases. If you gave smallpox an eight-month head start, there’d be a billion cases. So—
Bishop: So what can we—what can the tech innovation community do now to make sure we don’t give the next virus eight months?
Brilliant: You should know that this virus was detected by HealthMap, which is a product of Boston Children’s Hospital and Harvard, which may or may not have led to their sale or affiliation now with Booz Allen. But they detected this outbreak by using a Web scrubber, something like Google News or other digital scrubbers. I think there’s a huge market for that kind of intelligence. You should know that point-of-care diagnostics are going to get a huge bump from this. Several companies are on the cusp of being able to have an Ebola test with a finger stick—so no third party needs to have blood contamination—in a short period of time. I think that’s amazing. I think this outbreak will push lab diagnostics, early detection systems, and response systems, and like this tracking system, new IT systems will be built, for the Ebola outbreak, but will have applicability across many different diseases.
Bishop: And is there anything you particularly urge this audience to be looking at?
Brilliant: Yeah, but it wouldn’t be really in the conventional—I’d ask you to take a look at the entire world of global threats. Larry Summers had a very good article in yesterday’s Washington Post, and he’s arguing that the post-Second World War world order that we created, the IMF, the UN, WHO, these organizations are really long in their teeth and they’re falling apart. The wealthy old industrial powers are tired of funding them. The new powers are not ready to fund them yet. That has led the owners of WHO, the 200 member states, to slash the budget of WHO almost 25 percent in the last three or four years. The number of infectious disease epidemiologists for WHO for the world is 37. We have four on my staff; WHO has 37. The budget of WHO is less than the budget of the San Francisco Health Department. The pandemic preparedness budget for influenza at WHO is $7 million. That’s less than the New York City pandemic preparedness budget.
So for all of you, you’re first and foremost citizens, ask yourself what kind of a world we need to have to protect us from those things that can bring humanity to our knees. We don’t have it, we’re not doing it, we have to do it.
Bishop: Well, Larry, stay with us. I’m going to ask the rest of the panel to join us up on stage. I think it’s worth mentioning, obviously next year is going to be a huge year for the world order, in terms of the big debate that’s going on around what replaces the millennium development goals and whether they will be meaningful new goals for the world, whether they will actually have money attached with them and so forth. And I think that is an area where, if you are taking up Larry’s challenge to act as citizens in this area, to really be thinking about what initiatives do make sense for the world to prioritize around as the sustainable development goals, as they’re going to be called, get put in place next year.
I wanted to talk to Rima initially, from Ericsson. Because we’ve talked about Ebola. You’ve been involved with Ebola as well, through Ericsson. Would you just talk a bit about what you’ve learned about the role mobile devices can play in this way.
Qureshi: Yeah, I think there’s so many points to pick up on, it’s hard to know where to start. But Ericsson is working with the International Rescue Committee. We have—even though it was stated yesterday, we are not developing phones, we are contributing phones. We are looking at how we can also contribute other things in the Ebola crisis. And if I can pick up on some of the things that Larry talked about, I have been working, directly or indirectly, with emergency response with Ericsson,, for the last 10 years, working with a lot of the organizations that have been mentioned, and various agencies within the United Nations. And the feeling that I get is, of course there is a technological challenge that we need to resolve. Of course innovation is important. But I think my experience personally is it’s more about coordination. It’s about getting public and private enterprise to learn to work together, to be able to learn what it takes to come together and use the resources that we have to the best of our ability. And I think that’s part of the challenge, almost a bigger challenge than the technological challenge.
Bishop: Could you elaborate a bit on that?
Qureshi: I think if we are to start specifically, as an example, of the Ebola challenge and the countries that we are talking about, most likely the people that are living in these countries have some form of a phone, because there are enough of them around and there is 7.1 billion subscriptions globally today. But the chances are that the type of phone that they have is a very basic feature phone. So when we are talking about developing potentially innovative solutions on how we can help with the Ebola crisis, we have to take into account what kind of a network are we dealing with, what kind of capabilities are we going to be able to provide. And it’s not the fancy solutions that are needed. It’s very, very basic stuff. As an example, International Federation of Red Cross has a system that we have worked with as well in other locations called Trilogy, and the Trilogy system is a very basic SMS, or a text messaging system. And basically, what this system does, in the case of Ebola—because I know they’re using it there as well—it is basically to give a very simple text message that can be targeted to particular regions or particular groups of people to be able to say something as simple as go to this location to pick up certain medication or dispose of your loved ones, if they have contracted Ebola, in a certain way, and to do it in such a way that it doesn’t bring the network down.
So I think what we need to keep in mind is innovation is important, but you have to keep in mind where you are going with your innovation and what is the best way to use that innovation. I can take other examples which are maybe more disaster-type situations where we have done a lot of work with response on trying to build up networks after earthquakes, after typhoons and so on. And unfortunately, what we see very often is what we call humanitarian tourists, people who show up, who, very well-meaning, try to help but actually create more trouble. And if we could somehow figure out a way of taking all of that energy, resources, effort, and coordinating it better, I think we could do so much more.
Bishop: I want to turn to Geno, from Pfizer. Obviously, we’ve been talking about pandemics and detecting them, but if we stick with medical, I guess there’s this broader divide opening up in the discussions that we write about in The Economist, and other people have, about where the pharmaceutical industry is going and whether its really able to fulfill the promise that I think a lot of people felt it had 10 years ago, through the biotech revolution and the genome and so forth. I mean there seems to be a slowing down of innovation in some ways in the industry at a time when we would look to increase it. Now, can you just talk a bit about what can be done to get to that potential that is out there to really make a difference to health in a massive way, and longevity and so forth?
Germano: Well, you know, I actually think that we’re kind of on the cusp of a resurgence in the productivity, in pharmaceuticals that are really driven by important new discoveries in science, and then the leverage of big data and technology. So all three of these things are kind of converging at the same time and creating huge opportunities to meet some of the daunting healthcare needs that still exist today. So with genomics, with advances in immunology and advances in basic sciences, we’re finding new solutions for patients with a broad array of different types of conditions.
So, and I think leveraging the information, leveraging this information is giving us new tools to work with that are providing not only effective therapies, but much more targeted and specific therapies. And I think some great examples exist in the oncology field, where today we’re able to, through the information available through genomics, we’re able to develop targeted therapies that are very specific to particular mutations driving specific cancers. And at Pfizer, we developed a drug for patients with non-small cell lung cancer that is driven by a very specific mutation. It only accounts for about 5 percent of the non-small cell lung cancer that exists out there, but when it’s identified, it’s a highly effective therapy.
So we’re seeing opportunities across drug development, across providing access to patients. As Rima had mentioned—I can kind of pick up on some of the comments that you made. You know, we make vaccines, and distributing vaccines in the underdeveloped world is a very difficult process. And, you know, we have this term, the last mile, because you can develop the vaccine, you can manufacture the vaccine, you can provide quantities of the vaccine to the country, but that doesn’t mean anybody gets vaccinated. And some of the challenges and infrastructure needs that exist in that last mile from delivery into the country to administration into the patient is a significant issue, and we’re providing solutions for access types of issues like that through technology.
And then finally, in terms of just overall utilization of medicines, new tools are being developed every day that help us get more effective use of medicines by patients, again, for a broad array of different conditions.
Bishop: Now, I mean some of the big people, the big names of Silicon Valley, the Peter Thiels and so forth, have talked very actively about setting really bold goals for health improvement, like eradicating death and things of that kind. [LAUGHTER] What do you think about that? Is that something that a company like Pfizer, which is more of a mainstream player, is that something that you could embrace as a goal and actually pursue on a daily basis, or is that just too out there?
Germano: Well, I think that, you know, we come to work every day looking to extend people’s lives and improve the quality of people’s lives, and, you know, we’re able to that in many ways. Again, our vaccines division, for example, just one vaccine has nearly eradicated the pneumococcal disease in children in the United States. There’s been like a 96 percent reduction in invasive pneumococcal disease since the introduction of this vaccine. So that’s a pretty audacious goal and a pretty audacious accomplishment. And to say, “I want to abolish death,” I mean, that’s a great goal. It takes lots of innovation along the way in order to get there. But, you know, we see an opportunity to make a significant impact in a number of different areas, and in setting the goals—
Bishop: But when you hear something like that coming out of Silicon Valley, does it inspire you, or does it kind of piss you off a bit, make you feel what’s the point of—
Germano: Well, we’re already inspired, you know? Frankly, I mean, like I said, this—I think anybody that works in this industry that I work in, you’re pretty fired up about the things that you do and the impact that you can make with the medicines that we develop and bring to patients.
Bishop: I wanted to talk to you about Samasource and Sama and how you’ve evolved. Because initially, when we first spoke, you were very involved in the refugee crisis as your primary focus, and providing work to people in refugee camps, but you’ve broadened your vision a bit. Can you just tell us what you’re—where you see your role? And you’re a nonprofit, unlike Ericsson and Pfizer. Why have you—
Janah: Yes, very much unlike Ericsson and Pfizer.
Bishop: A small startup and—yes.
Janah: First of all, I think all of us on the panel should thank the 50 percent of this conference that stayed to hear about how to meet the world’s grand challenges. [LAUGHTER] Maybe you can inform the rest of your, the rest of the conference-goers about the solutions we’re talking about here.
So I’m a social entrepreneur, and I actually first wanted to start by responding to the Peter Thiel comment. Because about a month and a half ago, I was in a maternal ward in Uganda, in a hospital that serves about a million people, and that operates on an official budget of $65,000 a year. And in this maternal ward, I was with women who were in labor for up to five days. Many of them had birth injuries and were there to recover from birth injuries, from giving birth in rural areas. And what’s surprising to me is that so few people know that around 290,000 women die annually in childbirth and right after pregnancy and during pregnancy, and that the World Health Organization has found that 99 percent of all of these deaths are preventable.
So I think if we’re going to talk about extending life, or eradicating death, we should start with the problems that are really avoidable, and unfortunately for I think a lot of technologists who believe that so many of our solutions lie in technology, many of the solutions lie in extending basic healthcare, stuff we already know how to do, to a lot of people in developing countries.
And I would say that the same argument holds true for Ebola. One of our doctors—we formed a crowd-funding site called Samahope—we’re actually the first crowd-funding site that let’s you fund treatments for people around the world, medical treatments. And we started it a couple of years back and we’ve funded about 1,000 treatments. But I think what’s most interesting for me in this journey of founding this organization has been to see how little access the poorest people have to really basic forms of care, that don’t require a lot of technology, that don’t require a new vaccine, that don’t require putting up $1 billion to find a new drug, but simply require things like sterile gloves and razor blades. And the hospital that I visited had a shortage of mattress pads, so women were borrowing other women’s mattress pads, and that leads to the transmission of all sorts of diseases.
And I think very few people realize that the reason Ebola spread so fast in West Africa wasn’t because we didn’t have access to all of the latest and greatest technologies or because we didn’t have a vaccine—although I’m sure that would help, and I’m not a global health expert—but a lot of the doctors that I talked to on the ground in the field said, “We didn’t even have access to sterile gloves.” So people were literally borrowing gloves from other people. And I think we just have such a lack of awareness about the reality of life in a developing country and the reality for the bottom billions that we forget these things and we think that we need all of these high-tech solutions.
Bishop: That’s very interesting, because I mean you’ve had things like that blanket that keeps babies warm—
Janah: Embrace, yes.
Bishop: That’s made a huge difference. You’ve […] Bill Gates to launch initiatives to reinvent the toilet and reinvent the condom in order to make them much more user-friendly for the developing world. But are there a whole bunch of other areas that you can see relatively low-hanging fruit?
Janah: Absolutely. Another one is burns. So many people don’t realize this, but about seven million people around the world, seven million women each year are affected by severe burns, third degree burns, and they’re typically affected because they are around cook stoves in their houses, and in developing countries, people often live in small enclosures and they’re cooking around an open flame. So seven million women get severe burns each year. Many of these burns cause limb contractures, which essentially means you lose the use of your limb and you can no longer work, you can no longer cook, you can’t farm. And that’s the same number of women who are diagnosed with tuberculosis and HIV combined each year. That’s according to the World Health Organization. And so something as simple as a burn, which we know how to treat—there’s no new technology really needed we have the ability to give low-cost surgeries to people—even that is vastly underfunded. Dr. Paul Farmer, who many of you might know—he’s the founder of Partners in Health—has said that global surgery is the neglected stepchild of public health. So from my perspective as a social entrepreneur, I just see that there are a lot of problems that could be tackled with relatively little investment, but for some reason I think the technology community tends to aggregate around those problems that require high-tech solutions.
Bishop: I mean, it’s interesting—
Brilliant: Can I try to just draw something between Leila and Geno, because the answer in some cases is not high-tech, it’s low-tech. And you mentioned the final mile, and the fact that if you have a vaccine, it doesn’t mean people are going to get it. We had a smallpox vaccine for 70 years without eradicating smallpox—for 170 years, without eradicating smallpox. We had a polio vaccine for 60 years without eradicating polio. And then some technologists, particularly from Pfizer and Geigy and a couple of other companies, they looked at the smallpox vaccines and they say, “My God, that’s never going to last in a hot climate. Can we figure out a way to look at coffee”—which had recently been freeze-dried—“and freeze dry the vaccine?”
Well, that helped. “And then can we find a new way to getting the vaccine delivered, instead of using these big jet guns,” because no matter how good they are, the electric cord is not going to last all the way and go to the middle of India, into Liberia. And they said, “What if we take a sewing needle and we pound it until it gets bifurcated, and right in the middle of it, it would hold a meniscus of fluid and then make the vaccine of the concentration that, when diluted, that will hold exactly one dose, and then any villager can give the vaccine to someone else?” That’s what helped eradicate smallpox. Same thing with polio. In every one of these success stories, the Carter Center, working on a terrible disease called dracunculiasis—Guinea worm—found out that the single most important technology was cheesecloth. Because if you put cheesecloth over the opening of an […] and you pour your water through, it’ll filter out the microorganisms while they’re micro, they’re bigger than the little holes in the cheesecloth. So what we need is not no technology; what we need is technology that’s appropriate for the conditions that Leila and Geno are talking about.
Bishop: And there is this argument that Silicon Valley is very good at solving problems that are in the face of people in Silicon Valley. So coming up with an app to order Starbucks from your bath is relatively immediate, a problem you’re aware of every day and obviously quite irritating. Whereas the problems of getting burn victims treatment in Africa or India is not very—
Brilliant: That changes when people from Silicon Valley, or any other valley, go out and go to Africa and go to India—
Bishop: That’s partly what needs to happen. We just need to get people out there.
Janah: I can invite anyone who wants to come to visit a Samahope clinic, who’s in the room. You’re welcome—and I especially invite Peter Thiel, if any of you know him. [LAUGHTER]
Bishop: So I’ve just written a report for the task force that was set up by the G8 on what’s called social impact investing, which is the idea that you can invest with a very specific goal of achieving a social goal and making money at the same time. And we called the report “The Invisible Heart of Markets”—and I’m going to give a shameless plug. Please read it and see what you think of it.
But I wanted to ask the panel, as you think about tackling these big goals, should you be bringing kind of a capitalist mindset to bear on how do I make money and do well by doing good, or is this something that predominately is going to be a philanthropic initiative—and again, I declare an interest, having written a book called “Philanthrocapilatism,” which tries to have its cake and eat it, in the sense of bringing both sectors together. But I’m interested to see what you see as the balance between the for-profit world and the nonprofit, philanthropic world as we try and tackle these big issues.
Rima, why don’t you start?
Qureshi: It depends, I would say, a little bit on if you are planning on doing this yourself or if it is in conjunction with others. But—and it also depends where the benefit goes. It may not necessarily be money because you have sold a product, but it may be other benefits that you get from it instead.
Take the example of Ericsson Response, which is an initiative that we started in 2000. And basically, the way that this initiative started was employees that decided that they have a competence that they would like to use, and they wanted to be able to use their technical competence to help others in need. And one of the things that people need when there is any type of a disaster—in this case it was a disaster situation that they were trying to address—after you’ve got food and water and basic things—medication—is communication. How do you ensure that you enable basic communication after a disaster? So a lot of our employees basically decided to go onsite by themselves and try to help. And what we did is we created a program around it, and the reason that we did it is not because we were going to try to sell something to the disaster-affected area, but this was a way to keep the most valuable employees in the company. And it was also a great way to attract the kind of people that we wanted to have within the company—and actually it’s a great recruiting tool for us to be able to say we allow you to use up to four weeks of the year, paid, where you can go and you can do what we believe is part of the core competence of the company, and in those four weeks, you can effect so much change, because you’re providing a competence that somebody else doesn’t have. And we will cover all your costs.
So it’s not something that we are selling to the UN or to the government or anybody else. And yes we are a for-profit company. But we do this because we believe that this is a great thing for us to do. And in that case, it’s not true capitalism, but it is beneficial to both sides. So I think there are various models that could work.
Bishop: Leila?
Janah: So if I were in charge of designing systems—and not just in health, but in all sort of social impact areas—I would sort of say the government’s role is to collect tax revenue, which I think is necessary for certain basic human needs, but then not to run programs itself, but rather to identify the most efficient organizations on the basis of dollars per unit of outcome, whatever the return on investment is, and invest in those organizations. And what would then happen is the organizations which were able to generate earned revenue would be more effective, right, because each dollar would go further.
So a good example of this is a hospital in India called the Aravind Eye Clinic. Some of you may have heard about it. It’s been written about in The Economist. And it’s a brilliant model where they’ve realized that they can actually operate on a break-even or slightly better than break-even basis and serve mostly very low-income people who need cataract surgeries by charging a much higher price to rich people who are willing to pay for it, for a luxury experience. It’s a differential pricing model that makes total sense. It discriminates on the basis of income, and I think roughly 80 percent of their—correct me if I’m wrong, because you guys might know more, but roughly 80 percent of their patients are from very low-income backgrounds. And as a result of the fact that they’re break-even, they take very little tax money to fund.
And these types of models, which are typically driven by social entrepreneurs, I think are far more effective than many bureaucratic institutions, sometimes more effective than traditional nonprofits, because they think in a business mindset and they think about scale. But I do think, at the end of the day, and maybe this is not the right thing to say to a group of technology-oriented capitalists, but there are certain thing that we as humans have a moral duty to ensure, and one of those things is that no human being on our watch dies from a preventable condition because they lack the money to pay for something like a safe birth. And I actually think that there are smart capitalistic, profit-driven models—maybe not profit-driven, but profit-achieving models—that can treat more people if we allocate our funds rationally on the basis of outcomes.
Bishop: And what do you think about the B-corporation model, where you have a company that has a very specific social mission as well as trying to make money?
Janah: B-corporations are great, but I think that there’s still a line between—so B-corporation refers to a movement called a benefit corporation, and it’s a movement that includes both the certification that you can get as a private company and a new class of business in many states in the U.S. And the certification basically says that in your charter as a company, you agree to monitor social and environmental impact and to put that very high in your company’s list of priorities. I think the challenge is that profit is still the number one goal, and I think in some areas, that goal can distract us, or maybe divert us from achieving the sorts of social outcomes that we want to achieve. But I will say that I do believe in markets and I think that markets tend to select the most efficient organizations, but so rarely do we use markets in public or global health.
Bishop: So, Larry, I wanted to come back to you. I mean you run this urgent threats organization. Pandemics is one of your urgent threats; you have a number of others. And I think when we’ve talked in the past, you’ve said pandemics was the one you’re making most progress on. Just quickly tell us about the other threats and, you know, what—again, what this audience here could be thinking about or should be thinking about to help accelerate progress—because these are threats that were selected on the basis that they could lead to extinction of the human race in 10 years or something like that. So it’s quite urgent, I guess.
Brilliant: First, let me just support what Leila mentioned as a model, the Aravind Eye Hospital. It’s really spectacular. And what they do is they give the exact same surgery to the wealthiest and the poorest person. They charge differing fees for the room accommodations. So they understood that a hospital is a hotel that also has surgery. So there’s no difference in—the surgery is free. It’s if you want an air-conditioned room, you pay a lot more. And that subsidizes all the free patients, which as you say, are about 75 percent or 80 percent.
So Skoll Global Threats Fund works on pandemics, and water and climate change, nuclear weapons, and the Middle East. These are all, came out of Jeff Skoll’s concern that all the good that we might do collectively or individually could be washed away by one very bad bit of bad luck on the nuclear front, or one genomic shift or drift or reassortment in pandemics, and certainly in climate change. They also have in common that they represent I think the hardest problems to solve. They’re all called wicked problems, now, and just as Matthew said, they’re either existential threats—they’re not like an asteroid destroying every human being, but they’re near-existential threats. They could bring humanity to their knees.
We’ve made I think a lot of progress on pandemics. Fifteen years ago, the time that it took to find the first disease caused by a virus jumping from a monkey or another animal to a human being was over six months—and as I said earlier, if you give a virus a six-month head start, you’ve got a billion cases in many instances. That’s gone from six months to three weeks. So if we get it down to one incubation period, which is six, eight days, 10 days, 14 days, then we can end pandemics in our lifetime. Not end outbreaks; they’re inevitable. But pandemics are optional. We can end them, if we can find them soon enough, and then have the rudimentary and fair public health systems that go to every corner of the world. Just the basics. So I’m very pleased about the progress there.
In climate change, this is such a heavily political issue. We have all the technology. We know the legislation. We even have right wing Republican solutions to climate change. It’s a question of public will, and like all of these, it’s a question of governance, governance at the city, at the state, at the country, and certainly, as you can see, at the global level. Water, nuclear weapons, biological weapons, new kinds of war, these are all very difficult issues, but we have to deal with them. It’s a whole new class of things. And I hate to mention Larry Summers twice in one session—I’ve never done that before—but I once asked him how he could be so confident that economics was not really just the dismal science and that it had any solutions for these big problems, and he said, “Economics, especially macroeconomics, can solve all the world’s problems except two: market failures and externalities.” And I said, “Those are the only things I care about.” [LAUGHTER]
So in fairness I think to the companies of the world, it’s not their fault. The structure of the market is such that the market was never intended to deal with negative externalities or market failures, so what we have to do is we have to build in regulations and incentives and collectively exercise our will through those methods of making sure that if we’re going to stay in a market-based system, that that market-based system works for the greater good.
Bishop: So our time is pretty well used up. I just wanted to go down the line and basically ask each panelists, is there one problem that you would pick to focus on, if you weren’t doing your current job, because you think it’s within reach that we could find a solution if people really put their minds to it. And Geno, I’ll start with you.
Germano: Well, I think the one problem that would be great to solve is managing the cost of healthcare, because there’s so much more we could do to advance capability. You know, we call it healthcare, but it’s really sick care, you know, in this country and in most parts of the world. And I think that part of the reason is because the system doesn’t really work to help people stay healthy. It’s a very fragmented system. We have a lack of really clear understanding of what works, what doesn’t work, where the value is in the process, and if we could really harness the power of data and technology, you know, we could do a much better job of managing health so that we could prevent costs from escalating out of control and we could have more targeted and effective therapies to achieve outcomes for patients.
Bishop: Great, thank you. Larry?
Brilliant: I think climate change is the great exacerbater. It makes all the problems that we’re talking about worse. It is inevitable, unlike pandemics. It’s inevitable, it’s unstoppable, unless we do something now, and we are so close to tipping point. The last case of smallpox occurred on an island, Bhola Island, in the Bay of Bengal in Bangladesh, and I used to go back every year or two to visit the last case. I can no longer go back and visit Rahima Banu, because Bhola Island is gone, because climate change caused sea level rise, which destroyed that island. We’re going to see that all over. We’re going to have malaria in Hollywood. We’re going to see the coast around Miami destroyed. Even the Google office in Mountain View, a place I hold dear in my heart, will soon, theoretically at least, be in peril. I think we need to solve it, and George Shultz, a Republican, Tom Steyer, a Democrat, Bob Inglis, a very conservative Republican—they’ve agreed on a revenue-neutral carbon tax as the way that the conservative movement can embrace and bring forward climate change legislation. We’ve got that in a movie coming out soon called “Merchants of Doubt.” I hope we can get to something like that. We need to buy ourselves a decade or two and slow this thing down, because it will bring humanity to its knees.
Bishop: Rima?
Qureshi: I think the objective is really to think about how we can use technology, and I think even though I have stated that maybe it’s not necessarily the latest and greatest that is needed to solve some of the challenges, I think there is an awful lot of great technology that is just waiting to be utilized, and I think if we can find ways of deploying very, very simple solutions, that already exist in a lot of cases today, to those that are most in need—whether it be simple connection to a remote village to be able to remotely have access to a doctor so that they can get basic treatment. Of course, you still have the challenge of making sure that you get the vaccination to that village, but there are so much diagnostics capabilities that we can get to the villages and to the remote areas, basic things like being able to set up that basic connection to allow children to be educated, or to teach mothers what they need to do to be able to better take care of themselves. I think if we can strip away things like LTE and 4G and graphics and Wi-Fi and go to very, very basic levels of technology and try to use that as the platform for innovation here, it’s amazing what kind of solutions that we can find that would reuse that technology and solve a lot of the problems that exist. And I would say that a lot of that technology exists today.
Bishop: Thank you. Last word to you, Leila.
Janah: So I run a family of nonprofits called the Sama Group, and sama means equal in Sanskrit, and our founding principle is that all human beings have inherent worth and dignity and we try to level the playing field using technology. So we have two different innovations that do that. So I feel like I’m actively engaged in solving problems, and yet I’m always encountering new problems that I want to solve, and I think if I were to boil down how to address the root of so many of the issues that we’ve talked about here today, including climate change and the health crisis in the U.S., which is I think driven largely by the fact that we don’t appropriately regulate industries that advertise sugar to our children, among other things—I think that it all stems from campaign finance reform, actually, and from the way our political system has unfortunately been corrupted by interests that are not aligned with the public’s. And I think Larry Lessig does a much better job that I do about talking about this issue, but if I were not doing Sama Group, I’d probably be working on that.
Bishop: Okay, well on that very practical note, I’d like to thank the panel for giving us an inspiring look at how we might think about solving some of these big challenges that we so desperately need to solve. Thank you so much.


Geno Germano

Group President, Global Innovative Pharma Business, Pfizer Inc

Leila Janah

Founder and CEO, Sama Group

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