Global Disease is Solvable

horrific diseases. If you want to freak yourself out and you've got some time, you could check out the roll call of the top diseases on the World Health Organizations hit List. That list includes ebola and zeka and something called disease X, which represents the knowledge that a serious international epidemic could be caused by something that we don't

even know about yet. Disease X sounds terrifying, but of course there are plenty diseases that we do know about which we can try to fight, and they're the ones you're going to hear Steve Davis talk about in this episode. These diseases are some of the world's biggest killers, and the organization Steve runs Path is working to either eradicate or eliminate them. So top of Steve's list is polio. Polio is one of the most feared diseases of the

twentieth century. It can cause permanent paralysis, and it's potentially deadly. There's no cure for polio, but there is a vaccine. Successful vaccination programs mean the US has been polio free since nineteen seventy nine, and globally the number of reported cases has fallen by ninety nine percent in thirty years. But as you hear Steve say, the hardest part is getting to the last few cases to wipe out the disease for good. Another disase that is close to eradication

is malaria. It can feel like a flu, or it can be a lot more severe, requiring urgent treatment and actually endangering your life. The drive to wipe out malaria is one of the best known, and the World Health Organization publishes an annual report on the disease. However, last year they wrote that after great success in reducing infections, there'd be no progress made between twenty fifteen and twenty seventeen.

In twenty seventeen, there were two hundred and nineteen million cases of the illness and it kills more than four hundred thousand people. Steve also mentions riverblindness, and that's caused by a parasitic worm transmitted to humans when they're bitten by infected black flies. Riverblindness is found most often on the African continent, but it's also in Yemen, Brazil, and Venezuela.

More than two hundred million people are at risk of riverblindness, the world second leading infectious cause of blindness, so obviously it can cause vision loss, but also severe skin diseases and neurological damage. There's no vaccine for it, but countries have been doing huge work to control and treat new infections. Columbia was the first country in the world to be verified and declared free of river blindness, then Ecuador in twenty fourteen, Mexico in two thousan fifteen, and Guatemala in

two thousand and sixteen. Steve Davis describes himself as a transformative innovator with a passion for global health and saving lives, and he goes about doing this daily in his role as President and CEO of PATH. Now, I love the way this organization started out back in the nineteen seventies. There was a bunch of researchers in Seattle looking to help Chinese manufacturers make better quality condoms. Isn't not just

classic Seattle behavior and that was it. From their start in family planning, PATH have now become a global charitable conglomerate developing devices, medicines and services. Steve says PATH exists because access to good health too often depends on where we were born, our race, gender, ethnicity, age, and class. His organization tries not only to improve individual health but

also the delivery of healthcare in developing countries. That includes helping to build digital systems like mapping and data analytics tools that are used to fight ebola in the Democratic Republic of Congo. The scope of Path's work is vast now unusually as an NGEO, almost all of their work involves the private sector. That could be biopharma or digital distribution anything. They try to bring private sector assets and their ideas to bear on these huge global problems which

might not otherwise seem commercially attractive. We'll hear more now this conversation with Jacob Weisberg. Okay, here we go. There are many many diseases that kill hundreds of millions of people a here that are actually preventable, that we know how to treat it and hopefully how to even prevent it, but that the problem is we're not getting enough access to the people that need it the most of the

tools and the solutions. So the opportunity is now we are in this extraordinary moment in history, or we're actually pursuing to actually get rid of some of the oldest killers on the face of the earth. What's brought you to this problem? Well, I'm neither technologist by heart or a doctor, but I do know and I believe in the power of technology and human spirit together can conquer

a lot of things. And we've seen that already. And what's so exciting is I think we're in a space square in a time and history where those two things have come together to actually vanish some of the world's oldest killers. And I'm very inspired by the fact that not only do we have political will and commitment at a scale around a few of these diseases that we've never seen before, we also have the technology, including both

the biochemical technology of better vaccines, better medicines. But really importantly now is we have the digital tools to get to know where to go, to map, to do geospatial awareness, to all the things that it takes to actually identify where the outbreak is or where the problem is and how to get to them. And then of course we also have a lot of political commitments, so we have countries that are more capable to go after these diseases

and commitments to that. But in all of human history, if I've got this right, we've only eradicated one disease, smallpox, and that was maybe forty plus years ago. So what is it about technology or what leap have we made that makes you're solvable eliminating or eradicating five to ten diseases in a few decades conceivable? Yeah, Well, it is fascinating that in all of human history there's been only one human disease that we've eradicated, and that is smallpox.

And I should be sure to distinguish between eradication, which is completely eliminating the disease and really the potential for the disease versus elimination, which is seeing how that get in a region. We've really gotten rid of the problem, and it is actually so the number has gotten so low that it is it really will be very difficult for it to re enter that region. But what's happened

is I think a few things. One is, human health has just improved vastly over the last number of decades, and we've produced children mortality by about forty percent in the last twenty years. We've seen a lot of other improvements, and that is actually giving us sort of a platform to actually go after the really hard stuff, which is

to eliminate eradicate diseases. Secondly, there's been a large commitment in the global community over the last twenty years to global health and including what we see and in the SDGs as around human health. The SDGs are the Sustainable Development Goals, These commitments by countries around the world, including a commitment to improved human health in a significant way.

I think the biggest two things really are that we have money in the system, whether it's commitments made by governments, commitments made by large foundations to actually target the eradication of polio, the eradication of guinea worm, and the elimination of malaria in many regions of the world. The elimination of rabies, elimination of river blindness. And this is a new level of commitment, including a political commitment, a funding commitment that is enabled a lot of this to happen.

And then finally, I would say maybe the biggest game changer is the digital revolution that's enabled us to understand the data better, to target the communities, better to isolate cases, easier to share information better. All of that comes together to make a very powerful combination toward elimination or eradication. You mentioned a few different human diseases which I'm really interested in, But what's the next one do you think to be eradicated? Is it polio? Yeah? The likely two

diseases for eradication the next few years. Actually, we're just literally in the final stages is polio, which there's a large global commitment too. It's not quite getting to the finish line as fast as we thought, but we'll get there in the next couple of years. We're down to I think about thirty cases a total in the world in three countries, and then guinea worm is very likely

again given very large commitment to that effort. And then there's a suite of about fifteen diseases that the WHO, the World Health Organization, has put on a list for potential for either elimination or eradication. Some of those are quite hard to do. Probably the one we're working with the most is malaria, which is a huge problem in the world still. It kills around four hundred to five hundred thousand people a year, and yet we do have many many countries that are year by year being declared

malaria free. And so just this last year, I think four countries in the last two years have been declared malaria free. And that's the kind of work we now have to keep working on. There's a kind of paradox around the effort to finally eliminate or eradicated disease, isn't there in that when you're down to just a few cases, you spend a lot of money on those few cases, and you could spend that saved money to save a

lot more lives targeting a much more prevalent disease. How do you deal with that in the community and philanthropic world and the scientific world that you live in. Yeah, well, disease elimination and particularly disease eradication is not a no brainer. I mean it's obviously not a no brainer in terms of how hard it is and to pull all this together and also get the social and cultural peace right

along with the technology and data peace. But it's also not a no brainer from a sort of political and financial strategy, because in fact, the last cases become astronomically expensive because either the hardest to get, and so a lot of effort needs to go into finding them and

isolating them and getting rid of them. And some people could argue the money we're spending to eliminate or excuse me, eradicate polio, we could have taken that and done something else with a different disease or a different set of problems. But there's three reasons why I think make the compelling

case why we need to pursue this. One is still you know, the potential to end the suffering and death of people in the world who are vulnerable at diseases that you and I aren't because we've made the commitment here to do that is the moral reason we have to We know how to do it. Let's go finish the job, and let's make sure people are valued equally. There's a second reason, which is the potential for ongoing

cost saving. So the estimation is in the tens to twenty billion numbers around what it will save the world once we eliminate polio from having to treat it and manage it over the time. And then the final I think is a strong belief that we need to demonstrate to the world that we can actually get this job done, because then when we go back to the global community, whether it's taxpayers or legislators or funders, there is a commitment that we can actually set a target, get it done,

and go after the next one. Yeah. I mean nobody wants to march behind the banner that says let's almost eliminate polio, right, I mean you need a level of inspiration around an ambitious goal that says people have been suffering for centuries from this, let's get rid of it forever. Yeah. That's why I think it's exciting solvable because it's eminently doable, although wildly difficult. But it's also there's a little bit like the moment is now that we haven't ever had

this experience before. I mean, yes, there was one and huge success called smallpox. But the idea that we can sit at tables which I'm actually sitting at and talking about which disease and how in what countries can we eliminate it or could we take a global eradication strategy is pretty remarkable in the scheme of things. So you talked about data as the thing that really enables the

breakthrough here, But for data, you need good reporting. In these countries where many of these diseases they are most prevalent, don't have developed medical systems, they don't necessarily have good reporting. I mean, I love the idea that we can visualize these hotspots and pinpoint them, but how do we necessarily know how it's happening. Well, again, getting the right data and digital capabilities and infrastructure around these problems is not

trivial problem to solve. And the good news, I think is there's quite a bit of energy and again investment now know how in countries to do this. And the other is that these systems that are being built are not only being built around an elimination disease strategy, but they're improving hopefully the national health system altogether. And so the promises that we'll have improvement both around a disease area and for the whole health system. But you know,

quality is always a challenge. Can we get the right tools to the right people, Can we measure and validate numbers in a correct way. But you know, we've certainly seen through the polio eradication efforts, and my group helped set up the emergency operations centers and did the geospatial mapping, et cetera for some of the recent abola outbreaks in the Democratic Republic of Congo. And while that's a very

difficult problem in it, there's all sorts of complications. The data quality of what we know, where we know it, how fast we know it is actually quite remarkable how much it's improved. Who sets the priorities of which diseases we go after? There are different places in the world, they affect different constituencies. You have a quick list that it's polio, guinea worm. You seem to know what the

order is. Yeah, Well, the official list is the WHO, the World Health Organization and all of the member states of the United Nations onto that. So that that and that's where my list is. Here's the numbers. But then there's you know, things that influence those selections. Certainly one of them is just the state of the science. Do we have a good vaccine do we have the right diagnostic tools. All those things will matter in terms of feasibility.

And then the other is the again the funding and political commitment, and that can be at a regional level. So India recently stepped up and has committed to we are going to eliminate malaria. Zambia has recently put a declaration from their president that they're going to eliminate malaria in their region and so. And that then comes with both domestic funding and also global funding to support those efforts, and that that actually obviously influences where on those lists

we end up putting our energy and time. The big pharmaceutical companies work in their profit driven enterprises, and we've had this problem with incentives that the poor people who suffer most from disease are not buyers of expensive pharmaceuticals. Are we getting better at dealing with the pharmaceutical companies and getting them to do the kind of research we need to create drugs. There's no question we're doing better.

And I sit with the CEOs of many of those companies and see the progress we've made over the last fifteen years due to a lot of different efforts and leadership that we are making vast improvements, both in terms of commitments to research and development, to commitments to access, to commitments to participation in these global undertakings. That said, you know better is a relative term. We still have some work to do, and it's it's still not a

slam dunk. There are several things that you're absolutely correct. The vast majority of these diseases are diseases, which are diseases are the poor, and that the reason rich people aren't getting most of diseases. I mean, for instance, HIV is not on either of those lists, but HIV is a disease that the rich and the poor world both have, and therefore there's incentive for investments in those kinds of diseases.

Where there's not as much incentives, we've created mechanisms to enable pharmaceutical companies and biotech and other companies to engage.

So we've either there's like the END Fund, the end E and D Fund, which has been set up to provide more incentives to go after some of diseases they're My organization works on a number of vaccines that are not there's no really market force for them, but if we can get some philanthropic money to de risk that innovation, then that companies are willing to do it and do

it quite well. So we're working on a whole bunch of different ways to ensure that there's a market if somebody does invest, to find ways to subsidize or de risk some of this for some companies, and literally just to get the companies at the table able to commit to it as part of their larger scientific commitment. It must just drive you crazy to see people dying of disease in the developing world, and then people in the developed world have these superstitions against vaccination, which very much

controversy right now. But why is that happening? And if they knew what you knew, would people not be resistant

to vaccinating their children. Absolutely, to disconnect between being rural Ethiopian a couple of days and where you know a mother will be desperate to get her child to a vaccine campaign and to get that vaccination, and then I will fly home to my home state in Washington State, where we have measles outbreaks and all sorts of things from the anti vACC movement, And there is a concern and a great concern for those of us working in the field that the larger what's called vaccine hesitancy, that

you know, kind of concern whether it's some of it's coming out of a lot of disinformation that's been propagated by social media and other plays, but some of it is coming from just more concern about in some ways a victim of success that the more we've been able to innovate, we are vaccinating against more and more diseases. So suddenly parents are like, wait a minute, how many

shots of is my kid going to get? And then some of it is is simply you know, we have had some challenges in parts of the world where the vaccine didn't go well. There was corruption in China and the Philippines recently, and that doesn't help. So we're in this larger work of trying to get more people in a place. I mean, vaccines are effective, they're cost effective,

they're preventable, they're great global health tool. But we are fighting another battle now, which is once we get it's hard enough to get the scientific tool and get access figured out and great demand for these and get them remain cold old until they get out to a village and get the village leaders to the commitment for social change there and then to have this larger noise about vaccines is a new problem we're actually having to face.

I like that you said that the solvable is to eradicate or eliminate the range of five to ten diseases over a few decades. I noted that when Mark Zuckerberg set up his foundation, he said the goal was to eliminate all disease, and it just seemed to me so unrealistic given what we were just talking about, that there's been one human disease eradicated. It's not a miscalculation or misunderstanding on his part. Yeah, I mean, of all thes R,

I don't know what Mark was talking about it. I mean, it looks good on a headline, but maybe if a future I hope the planet lasts that long. But in there's some future where maybe we understand the body so differently, or we understand sort of fundamental organic chemistry so differently that this all changes. But first of all, we have new diseases popping up. There's thousands of diseases in the world, and now most of them most of us don't know about, or rarely do we get them. And they morph and

they keep changing and they keep arising. So we need to be hyper focused on the things that we can get done and not overstate the case. And I also think that we have a hard enough time actually just getting people to believe that there is the opportunity to generally improve human health, which has been proved vastly, but there's still a lot of you know, sort of negative headlines about it. It's all a waste of money. And then the second is the belief that we can even

eliminate one disease. There's still some people doubting whether we'll get all across the line on polio. So I'm sticking with one, one or two at a time. What's going to happen when polio is finally eradicated? Is there going to be a ceremony? Is there going to be an award? Is there going to be a day of global celebration? I mean there should be, right, I suspect there's you know,

somebody's thinking about that already. It's like they think about the queen's funeral and they've got a plan, but they can't talk about it. Look, first of all, it's a long process. So just to be clear that who makes these declarations and there's a long protocol on what it takes to declare something eliminated and then eradicated, and there's a waiting period, so it takes a number three years after the last case. So if that occurs, it's they will know at a long time and ahead and of advance.

But you know, there are two things there should be if we are successful we the global community, there should be a cause for human celebration. It's a commitment to science and human suffering ending and something to celebrate. But what's actually most interesting about that is to figure out sort of how to take that energy and those assets and that political movement and that science and what do we do next with that? And so we're already in

conversations about the so called polio legacy. What happens with all that capacity that it just doesn't go away and we can go tackle the next thing and the next thing, and how that's managed than the transition is going to be important. See what are some of the things our listeners can do? And I'm talking about listeners who aren't Bill Gates and who aren't epidemiologists, but who just care about this problem, want to contribute to the solvable you've

been talking about. Well, I think there's three things that listeners can do in this but one is find out more. I think this is one of those areas that for some reason, I think it's got lost in the storyline.

I sometimes talk about the focus on the trend lines, not always the headlines, and even though they're less interesting sometimes, but this trend line is good that we are making progress on a lot of human diseases and we can eliminate and eradicate them, So, you know, learn more about that incredibly interesting trend line that's happening in their lifetime. Second of all, there's all sorts of ways you can participate, everything from how Rotary members end up being very active

in both the polio and the malaria campaign. There's ngeos and organizations around the world doing work in this area, and they can identify those and get online and attract them and support them. And I guess the third, which I actually in some ways is the biggest, is just

believe we can get this done. You know, we live in a time of a lot of concern about the future of the species and the planet, and there's legitimate issues, but there again, there's a lot of evidence that we can do a lot of pretty miraculous things when we get our heads together and our acts together, and those things can lead to the next great thing. And I think turning kind of outrage at the world we live in too, optimism is the challenge ahead of us, and

I would love to see more optimists. And this is a great proofpoint that there should be some optimism. Steve, thanks for joining us. Unsolvable. Thank you. Combining political will, new technology, medical know how I'm private business is a juggling act that not many people could handle. So it

was incredible to hear about Steve's work. So many feelings right, Like it's scary to know that new diseases are popping up all the time, but it's also bolstering to hear that when we take the time to look, the trajectory is headed in the right way. More and more humans are beating diseases and it's a good track to be on. And how about that solvable that Steve offers us at the end of his interview, about believing that this can

be done and turning our outrage into optimism. That's a sentiment that could sound trite, but it's actually a really courageous way to face all of the precarity that we're facing as a species and as a planet, and it was so fun to hear him dunking on Mark Zuckerberg. The Best Solvable is a collaboration between Pushkin Industries and the Rockefella Foundation, with production by Laura Hyde, Hester Kant,

Laura Sheeter, and Ruth Barnes from Chalk and Blade. Pushkin's executive producer is Neia LaBelle, Research by Sheer, Vincent, engineering by Jason Gambrell and the great folks at GSI Studios. Original music composed by Pascal Wise and special thanks to Maggie Taylor, Heather Fine, Julia Barton, Carli Mgliori, Jacob Weisberg, and Malcolm Gladwell. You can learn more about solving today's biggest problems at Rockefeller Foundation dot org, slash solvable. I'm Mave Higgins. Now go solve it.