Power of Giving 2019 | Health & Medicine: Keynote, Dr. William Foege

Some years ago, I was on the board of my college
and at one of the meetings, the president of the faculty announced that his term
had ended—this would be his last meeting. He said he took the job as president of
the faculty because he felt an obligation, but he found that he enjoyed
it, and he asked his wife one night, “Would you in your wildest dreams have thought
that I would enjoy doing that?” And she said, “I hate to hurt your feelings, but
you’ve never figured in my wildest dreams One of my wildest dreams is
global health equity. Is there a cause for optimism? What’s the role of
philanthropy? And some lessons that have been learned. The cause for optimism—
first of all every place on earth is both local and global, therefore
anything we do in the United States is already related to global health. The
changes are so spectacular, it always surprises me that we can absorb them
without being awestricken. In 1900, the single most important cause of death in
this country was tuberculosis—and through a very persistent effort and
lots of philanthropy, this no longer scares us. It’s still a problem in much
of the world, however. My father was born in nineteen-five and his life expectancy
predicted that he would live until the early 1950s. He lived through the fifties and
the sixties, and the seventies, and the eighties, and the nineties, and he made it to this century. Why? Because in the United States, for an entire century, our life expectancy
increased by seven hours a day. Think of that. Seven hours a day. It’s as if you
never had to sleep. You just got seven hours every new day. So I grew up with
the fear of polio, not the fear of tuberculosis, but then through the March
of Dimes—which I see is the philanthropy of people in the aggregate—
we saw the miracle of a press conference in April of 1955, at the University of
Michigan. And there was an announcement that said four words: safe, potent, and
effective. And that’s the way the Salk vaccine was introduced to the world. The
field trials, conducted by Tommy Francis, required 1.8 million children, hundreds
of thousands of volunteers in the medical community, in the education
community, all before computers. And Tommy Francis had file cabinets up and down
the halls at the University of Michigan and he completed this study in less than
two years. It’s a miracle study and a medical milestone, so it’s the face of
philanthropy. But then a second milestone within weeks, because people began asking—
what’s the federal government going to do with this vaccine that works? The
federal government was going to do nothing, because Mrs. Hobby, the Secretary
of Health, Education and Welfare, said she was opposed to anything that looked like
socialized medicine. So, she did not have a plan. President Eisenhower told her to
develop a plan, and she had a press conference and announced she would seek
an appropriation in order to buy vaccine for poor children. Senator Lister Hill then had a press conference and he said, “No child will
have to declare themselves poor to the world in order to benefit, I will seek an
appropriation for vaccine for all children in this country.” And that passed,
and since then the federal government has paid for vaccines for children in
this country because it’s seen as a social good. So, yes, we can be optimistic. Ten years later Lyndon B. Johnson then proclaimed the US would help with global
smallpox eradication for the same reason— that it was a social good. The Americas
had been decimated by smallpox and in Europe, if you read the history, it’s just
amazing how many people had smallpox or died from smallpox. Voltaire
had smallpox and he estimated at that time that 30 percent of all Europeans
would have smallpox during their lifetime. He said a third would die, a third would end
up scarred, and only a third would get away
scot-free. But it wasn’t just Voltaire— Mozart had smallpox. His sister had
smallpox. Haydn had smallpox. Louis XV died of smallpox. Lady Montague had
smallpox. The change in history because of this one disease: 300 million deaths
last century and now it’s gone. It’s been 40 years since the last case. When I
first went to India, 56 years ago, what I saw was what I expected from
Europe in the nineteenth century. Lots of people had smallpox scars. Now you go
to India and you see no one under the age of 40 with pockmarks. Measles used to
kill three million children a year when I started in this business. And if you can
imagine three million couples now with an empty place at the dinner table each
year. That figure has gone from three million, to two million, to one million, down to about
a hundred thousand a year. Still too high, but that great progress has been made. When I started, fifty thousand children under the age of five would die every
day in the world. That figure went down to forty thousand, thirty thousand, and it
continues to drop. Malaria, we’re starting to see a true decrease in deaths around
the world. And blindness in Africa has changed completely thanks to Merck drug
company, for giving a free drug. So the good news just continues to accumulate. What’s the role of philanthropy? Well, if you look at what people traditionally
called global health, they were thinking of tropical medicine and countries in
the tropics—and there have been many chapters. The church sponsored programs
that started in the early nineteenth century. The colonial powers—particularly Britain
and France. The military, because they wanted to maintain health in their
troops. Then the foundations a hundred years ago—the Rockefeller Foundation. Global agencies after the the second World War, WHO, and UNICEF, and
Care and UNDP. Bilateral programs: USAID and counter programs in Canada and Sweden
and Denmark and so forth. And then nongovernmental organizations—first by
the dozens, then by the hundreds, now by the thousands. And academic programs in
the last 20 years, they’ve become very interested in global health. All of these
have confluence of philanthropy. And then the corporations became involved, with
the big change being Merck’s entering the field. New political
programs—The Carter Center has brought together politics and going directly to
heads of state with global health. New foundations—the Gates Foundation. A public interest—because of fear of Ebola, Zika. So some of the highlights around
those programs: In the beginning when the churches got involved in medical mission
work, Livingstone was actually writing home asking for doctors to keep the
missionaries alive. But soon hospitals and clinics became such magnets that
they continued to grow, and some of those hospitals have been going for 150 years. The Clara Swain Hospital in Bareilly, India was started by the
first woman physician to be sent to the mission field. The colonial powers—I
mentioned that France and England started big programs that still exist in
their former colonies. And foundations— a hundred years ago Rockefeller left a
legacy getting involved in hookworm eradication in this country. And then the
first School of Public Health at Johns Hopkins—they became interested in yellow
fever vaccine and started a program in Nigeria. They lost three of their
scientists to yellow fever before they finally isolated a virus and they were
able to send it back to New York, changing the ice continuously, and
developed what is now the vaccine used around the world—17D Yellow Fever
Vaccine. And Max Theiler, who worked for the Rockefeller Foundation, got a Nobel
Prize. The Rockefeller Foundation got a second Nobel Prize in 1970 when Norman
Borlaug, working on agriculture, got a prize for the Green Revolution in India
and Pakistan. Postwar, as all of these programs were developing, WHO is a
particular example. An essential organization developed by people of good
intention but flawed ideas. In the United States we insisted on three things: that
the regional offices had to be very strong, because we were trying to protect
the Pan American Health Organization here in Washington, DC. Those regional
offices became so strong, that they could undermine Geneva anytime they want. We also insisted on a board of directors of the ministers of health around the
world, so there are now 195 members. I can’t imagine a
CEO running a company in this country if they had to have 195 people on the board. And these are people that turn over all the time, that two or three years and
then they’re off to some other position. And the third thing, the countries have
insisted every year that WHO reduce its budget. One year the United States
was not paying its dues to WHO, and I wrote an editorial, and I quoted Dolly
Parton. Dolly Parton said, “You’d be surprised how much it costs to look this
cheap.” In the ninth, in 2014 outbreak of Ebola
in West Africa showed how much it cost for us to be that cheap. USAID, again a
great idea and good intention, but we put it in the State Department. So we’re
always tempted to use politics in making medical decisions. Corporations. Wyeth
developed a needle for vaccinating against smallpox and what did they do? They gave the patent of that needle to the World Health Organization. But the
real change in what happened with corporations came with Merck. Merck had
developed a drug to use in heartworm in dogs. It’s a complicated story. This was
developed from a soil sample taken from a golf course in Japan, worked on in this
country, and it protected dogs against heartworm. Then someone got the idea—
might it protect humans from Onchocerciasis? A similar organism that causes
river blindness in West Africa. Merck did the studies and found out indeed, it did
protect against Onchocerciasis, but it was even better in humans than in dogs. You
only had to give it once a year. So it was a relatively cheap drug, given once a
year to the poorest people in the world. Merck could not make a profit on it. They
offered it free to WHO, if WHO would figure out a way to deliver it. And WHO
became so bureaucratic, Merck finally walked away. They offered it to USAID and USAID saved them a lot of trouble by
just saying no. And then they offered it to the task force in Atlanta and we
figured out a way to distribute it. And they have now distributed over one billion
free treatments of this drug against Onchocerciasis in Africa, and the
blindness rates are going down. Then we saw the politics when The Carter Center
got involved. President Carter would go directly to
heads of state and he would tell them about the diseases. The head of state
would get the Minister of Health interested, of course, and so now The
Carter Center has been working on guinea worm eradication, on Onchocerciasis, or
river blindness, on trachoma—another blindness condition—and on lymphatic
filariasis which causes elephantiasis in people. And they’ve worked on agriculture. But he’s also gotten African leaders involved, so General Touré from Mali and
General Galan from Nigeria have both worked in health programs thanks to
President Carter. But the real game-changer occurred 20
years ago, when the Gates Foundation was started. Sixty-two years ago I was in Seattle
attending medical school and I was looking for someone interested in global
health. I could only find one person, Ray Raven Holt. I started working for him
after school and on Saturdays, and he said, “If you’re really interested in
global health, go to Atlanta, join CDC, and get in the epidemic intelligence service.” And it turned out to be such good advice. And so the Gates Foundation has brought
Seattle from a place where I could only find one person interested in global
health, to a place where the University of Washington and lots of other groups
are working on global health. I need to tell you one story about Bill Gates to
let you know what philanthropy really means to him. January 2000, six foundations
had a meeting in Seattle asking, “Is there any light at the end of the tunnel for
AIDS?” At that time people in Africa were dying faster than they could be replaced. This was true in the medical professions, this was true church groups, and
education groups. Dying faster than they could be replaced. So these six
foundations met to ask, “Could we discover something that is worth
investing in?” We came up with six ideas and the job was that I was supposed to
present these to Bill Gates and the other five
foundations would also present these to their corporate structure. I went to Bill
Gates’ office and it turned out to be a disastrous meeting, because as we went
into the office he was showing us a grant request and he said, “I’ve told you
before I never want to see anything like this again.” A grant request that was a
bottomless pit—if he invested this year he would have to invest next year—and as
he went down the list of things he never wanted to see again, I knew those were
the things we were in asking him for. So I went ahead and started through, told
him that six ideas that come up, went through the first five and he stopped me
and he said, “How much money are you talking about?” And I said, “We were talking
about $500 million a year, for 10 years.” That’s not a small
amount of money, but his immediate reaction was, “Oh it will take more than
that.” That gave me the courage to go to number six, which had to do with orphans
and AIDS in Africa. And his response was, “If you’re gonna worry about AIDS in
Africa, you have to worry about those orphans.” I rode back from that meeting to the foundation with his father
and I asked his father, “Can you tell me what just happened? He told us he never
wanted to see anything like that and in 20 minutes he approved all six
approaches.” And his father said, “He’s a business person, he knows what he wants
from his investment, but when faced with the human condition he’ll try to make
the right decision.” That’s what philanthropy is about. When I
talk to students these days about all the great things, new tools, and so
forth I tell them about Robert Brault who once said, “As to the seven deadly
sins, I deplore pride, wrath, lust, envy, and
greed, but I pretty much plan my day around gluttony and sloth.” As I talked to these students I’ve added one more thing to that list: envy. To
think of being a young student getting into global health today with better
tools, better resources, more interest— it’s just more than I can imagine. And
we’ve learned a lot of lessons. We’ve learned that everything that happens,
happens with a coalition. And the best coalitions have followed certain rules. That instead of saying, “We’re interested in doing this, what’s the next step?” They
all start with, “What’s the last step? What does the last mile look like? When will
we know that we’ve succeeded?” And once they come up with that statement, then
they can go back to what’s the next step. They also have to learn ego suppression
and they also have to find substitutes for turf guarding. And they have to
choose people who have four characteristics: they’re problem solvers,
they have absolute integrity, they are sensitive to other cultures, and they are
optimistic. How do you find those people? Well the usual way of finding a person
is you look at their CV, you interview them, and you talk to their supervisor. Problem is you never know why the supervisor is giving them a good rating,
and they may be trying to get rid of them. But you can find out all four of
these things if you call someone that that candidate has supervised. So talk to
one of the people that worked under them and they know immediately whether
they’re problem solvers, whether they have integrity, whether they’re sensitive
to other cultures, and whether they’re optimistic. So if you require pessimism,
contract out for it, never hire those people. And we’ve learned that it is a cause and effect world. Stephen Hawking said, “The
story of the world is the gradual realization that things do not happen in
an arbitrary way.” So improvements don’t happen by chance—they require a plan. And
know the truth. You can’t change things until you know the truth. Next, we have
learned the limits of science. “Certainty,” as physicist Richard Feynman said, “is the
Achilles heel of business, religion, science, medicine, politics.” Voltaire said,
“Doubt is not a pleasant condition but certainty is absurd.” There is something
better than science and that is uncertain science; science with a moral
compass, science in the service of equity, science used to protect the
future. And the power of science is not in its existence, it’s
in its application. The need for optimism, I keep coming back to, because Harlan
Cleveland who was ambassador to NATO in the late sixties became interested in global
health late in life and he said, “The fuel of global health is unwarranted optimism.” Well now it’s warranted. We can see the changes, so be willing to think centuries
ahead and always be thinking globally. William Penn, the Quaker leader, said, “To
heal the world is true religion.” That can be our goal. A final point: James Thurber,
the humorist from the last century, was attending a reception one night, and a
woman introduced herself as an American now living in Paris, and she said, “You
know they put your articles in French, and they’re even funnier in French.” And
he said, “Yes, they tend to lose something in the original.” So science loses something in the original, it has to be applied. And
philanthropy has been a potent force in getting our science used for the benefit
of the poor around the world. Thank you so much.

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