Brown University Commencement

May 27, 2006
Remarks by Patty Stonesifer, chief executive officer

Thank you for that kind introduction. It’s terrific to be here at Brown on this momentous spring weekend.

As you’ve just heard, I work at the Gates Foundation. My duties there coincide in some ways with the mission of the Brown parents on campus this weekend. At the foundation, we also make site visits to see what certain organizations have accomplished with the large amounts of money we’ve sent them.

I can’t speak for every parent here, but I’ve completed my evaluation. My daughter, Sandy, is graduating this weekend with a bioethics major—and based on what I’ve seen of her and Brown over the last four years—this is one phenomenal university.

People at Brown have a special dynamic spark to them. They’re really smart, but it’s a lot more than that. You get the sense they have the kind of minds destined to make great discoveries—minds that would start a business as well as run one … invent a product as well as improve one. I have a deep hope that the graduates of Brown can help humanity redress some of the inequities that are fracturing the world today.

I’m counting on Brown graduates, because our hope for the world rests not only on science, but on the commitment to humanity that gives science its meaning. That’s what I think sets this place apart, and that’s what I want to talk about today—the importance of matching our scientific breakthroughs with moral breakthroughs that compel us to put our science in the service of humanity.

We live in a world of tragic inequity that begins at birth. If you’re born in the African nation of Mali, you’re 18 times more likely than an American baby to have a funeral before you have a birthday. In infant mortality, life expectancy, health, nutrition, education, and employment—wretched inequities in the world today leave billions of our fellow human beings living in humiliating conditions—conditions of poverty and sickness that, if we shared them even for a week, would change our perspectives forever.

In the area of health especially, the world is fractured along familiar lines—rich vs. poor. Every year, four million newborns die in the first month of life, 99 percent of them in developing countries. Three million of these deaths could be prevented with simple tools and techniques we take for granted here in the United States—antibiotics for pneumonia, sterile blades to cut umbilical cords. But we don’t deliver them.

Is there a huge moral difference between killing people and letting them die?

We are making what Mahatma Gandhi called one of the "seven blunders of the world." A few weeks before he was assassinated, Gandhi gave his grandson a talisman with seven phrases engraved on it—seven sins that he said are forms of passive violence.

One of these seven sins was: “science without humanity.”

What did he mean by humanity? Gandhi was a Hindu, and Hindu scripture states, “This is the sum of duty: do not do to others what would cause pain if done to you.”

But Gandhi never tried to convert anyone to his religion; he just tried to make people better followers of their own religion. And on the core of our ethical duty, all religions say the same thing.

In the analects, Confucius says: “Do not do to others what you would not want done to yourself.”
 
The Buddha says: “Treat not others in ways that you yourself would find hurtful.”

Bahai scripture says: “Lay not on any soul a load that you would not wish to be laid on you, and desire not for anyone things you would not desire for yourself.”

Jesus says: “In everything, do to others what you would have them do to you, for this sums up the Law and the Prophets.”

The Jewish sage Hillel said: “What is hateful to you, do not do to another; that is the whole Torah. The rest is commentary.”

The Taoist sage Lao Tzu says: “Regard your neighbor’s gain as your own gain, and your neighbor’s loss as your own loss.”

The Prophet Muhammad said: “No one is a true believer until he desires for his brother what he desires for himself.”

And my favorite? Confucius was asked by a student if he could advise—in a single word—how best to live. Confucius replied: “Is not reciprocity that word?”

This is what it means to act with humanity. Our future depends on whether we can practice science with humanity.

In the early 1990s, Bill and Melinda Gates read a report that changed their lives. It detailed the millions of children who were dying every year in poor countries from diseases that we had long ago eliminated in this country. They were stunned. They thought that if the world had vaccines and cures for deadly diseases, we would be getting them to the people who needed them. But the report proved we weren’t. Bill clipped that article and sent it to his father with a note that said: “Dad, maybe we can do something about this.”

Since then, the Gates Foundation’s number one priority has been fighting the diseases that afflict the poorest people in the world—finding cures and treatments where none exist, and delivering those that do exist.

Over the past several years, as I’ve immersed myself in this work, I’ve suffered from a recurring nightmare; but it starts with a beautiful dream. I have a dream that one day there will be worldwide rejoicing over the discovery of an AIDS vaccine. Humanity will finally have discovered a tool that can stop this horrifying pandemic and save the lives of six million people a year, every year.

Then I have the nightmare: the vaccine is provided only to those who can pay for it. The poor don’t get it—and millions of people keep on dying.

That nightmare is very realistic. It’s happening right now, today, in measles, in diphtheria, in tetanus, in hepatitis B. In the developing world, 27 million children go without basic immunizations every year. As a result, in 2002 alone, 1.4 million children died. Some of these vaccines cost as little as three or four pennies per dose. But we don’t deliver them to every child who needs them. Reaching these children and saving their lives is the ultimate challenge of combining science with humanity.

Let me tell you two stories about this challenge.

In January of 2002, 12 years after it was first routinely given in the U.S., the Hib vaccine—which protects against pediatric meningitis and pneumonia—was introduced into the routine childhood immunization program in Malawi.

Worldwide, Hib is estimated to cause at least three million cases of serious disease—and 400,000 to 700,000 deaths each year in young children.

Malawi is one of the world’s poorest countries, ranking among the bottom 15 countries on the Human Development Index. It has one of the highest birth rates and one of the highest infant mortality rates in the world. In countries this poor, parents often don’t name their babies until they are two or three weeks old, because infant mortality is heartbreakingly high—and mothers and fathers feel that it is somehow more bearable to bury a child who has no name.

Making the Hib vaccine available in Malawi was a project of the Global Alliance for Vaccines and Immunization, or GAVI. Founded in 2000, GAVI is a collaboration of foundations, multilateral organizations, the vaccine industry, and governments, all committed to vaccinating every child in the world. GAVI put up money to guarantee purchases of the Hib vaccine, so pharmaceutical companies knew that if they made them, they could sell them. GAVI spent money to ship the vaccines to Malawi. GAVI also gave the country money to administer the vaccines, which they decided for themselves how to spend.

After the introduction of the Hib vaccine, the incidence of pediatric meningitis at one representative site in Malawi was cut in half within the year.

If there is a formula that drives this work, it has two parts: awareness and priority. When Bill and Melinda read about the diseases we weren’t preventing, they became aware—and the power of that awareness created a priority.

This is not unique to the Gates Foundation. President Bush’s programs for malaria and AIDS, the historic new U.S. spending for Africa, the Clinton Global Initiative, and the Global Fund all reflect a rising awareness and a greater priority given to saving lives in the developing world.

It’s our job as citizens to keep this priority rising. It may surprise you to know that President Bush’s 2007 budget request includes a $2 billion increase for the accounts that most directly impact the lives of poor people around the world.

Of course, the priority has to be shared by the developing countries themselves. They need to increase their spending on health and aim to end corruption. When GAVI offered to eligible nations the Hib vaccine free for five years, only 41 percent of nations accepted the offer—because it is so expensive that many governments felt that at the end of five years, they would be left to carry the cost, and it would blow a hole in their health budgets.

That shows that governments in both the developing world and the wealthy world have to do more. And we are not where we need to be. Malawi wants to push its vaccine coverage from the high 80s to above 95 percent. That is a noble and ambitious goal; it is one that GAVI shares. It is also, given the resources available in Malawi, very expensive.

To supply the pentavalent vaccine alone—which includes Hib, Hepatitis B, diphtheria, tetanus, and pertussis—will cost $55 million through 2012. The Government of Malawi says it can afford to pay one fifth of that.

Will the rest of the world fill the gap? Is there enough awareness? Is that awareness powerful enough to make it a priority—or are there other things we’d rather do than save these babies?

This is not a scientific question; it’s a moral question. We are on the verge of scientific breakthroughs that will give us power we never had before to save hundreds of millions of lives. Are we going to use this science to serve the poorest, most underprivileged people in the world?

Every year, 350 to 500 million people are infected with malaria, and more than one million people die of the disease—80 percent of them in Africa. Malaria is the leading cause of death for children in Africa, killing 2,000 African children every day.

When Dr. Johan Strömberg Nörklit, a Swedish physician, first arrived on the island of Zanzibar in 2000, he was confronted by women who pleaded to be sterilized. He assumed it was because they couldn’t get birth control and wanted to avoid having more children. He was wrong. They told him they wanted to be sterilized because they couldn’t bear to lose more children to malaria.

In 2000, in partnership with academia, pharmaceuticals, and biotech companies, we helped established the Medicines for Malaria Venture (MMV), a not-for-profit organization dedicated to discovering and developing malaria drugs, and delivering them to the populations that need them most.

In just five years of operation, MMV is managing the largest-ever portfolio of malaria drug research, with 20 projects in various stages of development. Its initial goal was to ensure that at least one new anti-malaria drug was registered before 2010. MMV has been so successful that it will register at least three by 2010.

This work is urgent. Deaths from malaria have doubled over the past 20 years, fueled by the rapid spread of resistance to widely-used malaria drugs. Traditional drugs are being replaced by ACTs—artemisinin combination therapies—which are effective, but cost 10 to 30 times more than traditional drugs. Right now, our foundation is supporting three technological approaches to obtaining cheaper artemisinin—including trying to make it from a bio-synthetic source.

There is also a dangerous complication. Taking artemisinin alone is cheaper than taking it in combination therapy, but taking it alone increases the risk that the parasite will develop resistance to it. If that happens in the next five to 10 years, there will be no class of drug to replace it—which would lead to a global catastrophe with a sharp spike in malaria deaths. That’s why developing cheaper ACTs is so urgent.

But even if we discovered a less expensive, more effective malaria medicine today, millions would die—because it takes years before a new drug can reach the people who need it. First it has to be registered by a regulatory agency like the FDA or the EMEA. It needs to be pre-qualified by the WHO, included in the WHO treatment guidelines, paid for by the Global Fund for AIDS, TB, and Malaria. The drug has to be registered and purchased in each country, included in the local treatment guidelines, and procured.

Pharmaceutical companies also need to get the drug to their local sales force and local distributors; it has to be available from retail outlets close to people’s homes. If we don’t take these steps to distribute the drug, they’ll end up sitting on the shelves of the company that developed them—and the companies will simply stop making them in the quantities we need.

Shortening the path of delivery is something we have to be working on now. We can’t simply work on research and think a new discovery will save us.

New malaria medicines are not the only new discoveries we are expecting. The Gates Foundation’s grantees now have more than 100 products in the pipeline. Several new vaccines may be available by 2010—a vaccine for HPV, the leading cause of cervical cancer; Japanese encephalitis; Meningococcal A; and possibly even a vaccine for TB or malaria.

A report last month from the London School of Economics noted that new research in drug and biotech companies—subsidized in part by charity—could lead to as many as 10 new drugs by the end of the decade to fight diseases suffered by the world’s poorest people. Yet the report said it’s not clear that the world will pay what it takes to get the new drugs to the poor people who need them.

Again—this is not a scientific question; it’s a moral question. Are we willing to save the lives of the poorest, least powerful people in the world?

If these people lived near us, we would save them. We would see our neighbors suffering, and we would use our power to end it. Doctors would volunteer their efforts; drug companies would accelerate research, corporations would donate money and resources; the government would increase funding; the public and private sectors would work together to distribute treatment; citizens groups would work the phones, descend on Congress, and march in the streets.

Consider what ordinary citizens did for people in New Orleans. People drove hundreds of miles to stand on a street corner in Louisiana and hold up a sign saying, “I’ll take five people.” The poorest among us found something to do about Katrina. What is the comparable action to take on global health?

Everyone on this campus holds some power; if you didn’t, you wouldn’t be here. This is a place of privilege. What are we going to do with our privilege?

I want to ask you here—if the U.S. were in the midst of a disease pandemic and your own neighbors were threatened, what would you do to help them? Now, please do the same thing on behalf of your suffering neighbors around the world.

I want to ask the graduates—those with degrees in science but also those with degrees in economics, English, bioethics—to use the power of your degree, and the power of your position in society, to make sure our government and its partners save the greatest number of lives.

We all say we care—but the only way to prove it is to make it a personal, political, and global priority.

Some years ago, Nelson Mandela came to Seattle and gave a breakfast talk to civic leaders who were proud of their commitment to change.

He opened with some general pleasantries, and then he stunned the room by saying: “Would all those of you who took personal action, any action big or small, to end the terrible injustice of apartheid, please stand up.” He then asked: “Will those of you who took personal action, something—anything—big or small, to help me walk free from my prison cell on Robben Island, please stand up.”

The next 60 seconds made up the longest, most painful minute of that decade for me and many others in that room. The power of the moment was magnified by the bearing of President Mandela—there was no anger in his question, there was no recrimination, he was not judging us, he was asking us to judge ourselves.

And to a person, we found we all came up short. Those of us who had done nothing wished we had done something, and those of us who had done something wished we had done more.

I asked myself that day and almost every day since—why didn’t we do more? Did we not see the people of South Africa as our neighbors? Or did we see them as neighbors, but just believe that our efforts wouldn’t matter? We knew there was a problem; maybe we didn’t believe we could have a part in the solution. We were wrong. They were our neighbors; we had the power to help them. It just wasn’t a priority.

There are millions of powerful people in the world today who have kind hearts and good minds—but like the people left sitting in front of President Mandela—they are ignorant: they don’t know they can, and must, act to change the world.

The real adventure in our future is not whether we will make new scientific breakthroughs, but whether we will use those breakthroughs to act out the ancient teaching of Confucius’ one word, reciprocity—to treat others as we want to be treated. The great moral teachers in history did not have the power that we have today to put that teaching into action to save millions of lives. You have that power. Please use it. Thank you.