SBRI Passport to Global Health

April 30, 2008
Prepared remarks by Melinda French Gates, co-chair

Thank you, Teryn.

I am honored to be introduced by you, because it's people like you that make Bill and me so optimistic about the future of global health.

When ambitious and talented college students start devoting their careers to helping the poorest and sickest people in the world, then we have reached a tipping point.

In the years ahead, more problems will be susceptible to solutions; the solutions will be more ingenious; and they will come faster and faster.

Bill and I were much older than Teryn when we started learning about global health. Let me say, by the way, that our first teacher was Bill Foege, tonight's award winner. I remember, we asked him for some help, and he sent along an extensively annotated list of 81 books and articles and seven video recordings. That was 10 years ago, and we’re almost finished with our homework.

I can pinpoint the precise moment when Bill and I decided it was time to understand global health.

The Inequity Problem

We read an article about the many diseases that had been more or less eliminated in this country but still killed millions of people in poor countries. One of the diseases on the list really bothered us, because we had never even heard of it. It was called rotavirus, and it killed half a million children every year.

Imagine everybody in Seattle dying. Then imagine it not only not making the front page—but not making the news at all. At first, we thought it had to be a mistake.

It turns out that rotavirus is the leading cause of diarrhea. And there is a treatment. It’s called pedialyte. You've probably heard of it. You've probably given it to your kids.

Bill and I just hadn't understood how many millions of people could be saved if the world's priorities were a little bit different.

We started to realize that in our world, we act as if some lives are more precious than others. Some children are treated as if they are worth saving, and others are not.

With rotavirus and pedialyte—in the developing world it's called oral rehydration therapy—the problem was delivery. The world knew how to treat those children; it just didn't do it.

In other cases, the problem was research. Scientists weren't studying the diseases listed in that article because they didn't have those diseases in their countries.

They simply didn't know about malaria, or leishmaniasis, or trypanosomiasis. And they couldn't get the funding or the training to research them, even if they had wanted to.

One glaring example of the research gap is the diagnostic test for tuberculosis. It's a lousy test. It's slow, and it's inaccurate. But for years, nobody tried to make a better one. And I mean years. When the test we are still using was developed, this country had 38 states, not 50. Washington was still a territory.

Other Side of the Mat

Bill and I did a lot of research that helped us understand these problems in the abstract. More importantly, we have had the privilege of seeing them on a human scale. We have met the people whose lives are destroyed by the inequities that persist in global health.

When we travel, we talk all the time about the things we have in common with the people we meet. I am especially drawn to the mothers. They'll invite me into their homes, and we'll sit together on the floor, often on opposite sides of a small mat.

I like talking with them. I understand how much they love their children, how desperately they want to protect them.

And I find myself wondering, What would I do, if I were on the other side of the mat? What would I want for my children? Just the chance for them to lead a happy, healthy life.

A couple of years ago in Zambia, I talked to a group of women in a tiny village outside of Kafue.

Malaria is a constant threat there, and it was especially threatening when I visited because it had been raining like crazy.

What they wanted for their children, they told me, was bed nets. They didn’t have enough to go around. There were 90 bed nets and 115 households.

That jolted me back to my side of the mat. It's inconceivable. How can a mother be forced to make a nightly decision about which child gets to sleep under a bed net, and which child gets bitten?

And from my side of the mat, I think to myself, That's why we need to find a way to get smart people thinking about malaria. What will it take to get bed nets to everybody who needs one? What will it take to protect all children from malaria, so they don't need bed nets in the first place?

SBRI Gives Hope

But I don't despair. I know that we can create a world where everybody has the chance to live a happy, healthy life. My evidence is: places like SBRI.

SBRI is the solution to the problem of the 100-year-old TB test. In fact, some SBRI scientists are working on a better test right now. But more generally, SBRI takes 200 sharp minds and applies them to hard problems—urgent problems that scientists simply haven't faced on before.

Because of SBRI and places like it, the science of global health won't stall again. On the contrary, as each new discovery builds on the last one, the science will accelerate.

And the science being done at SBRI is the top of the line. It doesn't get more sophisticated.

That's one reason why SBRI attracts so many brilliant researchers. At SBRI, they get the most advanced facilities—and they get to collaborate with hundreds of infectious disease experts in one of the most dynamic scientific communities in the world. In the end, they also know that their research will have applications that save people's lives.

I visited SBRI a few weeks ago, and I got to talk to the researchers in Leo Stamatatos's lab.

Their project is just astounding. They are trying to figure out how to produce antibodies that neutralize HIV, on the way to an AIDS vaccine.

Guess what? It's hard. We know that there are little pieces of the HIV virus—they're called epitopes—that have the potential to produce antibodies. But, to put it in laymen's terms, the epitopes need to hitch a ride on a protein so they can get to the immune system.

They are using awesome computer technology to cycle through thousands and thousands of proteins to find some that the epitopes can slot into, like a three-dimensional puzzle.

I asked the scientists on this project how they wound up at SBRI, and their answers just floored me.

George Sellhorn is from Indiana, and he went to graduate school to study soybean enzymes. He didn't even think about biomedical work until he'd finished his Ph.D. One day, he saw an ad for a job at SBRI. He knew he had the right technical skills, and now he’s on the cutting-edge of HIV research.

Zach Caldwell was a French literature major. I'm not kidding. But he found his way to SBRI.

You have a Flaubert scholar using the most advanced computational protein design techniques to save the lives of millions of impoverished people he'll never meet. That's the kind of synergy that's happening at SBRI.

And if not for SBRI, George and Zach would apply their intellect to other problems. Soybean yields. The use of metaphor in Madame Bovary.

Those are worthy goals, and, personally, I love Madame Bovary. But finally, scientific research for the developing world is also a viable option for intelligent young people.

The Potential of Science and Technology

And now is the perfect time for young scientists to get engaged in this work, because the technology is getting much better much faster.

That's why Bill and I started our foundation.

We believe we are living in a special time in history, when innovations are making it possible to solve the problems of inequity right now. In this century.

Let me give you a little case study to show just how revolutionary these convergences in technology can be. I want to get into a little bit of detail here, because the detail is the impressive part.

One of global health's goals is a malaria vaccine, and it's an elusive one.

Malaria has been with us for thousands of years, and the parasite is tricky. I should say parasites plural, because there are several different kinds, and each one has its own body of research.

Here's how the disease works.

Before the parasite makes people sick, it spends about a week in their liver, feasting on the nutrients there. During that week, what started as a handful of parasites multiplies into thousands.

Eventually, those thousands of parasites infect the blood stream. People get sick, and many of them die.

But what if we could stop the disease in the liver, when it isn't causing symptoms?

That is the question driving an SBRI project led by Stefan Kappe and his team.

They have found eight genes—out of a total of more than 5,000 genes in the parasite—that help it multiply in the liver.

The hope is that you can splice those genes out, and then the disease can't get out of the liver and into the blood. The hope is, you inject people with this parasite minus a few nasty genes. They don’t get sick; they do develop immunity.

That's a vaccine.

That approach proved 100 percent effective in mice. There are wizened old mice in SBRI's labs that have survived their whole lives after having been injected with the genetically modified form of malaria. SBRI is starting human trials later this year.

This is tremendously exciting science, and it never would have happened if researchers hadn't sequenced the malaria parasite's genome. That happened in 2002.

It never would have happened without a cell sorter that allowed the researchers to obtain 5,000 clean samples of infected liver cells. Before SBRI got the sorter in 2005, they were bracing for the challenge of sorting through 50 million liver cells by hand. With microscopes and pipettes.

They'd still be at work today, and the samples might not be pure enough to use anyway.

In short, SBRI's work relies on the cross-breeding of technology from an array of fields—computer science, genomics, flow cytometry.

The list goes on. It is the combined leverage of discoveries across so many disciplines that makes SBRI's science so impressive—and the prospects for the whole field so bright.

I don't want to give the impression that African children are going to have SBRI's malaria vaccine next year. Basic research is a painstaking process.

Ken Stuart founded SBRI in 1976, when nobody was interested in these problems. Over the years, he has achieved more research breakthroughs on African Sleeping Sickness than anybody else alive. But he still hasn’t cracked the case. He’s still at it.

And getting from the basic research to products is immensely complicated. Even if the malaria vaccine I just described works, how do you manufacture enough doses? How do you keep it cold when you’re delivering it to every corner of Africa, a continent lacking in good roads and electricity?

Obviously, we don't have all the answers yet. But we have started asking the right questions.

So we are at the beginning. As I said at the opening of this speech, young people like Teryn—and George and Zach—are reasons to be optimistic. They are beginning to solve some of the problems that Bill and I read about all those years ago.

So let me close by urging all of you do two things to mark the occasion of this beginning.

First, I hope you will celebrate by imagining a different future. By believing that life can be better for billions of people who have suffered for too long. Second, I ask you to commit yourselves to doing everything you can to make that better future happen.

We have the opportunity—now—to create the world we want to live in, a world in which all children are treated as if they are worth saving.