Larry Brilliant, President of the Skoll Global Threats Fund, works on pandemics, climate change, nuclear non-proliferation and the Middle East. He chatted with MedCrunch about the progress being made on eradicating pandemics and revealed what, according to him, is the biggest threat to humanity.
MedCrunch: Progress is being made on ending pandemics. What still needs to happen and where are the areas of improvement that you would like to focus on?
Larry Brilliant: I would say a lot of progress is being made on laying the infrastructure for preventing pandemics; I wouldn’t say ending pandemics. Although, you could say it either way: we’ll never stop the first virus that jumps from an animal to a human. That’s happening all the time. There’s a viral chatter between humans and animals. As progress increases, population increases, humans cut down the rainforest and consume more meat and wild animals. For example, last year, Africans consumed almost one billion wild animals in bush meat. Humans and animals are in each other’s territory. Over the last three decades there have been thirty very dangerous leaps of viruses that had pandemic potential. What we’re getting good at is finding them right away and then preventing the small outbreak from becoming a global pandemic.
MedCrunch: In your talk earlier today at TEDMED, you mentioned the willingness of governments to collaborate in order to prevent regional hotspots for epidemics. Are there still areas in which governments are not willing to collaborate?
Larry Brilliant: No. I have friends who are in China right now. By all accounts, the words that I hear about H7N1 are that the Chinese are all over it. They are working incredibly hard to sequence all organisms -ducks, pigs, humans. As I’ve been told, they’re collaborating in the most wonderful way. We know this wasn’t true in the case of SARS; I think that they learned from it. We all learned from it. It wasn’t only just China that lacked cooperation skills. Now things are different: nations are cooperating. Talking about governments and policy might sound boring to doctors, but in 2005 the international regulations and the way countries worked together on infectious diseases changed and affected them as well. Until 2005, only the health ministries could call the WHO and say: “Look, we’ve got a high up epidemic.” The WHO could not take that call, get that email or letter from hospitals or from doctors. Doctors weren’t able to report directly. As of 2005 this has changed. The WHO now must take messages from every clinician. The WHO must take the data from these digital health systems and every country must make it available. It changed everything. That’s what’s helping so much.
MedCrunch: Can you elaborate on the role of the community versus the government? What role do physicians play in terms of pandemics?
Larry Brilliant: How does someone’s data get into the system when something like flu is being counted? How do we know whether a disease is reported? What happens is the following: someone gets sick, he or she calls a doctor, makes an appointment, visits the physician, has a sample taken, goes to a lab and the lab results come back. That’s what flu -or as the CDC calls it, the influenza-like illness (ILI)- is all about. There is a lot of lag time and uncertainty build into it. With the proliferation of new systems we hope to be able to eliminate this lag time. Google Flutrends captured every single key search ever entered into Google and has been able to beat CDCs reports by two weeks and was more accurate. Currently, there are two dozens systems like this. One of them is FluNearYou, which involves the US community. Doctors, patients and communities volunteer to receive an email or a text message every Monday where they just need to answer one question: “Are you sick or are you well?” If someone answers “sick”, they’re asked three other questions: “Do you have fever? Do you have a cough? Do you have muscular pain?” If the answers to those three questions are “yes”, they’ll most likely have influenza. The program announced two months ago and now has over 80,000 participants in the system. The data is freely available to everyone. It’s open source. It will always be there and is not owned by any individual. It’s just displayed on something called a health map. I hope that everyone will join FluNearYou. Join It. What you get back is information about flu near you. Do I need to worry about an epidemic near me? What’s the prevalence of the disease?
MedCrunch: You are moving closer to the goal of effectively managing pandemics. What’s your next big challenge?
Larry Brilliant: I think the reason I got so optimistic is because I saw smallpox being eradicated. My first job when I got out of medical school was at the WHO. As a young kid, I entered a world where smallpox was a major killer and I watched how over the next ten years we managed to eradicate it. That gives you tremendous confidence. We are now close to eradicating polio. India hasn’t had a case of polio in two years. That makes me feel like we can, over time, build the infrastructure to control most other infectious diseases. In my work, that’s only one of the five threats I focus on. Climate change is potentially the greatest threat that humanity faces. It’s a hard one to sell to people, especially physicians. How do you tell people that an odorless, tasteless, invisible gas is going to destroy the world they know? And how does somebody who is struggling to make a living put bread on their table and send his or her kids to college say, “OK, I’m going to give up meat” or, “I’m going to stop emitting CO2 and get an electric car”. How do you go to a coal mining community and say, “You can’t mine coal anymore”? It’s not their fault. It’s not the miners’ fault. We wouldn’t have had the industrial revolution without coal. But if we continue to burn coal we will reach an irrevocable turning point where the world will never be the same. The people who are hurt the most are the poorest and the most vulnerable, the same ones that commissioners are swearing to serve. This is the biggest threat for me. I work on nuclear weapons, water and peace in regional conflicts. They are all important but the one that exacerbates all others is climate change.