The Urgent Threats We Face

The Urgent Threats We Face

Larry Brilliant, MD [10.29.09]


One of the urgent threats that humanity faces right now is the risk of pandemics. Either swine flu or bird flu or Ebola, Lassa Fever or West Nile or SARS or any of these diseases. Particularly HIV/AIDS, which was another one of these animal-based zoonotic diseases. I'm worried about global warming as a great exacerbation. It exacerbates the risk of pandemics. It exacerbates the rift between the rich and the poor. It exacerbates the problem of dealing with scarce water and it exacerbates the problems of cities. These are the urgent threats we face.

LAWRENCE BRENT BRILLIANT, M.D., is the President of the Skoll Urgent Threats Fund and Senior Adviser to Jeff Skoll. In this role, he will develop the strategy and approach for the newly launched Fund, as well as advise Jeff Skoll on ways to leverage his various commercial and philanthropic entities to drive positive change on urgent social and environmental issues.

Lawrence Brent Brilliant's Edge Bio Page


[Larry Brilliant:] I was reading about Susan Sontag's illness as a metaphor. We are now living in an age, not of cholera, but of pandemics. At the moment, we're living in an age of swine flu. Particularly, we're living in an age of an oxymoron, which is a mild pandemic. Never in history of epidemiology has the words "mild" and "pandemic" appeared in the same sentence. This is a good way to begin this conversation.

First of all, this pandemic has already affected one million people in the United States. Even though the official numbers are 35,000, CDC's estimates are one million. By the time it runs its course, three years from now or so, it will have affected over three billion people, half the people in the world.And no one knows if the low death rate that it has right now, about .6 deaths per 10,000 cases, will continue.  Or whether it will rise.  We don't know whether hundreds or thousands or millions or tens of millions or hundreds of millions will die.  We're living in an age of tremendous uncertainty.

And we have an antiviral. We actually have three antivirals. But this virus is mutating so quickly that it's becoming resistant to at least one of these antivirals. In the last two weeks, there have been five cases of Tamiflu-resistant swine flu. we don't know how virulent it's going to be; we don't know what it's case fatality is going to be, and we don't have a vaccine yet.

And this reminds me of my favorite slide in public health, which is a slide that lists the names of all the kings and queens and emperors who died of smallpox. It's not that I am particularly fond of seeing kings and queens and emperors dying. I'm indifferent to the rank of someone who dies. But it's important because it says that the wealth and the power of the richest people in the world in that time could not protect them from dying of smallpox.

We have that same situation right now. If this pandemic dramatically increased its death rate by picking up a bad protein, certainly a reasonable scenario, the richest and most powerful people that we know, the billionaires that are our friends, the people we go to school with who have built great companies or written phenomenal books... they're in this the same as the rest of us. The metaphor of an infectious disease, a pandemic for which there is no antiviral and there is no vaccine is a reminder that we're all in this together. And it's just one of the urgent threats that humanity faces right now.

Over the last 30 years, there have been 40 novel communicable diseases that have jumped species from animals to humans. And in doing that, the risk that a virus brings humanity to its knees increases with every bit of the Amazon we cut down. Every bit of green barrier between animals and humans that we cut down.

When China goes from having 15 million chickens as it did 30 years ago to 15 billion chickens, and humans and animals come in contact with each other more and more, the risk is that viruses that have been living in animals for thousands or tens of thousands of years will affect human beings. 

certainly one of the urgent threats that humanity faces right now is the risk of pandemics. Either swine flu or bird flu or Ebola, Lassa Fever or West Nile or SARS or any of these diseases. Particularly HIV/AIDS, which was another one of these animal-based zoonotic diseases. I'm worried about global warming as a great exacerbation. It exacerbates the risk of pandemics. It exacerbates the rift between the rich and the poor. It exacerbates the problem of dealing with scarce water and it exacerbates the problems of cities. These are the urgent threats we face.

Nuclear proliferation. Drought. Famine. War in the Middle East. Over the last few years, I've moved my thinking from charity as an act of goodness to philanthropy as an act of informed change-making to strategic philanthropy, an act of using money to get the most good. I now take the problems that could bring the world to its knees and try to find a way to devote the maximum amount of resources in the most impactful way to help the world deal with these issues. This is the problem of the new millennium.

Jeff Skoll has just started this new foundation which is called The Skoll Urgent Threats Fund. And it will be a grant-making organization and advocacy organization, and it will be particularly closely tied to his media company which makes documentary movies and other media to try to motivate a change in public will. The most famous movie of course that he made was "An Inconvenient Truth." "Kite Runner" and "Good Night and Good Luck" and several others that have had the same effect on making people see problems in a different way.

the Skoll Urgent Threat Funds will give grants, do advocacy and policy, and also use media and computer science to try to build a consensus for action in all of these areas. In some areas it's easier to understand what to do than in others. Trying to diminish the threat of nuclear proliferation is a policy, government, and United Nations activity. Dealing with pandemics is involves science, and requires funding scientists like Nathan Wolfe, Ian Lipkin and others who are at the cutting edge of their fields.

But it also involves figuring out how to use digital communications to improve the speed of early detection and early response. A group like inSTEDD is running. When you're dealing with water, it's everything. It's a consequence of global warming, it is a cause of drought, it is a cause of and a consequence of the changing nature of agriculture where rising sea levels poison the aquifers with salt and plants growing in a saline environment produce a lower yield, so farmers who have one acre are unable to produce enough food, enough kilocalories of food per hectare or acre to survive. And there's been an epidemic of farmer suicides in Africa and India related to the inability to cope with decreasing yields of food from the same lands that previously may have had double the yield. That's another science-based activity.

I've been very impressed with the Gates Foundation and Rockefeller's AGRA program. Which is trying to make salt-resistant seeds to increase the amount of food that yields per acre. there's a mixture here of science, policy, and increasing public will. They're all important. They're all the keys on the keyboard. They're all the tools in the tool chest, the arrows in the quiver. And that's what I like so much about this moment in time. We have more keys on the keyboard, more arrows in our quiver and we really have a chance to make a difference in each one of these areas. And I personally think it's the highest calling that you can have in life, and I'm fortunate to be able to play a small role in it. A small violin.

You know, I'll tell you. There are so many players now who have been doing this for such a good, long time. I'm optimistic about what happened in the House; I'm nervous about what will happen in the Senate. I'm concerned that the legislation is too tepid. I'm pleased there'll be a cap; I'm worried that the cap and trade system will have a lot of holes in it. But at least there's some progress now, and a recognition that the scientific basis of climate change is irrefutable.

But I'm worried that the people who will be hurt by climate change are exactly the people who didn't cause it. I’m worried that climate change will most disproportionately affect the poorest and most vulnerable of our brothers and sisters. I'm most concerned that there's no justice in the way in which the pain of climate change falls on farmers in Africa and people who are trying to live a subsistence life in India.

I'm very impressed with Mary Robinson's new group called Climate Justice. Even putting those two words together, "Climate Justice," bringing together human rights and a recognition of the effects that climate change will have in the world, is very important to me. I suspect that we'll be doing a lot more in that area. Trying to balance social equity along with adaptation to or mitigation of the changes wrought by this change in global warming.

I think the first evidence in my life that I was going to be a rabble-rouser was when I was kicked out of my confirmation class when I was 16. Because the rabbi had given us an assignment which was to answer the question, can God and science be reconciled? And I had written an essay saying not only can they be reconciled, I think that if you really reach the edge of the highest, purest science, there you will find all the questions that you would ask if you were searching for God. And if you really take the quest for God to its very furthest edge, there you will find the need for the tools that science has given. And he said to me, "That's the wrong answer." He said, "The right answer is, you have to choose between religion and science." I wouldn't do that, and I wouldn't rewrite my essay and he kicked me out.

I believe exactly the same thing today. I think that the people who I have met who have had the most profound degree of what you might call faith have been scientists. As they pushed away layer and layer of flesh, they found art and magic. And as they pushed away the boundaries of particle physics, they found mysteries. And each new step they took brought them more in awe of God, as Einstein clearly did.

faith and spiritualism are not the enemy of science. Doctrine and orthodoxy is. And a narrow orthodoxy is the bane of the scientist's existence, and it's the bane of the policy maker's existence. But I don't think we should conflate a true seeker's search for meaning and a true scientist's search for truth. I think they live together and they cohabitate well. We're emerging from eight years in which religion was a trump card over science. We're emerging from a time when scientists were forced to pull their papers in galley at journals because they violated the precepts of one religion in the United States. But at the same time, we're watching the evangelical community embrace those very notions that scientists presented to them years ago.

for example, one of the most optimistic things in the world to me is to watch these young evangelicals who are fighting to rid the world of nuclear weapons. Because they believe that is part of the mandate of creation care. It's also wonderful for me to watch that some of the leaders now fighting against global warming come from the evangelical community. I had a wonderful event where we presented some slides and graphs to a group of evangelicals about the changes that have happened, to prove that it is human-caused activities that have caused climate change. And the first slide that I showed spanned ten billion years. And two of the evangelicals took me aside and said, you know, "We're really with you on this. But would you just do me one favor? Would you please change that slide so that nothing begins before 5,000 years ago? We're still going to support it. But can you show the same change over 5,000 years?" Fortunately, or unfortunately, the change over 5,000 years, is every bit as dramatic.

Of course, I am also concerned about the battle of civilizations. I'm concerned that Muslims and Jews and Christians don't understand each other, don't like each other. I'm concerned that Hindus and Muslims have restored historical enmities when for the past 200 years they've lived together in peace. I'm very concerned about the fighting that has been provoked by and encouraged by differences in religion. But I'm not at all concerned that at the interface of spiritual quests and scientific quest that there's a lack of accord.