1
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The child's symptoms begin

2
00:00:03,295 --> 00:00:06,932
with mild fever, headache, muscle pains,

3
00:00:06,956 --> 00:00:09,043
followed by vomiting and diarrhea,

4
00:00:09,067 --> 00:00:13,167
then bleeding from the mouth,
nose and gums.

5
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Death follows in the form of organ failure
from low blood pressure.

6
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Sounds familiar?

7
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If you're thinking this is Ebola,

8
00:00:24,215 --> 00:00:26,092
actually, in this case, it's not.

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00:00:26,576 --> 00:00:31,931
It's an extreme form of dengue fever,
a mosquito-born disease

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which also does not have
an effective therapy or a vaccine,

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and kills 22,000 people each year.

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That is actually twice
the number of people

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00:00:42,918 --> 00:00:44,947
that have been killed by Ebola

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in the nearly four decades
that we've known about it.

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As for measles, so much
in the news recently,

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the death toll is actually tenfold higher.

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00:00:57,578 --> 00:00:59,349
Yet for the last year,

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it has been Ebola that has stolen
all of the headlines and the fear.

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Clearly, there is something
deeply rooted about it,

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something which scares us
and fascinates us

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more than other diseases.

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But what is it, exactly?

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Well, it's hard to acquire Ebola,

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but if you do, the risk
of a horrible death is high.

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Why?

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Because right now, we don't have any
effective therapy or vaccine available.

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And so, that's the clue.

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We may have it someday.

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So we rightfully fear Ebola,

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because it doesn't kill
as many people as other diseases.

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In fact, it's much less transmissible
than viruses such as flu or measles.

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We fear Ebola because of the fact
that it kills us and we can't treat it.

33
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We fear the certain inevitability
that comes with Ebola.

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00:01:56,524 --> 00:02:02,102
Ebola has this inevitability
that seems to defy modern medical science.

35
00:02:02,507 --> 00:02:04,261
But wait a second, why is that?

36
00:02:04,705 --> 00:02:07,607
We've known about Ebola since 1976.

37
00:02:08,036 --> 00:02:10,108
We've known what it's capable of.

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We've had ample opportunity to study it

39
00:02:12,786 --> 00:02:15,174
in the 24 outbreaks that have occurred.

40
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And in fact, we've actually had
vaccine candidates available now

41
00:02:19,991 --> 00:02:21,348
for more than a decade.

42
00:02:21,856 --> 00:02:26,295
Why is that those vaccines
are just going into clinical trials now?

43
00:02:26,930 --> 00:02:29,764
This goes to the fundamental
problem we have

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00:02:29,788 --> 00:02:32,792
with vaccine development
for infectious diseases.

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It goes something like this:

46
00:02:35,983 --> 00:02:38,786
The people most at risk for these diseases

47
00:02:38,810 --> 00:02:42,969
are also the ones least able
to pay for vaccines.

48
00:02:43,858 --> 00:02:47,257
This leaves little in the way
of market incentives

49
00:02:47,281 --> 00:02:50,245
for manufacturers to develop vaccines,

50
00:02:50,269 --> 00:02:54,989
unless there are large numbers of people
who are at risk in wealthy countries.

51
00:02:55,522 --> 00:02:57,902
It's simply too commercially risky.

52
00:02:59,244 --> 00:03:03,408
As for Ebola, there is absolutely
no market at all,

53
00:03:03,432 --> 00:03:09,060
so the only reason we have two vaccines
in late-stage clinical trials now,

54
00:03:09,084 --> 00:03:11,748
is actually because
of a somewhat misguided fear.

55
00:03:12,520 --> 00:03:15,744
Ebola was relatively ignored

56
00:03:15,768 --> 00:03:20,309
until September 11
and the anthrax attacks,

57
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when all of a sudden,
people perceived Ebola

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00:03:22,891 --> 00:03:25,064
as, potentially, a bioterrorism weapon.

59
00:03:25,485 --> 00:03:29,607
Why is it that the Ebola vaccine
wasn't fully developed at this point?

60
00:03:30,167 --> 00:03:32,763
Well, partially, because
it was really difficult --

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00:03:32,787 --> 00:03:35,436
or thought to be difficult --
to weaponize the virus,

62
00:03:35,460 --> 00:03:40,585
but mainly because
of the financial risk in developing it.

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00:03:41,028 --> 00:03:42,822
And this is really the point.

64
00:03:43,718 --> 00:03:46,238
The sad reality is, we develop vaccines

65
00:03:46,262 --> 00:03:50,134
not based upon the risk
the pathogen poses to people,

66
00:03:50,158 --> 00:03:54,268
but on how economically risky it is
to develop these vaccines.

67
00:03:54,887 --> 00:03:57,796
Vaccine development
is expensive and complicated.

68
00:03:57,820 --> 00:03:59,891
It can cost hundreds
of millions of dollars

69
00:03:59,915 --> 00:04:04,223
to take even a well-known antigen
and turn it into a viable vaccine.

70
00:04:05,001 --> 00:04:07,455
Fortunately for diseases like Ebola,

71
00:04:07,479 --> 00:04:10,869
there are things we can do
to remove some of these barriers.

72
00:04:11,385 --> 00:04:14,933
The first is to recognize
when there's a complete market failure.

73
00:04:15,314 --> 00:04:18,348
In that case, if we want vaccines,

74
00:04:18,372 --> 00:04:23,381
we have to provide incentives
or some type of subsidy.

75
00:04:24,197 --> 00:04:28,537
We also need to do a better job
at being able to figure out

76
00:04:28,561 --> 00:04:30,919
which are the diseases
that most threaten us.

77
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By creating capabilities within countries,
we then create the ability

78
00:04:36,199 --> 00:04:40,816
for those countries to create
epidemiological and laboratory networks

79
00:04:40,840 --> 00:04:45,109
which are capable of collecting
and categorizing these pathogens.

80
00:04:46,117 --> 00:04:48,379
The data from that then can be used

81
00:04:48,403 --> 00:04:51,682
to understand the geographic
and genetic diversity,

82
00:04:51,706 --> 00:04:54,342
which then can be used
to help us understand

83
00:04:54,366 --> 00:04:58,009
how these are being changed
immunologically,

84
00:04:58,033 --> 00:05:00,357
and what type of reactions they promote.

85
00:05:01,198 --> 00:05:03,525
So these are the things that can be done,

86
00:05:03,549 --> 00:05:07,233
but to do this, if we want to deal
with a complete market failure,

87
00:05:07,257 --> 00:05:12,681
we have to change the way
we view and prevent infectious diseases.

88
00:05:12,705 --> 00:05:16,892
We have to stop waiting
until we see evidence

89
00:05:16,916 --> 00:05:21,720
of a disease becoming a global threat
before we consider it as one.

90
00:05:22,617 --> 00:05:24,856
So, for Ebola,

91
00:05:24,880 --> 00:05:28,771
the paranoid fear
of an infectious disease,

92
00:05:28,795 --> 00:05:33,517
followed by a few cases
transported to wealthy countries,

93
00:05:33,541 --> 00:05:36,141
led the global community to come together,

94
00:05:36,165 --> 00:05:39,670
and with the work
of dedicated vaccine companies,

95
00:05:39,694 --> 00:05:41,360
we now have these:

96
00:05:42,465 --> 00:05:48,472
Two Ebola vaccines in efficacy trials
in the Ebola countries --

97
00:05:48,496 --> 00:05:54,001
(Applause)

98
00:05:54,025 --> 00:05:58,009
and a pipeline of vaccines
that are following behind.

99
00:05:58,763 --> 00:06:01,855
Every year, we spend billions of dollars,

100
00:06:01,879 --> 00:06:06,952
keeping a fleet of nuclear submarines
permanently patrolling the oceans

101
00:06:06,976 --> 00:06:10,967
to protect us from a threat
that almost certainly will never happen.

102
00:06:11,527 --> 00:06:14,463
And yet, we spend virtually nothing

103
00:06:14,487 --> 00:06:19,514
to prevent something as tangible
and evolutionarily certain

104
00:06:19,538 --> 00:06:21,716
as epidemic infectious diseases.

105
00:06:23,009 --> 00:06:26,904
And make no mistake about it --
it's not a question of "if," but "when."

106
00:06:26,928 --> 00:06:29,840
These bugs are going to continue to evolve

107
00:06:29,864 --> 00:06:31,867
and they're going to threaten the world.

108
00:06:32,280 --> 00:06:34,624
And vaccines are our best defense.

109
00:06:35,108 --> 00:06:39,417
So if we want to be able to prevent
epidemics like Ebola,

110
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we need to take on the risk
of investing in vaccine development

111
00:06:43,911 --> 00:06:45,949
and in stockpile creation.

112
00:06:46,760 --> 00:06:50,385
And we need to view this, then,
as the ultimate deterrent --

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00:06:50,409 --> 00:06:53,529
something we make sure is available,

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00:06:53,553 --> 00:06:57,192
but at the same time,
praying we never have to use it.

115
00:06:57,621 --> 00:06:58,772
Thank you.

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00:06:58,796 --> 00:07:03,074
(Applause)