Killing up to 500 million people in the 20th century alone, one of the last bastions of the world’s deadliest disease remained in India. Alongside a valiant army of 150,000 volunteers Larry Brilliant saw off the last of its ills through a persistent vaccination effort. It was the defining achievement of his life, not forgetting his efforts in saving 4 million people from blindness. Since then, Brilliant has tried to spearhead innovation tieing together the worlds of healthcare and technology in one empowering and cutting-edge swoop. Talk about the ‘reality distortion field’, he originally tried to convince Steve Jobs to strike out Apple from his ambitions altogether and instead join his fight to eradicate blindness. Ahead of his time in some respects, Brilliant pioneered Google’s shaky foray into the tech-philanthropy world and now works with one of the founding fathers of eBay Jeff Skoll on the five biggest threats to mankind, from pandemics to climate change. There is no challenge too small or too big that Brilliant cannot handle but the real question is; should Silicon Valley be doing more to help a world in peril?
You’ve been lucky enough to call people like Steve Jobs and Larry Page your friends, so you have a unique vantage point from inside these circles that are changing the world. You’re also on the ground in developing nations and able to see the damage caused in a society without tech innovation. Do you think Silicon Valley works as an innovation engine for the greater good?
Let me start by saying I think that the power of Silicon Valley is both exuberant and suffocating. I’m a beneficiary of the largesse of Silicon Valley, which I am very grateful for because I couldn’t be living where I am today if I didn’t have the privilege of owning stock in a lot of these companies and working for many of them. One of the reasons for that is the ecosystem in Silicon Valley is just sensational – we’ve got the lawyers, the accountants, the venture capitalists, the seed investors and the noble carriers of doing well and doing good like Marc Benioff, we’ve got all the SEC regulations and investment banks, all the engineers that are here. It’s like having a well-fertilised soil and all you have to do is put a seed in it. Whatever that seed is, it blooms. Sometimes it’s a beautiful flower and sometimes it’s a vicious weed but you’ve got all the things here for growing innovation.
"Steve was walking around barefoot with a shaved head, just like every other hippy that came to India at the time."
Larry Brilliant on his relationship with Apple's Steve Jobs
You have such an interesting and diverse resume of working with companies like Google using innovation to do good. What were the early conversations like with people like Larry Page and Sergey Brin, trying to get them to use their infinite resources to help these global issues?
Oh I think they sold it to me, and they got it from Marc Benioff. Benioff created this idea of ‘1/1/1’ where companies doing really well would give 1% of their equity, 1% of their profits and 1% of their people to work on the great problems of the day and work on philanthropic efforts. Benioff continues to do that at Salesforce, which I’m on the board for, and Google went through a period of a decade or so when maybe that wasn’t as preeminent but it’s back now and Google is trying again to live up to that.
You met Steve Jobs in India, is that right?
I did, I met him when he was 19 and I was about 25.
Is it true that you originally told him that Apple was a bad idea?
Not originally. He went back to the US to start Apple and I stayed on in India to eradicate smallpox. I then went back to Michigan where I was a professor and started the Seva Foundation, which he heard about and gave me the first money for and also joined the board. He gave me a lot of computers, he was really wonderful. This was in 1979 and Apple was just getting bigger and bigger, and I said, “Steve you’ve got so many skills, you’re wasting them making these little toy computers. Nobody’s going to want to buy those.” Of course, I was so smart and wise and prescient… I said, “Why don’t you come to be the executive director of Seva and we can really do some good in the world?” He turned me down obviously but he gave us more money.
"Collectively we made over 2 billion house calls."
Larry Brilliant on eradicating smallpox
What were your discussions like with Steve about Apple in the early days?
I met him when we were actually in a very bad state of the smallpox programme. He came over to the WHO [World Health Organisation] office. We both went to India to meet Neem Karoli Baba. I was there for 2 years before Neem Karoli Baba died, Steve got there 6 months after he died but he was still staying in the ashram in the Himalayas where my wife and I had lived. Steve was walking around barefoot with a shaved head, just like every other hippy that came to India at the time. When you are in India for a certain period of time there are 2 things that you want: air conditioning and a salad. That’s what you want after a long time, and when I went to WHO that’s what we had. So all the kids living in the ashram would at some point make their way to my door at WHO and ask if they could come in to cool off and have lunch. So Steve was one of them, and we had a wonderful lunch where he ate more salad than I’ve ever seen a human being eat, and he talked about this vision that he had. You know the old expression from the 1960s of giving ‘power to the people’? Steve said his idea was giving power to the people by empowering them with technology.
We’ve had a couple of discussions with people working in disease and pandemics. One of the most interesting people we met, who you might know of, is a guy called Prabhat Jha, who’s a well-known epidemiologist. He has revolutionised the way the dead are counted in India because 80% of deaths in India take place outside the healthcare system. He initiated a project called the ‘Million Deaths’ study, where he planned to create a cause of death index that would effectively verify data on how these millions of people had died. Like you he was working in very difficult conditions, so I’m just wondering how difficult it is to have those types of conversations with people?
Well, first of all, let me commend what this man has done because even today we know the cause of death of less than 60% of people who die, and even when we say we know, the death certificate will say something like ‘old age’ as the cause. Until you know the causes of death you don’t know how to steer resources for stopping them. Children who are dying from diarrhoea for example are not just dying from that, they are dying from a rotavirus, which we can create a vaccine against. Now if you didn’t count them and know what they died from then you wouldn’t be able to martial and mobilise the resources, so I want to commend what he is doing because it’s really important.
The smallpox eradication programme for the great big dramatic part of it was the last 4 countries, and that was India, Bangladesh, Pakistan and Nepal. There was a follow-on in the Horn of Africa, but that was a minor part on the spectrum of the smallpox disease that only killed 1 out of 100. The disease in India killed 35-40% of all the people who contracted it, and in the year that I joined WHO in 1972, it killed 188,000 people, mostly children. That’s a huge number, and that’s just the number that was reported, so going back to what you said about knowing the cause of death, I would imagine that we were only finding about 1 out of every 10 cases of smallpox and maybe 1 out of every 5 smallpox deaths. We see the figure that nearly half a billion people died from smallpox in the 20th century worldwide, and that’s just an estimate; we didn’t enumerate those deaths so we don’t really know how many people died.
Collectively we made over 2 billion house calls, knocking on doors and talking with people, then writing on the side of the door how many people lived there. It was amazing.
State of pandemics worldwide as of 2014. Image courtesy of Open Dream
There have been reports of a resurgence of measles in Europe amongst children because a lot of parents are refusing to vaccinate their children. It’s quite worrying to see that diseases like this are re-emerging. What’s your opinion around this?
In the US, the anti-vaccination movement is another kind of Luddite reaction to government authority, the media and science. The Lancet, which is a great scientific journal published in the UK, made a big mistake by publishing a fake and dishonest piece of science by a guy named Wakefield who was paid by some UK solicitors to fabricate a study showing a purported link between autism and vaccination. It’s not true – there is no link between autism and vaccination, but because that was published in Lancet it had the colour of authority. People who didn’t want to vaccinate their kids read that article, and then when it was pulled and he was taken to court and had his medical licence taken away, even that looked like it was all part of a conspiracy theory to hide the fact that what he was saying was true.
I think the underlying reason for the resistance to vaccination is that we don’t have a lot of deaths in the street. If there were a lot of deaths in the street from these infectious diseases then parents would be willing to take on a little incremental risk for their children to vaccinate them because of the bigger risk that they will die. Now that there is no measles, except for these outbreaks, people say that they don’t really believe in this notion that we are all in it together and therefore why should their child have to bear even a hundredth of a percent of the risk when if all the other kids are vaccinated, their child will be safe?
"That’s what is fascinating to me, to say that yes we want disease eradication programmes but for the first time technology is allowing us to dream big and prevent the next HIV/Aids."
Larry Brilliant on whether tech eliminate pandemics
You’re a real risk taker in the sense that you truly follow your convictions, which I really admire about you. If we could move on to talk about the Skoll Foundation, the president Jeff Skoll asked you to work there and you work on 5 global threats. How far have you come so far and what do you hope to achieve in the future with this initiative?
Every year Jeff and I come to Oxford. When we are there we do the Skoll World Forum that Jeff puts together with all the social entrepreneurs from across the country that we have funded. I think we have funded about 100 and given them each 1.5 million dollars. Along the way, Jeff got this idea that if there were a couple of bad things that could happen, these existential threats to humanity – pandemics, climate change or nuclear weapons, a regional conflict that could become a global war – any one of those could stop the nascent work being done by these social entrepreneurs. That’s why he started the global threats initiative.
Where I think we have had the most luck and the most success is with pandemics. We’ve come to understand that the rate-limiting step for a biological explosion of a new disease is how quickly you find them in the first place. The technology for finding the first outbreak has been sensational, whether it’s Google Flu Trends or Flu Near You or HealthMap, all these organisations and digital systems that have been able to find new diseases before they become entrenched. With the exception of Ebola, we’ve been able to act really quickly and stop nascent pandemics.
I’ll give you one example: there’s a disease called MERS (Middle East Respiratory System), which is a cousin of SARS. The disease is primarily found in Saudi Arabia but there were 2 cases that left Saudi Arabia: one went to Seoul and the other went to Bangkok. If you read about the MERS outbreak in South Korea you will see that hundreds of people succumbed to the disease there, which is a developed country with a phenomenal healthcare system. Nonetheless, one virus going into South Korea caused this amount of disease and death. At the same time, Thailand is far less developed and has a less developed healthcare system. But there were no secondary cases. Why? Because Thailand has one of the best digital disease recognition systems out there, called Doctorme. That came from Mark Smolinski at Skoll Global Threats Fund bringing a group of epidemiologists and engineers to Thailand and matching that with Thai engineers and epidemiologists to build this system now used all over Thailand. I’m very proud of the work that the Thais have done in early disease detection and it’s certainly a factor.
Recently I gave a talk in Abu Dhabi on disease eradication. I was saying that I am a big fan of disease eradication but when we finish, polio will have cost 21 billion dollars to eradicate. Malaria would cost another 20-30 billion dollars to eradicate. You add up the diseases we would like to eradicate, and it’s in the hundreds of billions. Every one of those diseases was originally one animal with one bug, and there was a moment in time when you could have found that animal and prevented that bug from going to one human so you wouldn’t have spent the hundreds of billions of dollars, and even more, you wouldn’t have had the billions of deaths. That’s what is fascinating to me, to say that yes we want disease eradication programmes but for the first time technology is allowing us to dream big and prevent the next HIV/Aids.
Images courtesy of Harper Collins
Sometimes Brilliant: The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History by Larry Brilliant is available to buy now through Harper One