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Dr. Brilliant's Wish`
Ethan Zuckerman, 23 Feb 06

Dr. Larry Brilliant is having a very good week. Tuesday evening, he was named the head of, Google's philanthropic arm. And this evening, he received the 2006 TED Prize for his work on disease eradication. Then again, Brilliant says that he's the luckiest man in the world. That's because he got to see the last case of killer smallpox in the world, and believes that he may well see the last case of polio.

His path into medicine - and now philanthropy - is an unusual one. Like many children of the sixties, he rode a bus from San Francisco to London to Turkey, and eventually over the Khyber Pass to India. (We suspect boats were involved somewhere. Or perhaps just a lot of drugs.) In India, he and his wife lived in a Himalayan monestary and worked with a guru, who later told Brilliant to join the UN and work on the elimination of smallpox, which Brilliant did in his work with the WHO.

The key to eliminating smallpox, Brilliant believes, is early detection and early response. This is what's made it possible to destroy the most deadly disease in history - a disease that's killed 500 million people, 2 million a year as recently as thirty years ago.

In 1967, it seemed outrageously optimistic to predict that smallpox could be eliminated. By 1974, it was endemic in only five countries, including India, where there were over a hundred thousand cases. Massive vaccination wouldn't work - tens of millions of new babies would have to be vaccinated each year. Instead, you need to build a "circule of immunity" around existing cases.

To do this, Brilliant and thousands of others made over a billion housecalls to households in India, showing people pictures of smallpox and trying to isolate the existing cases. The method works, and the disease was gone by 1980. Now polio is disappearing in a similar pattern - it's endemic in only four countries, and might be eliminated soon.

Unfortunately, other diseases haven't been responsive to this method. Smallpox was eliminated, but yaws, malaria and yellow fever were not.

The nightmare diseases of the future are not the childhood killers that are almost eliminated - they're new pandemics, like Avian Flu or SARS. Should avian flu start transmitting from person to person to person, Brilliant predicts that people will not get on airplanes, and commerce as we know it will cease for a sustained period, breaking just-in-time supply chains. While he doesn't think Avian Flu will neccesarily become a pandemic, he reports that 90% of epidemiologists believe a major pandemic will occur in the next two generations and will make a billion or more people sick.

How do we stop pandemics? Like smallpox: early detection and early response. We won't have a vaccine for avian flu for at least three years, so we need to isolate cases quickly. Our weapon in this is information - systems like GPHIN - the Global Public Health Information Network.

GPHIN scans news sites from around the world, digesting content in seven languages, to detect illnesses that might be pandemics. It helped identify SARS, and helped it from becoming a pandemic, and is serving as a global early warning system for Avian Flu.

With his TED wish, Brilliant wants to build INSTEDD - the International System for Total Early Disease Detection. (That TED is in the word is no coincidence, given the role of the prize in shaping the intervention.) He wants to build this around GPHIN, expanding the number of sites analyzed and expanding from 7 languages to 70, and add satellite data to help confirm media reports.

The goal? A system that can help the whole world stay healthy by helping us identify and treat those who are sick early and rapidly.

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At the risk of again being labeled a technophiliac (or worse), I'll point out that the human approach -- "a billion housecalls to households in India" -- has been and will continue to be greatly augmented by improved technologies.

Built by advanced nanotechnology (molecular manufacturing), powerful new sensors and ubiquitous communications devices will combine with inexpensive, highly parallel DNA and protein analysis to spot any new pathogen almost immediately. Within the next decade, we really could arrest both old and new diseases, helping "the whole world stay healthy."

However, all this progress depends as much on will and on good faith as it does on technical research. How much funding will be directed toward military purposes as opposed to commercial or humanitarian development?

Posted by: Mike Treder on 24 Feb 06

For those interested in learning more about the amazing Dr. Brilliant, check out this article in Fast Company from 2000:

Posted by: Roy King III on 24 Feb 06



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