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  • I'm the luckiest guy in the world.

  • I got to see the last case of killer smallpox in the world.

  • I was in India this past year,

  • and I may have seen the last cases of polio in the world.

  • There's nothing that makes you feel more --

  • the blessing and the honor of working in a program like that --

  • than to know that something that horrible no longer exists.

  • So I'm going to tell you --

  • (Applause)

  • so I'm going to show you some dirty pictures.

  • They are difficult to watch, but you should look at them with optimism,

  • because the horror of these pictures will be matched

  • by the uplifting quality of knowing that they no longer exist.

  • But first, I'm going to tell you a little bit about my own journey.

  • My background is not exactly the conventional medical education

  • that you might expect.

  • When I was an intern in San Francisco,

  • I heard about a group of Native Americans who had taken over Alcatraz Island,

  • and a Native American who wanted to give birth on that island,

  • and no other doctor wanted to go and help her give birth.

  • I went out to Alcatraz, and I lived on the island for several weeks.

  • She gave birth; I caught the baby; I got off the island;

  • I landed in San Francisco;

  • and all the press wanted to talk to me,

  • because my three weeks on the island made me an expert in Indian affairs.

  • (Laughter)

  • I wound up on every television show.

  • Someone saw me on television; they called me up; and they asked me

  • if I'd like to be in a movie and to play a young doctor

  • for a bunch of rock and roll stars who were traveling in a bus ride

  • from San Francisco to England.

  • And I said, yes, I would do that,

  • so I became the doctor in an absolutely awful movie

  • called "Medicine Ball Caravan."

  • (Laughter)

  • Now, you know from the '60s,

  • you're either on the bus or you're off the bus; I was on the bus.

  • My wife of 37 years and I joined the bus.

  • Our bus ride took us from San Francisco to London,

  • then we switched buses at the big pond.

  • We then got on two more buses

  • and we drove through Turkey and Iran, Afghanistan,

  • over the Khyber Pass into Pakistan, like every other young doctor.

  • This is us at the Khyber Pass, and that's our bus.

  • We had some difficulty getting over the Khyber Pass.

  • But we wound up in India.

  • And then, like everyone else in our generation,

  • we went to live in a Himalayan monastery.

  • (Laughter)

  • This is just like a residency program,

  • for those of you that are in medical school.

  • (Laughter)

  • And we studied with a wise man, a guru named Karoli Baba,

  • who then told me to get rid of the dress,

  • put on a three-piece suit,

  • go join the United Nations as a diplomat

  • and work for the World Health Organization.

  • And he made an outrageous prediction that smallpox would be eradicated,

  • and that this was God's gift to humanity,

  • because of the hard work of dedicated scientists.

  • And that prediction came true.

  • This little girl is Rahima Banu,

  • and she was the last case of killer smallpox in the world.

  • And this document is the certificate that the global commission signed,

  • certifying the world to have eradicated the first disease in history.

  • The key to eradicating smallpox was early detection, early response.

  • I'm going to ask you to repeat that: early detection, early response.

  • Can you say that?

  • Audience: Early detection, early response.

  • Larry Brilliant: Smallpox was the worst disease in history.

  • It killed more people than all the wars in history.

  • In the last century, it killed 500 million people.

  • You're reading about Larry Page already.

  • Somebody reads very fast.

  • (Laughter)

  • In the year that Larry Page and Sergey Brin --

  • with whom I have a certain affection and a new affiliation --

  • in the year in which they were born,

  • two million people died of smallpox.

  • We declared smallpox eradicated in 1980.

  • This is the most important slide that I've ever seen in public health,

  • [Sovereigns killed by smallpox] because it shows you

  • to be the richest and the strongest,

  • and to be kings and queens of the world,

  • did not protect you from dying of smallpox.

  • Never can you doubt that we are all in this together.

  • But to see smallpox from the perspective of a sovereign

  • is the wrong perspective.

  • You should see it from the perspective of a mother,

  • watching her child develop this disease and standing by helplessly.

  • Day one, day two, day three,

  • day four, day five, day six.

  • You're a mother and you're watching your child,

  • and on day six, you see pustules that become hard.

  • Day seven, they show the classic scars of smallpox umbilication.

  • Day eight.

  • And Al Gore said earlier

  • that the most photographed image in the world,

  • the most printed image in the world,

  • was that of the Earth.

  • But this was in 1974, and as of that moment,

  • this photograph was the photograph that was the most widely printed,

  • because we printed two billion copies of this photograph,

  • and we took them hand to hand, door to door,

  • to show people and ask them if there was smallpox in their house,

  • because that was our surveillance system.

  • We didn't have Google, we didn't have web crawlers,

  • we didn't have computers.

  • By day nine -- you look at this picture and you're horrified;

  • I look at this picture and I say, "Thank God,"

  • because it's clear that this is only an ordinary case of smallpox,

  • and I know this child will live.

  • And by day 13, the lesions are scabbing, his eyelids are swollen,

  • but you know this child has no other secondary infection.

  • And by day 20, while he will be scarred for life, he will live.

  • There are other kinds of smallpox that are not like that.

  • This is confluent smallpox,

  • in which there isn't a single place on the body where you could put a finger

  • and not be covered by lesions.

  • Flat smallpox, which killed 100 percent of people who got it.

  • And hemorrhagic smallpox, the most cruel of all,

  • which had a predilection for pregnant women.

  • I've probably had 50 women die.

  • They all had hemorrhagic smallpox.

  • I've never seen anybody die from it who wasn't a pregnant woman.

  • In 1967, the WHO embarked on what was an outrageous program

  • to eradicate a disease.

  • In that year, there were 34 countries affected with smallpox.

  • By 1970, we were down to 18 countries.

  • 1974, we were down to five countries.

  • But in that year, smallpox exploded throughout India.

  • And India was the place where smallpox made its last stand.

  • In 1974, India had a population of 600 million.

  • There are 21 linguistic states in India,

  • which is like saying 21 different countries.

  • There are 20 million people on the road at any time,

  • in buses and trains, walking; 500,000 villages, 120 million households,

  • and none of them wanted to report

  • if they had a case of smallpox in their house,

  • because they thought that smallpox was the visitation of a deity,

  • Shitala Mata, the cooling mother,

  • and it was wrong to bring strangers into your house

  • when the deity was in the house.

  • No incentive to report smallpox.

  • It wasn't just India that had smallpox deities;

  • smallpox deities were prevalent all over the world.

  • So, how we eradicated smallpox was --

  • max vaccination wouldn't work.

  • You could vaccinate everybody in India,

  • but one year later there'd be 21 million new babies,

  • which was then the population of Canada.

  • It wouldn't do just to vaccinate everyone.

  • You had to find every single case of smallpox in the world

  • at the same time, and draw a circle of immunity around it.

  • And that's what we did.

  • In India alone, my 150,000 best friends and I went door to door,

  • with that same picture,

  • to every single house in India.

  • We made over one billion house calls.

  • And in the process, I learned something very important.

  • Every time we did a house-to-house search,

  • we had a spike in the number of reports of smallpox.

  • When we didn't search, we had the illusion that there was no disease.

  • When we did search, we had the illusion that there was more disease.

  • A surveillance system was necessary,

  • because what we needed was early detection, early response.

  • So we searched and we searched,

  • and we found every case of smallpox in India.

  • We had a reward. We raised the reward.

  • We continued to increase the reward.

  • We had a scorecard that we wrote on every house.

  • And as we did that,

  • the number of reported cases in the world dropped to zero.

  • And in 1980, we declared the globe free of smallpox.

  • It was the largest campaign in United Nations history,

  • until the Iraq war.

  • 150,000 people from all over the world --

  • doctors of every race, religion, culture and nation,

  • who fought side by side, brothers and sisters,

  • with each other, not against each other,

  • in a common cause to make the world better.

  • But smallpox was the fourth disease that was intended for eradication.

  • We failed three other times.

  • We failed against malaria, yellow fever and yaws.

  • But soon we may see polio eradicated.

  • But the key to eradicating polio is early detection, early response.

  • This may be the year we eradicate polio.

  • That will make it the second disease in history.

  • And David Heymann, who's watching this on the webcast --

  • David, keep on going. We're close!

  • We're down to four countries.

  • (Applause)

  • I feel like Hank Aaron.

  • Barry Bonds can replace me any time.

  • Let's get another disease off the list of terrible things to worry about.

  • I was just in India working on the polio program.

  • The polio surveillance program is four million people going door to door.

  • That is the surveillance system.

  • But we need to have early detection, early response.

  • Blindness, the same thing.

  • The key to discovering blindness is doing epidemiological surveys

  • and finding out the causes of blindness,

  • so you can mount the correct response.

  • The Seva Foundation was started by a group of alumni

  • of the Smallpox Eradication Programme,

  • who, having climbed the highest mountain,

  • tasted the elixir of the success of eradicating a disease,

  • wanted to do it again.

  • And over the last 27 years, Seva's programs in 15 countries

  • have given back sight to more than two million blind people.

  • Seva got started because we wanted to apply these lessons

  • of surveillance and epidemiology

  • to something which nobody else was looking at as a public health issue:

  • blindness, which heretofore had been thought of only as a clinical disease.

  • In 1980, Steve Jobs gave me that computer, which is Apple number 12,

  • and it's still in Kathmandu, and it's still working,

  • and we ought to go get it and auction it off and make more money for Seva.

  • And we conducted the first Nepal survey ever done for health,

  • and the first nationwide blindness survey ever done,

  • and we had astonishing results.

  • Instead of finding out what we thought was the case --

  • that blindness was caused mostly by glaucoma and trachoma --

  • we were astounded to find out

  • that blindness was caused instead by cataract.

  • You can't cure or prevent what you don't know is there.

  • In your TED packages there's a DVD, "Infinite Vision,"

  • about Dr. V and the Aravind Eye Hospital.

  • I hope that you will take a look at it.

  • Aravind, which started as a Seva project,

  • is now the world's largest and best eye hospital.

  • This year, that one hospital will give back sight

  • to more than 300,000 people in Tamil Nadu, India.

  • (Applause)

  • Bird flu.

  • I stand here as a representative of all terrible things --

  • this might be the worst.

  • The key to preventing or mitigating pandemic bird flu

  • is early detection and rapid response.

  • We will not have a vaccine or adequate supplies of an antiviral

  • to combat bird flu if it occurs in the next three years.

  • WHO stages the progress of a pandemic.

  • We are now at stage three on the pandemic alert stage,

  • with just a little bit of human-to-human transmission,

  • but no human-to-human-to-human sustained transmission.

  • The moment WHO says we've moved to category four --

  • this will not be like Katrina.

  • The world as we know it will stop.

  • There'll be no airplanes flying.

  • Would you get in an airplane with 250 people you didn't know,

  • coughing and sneezing,

  • when you knew that some of them might carry a disease that could kill you,