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How do you personally feel
about mosquitoes?
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Oh, I'm certainly annoyed by them.
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Uh, in the summer in Seattle,
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you know, they bite
and you... you get welts.
5
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And, uh...
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But I've never lived anywhere
where there was malaria.
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Mosquitoes of the genus Anopheles
are the transmitters of malaria to man,
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and malaria is transferred
from man to insect,
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and then on to man again.
10
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You know,
malaria kills 400,000 kids a year.
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But it's not in rich countries at all.
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So, it's a type of neglected disease.
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When it comes to diseases,
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the opportunity is to develop
cutting-edge technologies
15
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like vaccines, antibodies,
16
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and even more controversial techniques
like gene editing,
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and use those
to try and eradicate these diseases
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from the face of the planet.
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It would be
one of mankind's biggest achievements
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to finish off malaria.
21
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Malaria is such a problem here.
22
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You have to go to the hospital,
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and if you don't have money,
malaria will kill you.
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It can kill the baby.
25
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It has killed many babies.
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It killed a baby who was close to me.
27
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My sister's baby.
28
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She started convulsing.
29
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Her fever was high. I did not waste time.
30
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I caught a ride and rushed her here.
31
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She had very strong malaria.
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Sorry. Sorry, baby girl.
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We got one. One oxygen.
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Ma'am, can you fill for us, oxygen?
35
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When you sit in those wards, you know,
you just see how frantic things are
36
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because the wards
are never adequately staffed
37
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because malaria is quite seasonal.
38
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It's as the rainy season comes,
39
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then the mosquito population
grows exponentially.
40
00:03:15,695 --> 00:03:16,613
As a kid,
41
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I can't even tell you how many
episodes of malaria I went through.
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{\an8}I can still clearly see, you know,
the picture of my father.
43
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{\an8}He was standing next to my bed,
44
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{\an8}looking at me.
45
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{\an8}I could really see, you know,
a lot of fear in his eyes.
46
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{\an8}If malaria was killing
600,000 people in the US or in Europe,
47
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{\an8}the problem would have
completely changed by now.
48
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{\an8}Malaria tends to be most concentrated
in the poorest populations,
49
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{\an8}the populations
with the least access to health care.
50
00:04:04,535 --> 00:04:08,206
There's this arc from Mali,
Burkina Faso, Côte d'Ivoire,
51
00:04:08,289 --> 00:04:11,209
through Nigeria
and the Democratic Republic of Congo,
52
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where the sheer intensity of transmission
that needs to be stopped
53
00:04:15,880 --> 00:04:18,633
is unlike just about anything else
we have to face.
54
00:04:22,095 --> 00:04:26,599
Malaria is a parasite
that you get from mosquito bites.
55
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The parasite travels
and infects your liver,
56
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and after staying in the liver
for a period of time,
57
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one infected liver cell will release
400,000 extra parasites
58
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that start invading your red blood cells.
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The parasite invades a red blood cell,
digests the red blood cell,
60
00:04:45,410 --> 00:04:48,746
then bursts the red blood cell
to keep invading more and more.
61
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So it takes over your bloodstream.
62
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When all your red blood cells
that are infected burst,
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you... you feel it.
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You feel the intense chills,
the spikes of fever, the sweats.
65
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You're exhausted.
66
00:05:03,303 --> 00:05:05,513
In some cases,
it's hitting your body so hard
67
00:05:05,596 --> 00:05:07,557
that you feel nausea, and you're vomiting,
68
00:05:07,640 --> 00:05:09,600
and that's a relatively mild case.
69
00:05:10,310 --> 00:05:14,397
As it progresses,
it can lead to respiratory distress,
70
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cause long-lasting anemia,
inflammation in your brain,
71
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and in far too many times,
it can lead to death.
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00:05:21,863 --> 00:05:24,115
The youngest children, the vulnerable,
73
00:05:24,198 --> 00:05:28,828
pregnant women will experience
a real devastating burden of malaria.
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00:05:33,458 --> 00:05:36,627
Originally, malaria was
a form of aquatic algae,
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00:05:36,711 --> 00:05:38,796
some 600 to 800 million years ago.
76
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{\an8}It actually still has vestiges
of photosynthesis.
77
00:05:42,175 --> 00:05:45,345
{\an8}We think more modern malaria
comes from birds,
78
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roughly 130 million years ago.
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It's a symbiotic relationship.
80
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The pathogens use us, essentially,
to help them procreate,
81
00:05:56,606 --> 00:05:59,108
and malaria needs two hosts.
82
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It needs the mosquito
and then a secondary host,
83
00:06:02,195 --> 00:06:05,281
whether that be humans,
reptiles, amphibians, the great apes.
84
00:06:05,365 --> 00:06:07,784
Uh, we all have malaria.
85
00:06:09,118 --> 00:06:11,037
People don't pay attention to it.
86
00:06:11,120 --> 00:06:14,916
{\an8}Americans are particularly good
at not thinking about anything
87
00:06:14,999 --> 00:06:17,126
{\an8}that doesn't affect them instantly.
88
00:06:18,669 --> 00:06:21,881
Malaria was something
that affected my grandparents.
89
00:06:22,423 --> 00:06:26,302
At the turn of the 20th century,
it was a big deal.
90
00:06:26,386 --> 00:06:28,971
I mean, the Centers for Disease Control
is in Atlanta
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because that's where
malaria was devastating.
92
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{\an8}Malaria-carrying mosquitoes
are nearby,
93
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{\an8}searching for their evening meal
of human blood.
94
00:06:37,855 --> 00:06:40,983
{\an8}Malaria was a big deal
in this country,
95
00:06:41,067 --> 00:06:43,736
and it went from being a really big deal
96
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to nothing.
97
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People don't die of malaria anymore
because we are able to control it.
98
00:06:50,993 --> 00:06:55,164
{\an8}If you rewind to
the big global malaria eradication effort
99
00:06:55,248 --> 00:06:57,625
{\an8}that was launched in the mid-20th century,
100
00:06:57,708 --> 00:07:02,171
{\an8}the tools that were used at the time
like environmental modification,
101
00:07:02,255 --> 00:07:04,966
making sure
there were no mosquito breeding sites,
102
00:07:05,049 --> 00:07:07,635
doing large-scale spraying
of insecticides.
103
00:07:07,718 --> 00:07:10,012
All of these things worked at the time.
104
00:07:10,096 --> 00:07:14,684
But those aren't necessarily
the right set of tools to deploy now
105
00:07:14,767 --> 00:07:17,645
in the places
where malaria still remains entrenched.
106
00:07:21,732 --> 00:07:23,693
The ski jumping.
That's pretty exciting, isn't it?
107
00:07:23,776 --> 00:07:27,655
It was in the 1990s,
I was thinking along with Melinda about,
108
00:07:27,738 --> 00:07:30,450
"Okay, where should the resources go?"
109
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And looking at what children die of
110
00:07:35,329 --> 00:07:38,916
and stunned to find out
it was pneumonia, diarrhea, and malaria.
111
00:07:39,417 --> 00:07:43,004
When I saw how little money
was going into malaria,
112
00:07:43,087 --> 00:07:45,089
it was a rather shocking thing.
113
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Literally tons of DDT
are used on this dread disease
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that attacks our young.
115
00:07:52,221 --> 00:07:54,640
Again war, destructive and terrible,
116
00:07:54,724 --> 00:07:57,268
contributes one of its discoveries
to save life.
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00:07:57,351 --> 00:07:59,562
Armies used to fund a lot of malaria work
118
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because soldiers would go off
to malarious places and die.
119
00:08:02,940 --> 00:08:07,153
But then the medicines that protect
the soldiers were considered good enough,
120
00:08:07,236 --> 00:08:09,405
and so it was no longer
a priority for them.
121
00:08:11,782 --> 00:08:17,914
There's more money put into baldness drugs
than are put into malaria.
122
00:08:18,748 --> 00:08:20,833
Now, baldness is... it's a terrible thing.
123
00:08:20,917 --> 00:08:22,585
Uh...
124
00:08:22,668 --> 00:08:27,381
In the year 2000,
the Gates Foundation is created,
125
00:08:27,965 --> 00:08:31,010
and, you know,
this saving children's lives
126
00:08:31,093 --> 00:08:35,431
could be our top priority
and really make a huge difference there.
127
00:08:38,976 --> 00:08:40,645
{\an8}Uh, malaria is getting worse.
128
00:08:41,145 --> 00:08:43,564
Bed nets can make a fantastic difference.
129
00:08:44,065 --> 00:08:46,567
Eventually, uh, there will be a vaccine.
130
00:08:46,651 --> 00:08:49,654
In terms of value for money,
which is what American people want,
131
00:08:49,737 --> 00:08:52,281
they won't find better value for money.
132
00:08:52,365 --> 00:08:54,700
{\an8}I met Bill Gates
133
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{\an8}over some cheeseburgers,
134
00:08:58,538 --> 00:09:01,374
{\an8}um, to discuss global health.
135
00:09:01,457 --> 00:09:04,126
I think he get... He's... he's offended by
136
00:09:04,210 --> 00:09:09,215
the stupid, wanton waste of anything,
137
00:09:09,757 --> 00:09:11,926
but human life at the top of the list.
138
00:09:12,969 --> 00:09:14,679
That seems to set him off.
139
00:09:14,762 --> 00:09:16,282
I mean, but he'll argue with anything.
140
00:09:17,265 --> 00:09:19,850
In the early days, it was wild.
141
00:09:20,351 --> 00:09:22,270
You know we call him Kill Bill?
142
00:09:22,853 --> 00:09:26,941
I can remember finance ministers
being in meetings, and he's going...
143
00:09:27,024 --> 00:09:28,568
"You're lying."
144
00:09:28,651 --> 00:09:32,113
"You're lying. That's a lie.
You know it's a lie."
145
00:09:32,196 --> 00:09:34,240
And I'm like, "Uh..."
146
00:09:34,323 --> 00:09:37,785
Yeah, he's a bit punk rock, Bill Gates.
You don't think of that, do you?
147
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{\an8}New vaccinations are needed
so that, uh, the children live.
148
00:09:41,831 --> 00:09:46,002
{\an8}How much are we, all as one humanity,
trying to help each other?
149
00:09:47,003 --> 00:09:51,048
You know, we made
a $30 million grant for malaria work.
150
00:09:51,132 --> 00:09:54,969
I was shocked that made us
the biggest funder in the entire field.
151
00:09:57,013 --> 00:10:00,975
The people who die of malaria
don't have a voice in the marketplace.
152
00:10:01,058 --> 00:10:03,477
There's not a profit opportunity.
153
00:10:03,561 --> 00:10:09,275
The market for dog food is 40 times bigger
than the market for malaria.
154
00:10:10,109 --> 00:10:14,780
{\an8}Since 1990, we have cut extreme poverty
and childhood mortality in half.
155
00:10:15,573 --> 00:10:16,699
You tend to believe
156
00:10:16,782 --> 00:10:19,869
when Bill says we can do something
that we can do it.
157
00:10:19,952 --> 00:10:21,454
{\an8}Do you think we can do it?
158
00:10:21,954 --> 00:10:23,039
Absolutely.
159
00:10:27,335 --> 00:10:29,211
{\an8}So tell me about Diabaté.
160
00:10:29,295 --> 00:10:32,798
Uh, Diabaté is leading
the Target Malaria work in Burkina Faso.
161
00:10:32,882 --> 00:10:35,635
His background was a lot in entomology.
He...
162
00:10:35,718 --> 00:10:36,552
Mosquitoes?
163
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Mosquitoes.
The world expert in identifying
164
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where mosquitoes
are gonna be swarming for mating.
165
00:10:48,481 --> 00:10:49,857
- Hi.
- Hello.
166
00:10:49,940 --> 00:10:52,260
- Good to see you.
- Good to see you too.
167
00:10:52,693 --> 00:10:56,405
First of all, I will say that statistics
are really good storytellers.
168
00:10:56,989 --> 00:11:00,910
Of these 247 million cases worldwide
every year,
169
00:11:01,827 --> 00:11:05,790
Africa's bearing about 235 million cases...
170
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- That's incredible.
- ...alone.
171
00:11:07,875 --> 00:11:09,168
The real problem today is that
172
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when you look at the conventional tools
that we have in hand,
173
00:11:12,088 --> 00:11:15,800
you take bed nets and then you take
the new drugs and everything,
174
00:11:15,883 --> 00:11:18,052
they have done a really incredible job.
175
00:11:18,135 --> 00:11:23,015
But right now, it seems like
they have reached the protective limit.
176
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With the current tools, basically,
177
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it looks like you are sitting
in a really very fast driving car,
178
00:11:30,314 --> 00:11:31,434
and your target is the moon.
179
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How are you going to make it?
180
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You absolutely need
a completely different engine.
181
00:11:37,154 --> 00:11:39,657
We need to put
a lot of effort and research
182
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trying to come up with new tools.
183
00:11:44,495 --> 00:11:47,998
To beat malaria, we'll have to
put a number of different tools together.
184
00:11:48,082 --> 00:11:50,668
We have to get better
at going after the mosquito
185
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and keeping mosquitoes
from transmitting to people.
186
00:11:52,878 --> 00:11:55,548
We also have to do
a better job of protecting people,
187
00:11:55,631 --> 00:11:58,801
and we have to do a better job of killing
the parasites that do get to people.
188
00:11:58,884 --> 00:11:59,969
And we're also looking at,
189
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"How can we protect people
when they still get bites
190
00:12:02,513 --> 00:12:06,016
to make sure that the parasite
never really has a chance to take root?"
191
00:12:06,892 --> 00:12:10,062
The reason
that we are still dealing with it now
192
00:12:10,146 --> 00:12:13,691
is because the malaria parasite,
it's got a complicated life cycle.
193
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The parasite looks different
at every stage of its life cycle.
194
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The malaria parasite has
a bunch of really complicated machinery
195
00:12:22,366 --> 00:12:25,369
that it uses to confuse the immune system,
196
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to evade the best thing
that our immune systems can throw at it.
197
00:12:29,248 --> 00:12:30,916
Uh, the parasite, it's evolving.
198
00:12:31,667 --> 00:12:34,462
The drugs that we use
that have been saving many lives,
199
00:12:34,545 --> 00:12:37,214
the parasite is now evolving resistance
to those drugs.
200
00:12:37,798 --> 00:12:42,011
And so to develop a vaccine,
we have to really outsmart the parasite.
201
00:12:43,471 --> 00:12:48,017
Obviously, the big goal is
to have an effective vaccine
202
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that's cheap, reliable,
203
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and that could be distributed
throughout the world.
204
00:13:08,370 --> 00:13:09,570
How are you?
205
00:13:10,080 --> 00:13:11,123
Yeah.
206
00:13:11,207 --> 00:13:16,587
These are where the seminal studies
were done for the RTS, S malaria vaccine.
207
00:13:17,630 --> 00:13:19,465
When we did our first vaccine trial,
208
00:13:19,548 --> 00:13:21,634
it was all done in this room
and this room.
209
00:13:22,718 --> 00:13:25,596
And so I have a lot of history
between these two rooms.
210
00:13:26,514 --> 00:13:30,559
I had worked on a malaria vaccine
for close to seven years.
211
00:13:31,352 --> 00:13:34,396
{\an8}We had great excitement
when we started this trial.
212
00:13:34,480 --> 00:13:35,981
{\an8}I really thought it would work,
213
00:13:36,065 --> 00:13:39,109
{\an8}and when we got the results,
it was extremely disappointing.
214
00:13:40,402 --> 00:13:43,280
Malaria causes death every two minutes.
215
00:13:43,364 --> 00:13:45,908
I think that's what it comes out to be.
216
00:13:45,991 --> 00:13:49,620
It's around ten,
fifteen thousand deaths per week.
217
00:13:49,703 --> 00:13:51,914
Every week, every year.
218
00:13:53,541 --> 00:13:55,960
You have to take the data at hand,
219
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look at it, and then come up
with a different solution.
220
00:13:58,796 --> 00:14:02,967
And so that led me to pivot
to a new intervention.
221
00:14:04,802 --> 00:14:08,055
We've isolated
a monoclonal antibody
222
00:14:08,138 --> 00:14:12,017
that is extremely effective
at preventing malaria.
223
00:14:12,768 --> 00:14:17,439
And so the question is,
"Is this something safe that could work?"
224
00:14:22,486 --> 00:14:25,823
Since there are only
a few hundred malaria parasites
225
00:14:25,906 --> 00:14:28,993
{\an8}that are injected each time
a mosquito bites you,
226
00:14:29,076 --> 00:14:32,955
{\an8}if you can stop the parasite there
with a shot of antibody,
227
00:14:33,038 --> 00:14:37,626
you can essentially stop malaria
from happening inside the human host.
228
00:14:39,336 --> 00:14:42,798
It binds the parasites
before they get into the liver.
229
00:14:42,882 --> 00:14:45,259
It... It's called controlling the host.
230
00:14:45,342 --> 00:14:48,345
You're giving them
the immune response you want.
231
00:14:49,346 --> 00:14:52,808
Can we give a single dose at one time,
232
00:14:53,350 --> 00:14:58,898
and will that dose of antibody provide
protection over the course of one year,
233
00:14:59,648 --> 00:15:02,484
or would you need
a second dose at six months?
234
00:15:02,568 --> 00:15:06,447
So, that's how the study is designed,
and we're now halfway through.
235
00:15:06,530 --> 00:15:08,115
We've given a single dose,
236
00:15:08,198 --> 00:15:10,701
and we'll be looking at
the six-month data.
237
00:15:13,370 --> 00:15:15,205
We're done. Hmm?
238
00:15:15,289 --> 00:15:21,253
{\an8}We have recruited so far 324 children
for this, uh, second part of the trial.
239
00:15:29,553 --> 00:15:34,058
Our syringe is one ml.
240
00:15:34,141 --> 00:15:35,893
Confirm that it is one ml.
241
00:15:36,894 --> 00:15:39,438
- The baby has come for a scheduled visit.
- Mm-hmm.
242
00:15:39,521 --> 00:15:40,689
The baby is not sick.
243
00:15:40,773 --> 00:15:42,107
Okay. Which visit is this?
244
00:15:42,191 --> 00:15:43,734
- Visit 112.
- 112.
245
00:15:43,817 --> 00:15:45,297
- Yes.
- Okay.
246
00:15:46,278 --> 00:15:49,114
It's mostly mothers
who participate in the trial.
247
00:16:02,586 --> 00:16:04,338
{\an8}I'm Bernadina Odhiambo,
248
00:16:05,130 --> 00:16:07,132
{\an8}and I'm 26 years.
249
00:16:11,971 --> 00:16:13,597
I'm a mother of two.
250
00:16:15,557 --> 00:16:18,060
There is Ian and Margaret.
251
00:16:21,146 --> 00:16:25,150
Here in Siaya,
there is high risk of malaria.
252
00:16:27,861 --> 00:16:32,908
We know that there's some measures that
we can take by ourselves to control it.
253
00:16:33,951 --> 00:16:37,121
I've made it as clean as possible.
254
00:16:38,372 --> 00:16:41,250
There are no stagnant waters around.
255
00:16:44,211 --> 00:16:47,798
We are all sleeping
under treated mosquito nets.
256
00:16:47,881 --> 00:16:50,426
We can use mosquito repellents.
257
00:16:52,928 --> 00:16:57,808
We heard of malaria studies
that are being conducted in Siaya County.
258
00:16:57,891 --> 00:17:02,187
I was much interested
since I'm a victim of malaria.
259
00:17:04,940 --> 00:17:09,653
My older son
got malaria when he was two months old.
260
00:17:12,072 --> 00:17:14,408
So,
when it came to the studies,
261
00:17:14,491 --> 00:17:16,827
I just decided to be part of them.
262
00:17:20,789 --> 00:17:24,084
{\an8}Once we started the study,
we were called upon.
263
00:17:24,585 --> 00:17:26,754
{\an8}We went to Kogelo.
264
00:17:28,338 --> 00:17:31,091
They were taking
some blood for tests.
265
00:17:31,175 --> 00:17:34,678
So, after that,
they were given a dose for malaria.
266
00:17:40,642 --> 00:17:44,646
You can see we're driving through
western Kenya, but we're seeing corn.
267
00:17:44,730 --> 00:17:47,816
We could be in, you know,
western Nebraska.
268
00:17:47,900 --> 00:17:51,528
This is our second site.
This is the Kogelo dispensary.
269
00:17:52,071 --> 00:17:54,490
Kogelo, it's in a rural area.
270
00:17:54,573 --> 00:17:59,036
One of its claim to fame is that's where
President Obama's father was born.
271
00:18:00,120 --> 00:18:04,374
I think you have to understand that
if you're bringing in a new intervention,
272
00:18:04,458 --> 00:18:07,920
they wanna have a good understanding
of what that data is.
273
00:18:10,297 --> 00:18:12,883
{\an8}So, we're really excited
that Bob is here today
274
00:18:12,966 --> 00:18:17,638
{\an8}to give us an update on the field
of malaria monoclonal antibodies.
275
00:18:17,721 --> 00:18:20,808
There you go.
276
00:18:22,810 --> 00:18:25,521
Welcome,
and thank you all for coming.
277
00:18:26,021 --> 00:18:28,065
When we all get vaccinated,
278
00:18:28,148 --> 00:18:31,735
the vaccine is given,
and you make an antibody response.
279
00:18:32,569 --> 00:18:34,655
You generate antibodies
that are really good,
280
00:18:34,738 --> 00:18:35,823
that do the protection.
281
00:18:35,906 --> 00:18:38,617
You generate antibodies
that don't do anything at all.
282
00:18:38,700 --> 00:18:41,411
Okay, so you have a team of antibodies.
283
00:18:42,371 --> 00:18:44,289
So, who knows who Michael Jordan is?
284
00:18:44,873 --> 00:18:46,125
The basketball player.
285
00:18:48,627 --> 00:18:49,711
No?
286
00:18:50,295 --> 00:18:51,338
How about Mbappé?
287
00:18:51,421 --> 00:18:53,173
Can he seal it now? Mbappé!
288
00:18:53,257 --> 00:18:55,551
Oh, what an accomplished finish!
289
00:18:55,634 --> 00:18:59,054
Suppose your entire team,
every single player was Mbappé.
290
00:18:59,555 --> 00:19:02,307
The odds of that team winning
would increase.
291
00:19:02,391 --> 00:19:04,643
So, that's what a monoclonal antibody is.
292
00:19:04,726 --> 00:19:07,938
How many doses should be given?
293
00:19:08,021 --> 00:19:10,983
We're at a stage now
where one dose could work for six months.
294
00:19:11,066 --> 00:19:14,528
We'd like to get it that one dose
would work for an entire year.
295
00:19:14,611 --> 00:19:17,072
- Thank you.
- Thank you for your questions.
296
00:19:17,781 --> 00:19:20,284
The question I most often get
is just cost.
297
00:19:20,367 --> 00:19:23,328
That, to me, is really the biggest hurdle.
298
00:19:23,412 --> 00:19:26,957
I... I don't think
it's necessarily a scientific hurdle.
299
00:19:28,167 --> 00:19:32,462
And then we try to convince people
that we can get this made much cheaper.
300
00:19:34,548 --> 00:19:38,468
If they get the cost down enough
and the effectiveness to be super high,
301
00:19:38,552 --> 00:19:42,806
then wherever you give out that antibody,
those kids don't get malaria.
302
00:19:44,516 --> 00:19:47,811
The main thing we've always done
for malaria is had drugs
303
00:19:47,895 --> 00:19:50,814
that, as you detect the fever,
you take the drugs.
304
00:19:51,982 --> 00:19:56,195
Cinchona trees are things
that grow at heights in South America,
305
00:19:56,278 --> 00:19:58,030
and somebody figured out
306
00:19:58,113 --> 00:20:02,159
if you boil the bark of the tree,
which is quinine, and you drink it,
307
00:20:02,242 --> 00:20:05,370
{\an8}that you recover
from your malaria very quickly.
308
00:20:07,372 --> 00:20:09,541
{\an8}Interesting thing about quinine,
309
00:20:09,625 --> 00:20:12,836
it's actually one of the ingredients
in tonic water.
310
00:20:14,046 --> 00:20:17,257
You know, tonic is a word
that we use to refer to medicine.
311
00:20:17,341 --> 00:20:18,217
A tonic.
312
00:20:18,300 --> 00:20:20,969
And tonic water, quinine water,
313
00:20:21,053 --> 00:20:24,431
was what sailors
back in the 18th and 19th century
314
00:20:24,514 --> 00:20:27,100
were typically taking as a preventative.
315
00:20:29,061 --> 00:20:30,381
It has a bitter taste,
316
00:20:30,437 --> 00:20:33,857
so the British colonists in India
added gin to cut the taste,
317
00:20:33,941 --> 00:20:35,859
and the gin and tonic was born.
318
00:20:36,360 --> 00:20:40,030
Obviously, now people don't drink
gin and tonic as an anti-malarial, but...
319
00:20:41,156 --> 00:20:43,116
Coffee also has a connection.
320
00:20:43,200 --> 00:20:46,870
{\an8}Originally, coffee was touted
as a malarial cure,
321
00:20:47,371 --> 00:20:50,040
{\an8}and that enters the lore of coffee,
322
00:20:50,123 --> 00:20:53,168
and it's advertised
right up really until the late 1800s
323
00:20:53,252 --> 00:20:55,254
as a cure for malarial fevers.
324
00:20:56,755 --> 00:20:59,508
The ancient Egyptians bathed
in human urine.
325
00:21:00,008 --> 00:21:04,179
{\an8}The Romans wore amulets around their neck
with the magic word "abracadabra."
326
00:21:04,263 --> 00:21:07,224
That's where it comes from, uh,
to ward off malaria.
327
00:21:09,851 --> 00:21:12,187
I mean,
malaria is very, very hard to eradicate.
328
00:21:12,271 --> 00:21:14,564
There have been many failed attempts.
329
00:21:17,401 --> 00:21:20,112
For a long time,
we've talked about infectious diseases
330
00:21:20,195 --> 00:21:22,239
in terms of, "Can we eradicate them?"
331
00:21:22,739 --> 00:21:25,534
We've eradicated one, smallpox.
332
00:21:26,201 --> 00:21:29,579
We came close with polio,
but we haven't quite gotten there,
333
00:21:30,080 --> 00:21:34,626
but with malaria,
it's a different kind of conversation.
334
00:21:43,468 --> 00:21:45,405
- How are you?
- Tony. How are you?
335
00:21:45,429 --> 00:21:47,657
- Good to see you. Welcome.
- Thanks for having me.
336
00:21:47,681 --> 00:21:49,099
Oh, it's a pleasure. Come on in.
337
00:21:50,392 --> 00:21:53,103
I think
it's a very important proof of concept
338
00:21:53,186 --> 00:21:55,856
that's going on now
in the antibody studies
339
00:21:55,939 --> 00:21:58,233
that are being done
in Kenya and elsewhere,
340
00:21:58,317 --> 00:22:05,032
{\an8}but I'm concerned that we lose attention
before we get to the endgame.
341
00:22:05,115 --> 00:22:09,953
I think elimination in different regions,
different countries,
342
00:22:10,037 --> 00:22:13,790
is entirely feasible with malaria.
343
00:22:14,499 --> 00:22:20,422
Eradication in the classic sense
is gonna be very, very difficult
344
00:22:20,505 --> 00:22:25,177
because of the prevalence of mosquitoes,
the climate, the need for control.
345
00:22:25,260 --> 00:22:28,347
So, I'm really high on hope
with the science.
346
00:22:28,430 --> 00:22:31,099
Eventually,
our tools will get so good that,
347
00:22:31,183 --> 00:22:34,436
you know, we'll be ambitious
to take some geography
348
00:22:34,519 --> 00:22:38,065
and try to have
the intervention be so extreme
349
00:22:38,148 --> 00:22:41,401
that we completely clear
the parasite out of that area.
350
00:22:41,485 --> 00:22:43,320
There are multiple steps and approaches.
351
00:22:43,403 --> 00:22:46,156
Mosquito approach,
treatment approach, prevention approach.
352
00:22:46,740 --> 00:22:48,575
What does the public health need,
353
00:22:48,658 --> 00:22:51,203
and what is the scientific opportunity?
354
00:22:51,286 --> 00:22:55,248
And you either pursue
the existing scientific opportunities,
355
00:22:55,332 --> 00:22:59,086
or you create scientific opportunities.
356
00:23:01,588 --> 00:23:03,382
To combat the mosquito menace,
357
00:23:03,965 --> 00:23:07,719
scientists continually study
the mosquitoes that carry diseases.
358
00:23:08,220 --> 00:23:11,223
They seek new ways
to control and destroy them.
359
00:23:12,724 --> 00:23:16,103
To get to zero,
you have to give people medicine,
360
00:23:16,186 --> 00:23:19,815
but you also
have to go after mosquitoes as well.
361
00:23:21,024 --> 00:23:23,860
{\an8}I think one of the difficulties we have is
362
00:23:23,944 --> 00:23:27,697
{\an8}that we... we have a disease
that's preventable and treatable.
363
00:23:27,781 --> 00:23:31,701
I started my career
by looking at a cage of mosquitoes
364
00:23:31,785 --> 00:23:36,206
and suddenly realizing
if you kill these mosquitoes,
365
00:23:36,289 --> 00:23:39,334
you can stop everything else
that happens afterwards.
366
00:23:42,671 --> 00:23:47,467
Historically, DDT is
the most famous anti-mosquito tool.
367
00:23:48,343 --> 00:23:50,262
It had negative effects,
368
00:23:50,345 --> 00:23:54,391
and the environmental movement said
we should move away from that.
369
00:23:54,474 --> 00:23:57,185
Now there's this idea we call gene drive,
370
00:23:57,269 --> 00:24:00,147
which is using the genetics of mosquitoes
371
00:24:00,230 --> 00:24:03,775
so that they... they can't grow
their population.
372
00:24:03,859 --> 00:24:06,278
That's the most exciting thing we have.
373
00:24:12,409 --> 00:24:16,955
{\an8}I got into this because when I was a kid,
I was always interested in living things,
374
00:24:17,038 --> 00:24:20,083
{\an8}and my parents took me to the Galápagos,
and that got me reading Darwin.
375
00:24:23,253 --> 00:24:24,796
I was just fascinated by
376
00:24:24,880 --> 00:24:29,134
how this incredibly intricate
tapestry of life had been woven,
377
00:24:29,217 --> 00:24:31,720
and I thought,
"I want to learn to do that."
378
00:24:31,803 --> 00:24:34,890
"I want to learn to shape species."
379
00:24:36,850 --> 00:24:40,395
If you could invent a technology
that would eradicate malaria forever,
380
00:24:40,479 --> 00:24:41,479
would you do it?
381
00:24:42,189 --> 00:24:44,524
So, the answer must involve CRISPR.
382
00:24:45,692 --> 00:24:48,862
CRISPR genome editing technology,
which is basically genomic scissors
383
00:24:48,945 --> 00:24:52,073
that allows us to cut
at one particular sequence in a genome
384
00:24:52,157 --> 00:24:57,329
and provide a DNA sequence
to be inserted at that site that gets cut.
385
00:24:57,412 --> 00:25:00,123
It could be used
to build what's called a gene drive
386
00:25:00,207 --> 00:25:04,377
that can allow us to spread
an alteration from one organism
387
00:25:04,461 --> 00:25:07,005
out into entire populations in the wild.
388
00:25:08,757 --> 00:25:10,467
In the full-power version
of this,
389
00:25:10,550 --> 00:25:12,230
what we call
a self-propagating gene drive,
390
00:25:12,302 --> 00:25:15,889
has no limit to this
beyond the species boundaries.
391
00:25:15,972 --> 00:25:18,725
That is,
if there is gene flow within a population,
392
00:25:18,808 --> 00:25:21,311
it will spread
to affect the entire population.
393
00:25:23,104 --> 00:25:26,900
If you have CRISPR,
the ability to change genes,
394
00:25:27,400 --> 00:25:31,488
and you have gene drive
which passes on heredity,
395
00:25:32,113 --> 00:25:37,244
we could actually rewrite genes
in such a way to decide what to pass on,
396
00:25:37,953 --> 00:25:39,579
and you can make 'em all male,
397
00:25:39,663 --> 00:25:42,707
and that way
you can't have them mate with anyone.
398
00:25:42,791 --> 00:25:44,292
So, if you make them all male,
399
00:25:45,168 --> 00:25:47,170
that's the end of that species,
400
00:25:47,254 --> 00:25:50,465
and it's the end
of that disease in theory.
401
00:25:51,841 --> 00:25:54,487
People are like, "Well,
could it get out of the mosquitoes?"
402
00:25:54,511 --> 00:26:00,183
"Could it cross to pollinating insects
that, you know, give us fruit?"
403
00:26:00,267 --> 00:26:03,478
There are legitimate questions
about such a powerful technique.
404
00:26:07,274 --> 00:26:09,651
Mosquitoes absolutely
have benefits to society.
405
00:26:09,734 --> 00:26:11,861
They're part of natural ecosystems.
406
00:26:12,612 --> 00:26:14,489
Other animals feed on them.
407
00:26:14,573 --> 00:26:16,908
Trout, salmon, top-water feeders.
408
00:26:16,992 --> 00:26:18,493
Birds eat them.
409
00:26:18,577 --> 00:26:19,578
Bats eat them.
410
00:26:20,203 --> 00:26:25,333
Certain orchids would probably go extinct
if those mosquito species went extinct.
411
00:26:25,417 --> 00:26:30,630
So, mosquitoes are a valuable part
of any natural ecosystem.
412
00:26:31,840 --> 00:26:34,551
When you remove one species
from an ecosystem,
413
00:26:34,634 --> 00:26:36,803
you can have
what's called a trophic cascade
414
00:26:36,886 --> 00:26:39,431
of unintended consequences
to other ecosystems.
415
00:26:39,514 --> 00:26:42,267
So, for example,
when the woolly mammoth went extinct,
416
00:26:42,350 --> 00:26:45,770
so too did the hapless ticks
that fed on the woolly mammoth.
417
00:26:48,773 --> 00:26:51,818
There's over a thousand species
of mosquitoes just in Africa.
418
00:26:51,901 --> 00:26:54,446
There's just so many species
that removing a few,
419
00:26:54,529 --> 00:26:57,324
the ones that spread malaria,
which is vanishingly few,
420
00:26:57,407 --> 00:27:01,036
the odds of anything ecologically
going wrong is very, very small.
421
00:27:01,703 --> 00:27:04,039
Not zero, but very, very small.
422
00:27:12,631 --> 00:27:14,883
Research is kind of
a long process.
423
00:27:15,425 --> 00:27:18,845
We want something right now,
but if you want to do research,
424
00:27:18,928 --> 00:27:23,058
like, you know, the specific technology
that we are developing, it takes time.
425
00:27:25,935 --> 00:27:28,521
And I'm part of
the project Target Malaria.
426
00:27:28,605 --> 00:27:33,443
We are using advanced genetic tools
to get rid of malaria in the future.
427
00:27:34,694 --> 00:27:37,739
We don't have
the gene drive mosquitoes in Africa yet
428
00:27:37,822 --> 00:27:38,822
for many reasons.
429
00:27:38,865 --> 00:27:41,409
There are so many
other elements around it,
430
00:27:41,493 --> 00:27:44,204
and all these different pieces need,
you know, to fall in place
431
00:27:44,287 --> 00:27:47,040
just to make sure
that you have something really very solid
432
00:27:47,123 --> 00:27:49,042
and very safe for the community.
433
00:27:51,002 --> 00:27:52,671
You know, malaria is rural,
434
00:27:53,213 --> 00:27:55,382
{\an8}and it's happening
during the rainy season.
435
00:27:56,091 --> 00:27:58,843
Taking mosquitoes, you know,
to spread the gene for you,
436
00:27:58,927 --> 00:28:01,388
and even in a really very difficult area,
437
00:28:02,013 --> 00:28:04,493
if you cannot get access,
the mosquito will do the job for you.
438
00:28:05,475 --> 00:28:08,812
So, we really feel
that this is a very transformative tool,
439
00:28:08,895 --> 00:28:11,940
but, you know, to release mosquitoes
in the field is really very easy.
440
00:28:12,023 --> 00:28:14,025
It's going to take me
just only 30 minutes,
441
00:28:14,109 --> 00:28:16,403
but we took seven years to get there.
442
00:28:16,486 --> 00:28:19,072
If you start right away with
the gene drive, then it's spreading,
443
00:28:19,155 --> 00:28:21,759
then you have all these different aspects
that you did not look at,
444
00:28:21,783 --> 00:28:23,263
then it's going to be very difficult.
445
00:28:23,326 --> 00:28:26,246
You need to work for the community
to get the social license.
446
00:28:26,329 --> 00:28:28,373
And this is not something
which is granted.
447
00:28:28,456 --> 00:28:30,875
You really need to build trust with them.
448
00:28:30,959 --> 00:28:34,421
I cannot just pop up in any single village
with a bucket of mosquitoes
449
00:28:35,046 --> 00:28:38,091
on the assumption that I'm a scientist
working for the good of the public.
450
00:28:38,174 --> 00:28:41,094
People really need to understand
what you're doing.
451
00:28:45,056 --> 00:28:46,683
Ah, good morning.
452
00:28:46,766 --> 00:28:47,892
How are you?
453
00:28:47,976 --> 00:28:49,227
Great. Thank you.
454
00:28:49,310 --> 00:28:50,145
Good morning.
455
00:28:50,228 --> 00:28:51,372
- How are you?
- I'm very fine.
456
00:28:51,396 --> 00:28:52,313
Great. Thank you.
457
00:28:52,397 --> 00:28:54,941
We're very delighted
to welcome you this morning.
458
00:28:55,024 --> 00:28:57,986
As you can see, this is our insectary.
459
00:28:58,069 --> 00:28:59,320
All the mosquitos are here.
460
00:29:01,781 --> 00:29:05,201
We know there are
a number of concerns that are out there,
461
00:29:06,035 --> 00:29:07,829
so sometimes it's really very good
462
00:29:07,912 --> 00:29:09,998
if you can take the leaders
of the community
463
00:29:10,081 --> 00:29:12,876
into the insectary
and then you show them the mosquitoes,
464
00:29:12,959 --> 00:29:14,753
how you do the transformation,
465
00:29:15,253 --> 00:29:18,673
and allow them, you know,
to ask all kinds of questions.
466
00:29:18,757 --> 00:29:23,052
As you can see,
the whole building is painted in white.
467
00:29:23,136 --> 00:29:27,557
This makes it easier to see
when something sits on the wall.
468
00:29:28,224 --> 00:29:35,224
With the fans,
if you stand here, you'll feel the wind.
469
00:29:35,315 --> 00:29:39,444
Everything is done in such a way
to keep the mosquitos inside.
470
00:29:39,527 --> 00:29:45,825
All the mosquitos on this line
have been genetically modified.
471
00:29:45,909 --> 00:29:48,578
Here's the paraffin,
which is like human skin.
472
00:29:48,661 --> 00:29:51,539
You also have the source of the heat
that you put on it.
473
00:29:51,623 --> 00:29:56,002
It makes the paraffin warm,
and the mosquitos can feel it right away.
474
00:29:56,503 --> 00:29:59,923
When they feel it,
they come and start sucking.
475
00:30:00,965 --> 00:30:03,176
I learned a lot today
in the insectary.
476
00:30:03,259 --> 00:30:07,514
I was amazed
at how a mosquito could be modified.
477
00:30:08,139 --> 00:30:10,809
{\an8}The mosquito is so small,
478
00:30:10,892 --> 00:30:13,394
{\an8}and to say that it can be modified,
479
00:30:13,478 --> 00:30:15,021
{\an8}well, it's astonishing.
480
00:30:15,104 --> 00:30:18,107
That's what we call DNA.
481
00:30:19,400 --> 00:30:22,570
When the modification is integrated
into the mosquito's genome,
482
00:30:22,654 --> 00:30:25,073
you will see that it has red eyes.
483
00:30:25,740 --> 00:30:30,119
{\an8}So, mosquitos that aren't modified
don't have red eyes?
484
00:30:30,203 --> 00:30:32,413
{\an8}No, they don't have red eyes.
485
00:30:35,667 --> 00:30:39,254
It's hard to change
the genetics of a species
486
00:30:39,337 --> 00:30:43,591
and know for sure
what the ultimate implications are.
487
00:30:44,217 --> 00:30:50,932
We can edit a certain receptor on one cell
that will prevent people from getting HIV.
488
00:30:51,015 --> 00:30:54,352
It would increase their chance
of getting West Nile disease.
489
00:30:54,936 --> 00:30:58,356
Most people today would say,
"That's an easy choice,"
490
00:30:58,439 --> 00:31:01,442
but is it gonna be an easy choice
in 10,000 years?
491
00:31:01,526 --> 00:31:04,904
It might turn out that West Nile disease
will wipe out humanity.
492
00:31:05,488 --> 00:31:08,658
It's very difficult to see down the field.
493
00:31:12,120 --> 00:31:14,038
You know, we'll get people who say
494
00:31:14,122 --> 00:31:16,958
even the benefit
of reducing those malaria deaths,
495
00:31:17,834 --> 00:31:20,461
you know, doesn't justify
opening Pandora's Box.
496
00:31:20,545 --> 00:31:23,131
I completely disagree with that.
497
00:31:23,214 --> 00:31:26,676
If you just got a few species in Africa,
498
00:31:26,759 --> 00:31:30,430
you'd get, you know,
80% of the disease burden.
499
00:31:30,513 --> 00:31:35,894
Um, it's not on the list
of, you know, Dr. Evil's toolbox,
500
00:31:35,977 --> 00:31:37,478
Uh...
501
00:31:37,562 --> 00:31:40,064
...and sadly,
that list is not an empty list.
502
00:31:40,148 --> 00:31:43,234
- But, uh, this is not... this is not on it.
- No, no.
503
00:31:44,986 --> 00:31:47,030
{\an8}Very often
people will come to you and say
504
00:31:47,113 --> 00:31:50,491
{\an8}that if you remove the mosquitoes,
then what is going to happen?
505
00:31:51,367 --> 00:31:55,121
{\an8}But my question is
that we have 600,000 deaths every year.
506
00:31:55,204 --> 00:31:57,040
{\an8}Something bad is already happening.
507
00:31:57,874 --> 00:32:00,001
{\an8}So you absolutely need
to do something about it.
508
00:32:03,838 --> 00:32:08,092
It's still hard
to come in from another place
509
00:32:08,176 --> 00:32:11,137
and tell a country
we want to use your people,
510
00:32:11,220 --> 00:32:17,018
and that you might benefit greatly,
but we're not sure, and in the end,
511
00:32:17,101 --> 00:32:20,313
we'll decide what to do with
this technology when we're done with it.
512
00:32:20,813 --> 00:32:26,194
The whole history of colonialism
is white people going into Africa
513
00:32:26,277 --> 00:32:30,323
to use human beings
like they're minerals or something.
514
00:32:32,700 --> 00:32:38,790
The population
really wants the success of this project
515
00:32:38,873 --> 00:32:44,170
{\an8}because we have seen
grave cases of malaria,
516
00:32:44,253 --> 00:32:48,341
{\an8}and the people are desperate
517
00:32:48,424 --> 00:32:51,803
{\an8}for an adequate solution.
518
00:32:53,805 --> 00:32:56,349
If it's your environment, it's your call,
519
00:32:56,432 --> 00:32:59,560
and I don't live in Africa,
and my kids are not at risk of malaria,
520
00:32:59,644 --> 00:33:02,480
but if my kids were at risk
and did live there,
521
00:33:03,064 --> 00:33:04,524
I would say, "Do it now."
522
00:33:04,607 --> 00:33:09,612
Self-propagating, go straight ahead,
no more ecological local field trials.
523
00:33:09,696 --> 00:33:12,323
If my kids were at risk,
I would just say, "Do it."
524
00:33:12,407 --> 00:33:14,158
Don't keep messing around.
525
00:33:15,660 --> 00:33:20,707
This is a good example
of why we in the developed world
526
00:33:20,790 --> 00:33:25,003
need to pay attention globally
to global diseases.
527
00:33:25,086 --> 00:33:26,671
I think there are two reasons.
528
00:33:26,754 --> 00:33:30,800
One, I actually think we have
a moral responsibility as a rich country
529
00:33:30,883 --> 00:33:35,680
to not have people unduly suffer
from preventable and treatable diseases
530
00:33:35,763 --> 00:33:38,516
just because
of where they happen to be born,
531
00:33:38,599 --> 00:33:41,185
but there's an enlightened self-interest
532
00:33:41,269 --> 00:33:43,980
when you're dealing
with infectious diseases.
533
00:33:44,063 --> 00:33:46,733
They can creep into other regions.
534
00:33:52,030 --> 00:33:54,365
The CDC is out
with a new health warning
535
00:33:54,449 --> 00:33:57,577
after confirming five cases of malaria
in the US.
536
00:33:57,660 --> 00:33:59,346
Breaking news is out of Maryland tonight...
537
00:33:59,370 --> 00:34:02,415
First malaria infection
in more than four decades.
538
00:34:03,708 --> 00:34:05,918
Malaria
is intensely unforgiving.
539
00:34:06,002 --> 00:34:08,129
And if we look in the face
of climate change,
540
00:34:08,212 --> 00:34:10,590
we're likely to see
more and more things go wrong.
541
00:34:10,673 --> 00:34:14,093
We don't want the world to be in a place
where anytime something goes wrong,
542
00:34:14,177 --> 00:34:17,430
tens to hundreds of thousands
of people die, avoidably, from malaria.
543
00:34:19,599 --> 00:34:22,602
We have
a susceptible environment in the US,
544
00:34:22,685 --> 00:34:25,980
especially in parts of the South
where the climate is warm
545
00:34:26,064 --> 00:34:28,608
and... and you find the Anopheles mosquito.
546
00:34:28,691 --> 00:34:32,361
The potential for local transmission
is really worrisome.
547
00:34:46,417 --> 00:34:48,604
- Good evening.
- Good evening.
548
00:34:48,628 --> 00:34:50,188
- How is family?
- Good.
549
00:34:50,213 --> 00:34:52,024
- Are you all doing well?
- Yes.
550
00:34:52,048 --> 00:34:54,550
Since this morning,
do you know what happened?
551
00:34:54,634 --> 00:34:55,635
{\an8}What?
552
00:34:55,718 --> 00:35:00,681
I visited the laboratory to see
how the malaria work has been going.
553
00:35:01,390 --> 00:35:07,855
{\an8}So, how does someone recognize
a modified mosquito?
554
00:35:07,939 --> 00:35:11,567
When you look at them,
the modified mosquitos have red eyes.
555
00:35:11,651 --> 00:35:12,902
Oh.
556
00:35:24,455 --> 00:35:25,873
Mama, Ian, how are you?
557
00:35:25,957 --> 00:35:27,250
I am okay.
558
00:35:28,126 --> 00:35:31,045
Ian, say hello to the doctor!
559
00:35:32,630 --> 00:35:33,923
Okay.
560
00:35:34,423 --> 00:35:37,009
Uh, in the last, uh, one month,
561
00:35:37,760 --> 00:35:41,514
from the time you came to the clinic,
there's no problem with the child?
562
00:35:41,597 --> 00:35:43,266
- He is good.
- Okay.
563
00:35:43,349 --> 00:35:47,603
So, anything that you'd want to report
about the child generally?
564
00:35:47,687 --> 00:35:49,313
This is now six months.
565
00:35:50,106 --> 00:35:53,985
Eh, home visits, clinic,
home visit and clinic.
566
00:35:56,654 --> 00:36:00,658
I'm so privileged
to be a part of this study
567
00:36:01,742 --> 00:36:04,120
because the boy, he has been good.
568
00:36:04,203 --> 00:36:07,540
He has not tested
for malaria for six months.
569
00:36:08,708 --> 00:36:10,334
Before, I was afraid
570
00:36:10,418 --> 00:36:13,629
because I was one of the victims
of malaria.
571
00:36:14,589 --> 00:36:17,967
And although it has not been proven
that it will work,
572
00:36:18,050 --> 00:36:21,220
but we are hoping, in a few years coming.
573
00:36:21,304 --> 00:36:24,557
And I am praying,
and it's my humble prayer
574
00:36:24,640 --> 00:36:25,975
{\an8}that this antibody...
575
00:36:27,351 --> 00:36:28,791
...will be going to work.
576
00:36:29,979 --> 00:36:31,439
So I'm not afraid.
577
00:36:35,401 --> 00:36:41,032
Are the redesigned mosquitos
going to stay with them
578
00:36:41,115 --> 00:36:43,701
inside the laboratory?
579
00:36:43,784 --> 00:36:46,787
You don't need to be afraid
of the modified mosquitos.
580
00:36:47,371 --> 00:36:52,752
The aim of this work is
to eradicate female mosquitos
581
00:36:52,835 --> 00:36:55,379
in order to combat malaria.
582
00:36:55,463 --> 00:36:59,759
It scares us because we often hear that
white people have done this, done that,
583
00:36:59,842 --> 00:37:01,219
and added things to our illnesses.
584
00:37:02,011 --> 00:37:04,805
If you go to the lab,
585
00:37:04,889 --> 00:37:08,684
the truth is that it's breathtaking,
586
00:37:08,768 --> 00:37:12,855
and the people there work hard,
and the work is going really well.
587
00:37:16,484 --> 00:37:19,862
It's really important to remember
that malaria is a disease of poverty,
588
00:37:19,946 --> 00:37:21,572
and when children are sick,
589
00:37:21,656 --> 00:37:23,908
they can't go to school,
so they can't learn,
590
00:37:23,991 --> 00:37:26,786
and when they can't learn,
they can't, uh, get a job
591
00:37:26,869 --> 00:37:29,956
and... and earn a proper living
for themselves.
592
00:37:30,039 --> 00:37:32,875
Parents have to look after them.
They can't earn a living.
593
00:37:32,959 --> 00:37:35,586
They have to spend money
on malaria treatments,
594
00:37:35,670 --> 00:37:38,130
and their health expenditure goes up,
595
00:37:38,214 --> 00:37:40,174
and getting out of that cycle
596
00:37:40,258 --> 00:37:43,302
is absolutely key
to help get out of the cycle of poverty.
597
00:37:45,721 --> 00:37:50,101
As long as malaria will be killing people
here in Africa a lot
598
00:37:50,977 --> 00:37:53,229
and completely destroying our economy,
599
00:37:54,272 --> 00:37:56,274
we will struggle, you know, to develop.
600
00:37:56,357 --> 00:37:57,984
This is where my roots are.
601
00:37:58,067 --> 00:38:00,069
I was born here, raised here.
602
00:38:00,152 --> 00:38:01,529
All my family is here.
603
00:38:01,612 --> 00:38:03,781
Nobody's going to build my country for me.
604
00:38:05,783 --> 00:38:06,867
I have to do it.
605
00:38:07,910 --> 00:38:09,036
We have to do it.
606
00:38:10,371 --> 00:38:11,205
Bye.
607
00:38:11,289 --> 00:38:12,707
- Bye.
- Bye.
608
00:38:18,629 --> 00:38:19,797
My hope
609
00:38:20,840 --> 00:38:25,177
is that we will be able, you know,
to eradicate malaria in my lifetime.
610
00:38:25,261 --> 00:38:30,016
I want to eradicate it in my lifetime,
which is a tougher constraint, so...
611
00:38:30,516 --> 00:38:33,311
You're gonna be in good shape.
Just stay healthy.
612
00:38:52,913 --> 00:38:55,333
Well, you always have something
before you feed the thing
613
00:38:55,416 --> 00:38:58,669
where you... you figure out
what to put into the prompt buffer,
614
00:38:58,753 --> 00:39:01,630
but the, you know, math expert...
615
00:39:01,714 --> 00:39:04,175
Bill Gates is exactly where
he... he should be.
616
00:39:04,258 --> 00:39:05,843
...expert. What are called plug-ins...
617
00:39:05,926 --> 00:39:09,221
The idea that you have a mind like that
trying to crack the code,
618
00:39:10,765 --> 00:39:12,767
you know, working every which way.
619
00:39:14,393 --> 00:39:15,936
This is a very good thing.
620
00:39:16,020 --> 00:39:19,940
By creating, you know,
let's call it a system's architecture...
621
00:39:20,024 --> 00:39:22,064
If he didn't exist,
we'd have to make him up,
622
00:39:22,109 --> 00:39:25,863
but if we did, no one would believe
the character, you know?
623
00:39:26,822 --> 00:39:30,242
I... I just think this is a man
who wants to be useful.
624
00:39:31,243 --> 00:39:32,745
It's sort of beautiful.
625
00:39:32,828 --> 00:39:34,622
It's about outcomes.
626
00:39:35,873 --> 00:39:39,960
But even the men with the deepest pockets,
627
00:39:40,711 --> 00:39:42,755
they can't fix a lot of these problems.
628
00:39:42,838 --> 00:39:44,006
They're too big.
629
00:39:44,090 --> 00:39:47,760
We need government buy-in,
and this is where advocacy comes in.
630
00:39:47,843 --> 00:39:51,430
This is where storytelling comes in
and storytellers.
631
00:39:51,514 --> 00:39:55,684
Left and right brain talking,
that's where we need to be.
632
00:40:08,572 --> 00:40:12,034
The world is facing
a lot of big challenges right now,
633
00:40:12,952 --> 00:40:14,578
but I believe we can solve them.
634
00:40:15,079 --> 00:40:18,624
♪ If today was not a crooked highway... ♪
635
00:40:19,959 --> 00:40:21,877
Overall,
the world's improved a lot,
636
00:40:21,961 --> 00:40:25,756
and, you know,
I enjoy being a small part of that.
637
00:40:26,632 --> 00:40:28,551
♪ If tomorrow was... ♪
638
00:40:28,634 --> 00:40:32,054
There are challenges
of political polarization,
639
00:40:32,138 --> 00:40:36,308
and limited resources,
and avoiding a climate disaster,
640
00:40:37,268 --> 00:40:41,605
and we have to drive the innovation
in order to get ahead of those challenges.
641
00:40:43,274 --> 00:40:44,108
♪ If I could hear... ♪
642
00:40:44,191 --> 00:40:45,526
We'll get it, you know.
643
00:40:45,609 --> 00:40:49,530
Will it be 15 years
or 20 years or 30 years?
644
00:40:49,613 --> 00:40:53,409
That depends on great work
and making it a priority.
645
00:40:54,368 --> 00:40:55,536
♪ Then I'd lie ♪
646
00:40:56,871 --> 00:41:00,416
♪ In my bed once again ♪
647
00:41:04,003 --> 00:41:08,174
♪ I can't see my reflection in the water ♪
648
00:41:10,426 --> 00:41:13,971
♪ I can't speak the sounds
To show no pain ♪
649
00:41:15,389 --> 00:41:19,268
♪ I can't hear the echo of my footsteps ♪
650
00:41:20,561 --> 00:41:24,023
♪ Or remember the sounds of my own name ♪
651
00:41:26,692 --> 00:41:30,362
♪ Yes, and only
If my own true love was waiting... ♪
56125
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