Transcriber: AHMED ALSHWAIREKH Reviewer: Jeong-Lan Kinser
Imagine this, imagine you are living
in a small rural village in the middle of nowhere.
There is no running water,
no electricity, no paved road.
The one dirt road is rutted,
and washed up part of the year,
and it is about a two hour walk to the nearest bus stop.
Now, there is a health clinic in your village,
you are very lucky,
but the nursing assistant who works there is often out serving other communities
in the surrounding area.
And you, have a sick baby with a high fever.
The nearest pharmacy is 20 km away.
Now, you might be able to get a warm coke
for all the good it will do you,
but can you get medicine?
So Malaria is a major killer around the world,
especially in Africa.
In 2010, 660,000 people were estimated
to have died from Malaria, 90% of them in Africa,
most of them, children under the age of five.
Now Malaria does not have a vaccine yet,
but there are effective treatments, if you can get to them.
Measles, well, there is a vaccine for that,
and over the last few decades, we have seen measles rates come down 74%,
but it still claims 450 lives every day,
most of them children under five.
Smallpox.
One time a major scourge, it has been eradicated
thanks to global immunization efforts.
And we can do that with other diseases
if we can get the vaccines and medicines to the people who need them.
So, how do we do that?
Well, Bill Gates said in a recent interview with the Washington Post -
and by the way,
Bill Gates, we all know, is probably one of the most successful businessmen
that a capitalist society has ever produced, right?
So he said this, and I'm going to quote him correctly:
"Capitalism did not eradicate smallpox,
it doesn't know how.
Polio eradication is a work in progress,
but it is not being done by markets.
It is being done by through foreign assistants, through aid".
Now on the other hand, Melinda Gates and others
have asked very pertinent questions about the seeming ubiquity
of Coca Cola and their products around the world.
In the farthest flung places around the world.
And she said this at a 2010 TEDTalk.
Again I want to quote her correctly:
"We're trying to deliver condoms to people or vaccinations.
How is it that they can get Coke to these far flung places?
If they can do that, why can't governments and NGOs do the same thing?
With vaccines and medicines to treat HIV, Malaria, TB?"
Well, I offered two reasons why that is difficult:
Money and logistics.
The Coca Cola supply chain is profit driven, all right?
It is the commercial model, every step along the supply chain,
from the raw materials to the manufacturing to the bottlers,
to the distributors, to the retail outlet,
somebody makes a profit, every time a bottle or a case exchanges hands,
somebody makes money.
Now, there's a crucial fact here though that the last mile or in a lot of places
the far flung places, the last 20 km, that’s the hardest part
in many places.
It is the most risky part.
It is the most expensive part,
and it is the part that Coca Cola is not paying for.
Because what happens is this shopkeeper gets on his bike, pedals in 20 km
down the rutted washed out road to the town that has a distribution point,
loads up a couple of cases on his bike,
pays for it then and there,
turns around and pedals back to his village,
and if he takes a tumble on that journey,
and shatters his inventory, the loss is his alone.
Now, with supply chains for medicines,
there is a lot of similarities in the last mile.
It is still tough.
It is still rough.
And it's still often 20, 30, or 50 km away.
Now, a lot of places like Mwanawina,
in Western Zambia, a small rural village,
they have to use oxcarts during the rainy season
because their road is washed up.
All right, and there are some key differences
with the soda supply chain.
First of all, nobody in that village is paying for vaccines.
They're free because we want to encourage families to vaccinate their children.
And because those villages are very impoverished.
There is no a whole lot of loose money hanging around,
and we don't want poverty to be a barrier to health.
Now, of course it is, but we try to remove as many of those as possible.
The same thing is true with many medicines to treat HIV,
to treat TB, to treat malaria.
We want to interrupt the infection cycle.
So nobody is paying for that, but there are some other key differences.
Everybody loves a cold Coke, right?
You don't want to drink a warm cold Coke,
but you could and it would still quench your thirst.
Vaccines and few other medicines have to be cold.
Otherwise, they lose their efficacy and potency.
They must be cold, even when there is no electricity.
They must be administered by a trained healthcare provider.
You don't need that for Coke, right?
So there is a lot of differences between these two supply chains.
And nobody in that village is earning a profit.
There is no short term return on investment,
in that supply chain.
Public health supply chains are mission driven.
The only profit is very long term.
It is in the health and well-being of those people.
That is not a model that Wall Street deals with very well.
But I will say that we are learning a lot
Things are getting better.
We are seeing real improvements
on the availability of medicines and vaccines,
and therefore real reductions
in preventable deaths
from vaccines preventable diseases,
from TB, from Malaria from HIV.
We are seeing real progress.
And here is just a small bit of evidence in this.
In one African country we took a look at,
and we compared the availability
of four different presentations, different dosage types
of the most effective Malaria treatment
with the availability of three types of soda
provided by a certain soda manufacturer.
We looked at 200 clinics, the availability of the medicines,
and the surrounding shops, the availability of the sodas,
and guess what we have found?
A higher percentage of clinics had at least one dosage type
of that Malaria medicine available
than the surrounding clinics had at least one type of soda from that manufacturer,
so we are seeing real progress.
But, it is not cheap.
So who pays for this?
If the villagers aren't able to pay either the whole price
or part of the price, then who pays?
Who pays to get these vaccines and medicines to those villagers?
Well, we do.
American taxpayers are major funders of these sorts of programs
of procurement and distribution
of vaccines and medicines to treat many different diseases.
Also contraceptives for family planning programs.
And by the way taxpayers
in Great Britain, Germany, France, Australia, New Zealand, Norway,
you name it
are also contributing to this effort.
So are taxpayers in Zambia and many other developed countries.
But it is not enough money, it never is,
because the need is very, very large.
And so I want to offer a couple little thoughts here about this.
The American taxpayers, we do contribute a lot
but we actually are only spending one third of 1%
of the federal budget.
One third of 1% of the federal budget on all global health programs
of which commodities, medicines are only a fraction.
In fact, total spending on foreign affairs,
diplomacy foreign assistance, the UN, all that sort of stuff
represents just 1% of the federal budget.
That's about 28 billion dollars.
Not chicken feed, but to put that in perspective,
we, American consumers spend about that much
every year on vitamins.
Why we are spending billions of dollars like this,
even though it is not enough?
We are still spending significant amounts. Why?
Well, here is one reason.
This is Joseph, a before and after picture.
He's HIV positive and thanks to us
he has access to antiretroviral therapy to treat his HIV and keep him healthy.
He and millions people like him
are now healthy members of their community,
able to support their families,
contribute to the stability of their communities.
Now that's the feel good reason.
There are also people who would say,
"Look, that's all fine and dandy, but we've got problems here in America.
Let's focus on that and the rest of the world can get along without us."
Well, for them I offer a second reason.
This is a map of daily airline traffic around the world.
In 48 hours, you can get from Mwanawina
or pretty much anywhere else in the world to right here.
Infectious diseases know no boundaries.
They don't respect borders.
And what happens in these far flung places can affect us,
can infect us here in the United States.
It happens all the time.
So, next time you hear somebody complaining about wasting taxpayer money,
on foreign assistance, take a moment and reflect what you are investing in.
Next time you are filing your taxes, that's coming up,
think about where a little bit of that money is going to.
Next time you buy a Coke or a Pepsi
or fill up a prescription, consider how fortunate we are,
because we at large, are all connected one way or another.
And what happens in Mwanawina does not stay in Mwanawina.
Thank you. (Applause)