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Larry Brilliant has had a career that lives up to his name. In the 1970s, he played a key role in work in Bangladesh and India to eradicate smallpox, personally witnessing the end of “an unbroken chain of transmission that went back to Pharaoh Ramses.” He then co-founded the Seva Foundation, which helps prevent and treat blindness in the developing world. He was the first director of tech philanthropy Google.org, and today he chairs the Skoll Global Threats Fund, tackling issues such as climate change and water security that, like smallpox before them, pose an existential danger to enormous swaths of humanity.
In his new memoir, Sometimes Brilliant, the physician and philanthropist details that remarkable journey, from his youth in Detroit and early medical career, through immersion in the ‘60s counterculture and Eastern philosophy, to his work today with tech moguls like eBay co-founder Jeff Skoll to achieve social change on a truly massive scale. In this edition of the Business of Giving, Dr. Brilliant walks us through some of his adventures as a civil-rights marcher, radical hippie doctor, meditating mystic, and groundbreaker in global health and Silicon Valley giving.
The following is a conversation between Dr. Larry Brilliant, author of Sometimes Brilliant, and Denver Frederick, host of The Business of Giving on AM 970 The Answer in New York City. This transcript has been lightly edited for clarity.
Denver: Back in July, Dr. Larry Brilliant joined us to discuss the launch of an HBO movie he had produced called Open Your Eyes, a compelling story of a husband and wife in Nepal whose sight is restored as result of the work of the Seva Foundation founded by Dr. Brilliant and his wife. Well, he’s been good enough to come back and join us again… this time to discuss his memoir that will be released on Tuesday and aptly entitled Sometimes Brilliant. Good evening, Larry, and welcome back to The Business of Giving.
Larry: Nice to see you again, Denver. Thank you.
Denver: You have had a most remarkable life, so much so, it’s hard to know where to begin. But I think I’ll start with you sitting in Hill Auditorium at the University of Michigan campus on November 5, 1962… listening to a speech. Tell us about that day and the impact that it had on you.
Larry: I think everybody who’s gone to college remembers the sophomore year. It’s a tough year, anyway. And for me, it was tougher because my dad was dying of cancer. As it would turn out, my dad and my grandfather both died inside of five days.
So, it was a tough time, and I had no inner resources to deal with that. I sort of locked myself up in my room in South Quad in Ann Arbor, and I think I was gobbling down burnt peanuts and reading Superman. That was my high and exalted way of dealing with depression. And I saw a little note in the college newspaper “The Michigan Daily” that said Martin Luther King was going to be on campus. Nobody really knew who Martin Luther King was. He hadn’t yet given his speech “I Have a Dream.” He didn’t yet have his Nobel Prize. The world outside was filled with the Cuban missile standoff. Bob Dylan was singing “A Hard Rain’s A-Gonna Fall.”
It was a pretty complicated moment. It was raining and miserable weather, but somehow I took my sophomore ass out of the dorm and wandered into the auditorium. And hardly anybody came. This huge auditorium that holds 3,000 people, it was hardly half-filled, or even less. The President was embarrassed, introduced Martin Luther King, and he looked out. Instead of feeling bad, he laughed. He just laughed. And he said, “You all come on up here and sit on the stage; there will be more of me to go around.” And not everybody went up on stage…it kind of crowded the stage, and we all listened to him. And it was not like anything I had ever heard before. I had never heard someone talk about brotherhood. I had never heard anyone say, “We are all God’s children. We’re all in it together.” I had never heard anybody say that there’s a great movement for justice. I had never heard anyone say that “the arc of the moral universe bends toward justice, but you and I have got to jump up and help bend it.” I had never heard anybody say, “Join me, and make the world a better place.” He said things that opened up a space for me — a depressed, wonky, kind of pimple-faced kid — something I could do. I could kind of crawl out of my depression, and it wouldn’t all just be about me and the pain that I felt. And, of course, everybody that was on stage with him that day… that was in the auditorium, just began to march. Most went down that summer to Mississippi. Many had encounters that would change their lives. I stayed home with my dad because he was sick, but shortly afterwards I was marching in Chicago.
Denver: Got arrested, right?
Larry: Well, when I went to medical school and had a white coat on, the Medical Committee for Human Rights said, “Come on down to Chicago. Martin Luther King is going to make his march to the city. We want people wearing white coats with their stethoscopes dangling ostentatiously to form a cordon to protect him.” I marched with Martin Luther King. We were all arrested together. And here’s a little secret: If you are ever going to be arrested — I tell my children — for a good cause, and there are some good causes, get arrested with 200, 300, 400, 500 of your best friends because then they put you in “pretend jail.” And you’re “pretend arrested.” And you can bring a guitar.
Denver: That’s great advice.
Larry: The cops were wonderful. This was not the kind of scene you think of when being arrested. They had to arrest us because we were blocking traffic. We had to go into Grant Park. They had to build a pretend jail, and Martin Luther King was there, and he just kept talking to us. I can’t remember the number of times I marched with him, but it certainly became the organizing principle of my life — the Civil Rights Movement, the movement against the war in Vietnam, and the movement itself. Because as it led into the ‘60s and the ‘70s, my generation, we thought we sensed that right around the corner was a better world… a world that had room for all of us, a room where black or white or male or female or tall or short or old or young… that we were all allowed into this great dream called America. And that was the magic that led to Haight Ashbury and the counterculture… and all rest of it.
Denver: And all the rest of it. Well, that day did have a profound influence on your life. As you noted, you became a doctor, I think, in part because your father had cancer. I know you had your own bout with it as well. So I’m going to move to the part of the book which really reads like fiction– not great fiction… because it’s almost too preposterous! We’re going to start in 1969 at the infamous Alcatraz prison in San Francisco Bay, and it’s going to end in Bhola Island in Bangladesh in 1977. Take us on that extraordinary journey.
Larry: I was in pretend jail in Chicago. It was a real jail in Alcatraz, but I wasn’t a prisoner. I was finishing up my internship at what was then called Presbyterian Hospital; now, it’s called Pacific Medical Center.The treaties that the Indians had with United States of America were breached more often than they were upheld. But there was one treaty called the Laramie Treaty that said that if any land– having been taken from Indians, any federal land having been taken from Indians– is declared surplus, it must first be returned or offered to be returned to the Indians from whom it was taken. It seemed like a fair deal.
Alcatraz was Indian land, and it was seized and turned into a prison, and then the prison was closed in the early ‘60’s. And when the prison was closed, a number of Indians invoked the Laramie Treaty and said, “Give it back!” And the government didn’t want to do that. So, one night, undercover, several dozen young Indians from many different tribes — the Mohawk Indian Richard Oakes was leading, and a Lakota Sioux Indian named John Trudell was later one of the leaders — they occupied Alcatraz before the name “occupy” had much meaning. And they took over, and they would stay on the island for 18 months. That became a big social drama. Every day in the newspapers and on TV shows in San Francisco, there would be interviews with the Coast Guard, who were ordered to put a ring around it and embargo and quarantine the island. And somehow there’d be an interview with Buffy Sainte-Marie, who would fly out there, or Joan Baez who would go out there; The Grateful Dead would do a concert on Alcatraz. And they did a scorecard, and they asked people in San Francisco Bay, “Who do you want to vote for?” They loved the Coast Guard… I mean, we do love the Coast Guard of San Francisco. But it was 90/10 for Indians over the Coast Guard.
This was the most popular occupation imaginable. But there was no water, no electricity, no medical care. And John Trudell’s wife was nine months pregnant. She wanted to give birth to a baby on Indian-held or reclaimed land, and the local columnist said, “Is there no doctor anywhere? Is there no doctor willing to go out there?“ Then, of course, that was made for me!
Denver: Yeah, absolutely! You were the guy!
Larry: So, I went out and I lived on Alcatraz, and the baby was born and given the name Wovoka, after a Paiute/Sioux Indian medicine man 200 years earlier who had prophesied that after his demise, he would return in 200 years, and it would be the beginning of the return of the Indian way. It was a magical night. A lot of bad things happened – a couple of Green Berets… Indians… who had taken some weird drugs started cutting themselves; there was bleeding. I had to sew people up, and in the end the Coast Guard had to medevac me and this one former Green Beret who was bleeding pretty badly. When our boat got to the shore… and I had finished sewing them up, an ambulance came and paramedics took him to the hospital. Then I looked up, and it seemed as if every television camera on the planet was there.
Denver: You became a media star.
Larry: And I was asked “What did the Indian want?” And, of course, I had never met an Indian until three weeks earlier.
Denver: Right. You’re their spokesman, all of a sudden.
Larry: Which, of course, no white kid from Detroit, Michigan could possibly carry that load. But Warner Brothers and some friends saw me on television. I got a phone call the next day asking if I wanted to join a movie caravan and play the role of a young doctor in a movie that Warner Brothers was making…kind of like a sequel to Woodstock… a bunch of hippies do rock and roll music. And they wanted a Rock Doc.
Denver: Medicine Ball Caravan.
Larry: Medicine Ball Caravan.
Denver: And you went around following the likes of Jethro Tull and Grateful Dead and Joni Mitchell and Jefferson Airplane and…
Larry: B.B. King!
Denver: Yep, absolutely! And then that movie actually ends with a concert with Pink Floyd in Canterbury, England, correct?
Larry: Yes. it was incredible. Pink Floyd was amazing and, of course, I was in the Rock Doc tent taking care of people who would have minor cuts or bruises… or had taken the wrong pill or the wrong color, and trying to bring them down and make them healthy. And that was the end of the caravan.
But I have to say this: we drove through Turkey, Iran, Afghanistan, Iraq, Pakistan. These are names that when you hear them today, you tense up. It wasn’t like that. They were the nicest people in the world.
Denver: Then the caravan is going to start up again. From England, you’re going to drive across Europe… But instead, fate intervenes, and there’s a cyclone in Bangladesh.
Larry: Yeah. I mean what happened was — we’ve all heard of the expression, “You’re either on the bus or off the bus,” the Ken Kesey expression. We started off driving, my wife and I — Elaine was her name at that time… before she changed her name to Girija. But Elaine and I had a little microbus — we had a VW — so we were like the caboose. There were 25 or 30 big buses, and then there was our little putt-putt, the doctor’s VW. And over time, the charm of being on the real bus and being part of, for me, the Hog Farm commune — Wavy Gravy’s commune, the old Merry Pranksters — that became pretty seductive. When we got to England, a lot of the people were going home after the formal Warner Brothers movie ended. A lot of others were thinking, “Can we get a couple of buses here and drive to Kathmandu?” K-K-K-Kathmandu. And it was the time of the hippie trail.
Denver: Yeah, sure. 1970 or so at that time.
Larry: Yeah, that was just succeeding the Silk Road. So we did. So we did a concert at the Round Tree with Stoneground, the band from the film. We raised $10,000. We brought a German MAN bus and a British Leyland transport. We had these two buses with 40 young people living in various different arrangements, living on that bus. And the trip took us well over a year. But I have to say this: we drove through Turkey, Iran, Afghanistan, Iraq, Pakistan. These are names that when you hear them today, you tense up. It wasn’t like that. They were the nicest people in the world. And again, we — just as in walking in Nepal — we looked like Martians! Can you imagine a bus — psychedelic-painted buses — and hippies wandering off wearing feather dusters and looking like cartoon characters? But everybody treated us so well. In fact, I can’t tell you — Afghanistan once, Iran once, in Pakistan several times — we’d be taken into the smallest little villages off the road, and if it was a Buddhist village, there’d be a little shrine with the statue of Buddha. If it was Hindu, there’d be a shrine to Shiva or Ram. If it was a Muslim village, there’d be a little drawing… maybe of the Kaaba of Mecca. And right next to that holy of holy places, there’d be a photograph framed of John F. Kennedy. It’s going to be a long time before there’s another photograph of an American President in those villages.
Denver: In those places, that’s for sure.
Larry: And that to me is the saddest part about having had this experience that my children cannot have now. My kids can’t go thru the Khyber Pass; they can’t walk up and down through Iran, and we can’t see these people as anything other than through the lens of the military efforts that have gone on. And it isn’t like that! That’s not who they are, and this is not who we are!
And then after about a week, I was totally hooked — hook, line and sinker. And I’ll tell you why that was. You can talk about theology, or you can talk about meditation or the practices. But for me, it was pretty simple. I would sit in front of this strange-looking man — he was a fat Indian, old, wrapped in a blanket — looked like a Scottish plaid blanket — and I sat there, and he would just emanate a feeling that he loved everybody in the world.
Denver: Not the way it was. Well, you end up in a Himalayan monastery. What happens there?
Larry: When I was an intern, you don’t get a lot of days off. But I got Thursdays off. A fellow named Baba Ram Dass — used to be called Richard Alpert–had been a professor at Harvard — he was doing three lectures in San Francisco every Thursday night, as it turned out, at the Unitarian Church. He had just come back from India. He had become Baba Ram Dass because he had met a guru. The guru’s name was Neem Karoli Baba, called also Maharaj-ji, and people hid his location; it was kind of opaque where he lived. But this guy Ram Dass, he had a way about him, not unlike Martin Luther King– that when you listened to him, the world stopped. I mean I remember him telling a story of a young man who is asked to kill a chicken, and his dad told him, “Take the chicken out where nobody can see you, and cut off its throat.” And after a couple hours, the guy comes back to his dad and says, “I didn’t do it.” He says, “Why didn’t you kill the chicken?” He says, “You told me to take the chicken out and kill it where no one sees. But everywhere I go, the chicken sees.” And that kind of light humor but if you think about that– a little deeper wisdom, coupled with the fact that he’d be talking about God… or the meaning of life… and trying to open the way to think about Judaism, Christianity, Islam, and Buddhism. There’d be a baby crying, and he would just incorporate that. I could never reproduce what Ram Dass did that night, but it was magical!
And all of the sudden on the bus trip– now years later, we are driving into India after having gone through the journey to the East–every night we read the book Journey to the East and here we are…we’re driving into New Delhi. Like all the other kids on the road, we want to get our mail, and you got your mail at the American Express office. So we’re parked in Connaught Circus, walking into American Express, and who’s in line in front of us? Ram Dass! That same guy who put us on top of the world years earlier. And one thing led to the other. My wife became extremely interested in the teaching of Ram Dass and his guru, and she immediately went to live in the ashram. And I wasn’t as smart as she was; I never have been. I stayed on the hippie trail for another six months, came back to San Francisco, paid off our debts. Then my wife and I had some tough negotiating over crackling phone lines when I was in San Francisco…I’m saying, “Come home.” And she was saying, “No. You come to the Himalayas and meet Maharj-ji.”
Denver: Sounds like not the first one you lost.
Larry: No. Well, I got lucky… there was a war, and all the Westerners were kicked out of India because the India-Pakistan war happened. She came home, but only on the provision that after we cleared up my medical school debts, that we would go back. And we did. We went back, and I met this teacher Neem Karoli Baba who at first I thought was a cult. I didn’t want to touch his feet. He has all these idols there. I mean it was really–
Denver: Not your cup of tea.
Larry: It was not my cup of tea. And then after about a week, I was totally hooked — hook, line and sinker. And I’ll tell you why that was. You can talk about theology, or you can talk about meditation or the practices. But for me, it was pretty simple. I would sit in front of this strange-looking man — he was a fat Indian, old, wrapped in a blanket — looked like a Scottish plaid blanket — and I sat there, and he would just emanate a feeling that he loved everybody in the world.
And that wasn’t what did it for me. In my young 26-year-old way, I sort of thought, “He should love everybody in the world; he’s a guru. Right? That’s sort of his job.“ But that’s not what got me. What got me is that when I sat in front of him, I loved everybody in the world, unconditionally! I forgave the guys at the hospital who had taken my photograph that was on a medical magazine, and had put it on the bulletin board with a hypodermic needle in my nose saying, “We welcome our young, radical doctor.” I forgave everybody. I didn’t feel hatred at all. So it was what happened to me, the feeling that I had of this universality that made me realize that whatever this guy has learned, whatever he’s doing, I want some of it. And that’s why I stayed.
Denver: Well, then your guru… or your yogi… speaks to you about smallpox. What’s going on in the world with smallpox at that time? What does he tell you?
Larry: I was like everybody else there at the ashram. We’d come in in the morning, and we’d meditate. He would come in, and we’d sit around him. It’s called darshan. It’s like having an audience. An audience means to hear the pope or to hear someone you respect; darshan means to see them, and it’s the same idea. It was just kind of an ordinary day. The rhythm of the ashram was going on. There’d be praying and chanting and singing and walking around and going to the little town and looking at all the temples. And this one day he just called me in, and the name that he had given me was Dr. America. So he would go, “Dr. America!” I didn’t even like the name because Ram Dass got a name Ram Dass… Krishna Das, the Das brothers. I wanted a spiritual name.
Denver: A little more exotic than Dr. America, but that’s what you got.
Larry: Dr. America. That’s the name that I got. He’d call; he’d say, “Dr. America!” And I came in, and he said, “How much money do you have?” And I went–I mean my first reaction was, “I thought this guy was above money.” And now, what’s he going to do?
Denver: This is what it’s all about?
Larry: Every little paranoid bit that I thought that I had squished in my brain came back up. And he said, “How much money do you have? “ And I thought about it. I said, “I have $500.” He turned his head back to me. He said “$500. That’s not a lot of money. Is that all you have?” And I said, “Yes, that’s all I have.” He said, “Oh, that’s all you have here. What do you have back in America?” And I’m thinking, “This is really going–” I said, “Well, I have $500 there, too.” And then he said in a sing-song way, “500 here, 500 there. That’s not much money.” He’s doing all this in Hindi. And then he looked at me and he said, “You’re going to have to go to work?” And I’m thinking, “Work? No, we’re living in a monastery.”
Denver: Right, I’m meditating all day.
Larry: He said, “You’re going to have to go to work.” I said, “Work? No.” He said, “$500. That’s not much money. You are no doctor.” He said,”You are no doctor.” And this is all in Hindi. “Tum ho doktar nahin.” And then he goes into English, and he says, “You are no doctor.”. He says, “You are no doctor. You N-O doctor. You N-O doctor. You N-O doctor. You’re going to be a UN doctor. You’re going to go work for the United Nations. That’s right. I can see it now. You’re going to go work for the United Nations. You’re going to give vaccinations in villages, and you’re going to help eradicate smallpox, a terrible disease that’s been killing children. This is God’s gift to humanity, that this one burden, this one disease that has killed people for thousands of years, it’s going to be obliterated.” It’s going to be “unmoolan,” which means literally pull out the root. It’s the same word in Hindi as eradicate.
Denver: And you know smallpox from nothing.
Larry: Well, I think in medical school, there might have been one slide and one course on tropical medicine. But I’d seen children in India while I was there with pock-marked faces… blind… and pock-marked faces. In that year, there were a quarter-of-a-million children who were afflicted in India with smallpox.
Denver: So you have to go to the World Health Organization’s offices to see if you can get a job, which is a long, long trip. Tell us how that all went down.
Larry: After he said that I was going to go become a United Nations medical officer, it was just so preposterous to me. I mean, I was a hippie. I graduated medical school and got an internship; that was it. I’d never had a job. I ran away with the circus. I didn’t have a job, and I just wanted to pretend he never said it. So for the next couple of weeks, Girija and I would avoid him, and we hoped that he wouldn’t raise the subject again. It was too embarrassing because I was so inadequate. And after a couple of weeks he said, “Did you get your job yet?” And I said, “No, Maharaj-ji.” “Did you go to WHO?” I said, “No Maharaj-ji.” He said, “Go! Right now.” So, we had to take a taxi to the bus station, take a bus, take a taxi and then a rickshaw, and go to the WHO office. I walked in there– Lord, help me, I walked in there with hair down to the middle of my back, a big bushy beard down to my belly, and I was still wearing an ashram gown that looked like a dress. I mean…where to change?
Denver: Yeah, good luck.
Larry: And I walked in there, and they looked at me and they said, “What are you here for?” And I said, “Well, my guru who lives in the Himalayas says that I am here to work with you to help eradicate smallpox. It is God’s gift to humanity because of the hard work of–” And that was it…I was out of there. And I went back to see Maharaj-ji, “Did you get your job?”
I said, “No, Maharaj-ji.” He said, “Go back.” And I went back again, and after four or five times–I got a little smarter. I trimmed the beard. I put on pants. I got a shirt.
Denver: And this was a 17-hour trip; this is not just down the street.
Larry: It’s 17-hours–yeah; this is not down the street. And I would come back, and I would say, “No.” And after a while, it was getting kind of old. I mean, even for somebody who was enthralled by the ashram and the monastic life, this was getting old. And then one day he said something like, “Did you get your job yet?” And I said, “No.” He said, “Go right now. Go this very minute.” And we were at his other ashram, which was only about a 4-hour ride away. We took a rickshaw to a train, a train to Delhi, a Delhi rickshaw. And I walked in–and by this time I had a white shirt, but still no tie. When I walked into the office, the receptionist named Edna Boyer, who was an Anglo-Indian — her mom had been Indian; her dad had been a British officer — and she didn’t look like the other Indians… didn’t wear a sari, and she was always very kind to me. I walked in there, and there was another American there, and he looked like a football coach.
And I walked in, and he said, “Son, what are you doing here? Who are you?” I said, “Oh, my guru who lives in the Himalayas says that I’m supposed to come work for the smallpox program. Did you know that this is God’s gift to humanity because–” And I said, “Who are you?” He said, “Oh, my name is D.A. Henderson. I’m the head of the smallpox program and I’m here from Geneva, but we have no smallpox program in India. It’s not one of Mrs. Gandhi’s priorities.”
Denver: That’s right!
Larry: “And that’s actually why I’m here. I’m here to go see her and try to convince her that we should have a program here.” I sat down. I was despondent. Mrs. Boyer came up and said, “The French woman who runs the smallpox program asked if you want to come up and be interviewed.” And so I went up to her office– Nicole Grasset. She looked like she was out of the pages of Vogue or had been walking down the Champs-Elysees. She didn’t look like the other people in India look. And there was D.A. Henderson, and she said, “Look, we can’t hire you; there’s no job, but D.A. Henderson said he’d interview you for the record.” And he did. He took me inside. He interviewed me.
Years later, after we eradicated smallpox– 10 years later– D.A. asked me to go back to India — by then I was a Professor at Michigan — and asked me to close down the shop because we had finished eradicating smallpox– take all the records, take them back to United States, microfilm them, put them in order so that there’d be a historical record. I found his interview of me. And he said, “I’ve just interviewed a young man named Larry Brilliant. He says he’s a doctor. He doesn’t look like a doctor. He appears to have gone “native.” Nice kid. I hope he does well, but he’s got no training. Got no medical training after internship, and we don’t have a program, so there’s no job for him. Good luck kid!” I mean that was it.
Denver: But eventually you do get hired… and probably– predominantly– because you speak Hindi… and you can type. And you begin to work on that program. I think the strategy for that program– working in India around smallpox– was really started by Bill Foege.
Larry: That’s right.
Denver: He went on to be the head of the CDC. I think he was very influential in Bill Gates’ life in terms of having him support global health. What was his strategy that saved the world from smallpox?
Larry: Well, the first thing was that in order to hire me, Nicole had to create a lower category than had ever been created.
Larry: I was not hired as a doctor. I was hired, as you say, as a typist, and I could speak Hindi. Indians liked me. I liked India, and I was comfortable with the customs. I lived in India for almost 10 years. And then after I was working as a typist for about six months, the big program began–which was “search and containment”: to find every single case of smallpox everywhere in the world.. at the same time, and draw a ring of immunity around it. Instead of just kind of haphazardly vaccinating everybody that you can…That was Bill’s strategy. He created that!
And on the eve of the first all-India search, there was a shortfall in epidemiologists. Some of the professors — these were all professors– 15 years older than me, and D.A. is almost 20 years older than me — I was the youngest person ever hired by WHO. I’m 26 at that point; these were all people in their 50s. And a professor of epidemiology from Leningrad, a Russian, couldn’t make it; a couple other people couldn’t make it. And Nicole said to Bill, “Do you want to try the kid?” I mean I can’t even imagine what their conversation was like, “Do you want to try the rookie?” I mean, “Put him in, coach.” And Bill offered to take me to the field; my first time in a village with smallpox was with Bill Foege.
And I remember going into this village, and we didn’t find any smallpox. And the driver said,”Let’s go,” and Bill said,” No, there’s probably some smallpox here.” We couldn’t find any, We went door to door. No one has smallpox. And Bill said to me, “You speak Hindi? Why don’t you tell them the tallest man in the world has come to their village, and let’s see what the kids do.” And I translated into Hindi, and the head man repeated — Bill was 6’7”, 6’8”– the tallest man in the world, and all of a sudden, these kids come flocking in. And we see children with smallpox on their arms, on their face; and then we start asking, “How many cases are there at home?” We were brought back … behind the curtain — and we found children who are dying of smallpox. And I had never seen anything so horrible in my life. My reaction, in retrospect, was crazy. I said, “How do you call 911? How do we get an ambulance?” And Bill put his arm on me and said, “Listen, son. There’s no treatment. There’s nothing you can do. That’s why we have to eradicate this. We have to prevent it.”
Denver: Every single case.
And then he said to me, “Every one of us has been exactly where you are right now — crying in the face of this unimaginable suffering, and feeling so helpless. And now you’re going to have to go through a transition where you can’t be a clinical doctor and think only of that one child in front of you. You’ve got to think as an epidemiologist, of all the people with hundreds of thousands of children in India that have this disease, and we have to build a program that scales, that’s well managed. It’s going to be difficult, but I think you can do it.
Larry: Every single one. Because no child should be in the situation that these are in right now. I was crying like — not only did I not look like a UN officer, I didn’t look like a doctor… I was crying like a baby. And then he said to me, “Every one of us has been exactly where you are right now — crying in the face of this unimaginable suffering, and feeling so helpless. And now you’re going to have to go through a transition where you can’t be a clinical doctor and think only of that one child in front of you. You’ve got to think as an epidemiologist, of all the people with hundreds of thousands of children in India that have this disease, and we have to build a program that scales, that’s well managed. It’s going to be difficult, but I think you can do it.”
Denver: And at this time in India, the rivers are not even flowing because there are so many dead bodies in them.
Larry: That was only true for one river, and that was in a place called Tatanagar, the main city of then the largest corporation in India, and I never saw that. Certainly, that was the rumor, that there were so many dead children that their rivers didn’t run. But Tatanagar had become the largest exporter of smallpox in the world. That was when we were close to cleaning up… finishing smallpox everywhere else. But this one industrial town was like Detroit in the ‘60s or Pittsburgh; it was a place that you can always go and get a job. And so young, uneducated Indians from all over the world came there, got a job– or were looking for a job– contracted smallpox, and then wanted to go home, and died on a train, and carried smallpox back all over. And that’s where we heard that the rivers were so clogged with bodies.
Denver: So you begin to go door to door. At this time you reproduced a picture, which at that time was the most reproduced picture in the world. Tell us about that.
Larry: I didn’t reproduce that, but it was reproduced by CDC. It was a young boy whose name was Muhammad Ali, a different Muhammad Ali, obviously. He was a Pakistani. A CDC epidemiologist was living in the area that this family that got smallpox. One brother got it; another brother got it, and this little baby then got it. The moment that the baby got a rash, the CDC epidemiologist came back and photographed him every day and chronicled and documented what the evolution of the smallpox rash was. And then that photo was reproduced as a placard, and every one of us carried it because Hindi had 1,200 languages. Smallpox was called “chechak” and “sheetla mata,” “mariamman,” “boshonto,” and so you couldn’t say, “Is this disease in your house?“ But you show the picture, “Is there any child that has a disease like this?” Inevitably, you’d be taken in.
We also turned it into leaflets. We dropped it from helicopters. I got into trouble dropping leaflets of all things–again– God, forgive me– on top of the WHO building. I got a little enthusiastic. Even my wife went up in helicopters. I remember a Russian who was dropping these leaflets all over India. Of all the different kinds of structures in the Indian government, it was the Indian Air Force that really liked the idea of eradicating smallpox. They had seen so many children die of smallpox in the Air Force barracks. And they would give us planes, and we were all over the place dropping these leaflets.
Denver: And you’re leading the peacetime army of 100,000 or so in Northern India. Eventually this culminates in Bhola Island in Bangladesh in 1977. Tell us about that moment.
Larry: So the last case of smallpox in India was a woman named Saiban Bibi, who was a Bangladeshi, who had crossed over into Assam, which is a northern state of India. Smallpox made her destitute; she was a beggar, and she got on a train and went across the border. And there were increasing numbers of importations into India as Pakistan had eradicated smallpox; Nepal and Sri Lanka had eradicated smallpox; India was now free, but there were cases coming across from Bangladesh. And I was asked to go to Bangladesh — they were struggling with the very last cases in the world — and I was sent down to Bhola Island, which was the same island that had that horrible cyclone in 1972. The Hog Farm had had its first idea to bring medicine to the survivors of that cyclone. Ironically, I went down to Bhola Island, and I sat in front of this young girl Rahima Banu, who was the last case of smallpox, the last case of variola major, a killer smallpox — but there’s another milder form — the last case of killer smallpox in the world. And I meditated and sat in front of her. I realized that when she coughed, and the last viruses left her body and landed on the soil in front of her in Bangladesh… and the sun killed off those viruses…that was the end of an unbroken chain of transmission that went back to Pharaoh Ramses. That was it.
Denver: Yeah, that’s right.
Now that I’m an adult, and I see a world filled with so much hate and pessimism, I think back to that moment. How could anyone not be optimistic when you think that a disease that killed half a billion people…500 million people… only a generation ago– that that disease is gone. And we did it by Russians and Americans working together…Indians…doctors in 30 countries. That’s what makes me optimistic. And she is the symbol to me of the end of one form of suffering, and to me, as a religious person, the symbol of what my guru had said would happen.
Larry: Now that I’m an adult, and I see a world filled with so much hate and pessimism, I think back to that moment. How could anyone not be optimistic when you think that a disease that killed half a billion people… 500 million people… only a generation ago– that that disease is gone. And we did it by Russians and Americans working together… Indians…doctors in 30 countries. That’s what makes me optimistic. And she is the symbol to me of the end of one form of suffering, and to me, as a religious person, the symbol of what my guru had said would happen.
Denver: And it did. It’s one of the extraordinary achievements in human history. An interesting footnote to that is that the vaccine for smallpox was actually found around 200 years earlier by Edward Jenner, and the story around it is utterly fascinating. Tell us about it.
Larry: I do love looking back into history and seeing some of these ridiculous, crazy ideas — I forgot what the aphorism is. “First, they laugh at you, then they deny what you’re saying; then they indict you; then they agree with you, and then they steal your idea.”
Denver: That’s the progression.
Larry: So this fellow who made his name studying cuckoo birds, and many people thought of him as cuckoo, Edward Jenner– he observed the aphorism that they used to say in England at the time… 1790s, that “she had a complexion as pretty as a milkmaid.” In fact we’ve said things like that even 20, 30 years ago, if you read literature from the ‘50s. And I always thought it meant that milkmaids drink milk, and that it gave them a nice complexion. I may have taken a glass of milk or two myself as a young teenager with acne. But that’s not what it meant. It meant that everybody else had pocks on their face and scars on their face… except milkmaids.
And he reasoned, “Why was this? Why does a milkmaid not have pocks on her face?” And he saw that sometimes a milkmaid had pock marks on her fingers, and these were the fingers that had milked the cow. And then he looked on the cow, and the udder…the nipple of the cow… had on it a pock mark. And — remember that nobody knows germ theory at this time. There’s not been a microscope yet. We think that miasma and bad air cause diseases in 1790s. And he thinks: “Well, maybe something hopped from that cow’s udder to the finger of the milkmaid, and then she was spared from getting smallpox on her face.” And then he does something absolutely crazy. He takes the oozy pus — no other way to say it — and he puts it into the arm of a young boy, and the boy’s name is Phelpps, and he carves a little scratch on the boy’s arm and puts the oozy pus in. Then he tells the boy to go out to a village near London that’s filled with smallpox into the market place. And the boy comes back, and they wait one week, two weeks, three weeks… and he doesn’t have smallpox.
By the reasoning of the time, he should have had smallpox. And Jenner takes this idea and he believes now–and you have to understand, this is a medical impossibility at the time. It’s a trans-specieal immunogenicity. And he goes to the Royal Society, which is the oldest learned academy in the world, and he says, “My idea is that if we take oozing pus from the fingers of milkmaids, and we give it to children, they will be spared from smallpox.” And they laughed him out, over and over. For years, they laughed him out. And over time, people began to realize that there is a disease cowpox–which if you get it– it protects you from smallpox. And because the process of scratching the hand with the cowpox–it used to be called “inoculation,” he changed it to “vaccination.”
Denver: It’s where vaccine came from, right?
Larry: That’s where vaccine came from. And the word “vaccine,” do you know what it means? It means cow, vaccas. So every time you’re sending your kid out to get a measles vaccine or influenza vaccine, you’re giving him a cow. Vaccine means cow. And so I just love the story of how we’ve all taken cows to protect us from the worst diseases in the world.
Denver: Well that is a great story. I’m gonna fast forward to 2006 and you, Larry, have just been awarded the TED prize. In your speech, you stated that your one wish for the world was to build a global system to detect each new disease or disaster as quickly as it emerges or occurs. Now as I understand it, and I may be wrong, if nothing were to be done — scientists believe that we are headed for an era of pandemics. But the tools and technologies you spoke about in 2006, they’re coming on line now to address these outbreaks. So let me ask you about each. First, why are we headed toward an age of pandemics?
Larry: Oh, I think we’re already here. Zika, Ebola, SARS, MERS, Swine Flu, Bird Flu, all of these diseases. More people…we’re living closer together. We’ve cut down forests that used to be places that only animals live with their viruses. HIV/AIDS jumped from chimpanzees and monkeys to humans. Many of the diseases that we know, like Ebola, jumped from bats to humans. SARS was a bat disease that jumped to a civet cat in a wet market in Hong Kong. So these are so zoonotic diseases, and over the past 30 years there have been 30 novel zoonotic diseases with pandemic potential. And as we move more into animal areas and consume more animals…
I mean, last year Africans alone consumed 1.8 billion wild animals. We’re heading into what looks like a prolonged battle with these new diseases. In fact, the other day, I was talking to some people who, with money from USAID and others, are trying to put together an atlas of all the bad viruses in animals everywhere in the world– to try to understand what the possible scope and scale of the problem are. So that’s one thing. I think we’re in for a photo finish against Zika, which is potentially one of the worst diseases we’ve seen since HIV/AIDS. But the photo finish is because… just as modernity is creating the circumstances that puts us more at risk of a pandemic, the same modernity is giving us the technology to avert getting those pandemics. And the major, major part of that technology is the ability to have early warning.
Some of the digital disease-detection systems — when I was at Google, we built Google Flu Trends. Now, there’s a participatory surveillance health map out of Harvard, Boston Children’s Hospital, and it now is running a program called Flu Near You. That’s able to show where influenza is in the United States a week or two before CDC can, because people are online, and they’re getting a little email or text message every Monday or Tuesday saying, “Are you sick, or are you well?” They answer it, and you can make a spot map immediately of the country and see where the disease is.
And the most important thing I learned in smallpox is that early detection, early response–that mantra– is what made it possible to eradicate smallpox. And that’s true for polio.. and every other disease. Ebola, which took six months to detect, that’s the reason that WHO and the rest of the world fell behind it. And there’s sort of a mathematical progression. If every disease leads to three more, every two or three days… or every week, you can see that if you leave that unattended for six months, you have a billion cases.
Denver: Yeah, it happens fast.
Larry: And you can’t do anything much if you start off with a billion sick people. But if it’s one case leads to three, leads to nine, leads to 27, and you’re there after there’s only three cases, then it’s pretty easy to draw a ring around it– even if you don’t have a vaccine or an anti- viral… if you just quarantine the old fashioned way. So we’re now in a position where the tools for early detection are growing, becoming more sophisticated…
Denver: And especially these informal networks which were never allowed before, correct?
Larry: That’s right. Until 2006, the World Health Organization and the United Nations were very stiff. They had by contract, by treaty, by agreement that WHO could not take cognizance, could not notice, could not act on a report that came from just a regular person about a new outbreak of an exotic disease. That report had to go to your local doctor, who had to put it out to the hospital, had to put it to your district or state, to your country, and then only to your health minister or health secretary who was allowed to call WHO.
In 2006, that was all changed. A new global treaty called the International Health Regulations was ratified, which now says WHO must take action if they get a phone call from a citizen, if they get a phone call from a church, if they get a phone call from a hospital, or if they get an electronic message from one of these new digital systems.
Denver: That’s a game changer.
Larry: Well, let me tell you how much of a changer it is. We estimate — it’s only an estimate — that 15 years ago, the first case of one these bad bugs — these pandemic potential viruses that jumped from an animal to a human — the first case took six months to be reported to WHO and acted upon. Now, we’re down to two, three, four weeks. And if we can get that number down, so it’s less than an incubation period, then I think that in the photo finish–
Denver: That’s a photo finish.
Larry: –between humans and bugs, humans are going to win. If we don’t, then–well, I don’t think I can bet on the bugs… I’m much less optimistic.
Denver: Right, for sure. Let me take it to one of your current reincarnations, and that’s as the Chairman of the Skoll Global Threats Fund, which was started by the Ebay founder Jeffrey Skoll. Now, there are five global threats that they’ve identified: climate change, water security, pandemics, nuclear proliferation and the Middle East conflict. So let me ask you, Larry, at the time when organizations are trying to narrow their focus so they can have an impact, why would an institution come into being with such a daunting agenda?
Larry: Well, Jeff Skoll is a lovely, wonderful man. He not only started this Skoll Global Threats Fund, he started the Skoll Foundation, which he’s endowed with $1 billion and has funded close to 100 social entrepreneurs to start them on their way in a whole variety of different activities. These young kids… you meet them, and it looks like they’ve got searchlights in the middle of their forehead. They really inspire you. He also started Participant Media which just won the Oscar for Spotlight and did movies like Contagion, Last Chance, Marigold Hotel, The Visitor, The Soloist, so many other great movies. So he’s a pretty eclectic guy.
I gave a speech at the Skoll World Forum one year. I met Jeff, and I said, “Have you been to India?” and he said, “Not much.” And I said, “All the things you’re doing, if you haven’t been to India, you’ve wasted your entire life. You have to come to India.” So he came to India, and we spent a week going around and looking at the new, modern companies. But I also took him to villages that had little children with polio. I showed him where the last cases of smallpox were; I took him up to my ashram, and we traveled the length and breadth of India together.
He came back saying that all these good things that he was trying to do with his movies and the Skoll Foundation… and all these other people, these new philanthropists, the Medicis of Silicon Valley, the Benioffs of the world, all the good things that people are trying to do… in the face of that, there are a category of events that could happen–maybe low probability but highly consequential– that could bring humanity to our knees.
And he had his list; everybody has their own list. And his list was pandemics; it was nuclear war; it was water; and certainly, it was climate change; and regional conflagrations that become World Wars. So he said, “I’m going to start an organization that looks just at these global threats.” And that was the rationale. Because whether you’re talking about cyber terrorism or bioterrorism, the instrumentality can be a virus that’s an organism or a virus which is a computer virus. But the motivations of the people who are willing to let loose these horrible things will be the same. So, you can gain a lot by looking at the governance issues, the psychological and social issues. If you’re looking at water and climate, there are people who argue the effects on the world are the same, that because of climate change, water…
Denver: They’re all interrelated, in other words.
Larry: So interrelated. Yeah. And I just take my hat off to him for being brave and courageous enough to create something with such a daunting vision.
We all know people like us in our life — the people who do great work. And then when it comes time to get the awards, they’re the ones you can’t find. We know people in our Boy Scout groups and our church groups. We know people in our schools who are always there, always doing the work, but not the first to say: “I did it!” Not the first to take credit. To be ambitious to do good: I think that’s Christian, it’s Jewish, it’s Buddhist, it’s Hindu, it’s the highest of all of ours. And then to say: “I’m doing it for God; I’m doing for the greater good; I’m doing it for the kids; I’m not doing it for me. That’s a little harder, and that’s what my teacher told me I should do.
Denver: Yeah, absolutely. Let me get you out on this. You have said that you’ve often wrestled with the meaning of this line — “Live your life without ambition, but live as those who are ambitious.” What does that phrase mean to you, Larry?
Larry: That’s a line from a theosophical book called Light On The Path by Mabel Collins. I think if you’re doing good work because you’re hoping to get a Nobel Prize or be feted at the next meeting of the hospital board, that’s great. Whatever your motivation is, the good work that you’re doing will live after you, and it’s noble and wonderful.
But there is another level. We all know people like this in our life — the people who do great work. And then when it comes time to get the awards, they’re the ones you can’t find. We know people in our Boy Scout groups and our church groups. We know people in our schools who are always there, always doing the work, but not the first to say: “ I did it!” Not the first to take credit. To be ambitious to do good: I think that’s Christian, it’s Jewish, it’s Buddhist, it’s Hindu, it’s the highest of all of ours. And then to say: ”I’m doing it for God; I’m doing this for the greater good; I’m doing it for the kids; I’m not doing it for me. That’s a little harder, and that’s what my teacher told me I should do. Now I fail every day… a hundred times. In this last two- minute conversation, I failed 50 times. You shouldn’t be afraid of failing; you should aspire to do the best you can with the tools you’ve been given, and not worry so much about taking credit. Even if you’re thinking about your own enlightened self-interest and counting karma points, leave that for the others.
Denver: It’s intrinsic motivation, not extrinsic, that really makes the difference. Well, Dr. Larry Brilliant, I want to thank you so much for being with us this evening. The book again is Sometimes Brilliant. It’s published by HarperCollins. And not only is it a wonderful read of a remarkable life, but the wisdom and insights provided will better inform your own life and your search for meaning in it. It was a real pleasure to have you on the show, Larry.
Larry: Thank you.
The Business of Giving can be heard every Sunday evening between 6 and 7 PM Eastern on AM 970 The Answer in New York and on I Heart Radio. You can follow us at bizofgive on twitter and at facebook.com/businessofgiving.