 The recipient of the 2018 McLean Center Prize in clinical ethics is Dr. William Fagy, an epidemiologist and infectious disease physician. Dr. Fagy is best known for his work to eradicate smallpox in the 1960s and 1970s when he served as an epidemiologist for the CDC and later as the chief of the CDC's smallpox eradication program. Dr. Fagy developed and applied a new strategy for delivering smallpox vaccination, the strategy that would eventually rid the world of this dreaded disease. Because of limited time and supplies during a smallpox outbreak in rural Nigeria, Dr. Fagy and his colleagues created the surveillance containment strategy of vaccination, an alternative to the then prevailing strategy of mass vaccination. The containment strategy enabled health workers to vaccinate a much more limited population than did the mass immunization programs. The smallpox vaccine was given only to those who were in the radius of the outbreak or at its periphery. At the time, the population of eastern Nigeria was 12 million, but Dr. Fagy and his colleagues stopped an outbreak in the region by vaccinating only 750,000 people. It was a remarkable achievement. Before it was eradicated, it is estimated that 300 million people died of smallpox in the 20th century alone. Since 1980, there have been zero deaths from this terrible disease, and it has begun to fade into history. The eradication of smallpox from the entire world is surely one of the most stunning achievements in the history of modern medicine and public health. After the successful eradication of smallpox, Dr. Fagy went on to serve as the director of the CDC in Atlanta from 1977 to 1983. There he oversaw the response to major health problems in the U.S. and abroad, including the beginning of the HIV AIDS crisis. In 1984, Dr. Fagy became the head of the task force for child survival, formed by the Rockefeller Foundation, UNICEF, the World Health Organization and the World Bank. There he helped raise the global immunization levels from approximately 20 percent in 1984 to 80 percent by 1991. Today the task force reaches populations in 157 countries. Jim Grant, the head of UNICEF, called the vaccination program success the greatest peacetime achievement in history. From 1999 to 2011, Dr. Fagy worked as an advisor to the Bill and Melinda Gates Foundation, helping develop its childhood immunizations as part of its larger global health program. To learn more about the complex public health campaign to eradicate smallpox, I highly recommend Dr. Fagy's 2011 book, House on Fire, The Fight to Eradicate Smallpox. His most recent book published this year is Fears of the Rich, The Needs of the Poor, My Years at CDC. He was honored in 2001 with the Mary Laska Award for Public Service, in 2007 with the Jimmy and Roslyn Carter Award for Humanitarian Contributions to the Health of Humankind, and also received the Presidential Medal of Freedom from President Obama in 2012. Dr. Fagy's contributions to clinical medical ethics are extraordinary. He applied ethical standards to save lives, to eliminate health disparities, to give protective immunizations to many of the world's children, and to promote global health equity. As Dr. Fagy notes, the smallpox eradication program shows that humanity does not have to live in a world of plagues, conflict, and uncontrolled health risks. The coordinated action of a group of dedicated people can plan and bring about a better future. The fact of smallpox eradication remains a constant reminder that we should settle for nothing less. Today, Dr. Fagy will present his keynote lecture entitled Global Health, Ethical Challenges. Please join me in congratulating Dr. William Fagy on this extraordinary career and in welcome him and his family to the University of Chicago. Dr. Tolton. First, let me thank the Dean for that nice introduction, and second, let me apologize to the audience because it's all downhill from here on. What a golden standard program you have here. I was wondering yesterday and today, what would happen to American medicine if we had a McLean Center in every medical center, and what would happen if Mark was asked to train all of those directors of those programs? It's really very, very overwhelming. I'm impressed with so many of the things that I've heard over the last day and a half, stimulating things. Creativity, we know from the studies that creativity usually involves two different fields of knowledge coming together that were not put together before, and I kept thinking of that as I heard about surgery and prevention. Those two words are not heard very often, they were heard yesterday. I thought about that with clinical medicine and philosophy. I thought about that with every discipline plus ethics, and when I heard they talk on violence this morning, I realized how violence is one of the things that over the centuries has detracted from happiness. Violence combined with depression, addiction, fatalism, poverty have been problems forever. So many good points, when Valerie talked about the informed consent yesterday and the fact that we have to think about how do we protect patients as well as physicians. In the area of immunization we spent so much time on informed consent, but it eventually led to a program with a surge charge on vaccines put into a program run by the government so that people who have adverse reactions from immunizations now have recourse to be able to get compensation. When I heard the malaria program I was reminded of the fact that malaria is the first disease that we've ever had a national surveillance program for in this country, 1950 and 1951. The second one happened to be in 1955 because of the cutter incident with polio vaccine. The third in 1957 with influenza and now we have dozens and dozens of national surveillance programs. Yesterday when I heard the question of why do we underfund WHO and then expect them to do more, I thought back to when WHO was formed about 70 years ago and the role of the United States and other countries in making that organization such a difficult organization to run. We insisted on strong regional offices because we were trying to protect the Pan American Health Organization. We made them so strong that regional directors could always undermine the director in Geneva and that continues to happen so it makes it very difficult to have a global program. We insisted on having a board of governors, all the ministers of health in the world, 195 ministers of health on the board, many of them in place for only two or three years at a time. They're not really invested in WHO but they love going to Geneva every May for the World Health Assembly. And then third every year we asked them to reduce their budget. There were some years ago when the U.S. was not providing its fair share, its dues and I should tell you that we save more money each year in this country because of smallpox eradication than our dues to WHO and still we were not paying our dues. I wrote an editorial for the American Public Health Association and I quoted Dolly Parton. She once said you'd be surprised how much it costs to look this cheap. In 2014 Ebola in West Africa showed us how much it costs to look that cheap. Ethics is not abstract. It should drive us to solutions to benefit our ultimate bosses. Who are our ultimate bosses? One who will be born in the future because they have given their proxy to us and they're depending on us to make the right decisions. Will Durant said immortality in his view was the absorption of one's soul in deathless acts. You're all involved in deathless acts and I thank you for that.