 Good morning, and I am truly delighted to welcome Dr. Peter A. Singer back to the University of Chicago. Currently, Dr. Singer is the Chief Executive Officer of Brand Challenges Canada, the Director of the Sandra Rotman Center and Professor of Medicine at the University of Toronto. On this very happy occasion, Dr. Singer has returned to our university to accept the second annual McLean Center Prize in Clinical Ethics. Dr. Singer first came to the University of Chicago in 1987 when he was 27 years old. This leaves a very simple calculation if you're wondering just how old he is. He came directly after completing his medical residency. He recalls that Mark Siegler, who was then developing the field of clinical ethics, traveled to Toronto ostensibly to give a lecture, but in fact really to recruit Peter to the University of Chicago. And while strolling down the streets of Toronto, they reached an agreement that Peter would do fellowship training here in Chicago. Following his time in Chicago, Peter went to Yale where he spent a number of years working with Dr. Alvin Feinstein, also a product of the University of Chicago. And then in 1991, after having his training at Chicago and then having training by Chicago while in New Haven, he went back to University of Toronto to become the director of the University of Toronto's Joint Center for Bioethics. Dr. Singer led the Joint Center for Bioethics from 1992 to 2006. Mark Siegler tells me that under Dr. Singer's direction, the Joint Center at Toronto was the largest bioethics program in North America and probably the largest in the world. The Joint Center involved partnerships between the University of Toronto and 15 affiliated hospitals in Toronto. It consisted of a network of over 180 faculty from most of the professional schools and academic divisions of the University of Toronto. In 2002, the Joint Center was designated the first World Health Organization collaborating center in bioethics. Our honoree says that he modeled the Toronto Joint Center on the McLean Center here at the University of Chicago and pursued the same principal goal of clinical ethics that Mark Siegler taught him here. And that goal is to improve care. Mark says that like all of our best students, Peter Singer moved beyond his teachers and took the original clinical ethics model to new heights. Ten years ago, Peter Singer began working on global health issues and focused on low and middle income countries. Mark recalls Peter telling him at that time, what I think is a very important statement, I can no longer work in clinical ethics without focusing on the health needs of the more than 5 billion patients in developing countries. Peter Singer emphasized this point by noting that 150,000 women and 1.6 million newborn children die in the 72 hours around the time of birth. More than 90% of these deaths happen in the developing world and more than 95% of these deaths are preventable if we can improve the availability and quality of healthcare. Dr. Singer's work has identified similar preventable problems that touch millions of patients in the fields of nutrition, non-communicable diseases such as hypertension and diabetes, psychiatric diseases, and of course, communicable diseases. In 2003, Dr. Singer along with Dr. Harold Varmus, Nobel Prize winner and former head of NIH, and Elias Zerhouni, who at the time was the director of NIH, published a paper in Science entitled Grand Challenges in Global Health. Now, the Grand Challenges concept was actually based on a century-old model originally formulated in 1901 by a very famous mathematician. David Hilbert, when Hilbert listed the important unsolved problems in mathematics. This was not just a list of a collection of unsolved problems, but indeed major problems that actually set the agenda for much of mathematics, of certainly the early part and in fact a good deal of the entire 20th century. And similarly in Dr. Singer's 2003 science paper, he and his team identified a Grand Challenge as a call for a specific scientific or technological innovation that would remove a critical barrier to solving an important health problem in the developing world with a high likelihood of global impact and feasibility. In 2003, based on the model of the Grand Challenges, the Gates Foundation announced a $200 million global health initiative. Some years later, the Canadian government created Grand Challenges Canada and appointed Dr. Singer as its founding CEO. Grand Challenges Canada funds healthcare innovators in low and middle income countries and aims to save and improve lives. It supports bold ideas that integrate science and technology with business innovation and provides sustainability and impact. Grand Challenges Canada was funded by the government of Canada at $225 million over five years. And in 2011, Dr. Singer and his colleague Dr. Abduladar co-authored a book entitled The Grandest Challenge, Taking Life-Saving Science from Lab to Village. Dr. Singer served as chair of the Canadian Academy of Sciences Assessment of Canada's Strategic Role in Global Health Care. He has been an advisor on ethics and global health issues to the Bill and Melinda Gates Foundation, the United Nations Secretary General's Office, the government of Canada, and to many African countries. In 2011, Dr. Singer was appointed to the Order of Canada, the highest civilian honor in Canada for his contributions to bioethics, healthcare research, and global health. Dr. Singer is a fellow of the Royal Society of Canada, the Canadian Academy of Science, and the U.S. Institute of Medicine of the National Academy of Sciences. For his pioneering work in clinical ethics and his monumental achievements in developing creative solutions to some of the most pressing global health problems, we are proud to present Dr. Peter Singer with the McLean Center Prize in clinical ethics. This $50,000 prize, which is the largest prize awarded for work in medical ethics, is presented to Dr. Singer by the McLean Center and by its advisory board, shared by Barry and Marianne McLean, who are both long-standing supporters of the University of Chicago. Thank you, Barry and Marianne. At this time, it is my great pleasure to present Dr. Singer with the McLean Center Prize. Following the receipt of the prize, Dr. Singer will speak to us this morning on the topic, the grandest challenge tackling inequalities in global health. President Zimmer, it's extremely humbling for me to accept this award. I'm very honored by it, but I'm extremely humbled by it because as I look across the audience and see many of the 300 fellows that Mark has trained, I really just see myself as a representative of that group. And when I think about the amazing things that have been done, and I'll speak to some of them by people in this room, it's extremely humbling for me to accept this award, really on behalf of this whole community. And I just want to say it takes a great university really to host a great center like this over a sustained period of time. And I want to congratulate you, President Zimmer, for your support over the past seven years of this center. And I want to congratulate your predecessors over the past 25 or 30 years for their sustained support from an institutional standpoint of this center and of all the people in this room. Thank you very much. You know, I've also come to realize that to have a successful entrepreneurial center, which is essentially what this is, it requires great partnerships, not only within the university, but also outside the university. And I know for a fact that this center would not be what it is without the fantastic partnership between Mark Siegler, and I'll have a few things to say about Mark in a moment, and the McLean family, starting with Dorothy McLean, DJ, whom I had the privilege to meet, and continuing with Barry and Mary Ann. I'm thrilled that you are here and all your colleagues who are trustees of this center, and I see some of them here. Dean is sitting with you and many others in the audience. One thing I've learned is that we often have a very siloed approach. Universities do one thing, businesses do something else, NGOs do something else, and governments do something else, and that's not the way to solve the biggest problems in the world. The way to solve the biggest problems in the world is to work across those sectoral lines. So I particularly want to pay tribute to the McLean family, to DJ, to Barry, to Mary Ann, and really to your whole family for working in partnership with the University of Chicago, with Mark, with Anna, who also needs a lot of tribute here, and with all of us to create something extremely special. I know that this would not be the same, and I know that it's not an issue of donation, because like in any venture capital enterprise, it actually is not primarily about the money, it's primarily about the guidance, the focus, and the ability to work in partnership to build, just like building a big business, to build an extremely successful center. And I know that you and Mark have really done that together, and on behalf of all of us here, Barry and Mary Ann, I really just want to acknowledge that, and thank you very much for your support of this center, of this prize, and of this university. So it's my great privilege to be able to speak today about Grand Challenges in Bioethics, Grand Challenges in Global Health. You see my Twitter address there, because I hope this can be a continuing conversation. If any of you are on Twitter, let's tweet at each other about these issues as time goes on. I want to start actually by acknowledging the first recipient of this prize. It's extremely humbling for me to receive the prize that Jack Wenberg received. He's had such an amazing impact, and also I want to acknowledge Mary Ann Secundi, the first director of the Tuskegee Center for Bioethics. And it's a great example of Mark spawning people who are leaders, who surely had she not died in an untimely manner, would have been the second recipient of this prize. And I think Mary Ann is really symbolic of the many leaders in this room, Mark, that you've helped to support, to enable, and to create. And of course, I need to acknowledge Mark in acknowledging Mark. I'm also acknowledging Anna, because if you're a fellow here, you have to put up with certain things. But if you're Anna, you have to put up with that over a long period of time. But like the fellows, I think that the, you know, we all realize that the opportunities are worth the other side of the equation. But Mark, when I think of what you have done, you know, there are very, very few people in the world who can truly claim in a legitimate sense that they have created a field. And you have created a field. And you have done it in an extremely focused way by having a very simple principle that you kept your eye on results and the endpoint of the improvements for the care of patients and families, and worked constructively within the, within the professions and within institutions to achieve that objective. That was your first principle. And your second principle was to support young people, or in some of our cases, almost young people, in terms of their own endeavors. And you really provided end-to-end support. You often came and recruited many of us before we got here. You fostered and enabled us while we were here. And then before we left, you would go on a type of advanced mission to our home institutions to essentially negotiate our positions and strengthen the negotiating position. And I know you did that with many people here. In my case, you actually even found my wife. I don't know if that sort of end-to-end service extends to others here, but it really was. And so, Mark, for all your accomplishments, I just wanted to really, on behalf of everyone here, acknowledge what you've produced, which is just amazing. You've changed the country for thousands, tens of thousands of patients. And you've changed the world with the 300 fellows you've produced and that force multiplier effect. So congratulations to you, Mark. I really have two simple messages that I want to talk about today. The first one is that bioethics is actually on reflection, and especially clinical ethics, the way it's practiced here. To my way of thinking, a form of social innovation or a form of social entrepreneurship that leads to sustainable impact at scale. And I'll try and prove that case as we go. And of course, social entrepreneurship closely related to entrepreneurship, period, and I'll try and make that case. And then the second point I want to make is the one that actually President Zimmer mentioned, that Mark has mentioned, which is that really to have that sustainable impact at scale, one needs to take a global point of view. This quote looking back is from a paper that Mark and the great Ed Pellegrino and I wrote about 10 years ago, 11 years ago. And I pulled this line out. To date, clinical ethics has primarily been a phenomenon of developed countries. But the development of global health ethics has begun, will surely pick up momentum. And I'm going to speak in my talk to the global dimensions of bioethics and global health as well. But let me start with the issue of social entrepreneurship. Many of you will remember Stephen Thulman, an extraordinarily distinguished philosopher who, like many of us, Mark recruited here. He was at the center for many years. As Stephen wrote a very important paper 20, 25 years ago called How Medicine Can Save the Life of Ethics. And Stephen's point was exactly actually what Mark did, which is for ethics or at least bioethics. I'm not talking about Aristotelian philosophy here that didn't need its life saving as a discipline, but certainly medical ethics, needed to work with medicine actually to improve patient care. The point I'd like to make today is that likely what can save the life of bioethics in the future, because everything needs its life saved every couple of decades, is actually social innovation and social entrepreneurship. I think a lot of that has already been incorporated into bioethics, and I'm going to try and make that point. You know, I was just at 27 as President Zimmer pointed out when I came here, and it just slide really is just the, for me, the epitome of the type of opportunities that Mark presents, and the center has presented, the university has presented, and the Mclain family has presented. This is a picture of Alyssa Smith in 2010, graduating from Meredith College in North Carolina with the Bachelors of Social Work. Now, Alyssa Smith was the first live donor liver transplant recipient in the United States, and she was just months old when she received her live donor transplant here at the University of Chicago in 1989. As many of you know, preceding that event, the surgeons here at the University of Chicago asked Mark to reflect on what ought to be the ethical guidelines for live donor transplantation. And Mark, John Lantos, myself along with the surgeons, worked through that problem and published in the open literature ethical guidelines for live donor transplantation. And the remarkable thing was this was published six months before Alyssa Smith's transplant, because the idea was actually not to do a technological leap and have the backlash the next day, but actually to put out the issues openly, honestly, and transparently. The crux of the ethical issue here is the risk to the donor, because you're taking a healthy person, often related, but not always, to the recipient, and subjecting them to a very, very small, but non-zero risk of serious illness and death by subjecting them to an operation. These guidelines introduced ideas like a waiting period, a cooling off period, so the donor could reflect on their choice before agreeing to the transplant and have been used in transplant centers around the world. At this point, more than 6,000, maybe more live donor transplants have been done, liver transplants. There have been about a dozen donor deaths that really symbolize and underscore the importance and the seriousness of this sort of reflection. And these are the sorts of opportunities that Mark presented to me and to all of us. And the other thing that this opportunity shows is really two words that I think have guided my career and I think guide the career of many people who are here, which is innovation and impact. These guidelines are actually a form of social innovation and they have had impact. I have met, and one of the most meaningful things for me personally is when I've met donors of live liver tissue, often a mother donating to her child. I've gone back and we've talked about how this all got started and the meaningfulness to those people, obviously, of saving the lives of their children and the piece of the puzzle that ethics represented. Now, it did require some surgery to do those transplants. I recognize that, but it may not have rolled out the way it did without this sort of work. And it's a good example, I think, of social innovation and meaningful impact in the lives of people. And that's why I wanted to start with it, including the young people that Mark has continuously engaged on challenges like this. A second example I wanted to give you actually involves Susan Toll. And I could have picked many people here. There are so many people doing such great things. But I wanted to pick as an example Susan's work because it also illustrates the same sort of social innovation and impact. So as you all know, Susan has developed the pulse to the physician's orders for life sustaining treatment. This is essentially a type of process that guides transfers of people towards the end of their lives from one facility to another. So for example, from a nursing home to an acute care hospital, I can't tell you the number of times as an intern, as a staff person in medicine, and I'm sure this resonates with many of you, that somebody would come in extremists into the emergency room, often from a nursing home, often with pneumonia, often with a severe underlying condition. We had no idea whether that person actually wanted to be in the hospital, whether they wanted to have the procedures that then almost automatically ensue that whole bundle of procedures. And this form, this process actually addresses that challenge. It's been adopted by 15 states with another 28 states in the process of adoption. It's been adopted in five countries. But if you just think about the thousands, the tens of thousands of people who have received better quality end of life care because of this social innovation, that is really innovation and impact. And that, Mark, I think is what this center is all about. And I think that's what we are all committed to doing. And as I say, I picked Susan's example, but I could have picked a dozen or two dozen examples in the room here of people who are essentially social innovators and making meaningful change in the lives of patients. So I did mention that Bioethics had probably already incorporated this idea of social innovation, social entrepreneurship. This is just a quote from Alice in Wonderland saying, I know who I was when I got up this morning, but I think I must have been changed several times since. I actually think what you are doing at this center is a form of social innovation, social entrepreneurship, and I'll define those terms in a moment. And I think we've been doing it without knowing it. So in the context of global health, I've been exposed over the past few years to the idea of social entrepreneurship, creating sustainable businesses that have both social and economic returns. And then focusing back on the work here, all of a sudden I realized that this Alice in Wonderland quote is true. What I had been doing for 25 years, what many of us have been doing is actually at minimum a form of social innovation. And at best a form of social entrepreneurship because we are all driven, I think, to use creative problem solving methods really to improve the care of patients and families. And I think that's really what drives us. And in very many cases, there's been incredible amount of impact in doing that. So I want to argue that bioethics is a form or can be a form of social innovation, that that's closely linked to social entrepreneurship, and what it's all about is sustainable impact at scale. So the 6000 liver transplants using that social innovation, the cooling off period that decision making is an example of sustainable impact at scale. The tens of thousands of patients who have either been transferred or not transferred from one facility to another at the end of their lives so their actual care conforms to their wishes, is an example of social impact at scale. So here's a standard stock definition of a social entrepreneur. Perini defines it as social entrepreneurship entails innovations designed to explicitly improve societal well-being housed within entrepreneurial organizations, initiate, guide or contribute to change in society. Entrepreneurship, innovation and social change represent the ingredients of the social entrepreneurship formula. And Bill Drayton, who's the founder of Ashoka, who really developed one of the largest networks of social entrepreneurs, defines it as follows. He says social entrepreneurs are not content just to give a fish or teach how to fish. They will not rest until they have revolutionized the fishing industry. I think this is actually closer. And Barry, as you will know, and as your colleagues will know, even this doesn't go far enough because the real definition of entrepreneurship, whether it's business entrepreneurship or social entrepreneurship, and by the way, I don't really see those as hugely different because any business person after they've gotten the initial revenues for them to be comfortable are actually, and often before, are interested in solving problems and affecting solutions. And that's really what they're about. So I think it's almost an arbitrary distinction. But I think the real definition of entrepreneurship is the person who will go along, try and solve a problem, they get kicked in the face, they're lying bleeding on the floor, they dust themselves off, they get up, and they keep walking in the same direction. They embrace failure, they embrace challenge, and they have incredible determination. They may or may not always be the most pleasant people to be with, and I don't think we'll have a back and forth with Anna or with Mary Ann or with my wife Heather or with your spouses or partners, but these are really the characteristics of social entrepreneurs. And at Grand Challenges Canada, we've actually developed an idea of innovation and of entrepreneurship called integrated innovation. We've argued that all too often technological innovations, social innovations like bioethics and business innovations have been seen as separate. But actually, to be able to achieve sustainable impact at scale, you need to integrate these things. So to take one easy example, and I'll come to the global stuff in a moment, one of the innovators we funded in Botswana, working in the Children's Hospital there, had the idea of taking a lung swab, and the swab was initially developed for bronchoscopies, and using it actually for sampling of stool in children with diarrhea. As you know, almost 2 million children every year die of diarrhea in the world, most in the developing world. There are 4 children under 5. Very poorly characterized situation because stool is not so easy to culture, kind of messy. So the idea was to take a swab that was developed for bronchoscopy and use it to sample stool in a child with diarrhea in the developing world. Now it's a particular type of flocculant swab, and the innovation was owned by an Italian company called Copan. So that brings the intellectual property issues, the business innovation. It is obviously a science and technological innovation because these are flocculant swabs, which have a different characteristic of sampling. And there are social and consumer preference issues involved when you're using a swab and with a parent sort of sampling through the rectum stool. So this is a good example of an innovation where you actually have to address all 3 of those things to be sustainable to go to scale, and that is what we're trying to achieve with integrated innovation and also to put the emphasis on entrepreneurship. So essentially in the first half of this talk, I've argued that bioethics as practiced here, but not as historically has been practiced everywhere, is a form of social innovation, social entrepreneurship, and in a sense we can all think about ourselves as social innovators, social entrepreneurs, because we're interested in innovation and we're interested in impact at scale on the lives of patients and their families. And by the way, the difference between a social innovator and a social entrepreneur according to some is that the metrics of success are at the core of the model of the social entrepreneur. So measurement of success, how many people you've reached, how many lives you've changed is not an incidental thing that you might put in a grant report, but it's central to your model of scaling, and that's what people have argued is the difference. I'd now like to talk a little bit about the second point I want to make, which is bioethics, a form of social innovation and social entrepreneurship, really needs to take a global perspective to have scale or put another way, it's an incredible and humbling opportunity when you take some of these problems in a global perspective. So for example, I worked for a long time starting here in Chicago on the issue of end of life care, and you know there are, one day I realized that most of the deaths in the world were actually not in the United States or in Canada or in North America, but more, 75, 80% of the deaths in the world were actually in the developing world. And when you look for discussions of end of life care, you can see thousands of articles on living wills in rich world settings, but actually very little discussion of end of life care in the developing world settings. The first real focus was an issue of BMJ in 2003 that zeroed in on end of life care, including in the developing world and picked up a few models like hospice Uganda. When you think about that, that's a huge lost opportunity because there are certainly things that the North can teach the South about narcotics, pain control, symptom control, etc. And in fact, you know, the legislative regimes around narcotics, for example, in India are resulting in huge amounts of suffering at the end of life of people who die, for example, in India. But at the same time, I think there's a lot that we can learn from families in the South around the more social family aspects of end of life care, the way death is not seen as a failure, the way it's dealt with in the family as part of the community. For example, if you think of the Masai culture in Tanzania. And so I think there's a lot of bilateral learning which just talks to the value left on the table when we don't think about bioethics as a global phenomenon. President Zimmer mentioned Grand Challenges Canada just before I talked through the specific problems and how some of these are being addressed. This slide just says a little bit about Grand Challenges Canada. President Zimmer has actually mentioned most of this. We focus on bold ideas with big impact, primarily in global health but broadly defined. You know, breaking down silos, if you've got an agricultural innovation or a water innovation that leads to better health outcomes. For us, that's global health. We focus on a broad vision of innovation as I described. We fund primarily innovators in low and middle income countries and we're totally engaged in results. We're not allergic to the public sector, we're not allergic to the private sector, we'll fund companies, we'll fund NGOs, we'll fund universities. And this actually is also, if I may say, characteristic of bioethics that I don't think has been helpful. On the one hand, you know, obviously the critiques around conflict of interest, corporate conflicts of interest are important. But just like the possibility of the North learning from the South, there is so much that different sectors can learn from each other. I think it's actually inhibited the growth of bioethics to spend so much time focusing much of its effort, or some of its effort on essentially anti-corporate critiques. Rather than turning it around and asking what can we learn from an entrepreneur about sustainability, scale, distribution channels and reaching people. So that's a longer discussion and not everyone in the audience will agree with that particular view. But it's part of a more general theme of learning across sectors, learning across nations. And we are not particularly good at that, the way our structures are set up, which is why it's so important that at the McLean Centre this actually does occur. So about half the business in Grand Challenges Canada, and again, this is really a credit to Canada, to the taxpayers of Canada. Canada was the first country that took a Grand Challenges approach to using its foreign aid dollars to stimulate innovation in foreign aid, followed by the Grand Challenges in development at USAID, and then subsequently followed by Grand Challenges Brazil that has launched. We've brought Norway and the UK into some of these Grand Challenge exercises, and Grand Challenges India is about to launch. And we've been working very closely with Israel on the question of how do you move from being a start-up nation to a start-up development nation on the launch of a Grand Challenge, the future launch of a Grand Challenge is Israel. So the movement has spread essentially because it's a way to solve global challenges. Most fundamentally, what the Grand Challenges approach is about is it's a form of global governance. It's a way for different groups in different countries, public and private, to come together to solve a common problem that none of these groups could solve alone. About half our business is driven by innovators themselves, and we call this the Stars in Global Health. We fund about $150,000, $100,000 proof of concept grants every year, and just to give you some examples of those innovators, at the top left here is an innovator from the University of Waterloo who developed a new type of pixel technology for digital x-rays. He then is testing it for chest x-rays for tuberculosis in India. And the key thing with this pixel technology is it's much cheaper in terms of capital and operating costs than traditional digital x-rays. So lots of opportunity to bring that technology actually once it's been tested in India back into North American settings, actually to disrupt markets from a price and affordability standpoint. A topic I know that many people here are interested in. In the middle, it's Carmen Loghi. She's working in an internally displaced persons camp in Haiti after the earthquake. She uses solar power tablets to do HIV counseling of women, which obviously is a rampant issue in those situations. On the right side is an innovator, again a Canadian innovator. And what he did was he developed a new type of polymer for artificial prosthetic knee joints, and developed artificial prosthetic knee joints that we funded him to test for landmine victims in the developing world. But the fact of the matter is this knee joint, because of the different polymer construction, costs about 50 bucks compared to one or two thousand dollars for the knee joints that are commonly, knee prostheses that are commonly used in Canada and the United States. Again, giving you a sense of A, how to go to scale at affordable price points in the developing world, but B, the potential for reverse innovation and disrupting developed world markets. Because I don't know if you've noticed, but one of the main issues that's actually impeding the future of our children is the cost of health care. Because every dollar you put into health is a dollar you can't put into education, is a dollar you can't put into roads, or is a dollar that you can't reduce taxes with to help businesses thrive. So this sort of disruption of high cost models, I think we'll see much more in the future. At the bottom is a guy who got a lot of press, the guy on the left, Fridros Akumou from Tanzania. Fridros noticed that when little kids were playing soccer in Tanzania, the sweaty socks attracted mosquitoes. So he isolated the compound in the smelly socks or the sweaty socks that did that, and essentially ended up putting it into this box that you see there. The box sits outside the hut in the village. It attracts mosquitoes at dawn and at dusk and kills the mosquitoes in the box. So it's complementary to other malaria technologies because when you think about bed nets, for example, those are all inside the hut and they keep the mosquitoes out. This is outside the hut and it attracts mosquitoes in order to kill them. And malaria is, of course, a problem that kills about 600,000 people a year. Most of them children, mostly in sub-Saharan Africa, most of those deaths preventable. So it's a nice complementary technology. It's also a good example of integrating innovations. There's a lot of science and technology in isolating that stuff. But he also has done interviews with villagers to see where the pools of mosquitoes are, tapping into their local village. That's a form of social innovation. And he has engaged local carpenters and studied how the construction of these boxes and taking them to scale can actually be used for local livelihoods. So again, it's a good example of bringing together the different types of innovation. The guy on the right is from Delhi, Ranjananda. And this is essentially the breathalyzer for tuberculosis. As you know, tuberculosis is a huge problem, including with the rise of multi-drug resistant tuberculosis. A lot of the problem is actually in diagnosis, especially deep into villages. The key diagnostic technology is still the same thing I was using when I was an intern. The ZN stain, the culturing of tuberculosis that takes a couple of weeks. So what Ranjan noticed was that actually the chemical signature on the breath of a patient with tuberculosis had a distinctive fingerprint. And this was due to certain volatile organic compounds in the breath of a patient with tuberculosis. So he developed this prototype machine that you see him breathing into and actually elicits that fingerprint and helps you diagnose tuberculosis from the breath and think about how much more portable that is and how much easier that is to reach into distant villages where diagnosis of tuberculosis is a problem. So that's some examples of half of what Grand Challenges Canada does. Really bold ideas driven by innovators. And one of the most humbling things for me and one of the most rewarding things is to be able to support innovators to pursue their bold ideas, especially innovators in the developing world to improve the lives of their families and of their communities. There's no question in my mind that talent is global. The only thing that's not global is opportunity. And we've created here I think the largest pipeline of innovation in global health enabling innovators in the developing world to pursue their dreams that has ever existed in the world. And it's very rewarding to be able to enable people to innovate. And I'm sure, Mark, this is the feeling that you had as you were enabling 300 fellows to innovate in bioethics. The other half of our work is on three defined challenges. And we've tried to select challenges that are neglected where we can be transformational. Canada doesn't have the same resources as other countries. So we have to be very selective and very smart in terms of where we use our taxpayer dollars. The first area we picked to focus in on was the issue of saving lives at birth. And President Zimmer has already mentioned that the deaths of women and especially of children are not evenly distributed. There is an incredible peak right around the time of birth. And right around the time of birth, it's shocking to think that 150,000 of the 300,000 or so women and 1.6 million of the 6 million or so children who die under the age of five die within a 72 hour window. And there has been extremely little innovation targeted against that particular selected time period. You know, the deaths of pneumonia, the deaths from diarrhea happen a bit later, but there are a lot of opportunities here for saving lives. And this is a program with which we partnered with USAID, the government of Norway, the Gates Foundation, and the UK aid, which formerly was known as DFID. And we've so far funded 39 innovations, some of them at the seed level, some of them at one or two million dollars transitioned to scale level to tackle this problem. It's obviously an important problem viewed as important. You can see a picture there at the launch where Hillary Clinton and Melinda Gates were both behind it and helping to launch it. And let me just give you some examples of the types of innovations that are being funded and supported by innovators here. So in terms of an example from science and technology, one example I'd like to bring to your attention is called the Odon device. So the story is there's this inventor called Jorge Odon in Argentina. And he was watching car mechanics fix his car and they were playing on the side and they were trying to figure out how to take a cork out of a wine bottle. And they put a balloon in the wine bottle to guide the cork out of the wine bottle. And he said, being an inventor, hey, I can apply this to, you know, delays in birth, in delivery and created a device called the Odon device that actually is a little balloon that goes over the head of the baby and guides the baby down the birth canal in cases of arrested labor. Now the significance of this is there's a huge problem with health workers sufficiently skilled to do cesarean sections and to deliver cases of arrested labor in the developing world. And this little device, which is the first innovation in assisted vaginal delivery in hundreds of years, you know, think forceps, think vacuum suction, is actually decreases the skill level that you need to deliver a baby with delayed birth. Now it's only been tested in about 30 women, normal women delivering in rich countries so far, but think about the potential of something like the Odon device. Another example of a business innovation is one of the groups that's being funded is called Cengenca Micro Health. It's essentially an insurance company in Nairobi. And what they've done is developed an electronic voucher system where women on their mobile phones can use the electronic payment voucher to pay taxi drivers for transportation to the clinic when they're in labor. Many of the deaths of women in labor, and these are shocking and needless deaths, happen because of transportation issues. And so here's a good example of essentially a social business trying to tackle the problem of saving lives at birth. A third example is actually shown on this slide, and that's an example of social innovation. This is Aminu Gawama. Aminu's mother died in childbirth. Aminu is from Nigeria, and I just want to tip my hat to Fumi and Shola and the great work being done here in terms of the Global Health Center and the development on global health working closely with the McLean Center. Aminu obviously developed a personal conviction to do something about the problem that killed his mother. And what he's done is he started working with imams in Nigeria to provide positive messaging about maternal health through Friday prayers. And in fact, in his words, he's focusing in on the quote-unquote refractory imams because I guess the non-refractory ones already provide positive messaging. But there's actually a lot of negative messaging about gender roles, about women. And this is a good example of a social innovation, and this actually gets pretty close to bioethics. You could have thought about this as a bioethics project. But Nigeria is actually one of the places where most of the women or a large majority of the women who die around the time of childbirth die, especially in northern Nigeria. And so that's an example of a social innovation. So this is one of the problems we're tackling, saving lives at birth. But it's not enough to save the life of a young child. You also have to think about what those lives will be like. There are 200 million children around the world who never reach their full developmental potential because their brains are knocked off by the time they're two or three, often in the first thousand days of life, from malnutrition, from lack of stimulation from their parents, from prematurity, and from infection like cerebral malaria. It's almost a completely neglected problem because there's been so much focus on the MDGs in survival, there hasn't been enough focus on child development. This is a terrible waste of human potential. Think about how much at the University of Chicago and the United States we care about talent. That is the fundamental substrate of prosperity because there's really only two ways a country can become rich. Either you have natural resources and you exploit them in a non-corrupt manner, or you're mining the ideas of your people, also known as talent, also known as innovation. So imagine, you know, essentially obviating that from the age of three. If you were an evil scientist and your goal was to keep poor countries poor, this would be a fantastic way to do it. So what Grand Challenge is Canada has done with the support of Lorraine Harper, that's the wife of our Prime Minister, who's the honorary chair of this initiative, has been to fund innovators to really look at this problem, take science-based solutions and take them to scale. So for example, a group in Indonesia is providing micronutrients to pregnant women and looking at the impact, not on the survival of the children, they've already done that, and it's improved survival, but on the cognitive development of the children. A group in South Africa is looking at coaching for women and families who have newborns in terms of interacting with their babies, stimulating their baby, and the effect of that on brain development and on cognition. A group in Colombia, and this is very interesting to me, is using kangaroo mother care, where the baby is held close to a family member, to the mother for the first days and weeks of life. The effect of kangaroo mother care, we know it improves survival, but they're looking at the effect on child development, on cognitive development. So there's some examples of the innovations in the Saving Brains program, another neglected area where we think we can be transformational. The final area we picked in terms of our defined challenges is global mental health. Mental health is up to 15% of the global burden of disease, and when you add up the total amount of spending on innovation in mental health in developing countries, it's less than $100 million. And just compare that with the amount we've spent on tuberculosis, on malaria, and on other conditions. So Grand Challenges Canada, we worked with NIH to list the Grand Challenges in global mental health, and then after the publication of these Grand Challenges, we announced that we were investing $20 million in stimulating innovations in the area of global mental health that addressed increased access, improved treatment, and addressing stigma. Stigma is a huge problem. You know, when we were doing these grants, we were at a proposal development workshop in Tanzania in Dar es Salaam, and I met a social worker there who told this following story. He said, you know, I went to this family and I said to the father, I said, how many children do you have? And he said, well, we have four children and another one. And I said, well, what do you mean this is social worker talking, I have another one. I said, the social worker said, well, can you show me your children? So he brings out the four children and the social worker says, well, what about the other one? The father and mother leave the social worker to a room in the back, unlock the door, and there behind a locked door is a child with mental illness, probably completely treatable, probably depression, which is probably the most common. And they're being referred to by their own family, stigmatized as the other one. Heard stories, one of the other grantees we supported in the Asian region, stories of children with Down syndrome walking down the street in the village who are just sort of swatted on the back of the head as they walk down the street because of the stigma associated with that. So just think about the amount of impact that simple innovations, often in service delivery, often in addressing stigma, can have on 15% of the global burden of disease. And that's what we are trying to achieve in the area of global mental health. There are about 250 times as many psychiatrists per capita in Canada as there are in Ethiopia. So you can't take a psychiatrically based model and transport it into the South. Often this is based on sort of online platforms, less skilled, but non-psychiatric health providers and innovations in addressing stigma. And towards the end of my talk, I also want to come back to the intersection between bioethics and some of these global challenges. So as President Zimmer mentioned, I had the very, very great privilege of working together with Harold Varmus, Elias Serhouni and others in the Gates Foundation as they identified the grand challenges in global health, initially funded them with $250 million and ultimately funded that program with half a billion dollars. And it was a great privilege to work with Harold Varmus. I'm not sure he would agree with you that he was, quote, a member of my team, but nonetheless it was really a great privilege and he's become a wonderful friend. One of the challenges that was identified there was the challenge of essentially dengue for which there is just an early vaccine but no really successful vaccine and no treatment and malaria. There's obviously different approaches, but one of them is to make it so the vectors, so the mosquitoes, the Anopheles mosquito and the other types of mosquito vectors can't transmit dengue or malaria. That was actually one of the grand challenges. At the time I remember there was a handful of scientists working on this problem. They never would have achieved the success without the enablement of this program and the ability to work together and share ideas. What you have now is actually successful field trials, both in genetically modified situations, so you've done gene transfer into the insects and driven them into the population so they don't transmit dengue or malaria, and in non-genetic ways by infecting the insects with a small intracellular parasite called Wolbachia, you've got successful field trials where these researchers have actually been able to reduce the rates of malaria and dengue in communities using that incredibly novel technique. Now, if there is any technology that will surely not see the light of day without ethics, even more so than live donor liver transplant, it is genetic modification of mosquitoes so they don't transmit disease. Think about the furor over genetically modified food. At least that just sits there on your plate. These mosquitoes, they're like a bad bee movie. They buzz around and everything. About eight years ago, my colleague Jim Lavery, who was the first bioethicist at the Fogart International Center at NIH, started to work on a model of engaging communities where these field tests were being done, where the technology would ultimately be deployed, and here's a picture of him working in Tapa Chula in Mexico. What Jim learned is it's one thing if you're sitting in Brussels and they say, no, these things, too much theoretical risk, precautionary principle, we're not doing it. It's another thing if you're sitting in a community in Tapa Chula, Mexico, and your kids are dying of dengue, and you've already got irradiated insects for agricultural uses that are being deployed, and so engaging those communities has been a critical part of moving this technology along. The last example I want to give you is actually the application of the Grand Challenges method. That was an example of ethics accompanying the science, like in the liver transplant example. The last example I want to give you is an example of actually the Grand Challenge approach itself being extended beyond science and technology. Think about that vector example. Beyond even the broader notions of social innovation, think about the different examples in saving lives at birth or in saving brains or in global mental health, and essentially to issues of, essentially, advocacy, things that come very close to ethics, and this picks up from the panel we just heard from. Think about the vaccine resistance that's been stimulated by Wakefield and by others. Think about the 12 cases of diphtheria that Laney was talking about, and now think about what that means for vaccination in the developing world, where every fifth child is not reached with vaccines. Some of those problems are issues of discovery and development of vaccines, no doubt. Many of them are problems of delivery, but the one D that really has been neglected in that whole situation is demand, and what is going on in the minds of the families, of the mothers, of the fathers in terms of accepting those vaccines. So what we did was we applied the Grand Challenges technique to that issue of vaccine demand. We ran a global challenge and ended up funding domestic civil society organizations in developing countries who had creative ways of engaging and beneficiaries in relationship to demand strategies. So for example, you see here on the top left, this is polio eradication campaign in Pakistan, and this is a local NGO that has gotten involved in working with families, with communities to really talk about polio eradication, the benefits at the grassroots level, and these grants by the way are $10,000, which really tells you what you can do for a relatively little amount of money on the advocacy side on this important problem. Think about the three countries where polio hasn't been eradicated. It's Afghanistan, Pakistan, and Nigeria. What did those three countries have in common? They have in common distrust of western approaches and obviously some of that is religiously and culturally based. I want to argue to you that actually the main barrier between us and polio eradication is not discovery of a polio vaccine, development of a polio vaccine, maybe not even the delivery, even though that's very closely involved with the demand issues. It is the demand side of the equation that really hasn't been adequately addressed. And so that's what this group is doing. Top right is a group that's engaged, I think, Chilean parliamentarians on the funding of the cervical cancer vaccine. In the middle is HIV vaccine, Freedom Fighters in South Africa. Bottom left is a group that has engaged children in Egypt using coloring books to talk about vaccines. And bottom right is a science cafe in Uganda. Just experiments on the demand side. Now USAID has gone a step beyond this about four weeks ago. They announced a challenge on using technology to document and prevent atrocities. And they are going to announce in December it's already up on their website a challenge that has to do with governance actually. It's called making voices count. It's a challenge in terms of creative ways of governance, anti-corruption efforts. Think about applying that technique to other areas. For example, criminalization of gay and lesbian behavior and violence against homosexuals in the developing world. It's criminal to be a homosexual in about 78 countries in the world. About 36 of them are in Africa. You often see a lot of violence associated with that. Think about applying a challenge approach to find creative ways to tackle that problem or issues of religious freedom. Also a huge issue around the world. So I want to argue that the Grand Challenges approach whilst it was born in mathematics grew up in the area of global health. Has a lot of applications well beyond not only to other sectors like agriculture and USAID has done one on powering agriculture looking at the intersection of energy and agriculture but also into fundamental issues of governance. So in closing, you know, what I want to say is this is a picture of my 50th birthday and my kids, two of my three kids and my wife Heather. What I want to say by showing this picture is just how fortunate we are in our living conditions, the wonderful education conditions at the University of Chicago. Not only is there some obligation for us to think globally but how rewarding it can be to take exactly the same skills we're prosecuting here in terms of achieving sustainable impact at scale and thinking about that as a global problem. So the question I would like to leave you with is not around the challenges that I've described but rather around the challenges that you face, how you can think about those in a more global perspective and how can you tackle the Grand Challenges in bioethics to improve global health. This is the book that Abdel and I wrote that President Zimmer mentioned and in closing I just want to thank you, present my Twitter address again so we can continue this conversation and thank Kelsey in our office who helped develop this presentation and maybe the last thought I'll leave and this is again a key to the genius mark that you have used. If there's one thing I've learned it's young people that one works with can change the world. People like Kelsey, people like Lauren Leahy who's on this slide who essentially developed this whole program. People like the 300 Fellows Mark that you've trained in this room who either now are young or at some time in the past were young and so would just like to thank you very, very much President Zimmer and Barry and Mary Ann and Mark and Anna and all of you for this great honor. I find it extremely humbling and the reason I find it humbling is I know that the work that all of you have done far outstrips what I've been able to present in this snapshot and the multiplier effect that you've all had on hundreds of thousands of families has been huge and with that I gratefully accept this award but really would like to acknowledge the work that everyone in the room has done, all your fellows have done and essentially dedicate it to the work that you all are doing. Thank you very much and I appreciate it.