 Good morning. I'm delighted to welcome you to the 25th anniversary McLean conference. A conference that each year remembers Dorothy Jean McLean, who was the original supporter and backer of the McLean Center, but she would be delighted to know that we've gone 25 years with the conferences, which she used to love. I had occasion a month or two ago to look at the program of the first conference, which was in 1988, and there were four or five speakers, several of whom will speak today. In fact, our first speaker, Dr. Singer, was actually on that earliest program as I think Susan Toll was. Susan is here. Where's Susan? I thought I saw Susan earlier. I want to acknowledge and thank the wonderful Board of Directors of the McLean Center, some of whom I spotted in the audience, Craig Dusheswa, Jeff Keller I saw, a moment ago Jeff, and of course Barry and Mary Ann will be along shortly. The McLean Center has had an especially good year this year. A few weeks ago we went down to Atlanta to accept the ASBH's Cornerstone Award. The fourth time they had made such an award for a program that changed the direction of the award is given for a program that changed the direction of American bioethics. Our predecessors included the Hastings Center and the Kennedy Institute. Both of them founded about 15 years before we were founded, and so we were extremely proud to accept that award. The Associate Directors of the Center, Laney Ross, is there, and Peter Angelos, Peter is there, and Dan Salmezzi and Marshall Chin along with the Dean came down with us to Atlanta to accept the award. I'm going to stay on time. We're going to get started. It's a full schedule as you know, having looked at the brochure. Our first speaker today will be Peter Singer. Peter was among the early group of fellows, I call them the pre-1989 fellows who came to us for fellowship training. Peter is now the Chief Executive Officer of Grand Challenges Canada. He's also the Director of the Sandra Rotman Center at the University Health Network, a professor of medicine at the University of Toronto, and the Foreign Secretary of the Canadian Academy of Health Sciences. Peter has advised the Bill and Melinda Gates Foundation on health care strategies and investments, has advised the UN Secretary General's Office, the Government of Canada, and several African governments on global health issues. Peter's talk today is called Social Entrepreneurship and Global Health, and Peter, it's wonderful to welcome you back to Chicago. Well, thank you very much, Mark. It really is terrific to be here, and just so we start in a festive mood, it's just amazing that it's the 25th of these conferences, and congratulations to you and the Associate Directors you mentioned for 25 conferences, 330 fellows, it's really an amazing accomplishment. Congratulations, Mark. Also, just so we get off on the right foot, since she's standing here, I wanted to thank Caroline and Kimberly and everyone else that's been involved in the organization of this on your behalf. So thank you all very much, and Kim. What I really want to talk about is bioethics and social entrepreneurship, just to pick up a bit on the conversation from last year. But before I do that, the third group I really want to thank, and I don't know if Barry's here yet, is Barry and the whole McLean family who've really done a fantastic job supporting this, and all the other supporters of this conference. Very unusual to come back for 25 years, that's sustainability, and that really has to do with the support of Barry, the McLean family, DJ and everyone else. So to get off on the right foot, why don't we give them a round of applause too. Thanks. So I want to talk about, pick up from last year, bioethics and social entrepreneurship, just a little context. I lead something called Grand Challenges Canada. Grand Challenges Canada is supported by the government of Canada. We support bold ideas with big impact in global health. We support innovators primarily in low and middle income countries, but also in Canada. We're focused on sustainability and scale. And about half of what we do is something called our STARS program, where we create tons of proof of concept grants. We funded about $295,000 bold ideas, where the idea really is just to find innovation wherever it exists and let people test it. And then 18 months later, those innovations can be supported with up to a million dollars to take them to scale. That's the big impact part. And I'll give a couple of examples of those. And the other half of our work is on three targeted challenges. Saving Lives at Birth, which focuses on stimulating innovation right around the time of birth, where there actually hasn't been much innovation, but where sadly most of the 300,000-plus women who die around the world every year and about 1.5 million of the 6.6 million children who die. So Saving Lives at Birth, Saving Brains, which is around child development, is arguing that it's not enough to save the life of a child. You also have to wonder what that child's life is going to be like. You know, if I asked you, how are you doing? And Martin said back to me, I'm surviving. That would be a very day-minimous answer. And yet that's the whole focus of our global health policy with women and children. And so Saving Brains is about child development. There's increasing evidence that in the first thousand days of life what happens to a child's brain from biological things like malnutrition, like malaria, from things like stimulation and reading to children, and from things like toxic stress are really having a lifelong influence on the child's life. So that's Saving Brains, and I'll give a couple of examples of that. And the consequences of these issues in child development, you know, if you mess up the brains of children in the first thousand days of life, and there's about 200 million children around the world who are in that situation, the long-term consequences are not only health, higher propensity towards depression, other non-communicable diseases, but you actually have lower wages and more criminality. So I've come around to the view that one of the main challenges in international development is actually child development. Our third area is about global mental health, which is the most neglected of neglected diseases. It's about 13 or 14% of the burden of disease, but the total amount of money spent on innovation in mental health in the world is probably less than $100 million total ever. And so, in summary then, Grand Challenges Canada supports bold ideas with big impact. We have these stars, we've got these targeted challenges, and overall we have supported about 400 innovations in three and a half years. And just the size of our turnover is about $56 million a year these days. And so it's a medium-sized foundation really trying to support innovation and social entrepreneurship, which is the focus of the talk. What I wanted to do today was just pick up with one example of a social entrepreneurship venture that I think I talked about a little bit last year and then talk about three recent deals that we have done that really sit at the interface between public and private finance and talk about how essentially public finance can be used to bring in private sector knowledge, private sector investment and move innovations forward that have developmental impact. So the social enterprise that I wanted to start by talking about, which I also talked about last year, just to give a very concrete focusing example was Soil Haiti. So Soil Haiti is an NGO. It's in Haiti obviously. And after the earthquake what they started to do was rent out toilets on a particular business model. So they developed these toilets called EcoSan toilets. They rented them to people at very low rates, developed a revenue stream. They pick up the effluent. They take it to a processing facility. They turn it into fertilizer. They grow vegetables. And so there's a whole business cycle around this social enterprise. And that social enterprise of Soil Haiti is at the moment providing sanitation services to about 2,600 people in Haiti and has created 40 jobs. So that's the typical thing you want to think about as social enterprise. Those things obviously grow through retained earnings. They've got ongoing revenue streams. They're driving the developmental impact. The goal in Soil Haiti is not the revenue. It's the sanitation and also the jobs. But that's created through this revenue stream. So that's where we were at last year. And I also defined social entrepreneurship for you. And you can think about social entrepreneurship as someone who's really, or a social entrepreneur, as someone who's really interested in changing the system, in disrupting the system, in achieving strong social and developmental goals. As Bill Drayton said, a social entrepreneur is someone who wants to not only buy and sell a fish, but transform the whole fishing industry. So picking up from there, thank you. Sorry about that. No problem. So thank you. Thanks very much. So pick it up from there. Great. Oh, there we go. So picking up from there, where I actually meant to start, is how many people here are on Twitter? Okay. So my Twitter address is at Peter A. Singer. If you follow me, I'll follow you, and we'll all get a net benefit out of being here this morning. So this is the overview of Grand Challenges Canada. It's always just our finance minister in Canada who helped to launch three and a half years ago. This is the description of the half and half, just a recap. And, you know, there's a lot of support for saving lives at birth, as you can see on the top right with Hillary Clinton and Melinda Gates. And for saving brains, that's the wife of our prime minister. And you see Mrs. Carter on the global mental health. This is the definition of a social entrepreneur I was talking about. Right at the top is from the Skoll Foundation, which is really probably the premier social enterprise foundation, social entrepreneurship foundation, and they define it as society's change agents, creators of innovations that disrupt the status quo and transform our world for the better. And there's the quote from Bill Drayton, the founder of Ashoka that I was talking about, about revolutionizing the fishing industry. These are just some pictures of that social enterprise, that I was talking about. You can see how people take pride in their toilets. Nicely decorated toilet on the left there. And there are some of the vegetables that are produced, some of the jobs that are produced. So this is what we were talking about last year, kind of retained earnings type of social enterprise. But what I want to talk about this year is three examples where we've used the public finance to bring in essentially blended value, leveraged in private finance, leveraged in private sector principles, where the issue still is primarily the social impact. But the engine, if you will, is on a commercial basis. So you would think about this as blended value impact first type of support. And the reason I want to do this in this context is a long time ago, 20, 25 years ago, 30 years ago, if you had a discussion in bioethics and you mentioned the private sector, that would be bad. Public sector good, private sector bad, just to oversimplify things. And we had many, many years of discussing conflicts of interest. And it's important actually to discuss conflicts of interest and it's important to be able to implement systems that guard against them. But I think we got to the point in bioethics where we were so interested on the conflict that we forgot about the interests. And what I want to do is actually present some examples that blend public and private principles, public and private finance, that show innovation, show entrepreneurship, that are maybe the other side of the story. And the reason I want to show it is, as I'll say at the end, I actually think what's happened here in the last 25 years is a fantastic example of social entrepreneurship. The way that the McLean Center has actually approached the field of medicine has been a social entrepreneurial type revolution in terms of changing the way health care workers interact with their patients. The way it's happened has been through this 330 fellows infiltrating throughout the U.S. and throughout the world. But I actually think about it in retrospect and I certainly didn't realize it at the time as a fantastic example of social entrepreneurship. And there is an analogy because, you know, for those of you that were in bioethics in the late 70s, early 80s, bioethics was simply a criticism from outside a field. It was a social movement. It was a social critique, you could argue. Much the same way as the conflicts of interest movement was a critique from outside the private sector. And that is maybe good for preconditioning social change, but I don't think it's very good for making social change, at least not in a stable democratic institutional context like medicine in the United States. And so I think about bioethics as a social enterprise. I think about clinical ethics as a social enterprise. I think about Mark as a social entrepreneur. And it's in that spirit. I want to zoom into this one issue of conflict of interest. So let me give you three concrete examples where we've actually used public finance to help move forward developmental goals. And this is the first example. It's called chip care. And you might think about this as the small and medium enterprise example. So about two years ago, we funded an engineering professor at the University of Toronto to develop an HIV CD4 technological platform. He was doing CD4 tests. We gave him $100,000. His technology was successful. About six months ago, we helped him go to a local angel investor group called Maple Leaf Angels. There was a lead angel who had already decided to invest. And the net result of that interaction was he spun off a company called, there was a spin-off company called Chip Care. The primarily based around this platform technology. The lead angel, Adrian Schnauer, who you see here personally invested in the company, became the chair of the board of the company. They hired the guy who was running Dignitas, which was a not-for-profit HIV thing in Malawi. And now what you've got, after our matching of the private angel investment, you had about $700,000 in angel money, about $700,000 from us. And then another five or six hundred thousand raised is a $2 million capitalized, small and medium enterprise that's developing an HIV technology that's novel. And the real novelty is not the CD4 technology, it's the platform that will be able to do multiple testing over time. You've got an experienced person who's bought and sold four businesses and knows how to take things to scale. You've got a commitment to this social good from the guy that they ensourced from the NGO, from the angel investor as well, as well as from other investors like ourselves. And you've got a company moving forward that's created jobs, got a developmental purpose. And that is the chip care example, sort of small and medium enterprise angel investment. So think about this as social angels. This we happen to do with a global health technology, but there's no reason that it couldn't apply to a technology or a service related to any other type of social good. So think about this model as a type of social angels model. The second example I wanted to give you is the ODON device. And anyone familiar with this? You might have seen this because this story was on the front page in the New York Times yesterday. And what happened, this whole story was actually pretty well told in a nice piece by Don McNeil. But what happened was eight years ago, there was this Argentinian car mechanic, and that was the title of the article, Argentinian car mechanic comes up with. So there was this Argentinian car mechanic, Jorge ODON. And eight years ago, he's an inventor and a car mechanic. He's in his garage. He's watching his buddies do a parlor trick, which is they stuck a quark in a wine bottle, and the question is how do they get the quark out? So they used a little balloon to bring the quark out of the wine bottle. So Jorge goes to bed that night, wakes up at 4 a.m. and says, hey, I have an app for that. His wife says you're crazy. He develops the ODON device, which is a little balloon, right on the right there, that goes over the head of the baby in the case of obstructed labor or prolonged second stage of labor to help deliver the baby. There's actually 10 million babies around the world, mothers and babies with this sort of birth complication in terms of morbidity and mortality. There's been very little innovation in this field since the development of forceps hundreds of years ago. The issue around forceps, of course, is they require a very skilled operator. What's interesting with this thing is that it can be used by midwives, so you can see the much broader applicability. So what happened was Jorge put a thing on YouTube about it. It was noticed by an obstetrician at the World Health Organization called Mario Marialdi about three, four years ago. Mario, together with Jorge, applied to that second program, the first program I mentioned, Saving Lives at Birth. About two, two and a half years ago, the I.D. Grand Challenges Canada, Gates Foundation, Norway, and UK aid provided a $250,000 grant for proof of concept. That helped to develop the device and test it in 30 healthy women. It was shown to work, at least in that proof of concept. And about two months ago, on the closing bell of the NASDAQ, Gary Cohen, who's there on the right, the executive vice president of Becton Dickinson, announced that Becton Dickinson or B.D. was going to pick up that device and commercialize it in an affordable manner in the developing world. Kind of on a shared value basis. So shared value is the notion that you're trading off margins of profit for much bigger markets in the developing world, that you are pursuing something, both for social good and on a commercial basis. Becton Dickinson had done this before, obviously with syringes. It knows how to commercialize, it knows how to manufacture, it knows how to do the regulation, it knows how to do the health worker training. All the practical things that maybe an inventor or an academic wouldn't necessarily know how to do. And Becton Dickinson said that they will be investing up to $15 million to actually bring the ODON device to market during the day period. So this is a second example, whereas the chip care example, if you will, is a small company, sorry, I'm going the wrong way, whereas the chip care example, if you will, is maybe a small company example with social angel financing. The Becton Dickinson example is a large company example of social benefit on a commercial basis. And so that's the second example that I want to show. It was on the front page of the Times. It was actually the second most emailed article yesterday on the New York Times website. The third example I want to use is this Global Health Investment Fund. So the Global Health Investment Fund was announced in September. It is a $100 million fund that was structured by JPMorgan. And Grand Challenges Canada was one of the anchor investors. We put in $10 million. The investments are going to go into late stage companies with diagnostic technologies, with vaccines, with devices and with drugs. This is a picture of our development minister with Jamie Dimon and with Bill Gates at the launch of the fund. You can see the various partners at the bottom. You've got governments like Sweden and Germany. You've got large companies and there's also some high net worth individuals. So this is $100 million of capital for global health technologies. There's a guarantee that the things will be commercialized on an affordable basis. And the idea here is the key to this thing and the reason that people one of the reasons, the primary reason people invest is because they're interested in social benefits in terms of the investors. But the sort of unique feature of this fund is the risk protection. So what the Gates Foundation and Sweden did is say if you all make money you can keep it as an investor. But if you lose money we'll protect you against the loss. We won't fully protect you, but for every dollar that you put in you'll only lose 40 cents on the downside. We'll protect the other 60 cents. So here's a case where Gates Foundation and Sweden actually didn't need to put in any money. They just needed to provide a guarantee using their balance sheet. Here's another example. This is also kind of on the other side small and medium enterprises but this is the financing side of it. So these are three examples in global health of situations where public and private interests are brought together in a way to pursue both developmental goals and primarily developmental goals if those weren't there these things wouldn't exist but to do it on a somewhat commercial basis to keep the thing moving to make sure it's sustainable and also to tap the resources the private sector which are not as well tapped maybe as they might be in an area like global health. So I actually have a little video on this fund I'm not sure given the time I think probably will rather leave the time for discussion and I'll just kind of summarize so what we've tried to create is this kind of this kind of ecosystem thinking about how different types of capital might come together on the left we've tried to create a very robust pipeline of proof of concept so and here these are grants they're between 100 and 250,000 we've done about 400 of them and I'm sorry but 350 of the proof of concept ones and the idea is that there's very high risk at that point it's completely reasonable to have public finance that supports that risk so the first 100,000 into the chip care the first 250 into the ODON device these are all very risky investments and they would be in the red but as we move along the notion is not purely public finance you know there's not enough money in all the treasuries of all the governments of the world and add in all the foundations of the world to solve the global health challenges that we face so the notion in the yellow part which is transition to scale is to try and use that public money to bring in private capital private expertise and I gave you the example of chip care the example of the ODON device the example of the global health investment fund and that's what the yellow thing is about we've set up an investment committee that looks at these things which includes the guy who scaled oral rehydration solution in Bangladesh it also includes venture capitalists and in the green you've got the 1 to 2 million dollar plus range of investments and two examples of that actually are the ODON device and the global health investment fund which was a 100 million dollar investment so this is kind of the kind of the ecosystem we have tried to we've tried to create around the fund and around some of these things and where I want to come back to in the end is back to where we're at the reason I went on this little journey is twofold at the level of social enterprise I actually think that what's happened here as I mentioned over the past 20 years is an example of social entrepreneurship I think the first social entrepreneur I met was Mark I didn't really realize it at the time but if you look at the definition of social entrepreneurship that's you know put forward by the school foundation that I just put back on this slide you'll see how well it fits what Mark has been doing so as someone who now for the last 2, 3, 4 years has been steeped in this idea of social enterprise only in respect do I realize that what's happened here over the past 25 years is actually a really good example of social entrepreneurship second I wanted to delve substantively into some of these public-private issues because this is the other side of conflict of interests it focuses not so much on the conflict it focuses more so on the interests and what I've come to learn over the past year or two or three is that successfully managed successfully structured these public-private ventures can be very very helpful in achieving developmental goals in the area of global health the area I'm working in but I want you also to think about it in the context of the areas that you're working in whether that's inner city mental health or other types of areas course there's areas that are going to be primarily areas of public finance so for example we support a lot of work in global mental health and I think in that area especially at this time service delivery models in global mental health are primarily going to be financed by domestic donor governments so I think one has to be you know not stupid about the way one approaches this interface but I did want to show some examples more on the interest side and then we can work back to talk about the conflict side because I actually think that to have proceeded just strictly within the focus on public finance for its own sake without this kind of leveraging would itself have not been such a wise idea almost unethical in the face of the deaths of women and children that we confront with the abilities of private sector companies and of private finance to actually do something about that huge global and developmental challenge so I'm going to stop there we still have some time for discussion and I'm going to thank you very much and look forward to the rest of the morning so thank you and let's have some discussion yeah I mean so relative to these amounts of capital I'm not sure the professional organizations do have tremendous amounts of money they have tremendous amounts of expertise they do have foundations they do have a donor base and they have a lot of value and let me give you one concrete example so and probably this is how those organizations can best play so the American Academy of Pediatrics has done a lot of work on toxic stress toxic stress is inherent to the idea of messing up kids brains in the first thousand days of life it's worked with the Harvard Center on the developing child and other groups it's done position papers that sort of work done by a professional organization the work that they do best namely those sort of knowledge transfer products are an extremely useful piece of a broader agenda on early child development and on saving brains is what we call it so I think that professional societies like that have a tremendous role to play but not because of their capital not because of their financial capital rather because of their knowledge capital and the way I put it when we were talking about the Zodan device I do this because I'm Canadian it's like a hockey team everybody has a position to play and you've got the inventor you've got the scientist you've got the company that knows how to manufacture you've got the professional organization kind of knowledge transfer products and I think sometimes we all try to play all the positions on the team at once and so in that type of ecosystem what we're trying to do is arrange a world where people can play to their strengths if you're good at defense play left wing don't play goalie and with that kind of team approach to global health and actually all social developmental goals I think we'll see better results on the social impact side and so that's a comment on the professional things it's also again coming back to this idea of conflict of interest if you demonize a whole sector like the private sector that has a set of expertise a set of capital that you need to get to your goal or to get to the goal on the other person's side that's not going to help you to reach your goal and that's one of the key lessons I've learned so thank you very much for that other questions or comments?