1 00:00:06,297 --> 00:00:09,551 [mosquito buzzing] 2 00:00:09,634 --> 00:00:11,636 [whimsical music playing] 3 00:00:17,934 --> 00:00:19,102 [buzzing continues] 4 00:00:19,185 --> 00:00:20,145 [buzzing stops] 5 00:00:21,187 --> 00:00:24,190 [man 1] How do you personally feel about mosquitoes? 6 00:00:25,108 --> 00:00:27,027 Oh, I'm certainly annoyed by them. 7 00:00:27,527 --> 00:00:30,071 Uh, in the summer in Seattle, 8 00:00:30,613 --> 00:00:33,450 you know, they bite and you… you get welts. 9 00:00:33,533 --> 00:00:35,201 And, uh… 10 00:00:35,285 --> 00:00:37,412 -[inquisitive music playing] -[faint buzzing] 11 00:00:39,330 --> 00:00:41,458 [thunder rumbles] 12 00:00:41,541 --> 00:00:45,712 But I've never lived anywhere where there was malaria. 13 00:00:46,671 --> 00:00:50,717 [man 2] are the transmitters of malaria to man, 14 00:00:51,384 --> 00:00:54,304 and malaria is transferred from man to insect, 15 00:00:54,387 --> 00:00:55,972 and then on to man again. 16 00:00:57,974 --> 00:01:01,644 [Gates] You know, malaria kills 400,000 kids a year. 17 00:01:03,563 --> 00:01:07,192 But it's not in rich countries at all. 18 00:01:07,776 --> 00:01:10,570 So, it's a type of neglected disease. 19 00:01:12,697 --> 00:01:14,407 When it comes to diseases, 20 00:01:14,491 --> 00:01:18,411 the opportunity is to develop cutting-edge technologies 21 00:01:18,495 --> 00:01:20,663 like vaccines, antibodies, 22 00:01:20,747 --> 00:01:24,542 and even more controversial techniques like gene editing, 23 00:01:25,043 --> 00:01:28,546 and use those to try and eradicate these diseases 24 00:01:28,630 --> 00:01:29,714 from the face of the planet. 25 00:01:29,798 --> 00:01:31,841 [inquisitive music continues] 26 00:01:32,759 --> 00:01:36,304 It would be one of mankind's biggest achievements 27 00:01:36,971 --> 00:01:38,598 to finish off malaria. 28 00:01:40,058 --> 00:01:42,060 [opening theme music playing] 29 00:01:49,609 --> 00:01:50,860 [music fades] 30 00:01:50,944 --> 00:01:53,905 -[indistinct chatter in the distance] -[crickets chirping] 31 00:01:55,573 --> 00:01:57,450 [brakes screech faintly] 32 00:01:57,534 --> 00:02:01,538 -[indistinct chatter] -[babies crying] 33 00:02:01,621 --> 00:02:05,500 [babies continue crying, coughing] 34 00:02:08,253 --> 00:02:10,213 [woman 1 in Dholuo] Malaria is such a problem here. 35 00:02:10,296 --> 00:02:12,090 You have to go to the hospital, 36 00:02:12,173 --> 00:02:17,637 and if you don't have money, malaria will kill you. 37 00:02:18,596 --> 00:02:20,181 [woman 2] It can kill the baby. 38 00:02:21,057 --> 00:02:23,852 It has killed many babies. 39 00:02:23,935 --> 00:02:27,480 It killed a baby who was close to me. 40 00:02:29,399 --> 00:02:30,859 My sister's baby. 41 00:02:32,819 --> 00:02:34,279 [woman 1] She started convulsing. 42 00:02:34,362 --> 00:02:36,865 Her fever was high. I did not waste time. 43 00:02:36,948 --> 00:02:39,784 I caught a ride and rushed her here. 44 00:02:40,285 --> 00:02:42,829 She had very strong malaria. 45 00:02:43,788 --> 00:02:46,040 [in English] Sorry. Sorry, baby girl. 46 00:02:46,124 --> 00:02:48,042 [woman 3] We got one. One oxygen. 47 00:02:48,126 --> 00:02:50,753 Ma'am, can you fill for us, oxygen? 48 00:02:50,837 --> 00:02:52,922 [soft music playing] 49 00:02:53,882 --> 00:02:58,303 When you sit in those wards, you know, you just see how frantic things are 50 00:02:58,386 --> 00:03:02,056 because the wards are never adequately staffed 51 00:03:02,599 --> 00:03:04,726 because malaria is quite seasonal. 52 00:03:04,809 --> 00:03:06,352 It's as the rainy season comes, 53 00:03:06,436 --> 00:03:10,398 then the mosquito population grows exponentially. 54 00:03:10,481 --> 00:03:12,609 [thunder rumbling] 55 00:03:15,695 --> 00:03:16,613 [man 3] As a kid, 56 00:03:16,696 --> 00:03:20,533 I can't even tell you how many episodes of malaria I went through. 57 00:03:21,034 --> 00:03:24,412 I can still clearly see, you know, the picture of my father. 58 00:03:24,913 --> 00:03:26,748 He was standing next to my bed, 59 00:03:27,540 --> 00:03:28,541 looking at me. 60 00:03:28,625 --> 00:03:32,378 I could really see, you know, a lot of fear in his eyes. 61 00:03:32,462 --> 00:03:33,713 [babies cooing] 62 00:03:33,796 --> 00:03:39,844 [Diabaté] If malaria was killing 600,000 people in the US or in Europe, 63 00:03:40,595 --> 00:03:42,805 the problem would have completely changed by now. 64 00:03:42,889 --> 00:03:44,891 [soft music continues] 65 00:03:48,645 --> 00:03:49,979 [birds chirping] 66 00:03:50,063 --> 00:03:54,317 [keyboard clacking] 67 00:03:55,652 --> 00:04:00,657 Malaria tends to be most concentrated in the poorest populations, 68 00:04:00,740 --> 00:04:03,117 the populations with the least access to health care. 69 00:04:03,201 --> 00:04:04,452 [inquisitive music playing] 70 00:04:04,535 --> 00:04:08,206 [Welkhoff] There's this arc from Mali, Burkina Faso, Côte d'Ivoire, 71 00:04:08,289 --> 00:04:11,209 through Nigeria and the Democratic Republic of Congo, 72 00:04:11,793 --> 00:04:15,797 where the sheer intensity of transmission that needs to be stopped 73 00:04:15,880 --> 00:04:18,633 is unlike just about anything else we have to face. 74 00:04:22,095 --> 00:04:26,599 Malaria is a parasite that you get from mosquito bites. 75 00:04:27,684 --> 00:04:29,978 The parasite travels and infects your liver, 76 00:04:30,520 --> 00:04:33,439 and after staying in the liver for a period of time, 77 00:04:33,523 --> 00:04:38,486 one infected liver cell will release 400,000 extra parasites 78 00:04:38,569 --> 00:04:40,738 that start invading your red blood cells. 79 00:04:41,489 --> 00:04:45,326 The parasite invades a red blood cell, digests the red blood cell, 80 00:04:45,410 --> 00:04:48,746 then bursts the red blood cell to keep invading more and more. 81 00:04:49,956 --> 00:04:51,958 So it takes over your bloodstream. 82 00:04:53,001 --> 00:04:56,337 When all your red blood cells that are infected burst, 83 00:04:56,421 --> 00:04:57,714 you… you feel it. 84 00:04:57,797 --> 00:05:01,384 You feel the intense chills, the spikes of fever, the sweats. 85 00:05:01,467 --> 00:05:03,219 You're exhausted. 86 00:05:03,303 --> 00:05:05,513 In some cases, it's hitting your body so hard 87 00:05:05,596 --> 00:05:07,557 that you feel nausea, and you're vomiting, 88 00:05:07,640 --> 00:05:09,600 and that's a relatively mild case. 89 00:05:10,310 --> 00:05:14,397 As it progresses, it can lead to respiratory distress, 90 00:05:14,480 --> 00:05:18,443 cause long-lasting anemia, inflammation in your brain, 91 00:05:18,526 --> 00:05:21,362 and in far too many times, it can lead to death. 92 00:05:21,863 --> 00:05:24,115 The youngest children, the vulnerable, 93 00:05:24,198 --> 00:05:28,828 pregnant women will experience a real devastating burden of malaria. 94 00:05:30,121 --> 00:05:32,040 [inquisitive music playing] 95 00:05:33,458 --> 00:05:36,627 [man 4] Originally, malaria was a form of aquatic algae, 96 00:05:36,711 --> 00:05:38,796 some 600 to 800 million years ago. 97 00:05:38,880 --> 00:05:42,091 It actually still has vestiges of photosynthesis. 98 00:05:42,175 --> 00:05:45,345 We think more modern malaria comes from birds, 99 00:05:45,428 --> 00:05:47,555 roughly 130 million years ago. 100 00:05:47,638 --> 00:05:50,224 [inquisitive music continues] 101 00:05:50,308 --> 00:05:52,268 [Winegard] It's a symbiotic relationship. 102 00:05:52,352 --> 00:05:56,022 The pathogens use us, essentially, to help them procreate, 103 00:05:56,606 --> 00:05:59,108 and malaria needs two hosts. 104 00:05:59,192 --> 00:06:02,111 It needs the mosquito and then a secondary host, 105 00:06:02,195 --> 00:06:05,281 whether that be humans, reptiles, amphibians, the great apes. 106 00:06:05,365 --> 00:06:07,784 -[faint grumble] -[Winegard] Uh, we all have malaria. 107 00:06:07,867 --> 00:06:09,035 [mosquitos buzzing] 108 00:06:09,118 --> 00:06:11,037 People don't pay attention to it. 109 00:06:11,120 --> 00:06:14,916 Americans are particularly good at not thinking about anything 110 00:06:14,999 --> 00:06:17,126 that doesn't affect them instantly. 111 00:06:17,210 --> 00:06:18,586 [inquisitive music playing] 112 00:06:18,669 --> 00:06:21,881 [Specter] Malaria was something that affected my grandparents. 113 00:06:22,423 --> 00:06:26,302 At the turn of the 20th century, it was a big deal. 114 00:06:26,386 --> 00:06:28,971 I mean, the Centers for Disease Control is in Atlanta 115 00:06:29,055 --> 00:06:32,100 because that's where malaria was devastating. 116 00:06:32,683 --> 00:06:34,852 [man 5] are nearby, 117 00:06:34,936 --> 00:06:37,772 searching for their evening meal of human blood. 118 00:06:37,855 --> 00:06:40,983 [Specter] Malaria was a big deal in this country, 119 00:06:41,067 --> 00:06:43,736 and it went from being a really big deal 120 00:06:43,820 --> 00:06:44,946 to nothing. 121 00:06:45,029 --> 00:06:48,241 People don't die of malaria anymore because we are able to control it. 122 00:06:48,324 --> 00:06:50,910 -[inquisitive music continues] -[airplane whirring] 123 00:06:50,993 --> 00:06:55,164 If you rewind to the big global malaria eradication effort 124 00:06:55,248 --> 00:06:57,625 that was launched in the mid-20th century, 125 00:06:57,708 --> 00:07:02,171 the tools that were used at the time like environmental modification, 126 00:07:02,255 --> 00:07:04,966 making sure there were no mosquito breeding sites, 127 00:07:05,049 --> 00:07:07,635 doing large-scale spraying of insecticides. 128 00:07:07,718 --> 00:07:10,012 All of these things worked at the time. 129 00:07:10,096 --> 00:07:14,684 But those aren't necessarily the right set of tools to deploy now 130 00:07:14,767 --> 00:07:17,645 in the places where malaria still remains entrenched. 131 00:07:17,728 --> 00:07:19,814 [inquisitive music playing] 132 00:07:21,732 --> 00:07:23,693 The ski jumping. That's pretty exciting, isn't it? 133 00:07:23,776 --> 00:07:27,655 [Gates] It was in the 1990s, I was thinking along with Melinda about, 134 00:07:27,738 --> 00:07:30,450 "Okay, where should the resources go?" 135 00:07:30,533 --> 00:07:34,745 And looking at what children die of 136 00:07:35,329 --> 00:07:38,916 and stunned to find out it was pneumonia, diarrhea, and malaria. 137 00:07:39,417 --> 00:07:43,004 When I saw how little money was going into malaria, 138 00:07:43,087 --> 00:07:45,089 it was a rather shocking thing. 139 00:07:45,173 --> 00:07:46,799 [grandiose music playing] 140 00:07:46,883 --> 00:07:50,303 [man 6] are used on this dread disease 141 00:07:50,386 --> 00:07:52,138 that attacks our young. 142 00:07:52,221 --> 00:07:54,640 Again war, destructive and terrible, 143 00:07:54,724 --> 00:07:57,268 contributes one of its discoveries to save life. 144 00:07:57,351 --> 00:07:59,562 Armies used to fund a lot of malaria work 145 00:07:59,645 --> 00:08:02,315 because soldiers would go off to malarious places and die. 146 00:08:02,940 --> 00:08:07,153 But then the medicines that protect the soldiers were considered good enough, 147 00:08:07,236 --> 00:08:09,405 and so it was no longer a priority for them. 148 00:08:11,782 --> 00:08:17,914 There's more money put into baldness drugs than are put into malaria. 149 00:08:18,748 --> 00:08:20,833 Now, baldness is… it's a terrible thing. 150 00:08:20,917 --> 00:08:22,585 -Uh… -[crowd laughs] 151 00:08:22,668 --> 00:08:27,381 In the year 2000, the Gates Foundation is created, 152 00:08:27,965 --> 00:08:31,010 and, you know, this saving children's lives 153 00:08:31,093 --> 00:08:35,431 could be our top priority and really make a huge difference there. 154 00:08:37,391 --> 00:08:38,893 [camera shutters clicking] 155 00:08:38,976 --> 00:08:40,645 Uh, malaria is getting worse. 156 00:08:41,145 --> 00:08:43,564 Bed nets can make a fantastic difference. 157 00:08:44,065 --> 00:08:46,567 Eventually, uh, there will be a vaccine. 158 00:08:46,651 --> 00:08:49,654 In terms of value for money, which is what American people want, 159 00:08:49,737 --> 00:08:52,281 they won't find better value for money. 160 00:08:52,365 --> 00:08:54,700 [man 7] I met Bill Gates 161 00:08:55,910 --> 00:08:57,745 over some cheeseburgers, 162 00:08:58,538 --> 00:09:01,374 um, to discuss global health. 163 00:09:01,457 --> 00:09:04,126 I think he get… He's… he's offended by 164 00:09:04,210 --> 00:09:09,215 the stupid, wanton waste of anything, 165 00:09:09,757 --> 00:09:11,926 but human life at the top of the list. 166 00:09:12,969 --> 00:09:14,679 That seems to set him off. 167 00:09:14,762 --> 00:09:16,264 I mean, but he'll argue with anything. 168 00:09:16,347 --> 00:09:17,181 [phone ringing] 169 00:09:17,265 --> 00:09:19,850 [Bono] In the early days, it was wild. 170 00:09:20,351 --> 00:09:22,270 You know we call him Kill Bill? 171 00:09:22,853 --> 00:09:26,941 I can remember finance ministers being in meetings, and he's going… 172 00:09:27,024 --> 00:09:28,568 [mimics Gates] "You're lying." 173 00:09:28,651 --> 00:09:32,113 "You're lying. That's a lie. You know it's a lie." 174 00:09:32,196 --> 00:09:34,240 And I'm like, "Uh…" 175 00:09:34,323 --> 00:09:37,785 Yeah, he's a bit punk rock, Bill Gates. You don't think of that, do you? 176 00:09:37,868 --> 00:09:41,080 New vaccinations are needed so that, uh, the children live. 177 00:09:41,831 --> 00:09:46,002 How much are we, all as one humanity, trying to help each other? 178 00:09:47,003 --> 00:09:51,048 You know, we made a $30 million grant for malaria work. 179 00:09:51,132 --> 00:09:54,969 I was shocked that made us the biggest funder in the entire field. 180 00:09:55,052 --> 00:09:56,929 [crowd applauding] 181 00:09:57,013 --> 00:10:00,975 [Gates] The people who die of malaria don't have a voice in the marketplace. 182 00:10:01,058 --> 00:10:03,477 There's not a profit opportunity. 183 00:10:03,561 --> 00:10:09,275 The market for dog food is 40 times bigger than the market for malaria. 184 00:10:10,109 --> 00:10:14,780 Since 1990, we have cut extreme poverty and childhood mortality in half. 185 00:10:15,573 --> 00:10:16,699 You tend to believe 186 00:10:16,782 --> 00:10:19,869 when Bill says we can do something that we can do it. 187 00:10:19,952 --> 00:10:21,454 [man 1] Do you think we can do it? 188 00:10:21,954 --> 00:10:23,039 Absolutely. 189 00:10:23,122 --> 00:10:24,582 [inquisitive music playing] 190 00:10:24,665 --> 00:10:27,251 -[children yelling] -[brakes screech] 191 00:10:27,335 --> 00:10:29,211 [Gates] So tell me about Diabaté. 192 00:10:29,295 --> 00:10:32,798 [Welkhoff] Uh, Diabaté is leading the Target Malaria work in Burkina Faso. 193 00:10:32,882 --> 00:10:35,635 His background was a lot in entomology. He-- 194 00:10:35,718 --> 00:10:36,552 Mosquitoes? 195 00:10:36,636 --> 00:10:38,721 [Welkhoff] Mosquitoes. The world expert in identifying 196 00:10:38,804 --> 00:10:40,890 where mosquitoes are gonna be swarming for mating. 197 00:10:40,973 --> 00:10:44,268 -[dramatic music playing] -[faint buzzing] 198 00:10:48,481 --> 00:10:49,857 -[Gates] Hi. -[Diabaté] Hello. 199 00:10:49,940 --> 00:10:52,109 -[Gates] Good to see you. -[Diabaté] Good to see you too. 200 00:10:52,693 --> 00:10:56,405 First of all, I will say that statistics are really good storytellers. 201 00:10:56,989 --> 00:11:00,910 Of these 247 million cases worldwide every year, 202 00:11:01,827 --> 00:11:05,790 Africa's bearing about 235 million cases… 203 00:11:05,873 --> 00:11:07,333 -[Gates] That's incredible. -…alone. 204 00:11:07,875 --> 00:11:09,168 The real problem today is that 205 00:11:09,251 --> 00:11:12,004 when you look at the conventional tools that we have in hand, 206 00:11:12,088 --> 00:11:15,800 you take bed nets and then you take the new drugs and everything, 207 00:11:15,883 --> 00:11:18,052 they have done a really incredible job. 208 00:11:18,135 --> 00:11:23,015 But right now, it seems like they have reached the protective limit. 209 00:11:23,599 --> 00:11:25,101 With the current tools, basically, 210 00:11:25,184 --> 00:11:29,814 it looks like you are sitting in a really very fast driving car, 211 00:11:30,314 --> 00:11:31,399 and your target is the moon. 212 00:11:31,482 --> 00:11:33,526 -[chuckles] -[Diabaté] How are you going to make it? 213 00:11:33,609 --> 00:11:35,695 You absolutely need a completely different engine. 214 00:11:35,778 --> 00:11:37,071 [inquisitive music playing] 215 00:11:37,154 --> 00:11:39,657 We need to put a lot of effort and research 216 00:11:39,740 --> 00:11:42,743 trying to come up with new tools. 217 00:11:42,827 --> 00:11:43,828 [machine chimes] 218 00:11:44,495 --> 00:11:47,998 [Welkhoff] To beat malaria, we'll have to put a number of different tools together. 219 00:11:48,082 --> 00:11:50,668 We have to get better at going after the mosquito 220 00:11:50,751 --> 00:11:52,795 and keeping mosquitoes from transmitting to people. 221 00:11:52,878 --> 00:11:55,548 We also have to do a better job of protecting people, 222 00:11:55,631 --> 00:11:58,801 and we have to do a better job of killing the parasites that do get to people. 223 00:11:58,884 --> 00:11:59,969 And we're also looking at, 224 00:12:00,052 --> 00:12:02,430 "How can we protect people when they still get bites 225 00:12:02,513 --> 00:12:06,016 to make sure that the parasite never really has a chance to take root?" 226 00:12:06,892 --> 00:12:10,062 [Gardy] The reason that we are still dealing with it now 227 00:12:10,146 --> 00:12:13,691 is because the malaria parasite, it's got a complicated life cycle. 228 00:12:13,774 --> 00:12:17,820 The parasite looks different at every stage of its life cycle. 229 00:12:19,071 --> 00:12:22,283 [Welkhoff] The malaria parasite has a bunch of really complicated machinery 230 00:12:22,366 --> 00:12:25,369 that it uses to confuse the immune system, 231 00:12:25,453 --> 00:12:28,622 to evade the best thing that our immune systems can throw at it. 232 00:12:29,248 --> 00:12:30,916 Uh, the parasite, it's evolving. 233 00:12:31,667 --> 00:12:34,462 The drugs that we use that have been saving many lives, 234 00:12:34,545 --> 00:12:37,214 the parasite is now evolving resistance to those drugs. 235 00:12:37,798 --> 00:12:42,011 And so to develop a vaccine, we have to really outsmart the parasite. 236 00:12:43,471 --> 00:12:48,017 Obviously, the big goal is to have an effective vaccine 237 00:12:48,100 --> 00:12:50,269 that's cheap, reliable, 238 00:12:50,352 --> 00:12:53,022 and that could be distributed throughout the world. 239 00:12:53,105 --> 00:12:56,317 -[indistinct shouting] -[horns honking] 240 00:12:56,400 --> 00:12:58,527 [dogs barking in the distance] 241 00:13:00,529 --> 00:13:02,364 -[horns continue honking] -[indistinct chatter] 242 00:13:08,370 --> 00:13:09,538 [man 8 in Dholuo] How are you? 243 00:13:10,080 --> 00:13:11,123 [in English] Yeah. 244 00:13:11,207 --> 00:13:16,587 These are where the seminal studies were done for the RTS,S malaria vaccine. 245 00:13:17,630 --> 00:13:19,465 When we did our first vaccine trial, 246 00:13:19,548 --> 00:13:21,634 it was all done in this room and this room. 247 00:13:22,718 --> 00:13:25,596 And so I have a lot of history between these two rooms. 248 00:13:26,514 --> 00:13:30,559 [Seder] I had worked on a malaria vaccine for close to seven years. 249 00:13:31,352 --> 00:13:34,396 We had great excitement when we started this trial. 250 00:13:34,480 --> 00:13:35,981 I really thought it would work, 251 00:13:36,065 --> 00:13:39,109 and when we got the results, it was extremely disappointing. 252 00:13:40,402 --> 00:13:43,280 Malaria causes death every two minutes. 253 00:13:43,364 --> 00:13:45,908 I think that's what it comes out to be. 254 00:13:45,991 --> 00:13:49,620 It's around ten, fifteen thousand deaths per week. 255 00:13:49,703 --> 00:13:51,914 Every week, every year. 256 00:13:53,541 --> 00:13:55,960 You have to take the data at hand, 257 00:13:56,043 --> 00:13:58,712 look at it, and then come up with a different solution. 258 00:13:58,796 --> 00:14:02,967 And so that led me to pivot to a new intervention. 259 00:14:03,050 --> 00:14:04,718 [inquisitive music playing] 260 00:14:04,802 --> 00:14:08,055 [Seder] We've isolated a monoclonal antibody 261 00:14:08,138 --> 00:14:12,017 that is extremely effective at preventing malaria. 262 00:14:12,768 --> 00:14:17,439 And so the question is, "Is this something safe that could work?" 263 00:14:18,107 --> 00:14:20,276 [inquisitive music continues] 264 00:14:22,486 --> 00:14:25,823 [woman 4] Since there are only a few hundred malaria parasites 265 00:14:25,906 --> 00:14:28,993 that are injected each time a mosquito bites you, 266 00:14:29,076 --> 00:14:32,955 if you can stop the parasite there with a shot of antibody, 267 00:14:33,038 --> 00:14:37,626 you can essentially stop malaria from happening inside the human host. 268 00:14:39,336 --> 00:14:42,798 [Seder] It binds the parasites before they get into the liver. 269 00:14:42,882 --> 00:14:45,259 It… It's called controlling the host. 270 00:14:45,342 --> 00:14:48,345 You're giving them the immune response you want. 271 00:14:49,346 --> 00:14:52,808 Can we give a single dose at one time, 272 00:14:53,350 --> 00:14:58,898 and will that dose of antibody provide protection over the course of one year, 273 00:14:59,648 --> 00:15:02,484 or would you need a second dose at six months? 274 00:15:02,568 --> 00:15:06,447 So, that's how the study is designed, and we're now halfway through. 275 00:15:06,530 --> 00:15:08,115 We've given a single dose, 276 00:15:08,198 --> 00:15:10,701 and we'll be looking at the six-month data. 277 00:15:11,243 --> 00:15:13,287 [nurse speaking Dholuo] 278 00:15:13,370 --> 00:15:15,205 [nurse in English] We're done. Hmm? 279 00:15:15,289 --> 00:15:21,253 We have recruited so far 324 children for this, uh, second part of the trial. 280 00:15:21,337 --> 00:15:23,797 [motorcycle engine revving] 281 00:15:25,382 --> 00:15:29,470 [inquisitive music playing] 282 00:15:29,553 --> 00:15:34,058 Our syringe is one ml. 283 00:15:34,141 --> 00:15:35,893 Confirm that it is one ml. 284 00:15:36,894 --> 00:15:39,438 -The baby has come for a scheduled visit. -[Kwambai] Mm-hmm. 285 00:15:39,521 --> 00:15:40,689 [nurse] The baby is not sick. 286 00:15:40,773 --> 00:15:42,107 Okay. Which visit is this? 287 00:15:42,191 --> 00:15:43,734 -[nurse] Visit 112. -112. 288 00:15:43,817 --> 00:15:45,235 -[nurse] Yes. -Okay. [speaks Dholuo] 289 00:15:46,278 --> 00:15:49,114 [in English] It's mostly mothers who participate in the trial. 290 00:15:49,198 --> 00:15:52,868 -[child crying] -[indistinct chatter in Dholuo] 291 00:15:53,494 --> 00:15:54,745 [faint thudding] 292 00:15:57,373 --> 00:15:58,457 [thudding continues] 293 00:16:02,586 --> 00:16:04,338 I'm Bernadina Odhiambo, 294 00:16:05,130 --> 00:16:07,132 and I'm 26 years. 295 00:16:11,971 --> 00:16:13,597 I'm a mother of two. 296 00:16:15,557 --> 00:16:18,060 There is Ian and Margaret. 297 00:16:19,520 --> 00:16:21,063 [inquisitive music playing] 298 00:16:21,146 --> 00:16:25,150 [Odhiambo] Here in Siaya, there is high risk of malaria. 299 00:16:27,861 --> 00:16:32,908 We know that there's some measures that we can take by ourselves to control it. 300 00:16:33,951 --> 00:16:37,121 I've made it as clean as possible. 301 00:16:38,372 --> 00:16:41,250 There are no stagnant waters around. 302 00:16:41,750 --> 00:16:43,419 [speaks in Dholuo] 303 00:16:44,211 --> 00:16:47,798 [Odhiambo in English] We are all sleeping under treated mosquito nets. 304 00:16:47,881 --> 00:16:50,426 We can use mosquito repellents. 305 00:16:52,928 --> 00:16:57,808 We heard of malaria studies that are being conducted in Siaya County. 306 00:16:57,891 --> 00:17:02,187 I was much interested since I'm a victim of malaria. 307 00:17:02,771 --> 00:17:04,857 [Odhiambo speaks Dholuo] 308 00:17:04,940 --> 00:17:09,653 [Odhiambo in English] My older son got malaria when he was two months old. 309 00:17:09,737 --> 00:17:11,321 [motorcycle engine accelerates] 310 00:17:12,072 --> 00:17:14,408 [Odhiambo] So, when it came to the studies, 311 00:17:14,491 --> 00:17:16,827 I just decided to be part of them. 312 00:17:16,910 --> 00:17:18,620 [inquisitive music playing] 313 00:17:20,789 --> 00:17:24,084 [Odhiambo] Once we started the study, we were called upon. 314 00:17:24,585 --> 00:17:26,754 We went to Kogelo. 315 00:17:27,254 --> 00:17:28,255 [woman 5 speaks in Dholuo] 316 00:17:28,338 --> 00:17:31,091 [Odhiambo in English] They were taking some blood for tests. 317 00:17:31,175 --> 00:17:34,678 So, after that, they were given a dose for malaria. 318 00:17:36,638 --> 00:17:40,559 [inquisitive music playing] 319 00:17:40,642 --> 00:17:44,646 You can see we're driving through western Kenya, but we're seeing corn. 320 00:17:44,730 --> 00:17:47,816 We could be in, you know, western Nebraska. 321 00:17:47,900 --> 00:17:51,528 This is our second site. This is the Kogelo dispensary. 322 00:17:52,071 --> 00:17:54,490 Kogelo, it's in a rural area. 323 00:17:54,573 --> 00:17:59,036 One of its claim to fame is that's where President Obama's father was born. 324 00:18:00,120 --> 00:18:04,374 I think you have to understand that if you're bringing in a new intervention, 325 00:18:04,458 --> 00:18:07,920 they wanna have a good understanding of what that data is. 326 00:18:10,297 --> 00:18:12,883 [Steinhardt] So, we're really excited that Bob is here today 327 00:18:12,966 --> 00:18:17,638 to give us an update on the field of malaria monoclonal antibodies. 328 00:18:17,721 --> 00:18:20,808 -There you go. -[audience applauding] 329 00:18:20,891 --> 00:18:22,726 [speaks Dholuo, chuckles] 330 00:18:22,810 --> 00:18:25,521 [in English] Welcome, and thank you all for coming. 331 00:18:26,021 --> 00:18:28,065 When we all get vaccinated, 332 00:18:28,148 --> 00:18:31,735 the vaccine is given, and you make an antibody response. 333 00:18:32,569 --> 00:18:34,655 You generate antibodies that are really good, 334 00:18:34,738 --> 00:18:35,823 that do the protection. 335 00:18:35,906 --> 00:18:38,617 You generate antibodies that don't do anything at all. 336 00:18:38,700 --> 00:18:41,411 Okay, so you have a team of antibodies. 337 00:18:42,371 --> 00:18:44,289 So, who knows who Michael Jordan is? 338 00:18:44,873 --> 00:18:46,125 The basketball player. 339 00:18:46,208 --> 00:18:48,544 [crowd cheering] 340 00:18:48,627 --> 00:18:49,711 No? 341 00:18:50,295 --> 00:18:51,338 How about Mbappé? 342 00:18:51,421 --> 00:18:53,173 [commentator] 343 00:18:53,257 --> 00:18:55,551 Oh, what an accomplished finish! 344 00:18:55,634 --> 00:18:59,054 [Seder] Suppose your entire team, every single player was Mbappé. 345 00:18:59,555 --> 00:19:02,307 The odds of that team winning would increase. 346 00:19:02,391 --> 00:19:04,643 So, that's what a monoclonal antibody is. 347 00:19:04,726 --> 00:19:07,938 How many doses should be given? 348 00:19:08,021 --> 00:19:10,983 We're at a stage now where one dose could work for six months. 349 00:19:11,066 --> 00:19:14,528 We'd like to get it that one dose would work for an entire year. 350 00:19:14,611 --> 00:19:17,072 -Thank you. -[Seder] Thank you for your questions. 351 00:19:17,781 --> 00:19:20,284 [Seder] The question I most often get is just cost. 352 00:19:20,367 --> 00:19:23,328 That, to me, is really the biggest hurdle. 353 00:19:23,412 --> 00:19:26,957 I… I don't think it's necessarily a scientific hurdle. 354 00:19:28,167 --> 00:19:32,462 And then we try to convince people that we can get this made much cheaper. 355 00:19:34,548 --> 00:19:38,468 [Gates] If they get the cost down enough and the effectiveness to be super high, 356 00:19:38,552 --> 00:19:42,806 then wherever you give out that antibody, those kids don't get malaria. 357 00:19:44,516 --> 00:19:47,811 The main thing we've always done for malaria is had drugs 358 00:19:47,895 --> 00:19:50,814 that, as you detect the fever, you take the drugs. 359 00:19:51,982 --> 00:19:56,195 Cinchona trees are things that grow at heights in South America, 360 00:19:56,278 --> 00:19:58,030 and somebody figured out 361 00:19:58,113 --> 00:20:02,159 if you boil the bark of the tree, which is quinine, and you drink it, 362 00:20:02,242 --> 00:20:05,370 that you recover from your malaria very quickly. 363 00:20:05,454 --> 00:20:07,289 [inquisitive music playing] 364 00:20:07,372 --> 00:20:09,541 Interesting thing about quinine, 365 00:20:09,625 --> 00:20:12,836 it's actually one of the ingredients in tonic water. 366 00:20:12,920 --> 00:20:13,962 [water bubbling] 367 00:20:14,046 --> 00:20:17,257 [Gardy] You know, tonic is a word that we use to refer to medicine. 368 00:20:17,341 --> 00:20:18,217 A tonic. 369 00:20:18,300 --> 00:20:20,969 And tonic water, quinine water, 370 00:20:21,053 --> 00:20:24,431 was what sailors back in the 18th and 19th century 371 00:20:24,514 --> 00:20:27,100 were typically taking as a preventative. 372 00:20:27,184 --> 00:20:28,977 [faint fizzing] 373 00:20:29,061 --> 00:20:30,354 [Winegard] It has a bitter taste, 374 00:20:30,437 --> 00:20:33,857 so the British colonists in India added gin to cut the taste, 375 00:20:33,941 --> 00:20:35,859 and the gin and tonic was born. 376 00:20:36,360 --> 00:20:40,030 Obviously, now people don't drink gin and tonic as an anti-malarial, but… 377 00:20:41,156 --> 00:20:43,116 Coffee also has a connection. 378 00:20:43,200 --> 00:20:46,870 Originally, coffee was touted as a malarial cure, 379 00:20:47,371 --> 00:20:50,040 and that enters the lore of coffee, 380 00:20:50,123 --> 00:20:53,168 and it's advertised right up really until the late 1800s 381 00:20:53,252 --> 00:20:55,254 as a cure for malarial fevers. 382 00:20:56,755 --> 00:20:59,508 The ancient Egyptians bathed in human urine. 383 00:21:00,008 --> 00:21:04,179 The Romans wore amulets around their neck with the magic word "abracadabra." 384 00:21:04,263 --> 00:21:07,224 That's where it comes from, uh, to ward off malaria. 385 00:21:07,307 --> 00:21:09,768 [inquisitive music playing] 386 00:21:09,851 --> 00:21:12,187 [Gates] I mean, malaria is very, very hard to eradicate. 387 00:21:12,271 --> 00:21:14,564 There have been many failed attempts. 388 00:21:14,648 --> 00:21:15,899 -[gunshot] -[sharp buzz] 389 00:21:17,401 --> 00:21:20,112 [Specter] For a long time, we've talked about infectious diseases 390 00:21:20,195 --> 00:21:22,239 in terms of, "Can we eradicate them?" 391 00:21:22,739 --> 00:21:25,534 We've eradicated one, smallpox. 392 00:21:26,201 --> 00:21:29,579 We came close with polio, but we haven't quite gotten there, 393 00:21:30,080 --> 00:21:34,626 but with malaria, it's a different kind of conversation. 394 00:21:34,710 --> 00:21:37,504 [inquisitive music continues, builds] 395 00:21:37,587 --> 00:21:39,131 [music fades] 396 00:21:40,882 --> 00:21:41,758 [doorbell chimes] 397 00:21:43,468 --> 00:21:45,345 -[man 9] How are you? -[Gates] Tony. How are you? 398 00:21:45,429 --> 00:21:47,597 -[man 9] Good to see you. Welcome. -Thanks for having me. 399 00:21:47,681 --> 00:21:49,099 Oh, it's a pleasure. Come on in. 400 00:21:49,182 --> 00:21:50,309 [door shuts] 401 00:21:50,392 --> 00:21:53,103 [man 9] I think it's a very important proof of concept 402 00:21:53,186 --> 00:21:55,856 that's going on now in the antibody studies 403 00:21:55,939 --> 00:21:58,233 that are being done in Kenya and elsewhere, 404 00:21:58,317 --> 00:22:05,032 but I'm concerned that we lose attention before we get to the endgame. 405 00:22:05,115 --> 00:22:09,953 I think elimination in different regions, different countries, 406 00:22:10,037 --> 00:22:13,790 is entirely feasible with malaria. 407 00:22:14,499 --> 00:22:20,422 Eradication in the classic sense is gonna be very, very difficult 408 00:22:20,505 --> 00:22:25,177 because of the prevalence of mosquitoes, the climate, the need for control. 409 00:22:25,260 --> 00:22:28,347 So, I'm really high on hope with the science. 410 00:22:28,430 --> 00:22:31,099 [Gates] Eventually, our tools will get so good that, 411 00:22:31,183 --> 00:22:34,436 you know, we'll be ambitious to take some geography 412 00:22:34,519 --> 00:22:38,065 and try to have the intervention be so extreme 413 00:22:38,148 --> 00:22:41,401 that we completely clear the parasite out of that area. 414 00:22:41,485 --> 00:22:43,320 There are multiple steps and approaches. 415 00:22:43,403 --> 00:22:46,156 Mosquito approach, treatment approach, prevention approach. 416 00:22:46,740 --> 00:22:48,575 What does the public health need, 417 00:22:48,658 --> 00:22:51,203 and what is the scientific opportunity? 418 00:22:51,286 --> 00:22:55,248 And you either pursue the existing scientific opportunities, 419 00:22:55,332 --> 00:22:59,086 or you create scientific opportunities. 420 00:22:59,169 --> 00:23:00,545 [clicking] 421 00:23:01,588 --> 00:23:03,382 [man 10] 422 00:23:03,965 --> 00:23:07,719 scientists continually study the mosquitoes that carry diseases. 423 00:23:08,220 --> 00:23:11,223 They seek new ways to control and destroy them. 424 00:23:12,724 --> 00:23:16,103 [Gates] To get to zero, you have to give people medicine, 425 00:23:16,186 --> 00:23:19,815 but you also have to go after mosquitoes as well. 426 00:23:21,024 --> 00:23:23,860 I think one of the difficulties we have is 427 00:23:23,944 --> 00:23:27,697 that we… we have a disease that's preventable and treatable. 428 00:23:27,781 --> 00:23:31,701 I started my career by looking at a cage of mosquitoes 429 00:23:31,785 --> 00:23:36,206 and suddenly realizing if you kill these mosquitoes, 430 00:23:36,289 --> 00:23:39,334 you can stop everything else that happens afterwards. 431 00:23:39,418 --> 00:23:41,920 [inquisitive music playing] 432 00:23:42,671 --> 00:23:47,467 [Gates] Historically, DDT is the most famous anti-mosquito tool. 433 00:23:48,343 --> 00:23:50,262 It had negative effects, 434 00:23:50,345 --> 00:23:54,391 and the environmental movement said we should move away from that. 435 00:23:54,474 --> 00:23:57,185 Now there's this idea we call gene drive, 436 00:23:57,269 --> 00:24:00,147 which is using the genetics of mosquitoes 437 00:24:00,230 --> 00:24:03,775 so that they… they can't grow their population. 438 00:24:03,859 --> 00:24:06,278 That's the most exciting thing we have. 439 00:24:07,320 --> 00:24:09,656 [peculiar music playing] 440 00:24:09,739 --> 00:24:11,366 [bird tweeting] 441 00:24:12,409 --> 00:24:16,955 I got into this because when I was a kid, I was always interested in living things, 442 00:24:17,038 --> 00:24:20,083 and my parents took me to the Galápagos, and that got me reading Darwin. 443 00:24:20,167 --> 00:24:21,626 [peculiar music continues] 444 00:24:21,710 --> 00:24:23,170 -[music halts] -[seagull caws] 445 00:24:23,253 --> 00:24:24,796 [Esvelt] I was just fascinated by 446 00:24:24,880 --> 00:24:29,134 how this incredibly intricate tapestry of life had been woven, 447 00:24:29,217 --> 00:24:31,720 and I thought, "I want to learn to do that." 448 00:24:31,803 --> 00:24:34,890 "I want to learn to shape species." 449 00:24:34,973 --> 00:24:36,766 [faint splashes] 450 00:24:36,850 --> 00:24:40,395 If you could invent a technology that would eradicate malaria forever, 451 00:24:40,479 --> 00:24:41,313 would you do it? 452 00:24:42,189 --> 00:24:44,524 So, the answer must involve CRISPR. 453 00:24:45,692 --> 00:24:48,862 [Esvelt] CRISPR genome editing technology, which is basically genomic scissors 454 00:24:48,945 --> 00:24:52,073 that allows us to cut at one particular sequence in a genome 455 00:24:52,157 --> 00:24:57,329 and provide a DNA sequence to be inserted at that site that gets cut. 456 00:24:57,412 --> 00:25:00,123 It could be used to build what's called a gene drive 457 00:25:00,207 --> 00:25:04,377 that can allow us to spread an alteration from one organism 458 00:25:04,461 --> 00:25:07,005 out into entire populations in the wild. 459 00:25:07,088 --> 00:25:08,673 [inquisitive music playing] 460 00:25:08,757 --> 00:25:10,467 [Esvelt] In the full-power version of this, 461 00:25:10,550 --> 00:25:12,219 what we call a self-propagating gene drive, 462 00:25:12,302 --> 00:25:15,889 has no limit to this beyond the species boundaries. 463 00:25:15,972 --> 00:25:18,725 That is, if there is gene flow within a population, 464 00:25:18,808 --> 00:25:21,311 it will spread to affect the entire population. 465 00:25:21,937 --> 00:25:23,021 [faint buzzing] 466 00:25:23,104 --> 00:25:26,900 If you have CRISPR, the ability to change genes, 467 00:25:27,400 --> 00:25:31,488 and you have gene drive which passes on heredity, 468 00:25:32,113 --> 00:25:37,244 we could actually rewrite genes in such a way to decide what to pass on, 469 00:25:37,953 --> 00:25:39,579 and you can make 'em all male, 470 00:25:39,663 --> 00:25:42,707 and that way you can't have them mate with anyone. 471 00:25:42,791 --> 00:25:44,292 So, if you make them all male, 472 00:25:45,168 --> 00:25:47,170 that's the end of that species, 473 00:25:47,254 --> 00:25:50,465 and it's the end of that disease in theory. 474 00:25:51,841 --> 00:25:54,427 [Gates] People are like, "Well, could it get out of the mosquitoes?" 475 00:25:54,511 --> 00:26:00,183 "Could it cross to pollinating insects that, you know, give us fruit?" 476 00:26:00,267 --> 00:26:03,478 There are legitimate questions about such a powerful technique. 477 00:26:03,562 --> 00:26:05,063 [faint splashes] 478 00:26:05,146 --> 00:26:07,190 [soft music playing] 479 00:26:07,274 --> 00:26:09,651 [Winegard] Mosquitoes absolutely have benefits to society. 480 00:26:09,734 --> 00:26:11,861 They're part of natural ecosystems. 481 00:26:12,612 --> 00:26:14,489 Other animals feed on them. 482 00:26:14,573 --> 00:26:16,908 Trout, salmon, top-water feeders. 483 00:26:16,992 --> 00:26:18,493 Birds eat them. 484 00:26:18,577 --> 00:26:19,578 Bats eat them. 485 00:26:20,203 --> 00:26:25,333 Certain orchids would probably go extinct if those mosquito species went extinct. 486 00:26:25,417 --> 00:26:30,630 So, mosquitoes are a valuable part of any natural ecosystem. 487 00:26:31,840 --> 00:26:34,551 When you remove one species from an ecosystem, 488 00:26:34,634 --> 00:26:36,803 you can have what's called a trophic cascade 489 00:26:36,886 --> 00:26:39,431 of unintended consequences to other ecosystems. 490 00:26:39,514 --> 00:26:42,267 So, for example, when the woolly mammoth went extinct, 491 00:26:42,350 --> 00:26:45,770 so too did the hapless ticks that fed on the woolly mammoth. 492 00:26:45,854 --> 00:26:48,690 -[soft music continues] -[faint splashes] 493 00:26:48,773 --> 00:26:51,818 [Esvelt] There's over a thousand species of mosquitoes just in Africa. 494 00:26:51,901 --> 00:26:54,446 There's just so many species that removing a few, 495 00:26:54,529 --> 00:26:57,324 the ones that spread malaria, which is vanishingly few, 496 00:26:57,407 --> 00:27:01,036 the odds of anything ecologically going wrong is very, very small. 497 00:27:01,703 --> 00:27:04,039 Not zero, but very, very small. 498 00:27:04,122 --> 00:27:06,666 [indistinct chatter] 499 00:27:06,750 --> 00:27:07,584 [horn honks] 500 00:27:09,419 --> 00:27:12,547 [mosquitos buzzing] 501 00:27:12,631 --> 00:27:14,883 [Diabaté] Research is kind of a long process. 502 00:27:15,425 --> 00:27:18,845 We want something right now, but if you want to do research, 503 00:27:18,928 --> 00:27:23,058 like, you know, the specific technology that we are developing, it takes time. 504 00:27:23,141 --> 00:27:24,976 [inquisitive music playing] 505 00:27:25,935 --> 00:27:28,521 [Diabaté] And I'm part of the project Target Malaria. 506 00:27:28,605 --> 00:27:33,443 We are using advanced genetic tools to get rid of malaria in the future. 507 00:27:33,526 --> 00:27:34,611 [faint buzzing] 508 00:27:34,694 --> 00:27:37,739 [Diabaté] We don't have the gene drive mosquitoes in Africa yet 509 00:27:37,822 --> 00:27:38,782 for many reasons. 510 00:27:38,865 --> 00:27:41,409 There are so many other elements around it, 511 00:27:41,493 --> 00:27:44,204 and all these different pieces need, you know, to fall in place 512 00:27:44,287 --> 00:27:47,040 just to make sure that you have something really very solid 513 00:27:47,123 --> 00:27:49,042 and very safe for the community. 514 00:27:51,002 --> 00:27:52,671 You know, malaria is rural, 515 00:27:53,213 --> 00:27:55,382 and it's happening during the rainy season. 516 00:27:56,091 --> 00:27:58,843 Taking mosquitoes, you know, to spread the gene for you, 517 00:27:58,927 --> 00:28:01,388 and even in a really very difficult area, 518 00:28:02,013 --> 00:28:04,474 if you cannot get access, the mosquito will do the job for you. 519 00:28:04,557 --> 00:28:05,392 [Gates chuckles] 520 00:28:05,475 --> 00:28:08,812 [Diabaté] So, we really feel that this is a very transformative tool, 521 00:28:08,895 --> 00:28:11,940 but, you know, to release mosquitoes in the field is really very easy. 522 00:28:12,023 --> 00:28:14,025 It's going to take me just only 30 minutes, 523 00:28:14,109 --> 00:28:16,403 but we took seven years to get there. 524 00:28:16,486 --> 00:28:19,072 If you start right away with the gene drive, then it's spreading, 525 00:28:19,155 --> 00:28:21,700 then you have all these different aspects that you did not look at, 526 00:28:21,783 --> 00:28:23,243 then it's going to be very difficult. 527 00:28:23,326 --> 00:28:26,246 You need to work for the community to get the social license. 528 00:28:26,329 --> 00:28:28,373 And this is not something which is granted. 529 00:28:28,456 --> 00:28:30,875 You really need to build trust with them. 530 00:28:30,959 --> 00:28:34,421 I cannot just pop up in any single village with a bucket of mosquitoes 531 00:28:35,046 --> 00:28:38,091 on the assumption that I'm a scientist working for the good of the public. 532 00:28:38,174 --> 00:28:41,094 People really need to understand what you're doing. 533 00:28:41,177 --> 00:28:42,929 [birds chirping] 534 00:28:45,056 --> 00:28:46,683 [Diabaté in French] Ah, good morning. 535 00:28:46,766 --> 00:28:47,892 How are you? 536 00:28:47,976 --> 00:28:49,227 Great. Thank you. 537 00:28:49,310 --> 00:28:50,145 Good morning. 538 00:28:50,228 --> 00:28:51,312 -How are you? -I'm very fine. 539 00:28:51,396 --> 00:28:52,313 Great. Thank you. 540 00:28:52,397 --> 00:28:54,941 [Diabaté] We're very delighted to welcome you this morning. 541 00:28:55,024 --> 00:28:57,986 As you can see, this is our insectary. 542 00:28:58,069 --> 00:28:59,320 All the mosquitos are here. 543 00:28:59,404 --> 00:29:01,698 [inquisitive music playing] 544 00:29:01,781 --> 00:29:05,201 [Diabaté in English] We know there are a number of concerns that are out there, 545 00:29:06,035 --> 00:29:07,829 so sometimes it's really very good 546 00:29:07,912 --> 00:29:09,998 if you can take the leaders of the community 547 00:29:10,081 --> 00:29:12,876 into the insectary and then you show them the mosquitoes, 548 00:29:12,959 --> 00:29:14,753 how you do the transformation, 549 00:29:15,253 --> 00:29:18,673 and allow them, you know, to ask all kinds of questions. 550 00:29:18,757 --> 00:29:23,052 [Diabaté in French] As you can see, the whole building is painted in white. 551 00:29:23,136 --> 00:29:27,557 This makes it easier to see when something sits on the wall. 552 00:29:28,224 --> 00:29:35,231 With the fans, if you stand here, you'll feel the wind. 553 00:29:35,315 --> 00:29:39,444 Everything is done in such a way to keep the mosquitos inside. 554 00:29:39,527 --> 00:29:45,825 All the mosquitos on this line have been genetically modified. 555 00:29:45,909 --> 00:29:48,578 Here's the paraffin, which is like human skin. 556 00:29:48,661 --> 00:29:51,539 You also have the source of the heat that you put on it. 557 00:29:51,623 --> 00:29:56,002 It makes the paraffin warm, and the mosquitos can feel it right away. 558 00:29:56,503 --> 00:29:59,923 When they feel it, they come and start sucking. 559 00:30:00,965 --> 00:30:03,176 [man 11] I learned a lot today in the insectary. 560 00:30:03,259 --> 00:30:07,514 I was amazed at how a mosquito could be modified. 561 00:30:08,139 --> 00:30:10,809 The mosquito is so small, 562 00:30:10,892 --> 00:30:13,394 and to say that it can be modified, 563 00:30:13,478 --> 00:30:15,021 well, it's astonishing. 564 00:30:15,104 --> 00:30:18,107 That's what we call DNA. 565 00:30:19,400 --> 00:30:22,570 When the modification is integrated into the mosquito's genome, 566 00:30:22,654 --> 00:30:25,073 you will see that it has red eyes. 567 00:30:25,740 --> 00:30:30,119 So, mosquitos that aren't modified don't have red eyes? 568 00:30:30,203 --> 00:30:32,413 [Diabaté] No, they don't have red eyes. 569 00:30:33,081 --> 00:30:35,583 [soft music playing] 570 00:30:35,667 --> 00:30:39,254 [Specter in English] It's hard to change the genetics of a species 571 00:30:39,337 --> 00:30:43,591 and know for sure what the ultimate implications are. 572 00:30:44,217 --> 00:30:50,932 We can edit a certain receptor on one cell that will prevent people from getting HIV. 573 00:30:51,015 --> 00:30:54,352 It would increase their chance of getting West Nile disease. 574 00:30:54,936 --> 00:30:58,356 Most people today would say, "That's an easy choice," 575 00:30:58,439 --> 00:31:01,442 but is it gonna be an easy choice in 10,000 years? 576 00:31:01,526 --> 00:31:04,904 It might turn out that West Nile disease will wipe out humanity. 577 00:31:05,488 --> 00:31:08,658 It's very difficult to see down the field. 578 00:31:08,741 --> 00:31:12,036 [inquisitive music playing] 579 00:31:12,120 --> 00:31:14,038 [Gates] You know, we'll get people who say 580 00:31:14,122 --> 00:31:16,958 even the benefit of reducing those malaria deaths, 581 00:31:17,834 --> 00:31:20,461 you know, doesn't justify opening Pandora's Box. 582 00:31:20,545 --> 00:31:23,131 I completely disagree with that. 583 00:31:23,214 --> 00:31:26,676 If you just got a few species in Africa, 584 00:31:26,759 --> 00:31:30,430 you'd get, you know, 80% of the disease burden. 585 00:31:30,513 --> 00:31:35,894 Um, it's not on the list of, you know, Dr. Evil's toolbox, 586 00:31:35,977 --> 00:31:37,478 -Uh… -[chuckles] 587 00:31:37,562 --> 00:31:40,064 …and sadly, that list is not an empty list. 588 00:31:40,148 --> 00:31:43,234 -But, uh, this is not… this is not on it. -[Esvelt] No, no. 589 00:31:44,986 --> 00:31:47,030 [Diabaté] Very often people will come to you and say 590 00:31:47,113 --> 00:31:50,491 that if you remove the mosquitoes, then what is going to happen? 591 00:31:51,367 --> 00:31:55,121 But my question is that we have 600,000 deaths every year. 592 00:31:55,204 --> 00:31:57,040 Something bad is already happening. 593 00:31:57,874 --> 00:32:00,001 So you absolutely need to do something about it. 594 00:32:00,084 --> 00:32:03,004 -[faint buzzing] -[inquisitive music continues] 595 00:32:03,838 --> 00:32:08,092 [Specter] It's still hard to come in from another place 596 00:32:08,176 --> 00:32:11,137 and tell a country we want to use your people, 597 00:32:11,220 --> 00:32:17,018 and that you might benefit greatly, but we're not sure, and in the end, 598 00:32:17,101 --> 00:32:20,313 we'll decide what to do with this technology when we're done with it. 599 00:32:20,813 --> 00:32:26,194 The whole history of colonialism is white people going into Africa 600 00:32:26,277 --> 00:32:30,323 to use human beings like they're minerals or something. 601 00:32:30,406 --> 00:32:32,617 [indistinct chatter in French] 602 00:32:32,700 --> 00:32:38,790 [man 12 in French] The population really wants the success of this project 603 00:32:38,873 --> 00:32:44,170 because we have seen grave cases of malaria, 604 00:32:44,253 --> 00:32:48,341 and the people are desperate 605 00:32:48,424 --> 00:32:51,803 for an adequate solution. 606 00:32:53,805 --> 00:32:56,349 [Esvelt in English] If it's your environment, it's your call, 607 00:32:56,432 --> 00:32:59,560 and I don't live in Africa, and my kids are not at risk of malaria, 608 00:32:59,644 --> 00:33:02,480 but if my kids were at risk and did live there, 609 00:33:03,064 --> 00:33:04,524 I would say, "Do it now." 610 00:33:04,607 --> 00:33:09,612 Self-propagating, go straight ahead, no more ecological local field trials. 611 00:33:09,696 --> 00:33:12,323 If my kids were at risk, I would just say, "Do it." 612 00:33:12,407 --> 00:33:14,158 Don't keep messing around. 613 00:33:15,660 --> 00:33:20,707 This is a good example of why we in the developed world 614 00:33:20,790 --> 00:33:25,003 need to pay attention globally to global diseases. 615 00:33:25,086 --> 00:33:26,671 I think there are two reasons. 616 00:33:26,754 --> 00:33:30,800 One, I actually think we have a moral responsibility as a rich country 617 00:33:30,883 --> 00:33:35,680 to not have people unduly suffer from preventable and treatable diseases 618 00:33:35,763 --> 00:33:38,516 just because of where they happen to be born, 619 00:33:38,599 --> 00:33:41,185 but there's an enlightened self-interest 620 00:33:41,269 --> 00:33:43,980 when you're dealing with infectious diseases. 621 00:33:44,063 --> 00:33:46,733 They can creep into other regions. 622 00:33:47,358 --> 00:33:49,569 -[inquisitive music playing] -[faint buzzing] 623 00:33:52,030 --> 00:33:54,365 [reporter 1] with a new health warning 624 00:33:54,449 --> 00:33:57,577 after confirming five cases of malaria in the US. 625 00:33:57,660 --> 00:33:59,287 Breaking news is out of Maryland tonight… 626 00:33:59,370 --> 00:34:02,415 [reporter 3] in more than four decades. 627 00:34:03,708 --> 00:34:05,918 [Welkhoff] Malaria is intensely unforgiving. 628 00:34:06,002 --> 00:34:08,129 And if we look in the face of climate change, 629 00:34:08,212 --> 00:34:10,590 we're likely to see more and more things go wrong. 630 00:34:10,673 --> 00:34:14,093 We don't want the world to be in a place where anytime something goes wrong, 631 00:34:14,177 --> 00:34:17,430 tens to hundreds of thousands of people die, avoidably, from malaria. 632 00:34:17,513 --> 00:34:19,515 [inquisitive music continues] 633 00:34:19,599 --> 00:34:22,602 [Steinhardt] We have a susceptible environment in the US, 634 00:34:22,685 --> 00:34:25,980 especially in parts of the South where the climate is warm 635 00:34:26,064 --> 00:34:28,608 and… and you find the Anopheles mosquito. 636 00:34:28,691 --> 00:34:32,361 The potential for local transmission is really worrisome. 637 00:34:32,445 --> 00:34:34,155 [inquisitive music continues] 638 00:34:36,866 --> 00:34:38,659 [music fades] 639 00:34:38,743 --> 00:34:41,079 [faint indistinct chatter in the distance] 640 00:34:42,288 --> 00:34:46,334 [indistinct chatter in Dholuo] 641 00:34:46,417 --> 00:34:48,544 -[Soumalo in Dholuo] Good evening. -[all] Good evening. 642 00:34:48,628 --> 00:34:50,129 -[Soumalo] How is family? -[all] Good. 643 00:34:50,213 --> 00:34:51,964 -[Soumalo] Are you all doing well? -[all] Yes. 644 00:34:52,048 --> 00:34:54,550 Since this morning, do you know what happened? 645 00:34:54,634 --> 00:34:55,635 [all] What? 646 00:34:55,718 --> 00:35:00,681 [Soumalo] I visited the laboratory to see how the malaria work has been going. 647 00:35:01,390 --> 00:35:07,855 So, how does someone recognize a modified mosquito? 648 00:35:07,939 --> 00:35:11,567 When you look at them, the modified mosquitos have red eyes. 649 00:35:11,651 --> 00:35:12,902 [woman 1] Oh. 650 00:35:12,985 --> 00:35:15,988 [motorcycle engine accelerating] 651 00:35:22,161 --> 00:35:24,372 [crickets chirping] 652 00:35:24,455 --> 00:35:25,873 [man 13] Mama, Ian, how are you? 653 00:35:25,957 --> 00:35:27,250 I am okay. 654 00:35:28,126 --> 00:35:31,045 Ian, say hello to the doctor! [chuckles] 655 00:35:32,630 --> 00:35:33,923 [man 13 in English] Okay. 656 00:35:34,423 --> 00:35:37,009 Uh, in the last, uh, one month, 657 00:35:37,760 --> 00:35:41,514 from the time you came to the clinic, there's no problem with the child? 658 00:35:41,597 --> 00:35:43,266 -He is good. -[man 13] Okay. 659 00:35:43,349 --> 00:35:47,603 So, anything that you'd want to report about the child generally? 660 00:35:47,687 --> 00:35:49,313 [Odhiambo] This is now six months. 661 00:35:50,106 --> 00:35:53,985 Eh, home visits, clinic, home visit and clinic. 662 00:35:56,654 --> 00:36:00,658 I'm so privileged to be a part of this study 663 00:36:01,742 --> 00:36:04,120 because the boy, he has been good. 664 00:36:04,203 --> 00:36:07,540 He has not tested for malaria for six months. 665 00:36:08,708 --> 00:36:10,334 Before, I was afraid 666 00:36:10,418 --> 00:36:13,629 because I was one of the victims of malaria. 667 00:36:14,589 --> 00:36:17,967 And although it has not been proven that it will work, 668 00:36:18,050 --> 00:36:21,220 but we are hoping, in a few years coming. 669 00:36:21,304 --> 00:36:24,557 And I am praying, and it's my humble prayer 670 00:36:24,640 --> 00:36:25,975 that this antibody… 671 00:36:26,058 --> 00:36:27,268 [baby crying] 672 00:36:27,351 --> 00:36:28,728 [Odhiambo] …will be going to work. 673 00:36:29,979 --> 00:36:31,439 So I'm not afraid. 674 00:36:31,522 --> 00:36:33,482 [soft music playing] 675 00:36:35,401 --> 00:36:41,032 [in Dholuo] Are the redesigned mosquitos going to stay with them 676 00:36:41,115 --> 00:36:43,701 inside the laboratory? 677 00:36:43,784 --> 00:36:46,787 You don't need to be afraid of the modified mosquitos. 678 00:36:47,371 --> 00:36:52,752 The aim of this work is to eradicate female mosquitos 679 00:36:52,835 --> 00:36:55,379 in order to combat malaria. 680 00:36:55,463 --> 00:36:59,759 It scares us because we often hear that white people have done this, done that, 681 00:36:59,842 --> 00:37:01,219 and added things to our illnesses. 682 00:37:02,011 --> 00:37:04,805 [Soumalo] If you go to the lab, 683 00:37:04,889 --> 00:37:08,684 the truth is that it's breathtaking, 684 00:37:08,768 --> 00:37:12,855 and the people there work hard, and the work is going really well. 685 00:37:13,648 --> 00:37:15,566 [soft music continues] 686 00:37:16,484 --> 00:37:19,862 [Jamet] It's really important to remember that malaria is a disease of poverty, 687 00:37:19,946 --> 00:37:21,572 and when children are sick, 688 00:37:21,656 --> 00:37:23,908 they can't go to school, so they can't learn, 689 00:37:23,991 --> 00:37:26,786 and when they can't learn, they can't, uh, get a job 690 00:37:26,869 --> 00:37:29,956 and… and earn a proper living for themselves. 691 00:37:30,039 --> 00:37:32,875 Parents have to look after them. They can't earn a living. 692 00:37:32,959 --> 00:37:35,586 They have to spend money on malaria treatments, 693 00:37:35,670 --> 00:37:38,130 and their health expenditure goes up, 694 00:37:38,214 --> 00:37:40,174 and getting out of that cycle 695 00:37:40,258 --> 00:37:43,302 is absolutely key to help get out of the cycle of poverty. 696 00:37:43,386 --> 00:37:45,638 [monitor beeping] 697 00:37:45,721 --> 00:37:50,101 As long as malaria will be killing people here in Africa a lot 698 00:37:50,977 --> 00:37:53,229 and completely destroying our economy, 699 00:37:54,272 --> 00:37:56,274 we will struggle, you know, to develop. 700 00:37:56,357 --> 00:37:57,984 This is where my roots are. 701 00:37:58,067 --> 00:38:00,069 I was born here, raised here. 702 00:38:00,152 --> 00:38:01,529 All my family is here. 703 00:38:01,612 --> 00:38:03,781 Nobody's going to build my country for me. 704 00:38:05,783 --> 00:38:06,867 I have to do it. 705 00:38:07,910 --> 00:38:09,036 We have to do it. 706 00:38:10,371 --> 00:38:11,205 Bye. 707 00:38:11,289 --> 00:38:12,707 -Bye. -Bye. 708 00:38:12,790 --> 00:38:15,042 [motorcycle engine revs] 709 00:38:15,126 --> 00:38:17,461 [indistinct chatter in Dholuo] 710 00:38:18,629 --> 00:38:19,797 [Diabaté in English] My hope 711 00:38:20,840 --> 00:38:25,177 is that we will be able, you know, to eradicate malaria in my lifetime. 712 00:38:25,261 --> 00:38:30,016 I want to eradicate it in my lifetime, which is a tougher constraint, so… 713 00:38:30,516 --> 00:38:33,311 You're gonna be in good shape. Just stay healthy. [chuckles] 714 00:38:33,394 --> 00:38:35,313 [inquisitive music playing] 715 00:38:42,361 --> 00:38:44,238 [thunder rumbles] 716 00:38:50,911 --> 00:38:52,830 [music fades] 717 00:38:52,913 --> 00:38:55,333 Well, you always have something before you feed the thing 718 00:38:55,416 --> 00:38:58,669 where you… you figure out what to put into the prompt buffer, 719 00:38:58,753 --> 00:39:01,630 but the, you know, math expert… 720 00:39:01,714 --> 00:39:04,175 [Bono] Bill Gates is exactly where he… he should be. 721 00:39:04,258 --> 00:39:05,843 …expert. What are called plug-ins… 722 00:39:05,926 --> 00:39:09,221 The idea that you have a mind like that trying to crack the code, 723 00:39:10,765 --> 00:39:12,767 you know, working every which way. 724 00:39:14,393 --> 00:39:15,936 This is a very good thing. 725 00:39:16,020 --> 00:39:19,940 By creating, you know, let's call it a system's architecture… 726 00:39:20,024 --> 00:39:22,026 [Bono] If he didn't exist, we'd have to make him up, 727 00:39:22,109 --> 00:39:25,863 but if we did, no one would believe the character, you know? 728 00:39:26,822 --> 00:39:30,242 I… I just think this is a man who wants to be useful. 729 00:39:31,243 --> 00:39:32,745 It's sort of beautiful. 730 00:39:32,828 --> 00:39:34,622 It's about outcomes. 731 00:39:35,873 --> 00:39:39,960 But even the men with the deepest pockets, 732 00:39:40,711 --> 00:39:42,755 they can't fix a lot of these problems. 733 00:39:42,838 --> 00:39:44,006 They're too big. 734 00:39:44,090 --> 00:39:47,760 We need government buy-in, and this is where advocacy comes in. 735 00:39:47,843 --> 00:39:51,430 This is where storytelling comes in and storytellers. 736 00:39:51,514 --> 00:39:55,684 Left and right brain talking, that's where we need to be. 737 00:40:02,358 --> 00:40:03,234 [button clicks] 738 00:40:03,317 --> 00:40:05,945 ["Tomorrow Is a Long Time" by Bob Dylan playing] 739 00:40:08,572 --> 00:40:12,034 [Gates] The world is facing a lot of big challenges right now, 740 00:40:12,952 --> 00:40:14,578 but I believe we can solve them. 741 00:40:15,079 --> 00:40:18,624 ♪ If today was not a crooked highway… ♪ 742 00:40:19,959 --> 00:40:21,877 [Gates] Overall, the world's improved a lot, 743 00:40:21,961 --> 00:40:25,756 and, you know, I enjoy being a small part of that. 744 00:40:26,632 --> 00:40:28,551 ♪ If tomorrow was… ♪ 745 00:40:28,634 --> 00:40:32,054 [Gates] There are challenges of political polarization, 746 00:40:32,138 --> 00:40:36,308 and limited resources, and avoiding a climate disaster, 747 00:40:37,268 --> 00:40:41,605 and we have to drive the innovation in order to get ahead of those challenges. 748 00:40:43,274 --> 00:40:44,108 ♪ If I could hear… ♪ 749 00:40:44,191 --> 00:40:45,526 [Gates] We'll get it, you know. 750 00:40:45,609 --> 00:40:49,530 Will it be 15 years or 20 years or 30 years? 751 00:40:49,613 --> 00:40:53,409 That depends on great work and making it a priority. 752 00:40:54,368 --> 00:40:55,536 ♪ Then I'd lie ♪ 753 00:40:56,871 --> 00:41:00,416 ♪ In my bed once again ♪ 754 00:41:04,003 --> 00:41:08,174 ♪ I can't see my reflection in the water ♪ 755 00:41:10,426 --> 00:41:13,971 ♪ I can't speak the sounds To show no pain ♪ 756 00:41:15,389 --> 00:41:19,268 ♪ I can't hear the echo of my footsteps ♪ 757 00:41:20,561 --> 00:41:24,023 ♪ Or remember the sounds of my own name ♪ 758 00:41:26,692 --> 00:41:30,362 ♪ Yes, and only If my own true love was waiting… ♪ 759 00:41:30,446 --> 00:41:31,947 [song fades]