Sue Desmond-Hellmann

OK, first, some introductions. My mom, Jennie, took this picture. That's my dad, Frank,
in the middle. And on his left, my sisters: Mary Catherine, Judith Ann, Theresa Marie.
John Patrick's sitting on his lap and Kevin Michael's on his right. And in the pale-blue
windbreaker, Susan Diane. Me. I loved growing up in a big family. And one of my
favorite things was picking names. But by the time child number seven came along, we
had nearly run out of middle names. It was a long deliberation before we finally settled
on Jennifer Bridget. Every parent in this audience knows the joy and excitement of
picking a new baby's name. And I was excited and thrilled to help my mom in that
special ceremonial moment.

But it's not like that everywhere. I travel a lot and I see a lot. But it took me by surprise
to learn in an area of Ethiopia, parents delay picking the names for their new babies by a
month or more. Why delay? Why not take advantage of this special ceremonial time?
Well, they delay because they're afraid. They're afraid their baby will die. And this loss
might be a little more bearable without a name. A face without a name might help them
feel just a little less attached.

So here we are in one part of the world -- a time of joy, excitement, dreaming of the
future of that child -- while in another world, parents are filled with dread, not daring to
dream of a future for their child beyond a few precious weeks. How can that be? How
can it be that 2.6 million babies die around the world before they're even one month
old? 2.6 million. That's the population of Vancouver. And the shocking thing is: Why? In
too many cases, we simply don't know.

Now, I remember recently seeing an updated pie chart. And the pie chart was labeled,
"Causes of death in children under five worldwide." And there was a pretty big section
of that pie chart, about 40 percent -- 40 percent was labeled "neonatal." Now,
"neonatal" is not a cause of death. Neonatal is simply an adjective, an adjective that
means that the child is less than one month old. For me, "neonatal" said: "We have no
idea."

Now, I'm a scientist. I'm a doctor. I want to fix things. But you can't fix what you can't
define. So our first step in restoring the dreams of those parents is to answer the
question: Why are babies dying?

So today, I want to talk about a new approach, an approach that I feel will not only help
us know why babies are dying, but is beginning to completely transform the whole field
of global health. It's called "Precision Public Health."
For me, precision medicine comes from a very special place. I trained as a cancer doctor,
an oncologist. I got into it because I wanted to help people feel better. But too often my
treatments made them feel worse. I still remember young women being driven to my
clinic by their moms -- adults, who had to be helped into my exam room by their
mothers. They were so weak from the treatment I had given them. But at the time, in
those front lines in the war on cancer, we had few tools. And the tools we did have
couldn't differentiate between the cancer cells that we wanted to hit hard and those
healthy cells that we wanted to preserve. And so the side effects that you're all very
familiar with -- hair loss, being sick to your stomach, having a immune system, so
infection was a constant threat -- were always surrounding us.

And then I moved to the biotechnology industry. And I got to work on a new approach
for breast cancer patients that could do a better job of telling the healthy cells from the
unhealthy or cancer cells. It's a drug called Herceptin. And what Herceptin allowed us to
do is to precisely target HER2-positive breast cancer, at the time, the scariest form of
breast cancer. And that precision let us hit hard the cancer cells, while sparing and
being more gentle on the normal cells. A huge breakthrough. It felt like a miracle, so
much so that today, we're harnessing all those tools -- big data, consumer monitoring,
gene sequencing and more -- to tackle a broad variety of diseases. That's allowing us to
target individuals with the right remedies at the right time.

Precision medicine revolutionized cancer therapy. Everything changed. And I want

everything to change again. So I've been asking myself: Why should we limit this
smarter, more precise, better way to tackle diseases to the rich world? Now, don't
misunderstand me -- I'm not talking about bringing expensive medicines like Herceptin
to the developing world, although I'd actually kind of like that. What I am talking about
is moving from this precise targeting for individuals to tackle public health problems in
populations.

Now, OK, I know probably you're thinking, "She's crazy. You can't do that. That's too
ambitious." But here's the thing: we're already doing this in a limited way, and it's
already starting to make a big difference.

So here's what's happening. Now, I told you I trained as a cancer doctor. But like many,
many doctors who trained in San Francisco in the '80s, I also trained as an AIDS doctor.
It was a terrible time. AIDS was a death sentence. All my patients died. Now, things are
better, but HIV/AIDS remains a terrible global challenge. Worldwide, about 17 million
women are living with HIV. We know that when these women become pregnant, they
can transfer the virus to their baby. We also know in the absence of therapy, half those
babies will not survive until the age of two. But we know that antiretroviral therapy can
virtually guarantee that she will not transmit the virus to the baby. So what do we do?

Well, a one-size-fits-all approach, kind of like that blast of chemo, would mean we test
and treat every pregnant woman in the world. That would do the job. But it's just not
practical. So instead, we target those areas where HIV rates are the highest. We know in
certain countries in sub-Saharan Africa we can test and treat pregnant women where
rates are highest. This precision approach to a public health problem has cut by nearly
half HIV transmission from mothers to baby in the last five years.

Screening pregnant women in certain areas in the developing world is a powerful

example of how precision public health can change things on a big scale.

So ... How do we do that? We can do that because we know. We know who to target,
what to target, where to target and how to target. And that, for me, are the important
elements of precision public health: who, what, where and how.

But let's go back to the 2.6 million babies who die before they're one month old. Here's
the problem: we just don't know. It may seem unbelievable, but the way we figure out
the causes of infant mortality in those countries with the highest infant mortality is a
conversation with mom. A health worker asks a mom who has just lost her child, "Was
the baby vomiting? Did they have a fever?" And that conversation may take place as
long as three months after the baby has died. Now, put yourself in the shoes of that
mom. It's a heartbreaking, excruciating conversation. And even worse -- it's not that
helpful, because we might know there was a fever or vomiting, but we don't know why.
So in the absence of knowing that knowledge, we cannot prevent that mom, that family,
or other families in that community from suffering the same tragedy.

But what if we applied a precision public health approach? Let's say, for example, we
find out in certain areas of Africa that babies are dying because of a bacterial infection
transferred from the mother to the baby, known as Group B streptococcus. In the
absence of treatment, mom has a seven times higher chance that her next baby will die.
Once we define the problem, we can prevent that death with something as cheap and
safe as penicillin. We can do that because then we'll know. And that's the point: once
we know, we can bring the right interventions to the right population in the right places
to save lives.

With this approach, and with these interventions and others like them, I have no doubt
that a precision public health approach can help our world achieve our 15-year goal.
And that would translate into a million babies' lives saved every single year. One million
babies every single year.
And why would we stop there? A much more powerful approach to public health --
imagine what might be possible. Why couldn't we more effectively tackle malnutrition?
Why wouldn't we prevent cervical cancer in women? And why not eradicate malaria?

Yes, clap for that!

So, you know, I live in two different worlds, one world populated by scientists, and
another world populated by public health professionals. The promise of precision public
health is to bring these two worlds together. But you know, we all live in two worlds:
the rich world and the poor world. And what I'm most excited about about precision
public health is bridging these two worlds. Every day in the rich world, we're bringing
incredible talent and tools -- everything at our disposal -- to precisely target diseases in
ways I never imagined would be possible. Surely, we can tap into that kind of talent and
tools to stop babies dying in the poor world. If we did, then every parent would have
the confidence to name their child the moment that child is born, daring to dream that
that child's life will be measured in decades, not days.

Thank you.