Baccalaureate Address: Margaret A. Hamburg, M.D.
Story posted May 23, 2003
Working for a Safer World: Our Shared Challenge
by Margaret A. Hamburg, M.D.
May 23, 2003
President Mills, members of the faculty, alumni, parents, friends, and above all - graduates of the Bowdoin class of 2003:
We gather on this beautiful campus to celebrate a very special time in the lives of all who will receive diplomas and in the lives of all who have given love, inspiration, and support to these graduates.
For generations, Bowdoin College has stood as an important center of academic life, scholarship and cultural achievements. It is a place where great teachers and great students have come together to learn, to create, to contribute. It is a place of great history and great hope. I am certain that tomorrow's graduates will proudly carry this spirit and these values forward as they embark upon their new lives.
It's an honor to be here with you today, but also a challenge. I have been invited to join you at this most memorable time to participate in what may be its least memorable moment for some of you - the baccalaureate address.
I recognize that it is not a moment that commands student attention. There are no more tests. The grades are in. The diplomas are signed. For the Class of 2003, they can't do anything to you anymore. But beginning tomorrow, you start playing for higher stakes than grades and graduation. Tomorrow you inherit the world. It's not your parents' or your professors' world anymore. It's yours. You've got to live in it, work in it, likely get married in it, and raise children in it - so you've got to make it safe.
It is a daunting task to think about how to make a difference in this challenging world...how can the graduating students use their energy and their education as a force for good? And how can all of us, in the various thing we do and lives we lead, strive to make sure that the world of the future is safer, healthier and more secure? For this is a challenge we all must share.
During the past four years since freshman year began, you have witnessed historic and often tragic changes in the world. You have seen terrorists take the lives of thousands of people in our country and destroy the World Trade Center and a part of the Pentagon. Our country's military has undertaken two difficult and costly wars abroad. With the rest of the world you have struggled to adjust to a new and very uncomfortable level of vulnerability.
These events, though distant from Brunswick, Maine, and the Bowdoin campus, have been a distressing wake-up call about many aspects of the world we live in. These events have also significantly changed what it means to graduate from a prestigious American college such as this one. I know that for some of you who have lost friends and loved ones, the lessons have been especially poignant. Even if you did not know anyone who lost their life in the World Trade Center or the Pentagon attacks, anyone in the path of an anthrax-tainted letter, or anyone serving with U.S. forces in Iraq or Afghanistan, the prospect that your life will be insulated from world events is gone forever.
Over the years - through the jobs I've held and the work I do - I have come to understand that we really are all in this together. Our world is getting more interdependent every day. Our health and security and prosperity depend more and more on events that may happen halfway around the world.
The job market you're facing is the toughest in years. Will our economy pick up? That depends in part on what happens with the down economies of Germany and Japan and other nations, where people now have less money to buy our products. It depends in part on what happens with SARS, which has disrupted economies in Asia and already caused more than $30 billion worth of damage. It depends in part on terrorist actions, because terrorism leaves people skittish about traveling and investing. How safe are we from terrorism? That depends in part on the skill of security forces in hot spots like Saudi Arabia, Pakistan, and Afghanistan. It also depends on the conditions of life in places all over the world. How safe are we from disease - that depends in part on the skill and reach of health officials in places as far afield as South Africa, China, and India.
We live in a nation whose history was launched by a declaration of independence. But our future depends on accepting - and acting on - our interdependence.
This lesson is not always obvious, and sometimes it takes a while to sink in. Let me tell you some of the ways I've come to see this. Back in 1994, when I was working as New York City Health Commissioner, we were concerned with an outbreak of a plague in Surat, India. It was a pneumonic form - like SARS - which can be spread person to person with relative ease. We were worried that, with international travel, someone infected with the plague could slip into our urban center, go unrecognized and untreated, and spark a serious outbreak of disease. We knew just how explosive such things could be.
So, naturally, we took some precautionary steps, and I called over to City Hall and offered to brief them on the situation. Some staffer in the Mayor's office sent me back a terse message saying, "We don't need your briefing about something happening in India; we can read the papers." I sent a message back asking if they were aware that more than 30 flights a day came into JFK Airport with passengers from India. Shortly thereafter, the phone rang in my office, with Mayor Giuliani on the other end asking if we should shut down JFK Airport. That was not exactly the solution, but he had gotten the message. He understood that a disease in a remote part of the world could be in our backyard tomorrow.
Some years later, I left New York and accepted a Presidential appointment as Assistant Secretary in the Department of Heath and Human Services in the Clinton Administration. I was working hard there on developing defenses for the threat of bioterrorism. It was not easy. Again, the first step was to convince people that the threat was real. Then to convince them that public health and medicine had a critical role to play.
Early in my tenure there, I was part of a small group charged with briefing the President on this issue. This was at a time when a lot of people wrote off the threat of bioterrorism as simply the stuff of science fiction. Clinton listened very intently. He asked sharp questions. At the end, he walked around the big cabinet table and took a seat next to me and Secretary Shalala. He laughed and said, "I know a lot of people are going to accuse me of reading too many bad novels, and maybe itís true, but this stuff is real and we have to do more." He gave us the go-ahead to put together an emergency appropriation request and he would take it to Congress. It became the first program specifically targeted to the medical and public health aspects of bio-terrorism - and it was this work that laid the foundation for the response to the terror attacks in fall 2001 and put in place many of the programs that have now been greatly accelerated following the anthrax attacks.
But not everyone understood the new world, the new threats or our interdependence as well as President Clinton and Mayor Giuliani. In fact, when I showed up for the White House meeting to develop the budget President Clinton requested, an official from the Office of Management and Budget was presiding. He greeted officials from the National Security Council, Federal Bureau of Investigation, Central Intelligence Agency, Department of Defense, then looked at me and said: "What is the Department of Health and Human Services doing here?" I explained I did belong there, that biological weapons unleash disease, and that doctors work with disease. Believe it or not, an FBI representative told me later that if there were a biological event, not to worry, their FBI agents would defuse the pathogens. Of course, pathogens are the biological organisms that cause disease. He might as well have said "we'll arrest the germs." You can't defuse pathogens as if they were a bomb; you contain them with surveillance and quarantine and care; you destroy them with medicines and prevent the disease they produce with vaccines. Many people just don't understand. They assume that a national security issue can't be a health issue; a health issue can't be a national security issue.
Even some of the health people didn't buy it in those early days. I remember well a meeting with the top scientists at the National Institutes of Health in the pre 9/11 and pre-Anthrax days, trying to engage them on our biodefense activities. One of those scientists - a good friend, former boss and mentor who is now among the most visible government scientists working on bio-terrorism defense - patted me on my arm and said, "You know, you should really be working on real world issues."
These were some of the smartest people in the world - but they did not yet realize that their world had changed.
I am now working as Vice President for Biological Programs at NTI - an organization founded by Ted Turner, co-chaired by Mr. Turner and former Senator Sam Nunn, and committed to reducing the dangers from nuclear, biological and chemical weapons. I began my work there nine months before September 11, and it was still quite hard to get attention to these issues. Senator Nunn and I wrote an opinion piece on the threat of biological weapons and submitted it to a major national news magazine just a few weeks before September 11 and the subsequent anthrax attacks. They said:"Nice piece, but we're not doing much on that now."
It's too bad that it took an attack to get us to mobilize and pay attention. Sadly, it's in the nature of much of life, including national security and public health, to respond to a threat only after it happens. We have to find some way to take the threat as seriously before it happens as we would after it strikes. Unfortunately, until a big threat strikes, the disbelief and denial and a reluctance to change often keeps us two or three steps behind where we ought to be.
When times change, our perspectives must change. Here I think of my beloved Aunt Winnie - actually my grandmother's sister. In a world of change, she didn't budge. When I was admitted to Harvard Medical School, Aunt Winnie said: "Oh, how wonderful!! Now you can marry a doctor!" When I was appointed New York City Health Commissioner, she said: "Why couldnít you just be a real doctor?" I loved my Aunt Winnie, but I never would have wanted to see her in a policy-making role in the 21st century. No, those jobs belong to you. The world is changing fast and you may be in the best position to keep up.
The fact is we need you involved now. We can't afford to wait until you're 40 or 50 or getting a little gray to feel your influence. Why? Because everyone in positions of power today in business and government grew up during a different era. A lot of us learned from an old set of ideas. Many of enduring value, but we've been trying to unlearn others ever since. Here are a few of the old ideas that hold us back and are slow to go away:
- Russia and China are enemies of the United States.
- If we're friends with a nation's leaders, we don't need to worry about its people.
- What happens over there doesn't affect us here.
- A strong military is all you need for strong security.
- It doesn't matter if people like us as long as they fear us.
- Our security requires that we keep thousands of nuclear weapons on the ready to fire within minutes.
- National security is a matter of armies and borders, not poverty or disease or resentment.
These ideas had a large following during the Cold War. Today, they are provably false. Yet these ideas still underpin many of our policies and attitudes. Russia and China are important partners of ours now. Yet important security cooperation is still undercut by old suspicion. We're friends with the leaders of Saudi Arabia, yet 15 Saudi nationals hijacked our planes on September 11 - and we have no effective efforts underway to diminish the hatred that made that possible. The United States still pays the least of any advanced country in foreign assistance, even though what happens abroad clearly affects our security, our prosperity and our health here at home. A strong military could not prevent the attacks on September 11, nor can it help defuse the hatred that gives rise to the terrorists - yet the response to September 11 was to dramatically increase funding to the military and homeland defense, but pay little to reduce the conditions that help breed terrorism, to help our friends or improve the perception of us abroad. Today, the United States and Russia still have thousands of nuclear weapons on hair trigger alert ready to fire within minutes - even though we are no longer enemies, we have no incentive to incinerate one another, and chances remain of an accidental or an unauthorized launch. We still fund global health issues very sparsely - even though diseases like AIDS, TB and malaria are devastating our economic partners in other parts of the world and are devastating the military forces in nations we rely on as partners in the war on terror.
These dangerous policies are proof of how hard it is for people to change their views AND change the old habits inspired by those views. The world has changed. We have moved from an era in which our security depended on confrontation to an age in which our security depends on cooperation. It's a new age that features new problems and old problems with new urgency.
I believe three specific problems threaten our survival.
First, the persistent and growing gap between the haves and the have-nots. There is some debate over whether the disparities are growing, shrinking or stable, but there can be no denying that in our globalized world, these disparities are easier to see and harder to accept and breed greater resentment - which terrorists are eager to exploit.
Second, the intractable conflicts that fester around the globe. These conflicts - such as those between India and Pakistan and between Israel and Palestine - take many lives, destroy families and communities, and create deep grievances which - again - terrorists are eager to exploit.
Third, nuclear, biological, and chemical weapons, materials, and know-how are becoming more widely available to both rogue states and terrorists. Based on what we saw September 11, if terrorists had these weapons of mass destructin, they wouldn't hesitate to use them against us.
These are crucial problems. They can be solved. But they will not be solved with the old policies and old approaches that got us into this trouble to begin with. We must broaden our thinking and approach. We need to give up some old ideas, and embrace important new ones. Here are some ideas that I think can guide us to a safer world.
- National security depends on healthy and wealthy partners; disease undercuts both. What is more, disease does not recognize national boundaries so we must address it wherever and whenever it occurs.
- Hatred is a serious national security threat.
- The ability to inspire fear is less valuable than the ability to diminish hatred.
- If people are free and prosperous, they will not fund or support terror.
- [Editorís note: Dr. Hamburg next addressed the importance of world health issues, and her text is forthcoming.
- It is essential to have good relations with a nation's people - not only its leaders.
- We can't win the war on terror without massive international cooperation.
- We can't get nations to cooperate with us on our concerns, unless we cooperate with them on theirs.
Your future, and the safety of the world you will live in, will depend upon the world's ability to remodel the old ideas and embrace the new. Yet, as I said, most people now in power in business and government developed their mindsets in different times and many of their strategies in the Cold War world - and then the world changed drastically.
This is why we need you. You didn't grow up with the old thinking. You see the new realities more quickly. How many of you graduates have parents who know more about computers than you do? How many of your parents are quicker to access information or download music from the Internet? Not many. Your young fresh minds take in new lessons more easily - and you aren't burdened by having to unlearn the old ways. Let me offer just one example of the old way versus the new. As I said earlier, the United States pays the least money on a percentage basis of any advanced nation to fight poverty and disease in the developing world. You still have members of Congress actually boasting on their websites about how much they cut foreign assistance
. They can get away with that boast, because global health has not been a big priority in the minds of many Americans
. Many politicians complain it's a waste, and the average citizen doesn't have the facts to prove they're wrong. Yet, consider what our stinginess in global health means for public health here in America. In the past decade, the impact of infectious diseases on the United States has increased significantly. Illnesses unknown here a few years ago - such as West Nile - have emerged to kill hundreds of Americans, and old diseases such as measles and tuberculosis have reappeared, sometimes in epidemic proportions. SARS is a current and frightening example of a new and emerging infection that threatens us all.
One approach to preventing disease is to limit exposure. But in the global era, we are, in fact, increasingly exposed. Every year, tens of millions of people visit the United States from other nations; billions of tons of food and other products enter the United States from other nations. We cannot expect to stop travel and trade. We cannot expect to isolate disease at customs. We have to stop it where it starts.
This has everything to do with our health, wealth and our future. If we understood it that way, we could easily generate the spending and effort it would take to make a major and enduring difference. And many people do understand it that way, but it is so hard to change. We can't get our spending on global health to the high levels where it ought to be - because of the lower levels where it used to be. It doesn't matter that we've realized we're out of the old era - we're still stuck in the old habits. I will make a clear exception in the case of President Bush's new initiative to fight AIDS. That is a welcome and meaningful breakthrough. But we still face millions of preventable childhood deaths around the world every year - children who die from diseases for which there are effective vaccines that cost only a quarter. And we are not making the policy changes necessary to stop that. We seem to catalogue that ongoing tragedy in some file labeled "has to do with people far away; doesn't affect United States." But this is crazy. If we don't change that mindset, the turmoil in our world will only increase.
If you agree and share these concerns, I hope that you will roll up your sleeves and join in. It's your future being shaped. We need every energetic ally we can find. There's an old quote that my mother had up on the refrigerator when I was growing up. You all have probably heard it. Itís from Margaret Mead, the renowned anthropologist. It read, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."
When I was growing up, I saw only the positive side of that quote. Now I wonder if maybe some future terrorist grew up with the same quote on his/her refrigerator - certainly a small group of committed people changed the world on September 11. Today, sadly, smaller and smaller groups can do bigger and bigger damage. The entire nature of terrorism has grown more deadly. Former CIA Director James Woolsey has said that terrorists used to be seeking a place at the table; now they just want to blow it up. One extremist Muslim cleric chillingly told a U.S. newspaper: "We don't want to change your mind, we want to destroy you."
I believe that in this age of terror, the only thing that can stop a small group of committed individuals is a large group of committed individuals. Only all of us acting together, with wise policies and sound judgments, can make our world safer.
You're entitled to a world that offers you every opportunity. But it won't be handed to you. You have to take a hand in building it. More than 40 years ago, President Kennedy said in his inaugural address: "In the long history of the world, only a few generations have been granted the role of defending freedom in its hour of maximum danger. I do not shrink from this responsibility. I welcome it. I do not believe that any of us would exchange places with any other people or any other generation."
Today, it's your generation that has that role of defending freedom and defending your future.
In the fall of 2000, my old boss President Clinton - speaking at the United Nations for the last time, to history's largest-ever gathering of Heads of State - closed his remarks with thoughts that are as good as any I've heard. Let me quote him: "The leaders here assembled can rewrite human history in the new millennium.... But we must believe the simple things - that everywhere in every land, people in every station matter. Everyone counts, everyone has a role to play, and we all do better when we help each other."
Let me close with a paraphrase of those remarks to this Bowdoin College graduating class of 2003: "The future leaders here assembled can rewrite history in the new millennium. Study the world. Understand its principles. Write its new laws. And never believe for a moment that you can separate your fate from those far away or from those less fortunate. With this outlook, you will all do very well - and so will your great grandchildren. Congratulations, good luck, and Godspeed.
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