Gates' Goal Shows High Hopes for Global Health

Bill Gates surprised even his closest advisers when he said his dream is to eliminate the world's top 20 diseases in his lifetime. Gates-watchers say it's not naïve over-reaching. The Gateses have an optimistic belief in technology and management that, combined with their resources, could make a difference.

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MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

It's a big gift and its been given to an organization with big ambitions. One day after Warren Buffett announced his unprecedented $31 billion donation to the Bill and Melinda Gates Foundation, the question is what can a charitable foundation with unprecedented resources realistically achieve? Bill Gates has made it clear he's not thinking small.

Mr. BILL GATES (Bill and Melinda Gates Foundation): Within our lifetime I would expect that all these top 20 diseases, we would have vaccines and medicines to eliminate the disease burden of those.

NORRIS: Melinda Gates has said she dreams of a vaccine to conquer AIDS. Those aspirations top even Richard Nixon's 1971 declaration of a war on cancer.

As NPR's Richard Knox reports, the Gates dream for global health may not be too farfetched.

RICHARD KNOX reporting:

It's safe to say that public health experts were bowled over by Bill Gates's vision of ridding the world of the top 20 diseases, but that doesn't mean they thought he was overreaching.

Mr. NILS DAULAIRE (Global Health Council): I don't think Bill Gates's statement was grandiose at all. He recognizes what can be done. Now, with this level of resources, I'm hoping it will.

KNOX: That was Nils Daulaire of the Global Health Council. He says the 12-year-old Gates Foundation, with a mere $30 billion endowment, has already raised the sense of possibilities beyond what anybody in the field has ever seen.

Mr. DAULAIRE: The whole focus on the development of new vaccines against AIDS, tuberculosis, malaria, various childhood diseases, those were kick-started by investments from the Gates Foundation.

KNOX: But eliminating the world's top 20 diseases? Do Bill and Melinda Gates know what they're talking about?

Dr. CHRISTOPHER MURRAY (Harvard University): I think nobody on the planet could call Bill or Melinda naïve.

KNOX: Dr. Christopher Murray of Harvard is author of a 1000-page tome called The Global Burden of Disease. He says it doesn't matter how long the wish list of diseases is.

Dr. MURRAY: I'm sure some will be achieved and some won't be, but I'm a huge believer in articulating ambitious objectives and striving for them. I think that's actually what drives change in the world.

KNOX: Murray says the world's leading killers offer the Gates Foundation many opportunities to make a big difference with existing medicines and methods, diseases such as pneumonia and diarrhea that kill millions of children every year. Creative management and yes, money, can make a big difference. But the top killers include much bigger challenges.

Dr. MURRAY: They include heart disease, stroke, road traffic accidents and actually depression, and the challenge is to come up with strategies, drugs, vaccines that are affordable for poor countries.

KNOX: It's not entirely clear whether Bill Gates meant to include these non-infectious diseases on his hit list. Until last November, Dr. Richard Klausner was Chief of Global Public Health for the Gates Foundation.

Dr. RICHARD KLAUSNER (National Academy of Sciences): It never purported, at least while I was there, to be talking about all disease. We really didn't work on cancer, heart disease, depression. This is really about neglected diseases, where this level of resources and this level of attention can really have an impact and, you know, it's only $60 billion.

KNOX: It's all relative. Once the Gates Foundation gets its new money, that $60 billion will allow it to disburse around $3.5 billion a year. That's more than three times what the World Health Organization spends, but it's only a small fraction of the $80 billion the world devotes to drug and vaccine research and development and it's a tiny fraction of the $400 billion the world's poor and middle income countries spend on health.

But Harvard's Chris Murray says the Gates Foundation has a disproportionate effect on setting agendas. People in the field are already talking about a golden age of public health, an era undreamt of just six or eight years ago.

Dr. MURRAY: We have hundreds of students coming in to Harvard College who are incredibly excited and motivated about doing something in global health and that's completely caught people by surprise.

KNOX: But can that be sustained, even with the Gates' billions, against such daunting problems?

Dr. MURRAY: My only fear about this sort of golden opportunity or golden era that we're living through is that if two or three years roll by and we haven't got anything much to show for success, then I think there'll be a huge countermovement to say we focus too much on global health.

KNOX: Murray says there are still those who say health is a luxury that poor countries should worry about after they've had more development.

Richard Knox, NPR News.

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Q&A: Gates' Growing Public Health Brand

Bill and Melinda Gates, and Warren Buffet, right.

Microsoft co-founder and chairman Bill Gates, left, answers questions during a news conference in New York with wife Melinda Gates and investment guru Warren Buffett, regarding Buffett's pledge of $31 billion to the Bill and Melinda Gates Foundation. Nicholas Roberts/AFP/Getty Images hide caption

itoggle caption Nicholas Roberts/AFP/Getty Images

When a Public Health Giant Doubles in Size

  

The sheer size of the new Bill and Melinda Gates Foundation grants will no doubt influence how governments and other foundations choose to spend their public-health dollars, says Gerald Keusch, associate dean for global health at Boston University's School of Public Health.

  

Here, Keusch talks about how Buffett's gift to Gates may affect other public-health players:

  

Q: Can it be a bad thing to have so much money concentrated in one foundation?

  

When you're the 800-pound gorilla, you have a lot of power and impact and potential. It also creates some ambivalence on the part of the other players.

  

Q: What sorts of problems can crop up?

  

I worry about the effect that Gates' money has on the investment of others. Say you are the government of Uganda, and you've decided you're going to invest a certain amount of dollars in improving birth outcomes. And now Gates says, we're going to put X million dollars into your country and suddenly the country's own monetary commitment disappears. Then five or 10 years down the road, Gates says, "That's enough," and pulls out. There's no continuity of support. I hope the foundation will now look more at long-term sustainability.

  

Where would you like to see Gates put this new influx of money?

  

One hope would be that with this huge amount of additional money, they not only sustain the current kinds of investments but can now pick up on the infrastructure, training and the capacity of developing countries to deliver health care. Those are areas where Gates has not made any significant investment.

  

Should Warren Buffett have created a new foundation?

  

No, I think Buffett's philosophy is right on target. It's not a good idea to set up another foundation. The Gates Foundation has made a huge positive contribution, and Buffett's gift is a recognition of the priority they've made of global health in comparison to the other foundations, which have many priority areas.

  

They have a great opportunity now to get involved in an instructive, creative and complementary manner with their counterparts — other foundations, the governments of developing countries, as well as governments with serious funds for health programs, such as United States and Britain.

The Bill and Melinda Gates Foundation was already one of the top players on the global public-health scene; its annual donations — $1.36 billion in 2005 — dwarf those of other private charitable organizations. Now, with its spending set to double thanks to a gift from Warren Buffett, the foundation wields a fortune that holds the potential for even wider-scale change.

The foundation has invested in many areas of public health, from providing childhood immunizations to agricultural research in developing countries. One of the foundation's major priorities is HIV/AIDS prevention and treatment, with more than $350 million given in grants.

Thomas Quinn, who is director of the Johns Hopkins Center for Global Health and has followed the foundation's AIDS work, spoke with NPR about Gates' role in the global effort to stop the disease. The foundation's attractions are not only its deep coffers, says Quinn, but its innovative and adventurous approach to research:

Q: How do the Gates Foundation programs differ from United Nations and World Health Organization global health programs?

The Gates Foundation right now is the largest philanthropic organization supporting global health research. For example, UNAIDS carries out surveillance of programs and makes global recommendations in prevention and treatment, but it doesn't fund major initiatives, like those involving research activities.

So right now, for instance, the Gates Foundation is supporting vaccine research for HIV and childhood diseases. WHO and UNAIDS are awaiting the results of those vaccine trials, and if they show protection, WHO or UNAIDS would then make recommendations to countries to implement these types of interventions. And the Global Fund to Fight AIDS, Tuberculosis and Malaria, provides funding for treatment and care — it doesn't fund research.

All of these groups actually work well together, because they target different areas.

As a private group, does the Gates Foundation have more freedom in choosing the types of research it wants to fund?

Yes, the Gates Foundation is trying to fill in the gaps. They're really a transition between the National Institutes of Health and, ultimately, the Global Fund for AIDS, TB and Malaria. The foundation can fund really innovative, thought-provoking studies that perhaps a peer-review group like the NIH might avoid because they're high risk.

We have a trial right now in Uganda. NIH is funding one part of it: the circumcision of HIV-negative people to see if that prevents HIV acquisition. Gates is funding the other part: the circumcision of HIV-positive people to see if that prevents transmission. Both parts of the trial are in the same district and have the same investigators. But NIH felt comfortable funding one part, and Gates felt comfortable funding the other part — that's a little bit riskier, to circumcise people who are HIV-positive.

Are there other differences between an NIH-funded trial and a Gates-funded research?

If you go to the NIH, you might be lucky to get a couple of million dollars to do a research project. You can go to Gates and get $40 million. They think on a bigger scale because they have the funds.

NIH can't match the scale of the Gates Foundation grants, because it has a mandate to fund research in all diseases, most of which have a U.S. or domestic base. They have to cover everything with a budget that is currently capped. Gates has chosen to focus on the big three — AIDS, TB and malaria — and childhood vaccines, and applications of this research to developing countries.

What is the foundation's reputation in the developing countries they work with?

It's superb, they're a godsend to many of these countries. They try and make a difference. Prior to the Gates Foundation, there was a real void. There were some foundations, but they didn't have the richness or financial depth. Ford, Carnegie and Rockefeller, they have also been committed to these health inequalities. But the Gates Foundation spent $1.3 billion last year. That's phenomenal, and that's on an annual basis, that makes a big difference.

Where has the foundation made the most difference so far?

I think they've made a huge difference in immunization programs. They have funded vaccine programs immensely, making them available where they weren't before and saving millions of lives. And from my perspective, that's one of their greatest achievements.

Gates is preparing to devote his work full-time to the foundation. Is that a good thing?

He is extremely bright and loves making a difference in global health. The good news is that he's traveled widely, he knows people who can make a difference, he knows how to run a big organization, and we can all agree he's done pretty well with that. We'll have to see how it plays out, but I think having Gates and his wife, Melinda, more involved on a day-to-day basis will only be good for the entire field of global health.

Editor's Note: Both Quinn and Keusch have been involved in Gates Foundation-funded projects. The Gates Foundation also provides support for coverage of global public health on NPR.

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