The Gates Foundation’s expansion of its support, and the thinking that lies behind it

1 Feb 2010

Paul Chinnock

Source: TropIKA.net

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Bill Gates’ “Annual Letter” provides an insight into how decisions are reached at the Gates Foundation. Photo: ehavir.

The Gates Foundation becomes ever more influential in research and control efforts that address the infectious diseases of poverty. At the World Economic Forum, Bill and Melinda Gates announced a new $10 billion, 10-year commitment to support vaccine development and delivery – the largest commitment the foundation has ever made.

The announcement comes a few days after the publication of Bill Gates’ “Annual Letter” in which he sets out his current thinking and what he sees as the priority areas for action.

In his address to the World Economic Forum, Bill Gates said, “We must make this the decade of vaccines. Vaccines already save and improve millions of lives in developing countries. Innovation will make it possible to save more children than ever before.” He cited modelling studies that have estimated it to be possible to save the lives of 7.6 million under-fives if vaccine coverage can be scaled up to 90%. He stressed the importance of public-private partnerships in working towards this goal, quoting examples of achievements that have already made. And he called on other donors to act to address the many funding gaps that still remain.

Reactions

Amongst the many organizations that have welcomed the $10-billion commitment is IVAC, the International Vaccine Access Centre. “The Bill & Melinda Gates Foundation has once again set the bar for results-driven aid. By aiming at pneumonia, diarrhoea, and malaria, the funding will save millions of lives,” said Orin Levine, IVAC’s Executive Director. “But the Gates Foundation cannot achieve the full promise of vaccines on its own. Manufacturers must increase their investments in vaccine research and development, donor countries must mobilize to help fund new vaccines, and developing countries must make the investments and take the steps necessary for delivering life-saving vaccines to their children.”

“The Gates Foundation’s commitment to vaccines is unprecedented, but needs to be matched by unprecedented action. It’s absolutely crucial that both governments and the private sector step up efforts to provide life-saving vaccines to children who need them most,” said Dr Margaret Chan, WHO Director-General.

Dr Christopher Elias, President and CEO of PATH said the commitment would have “a tremendous impact on children and families in the poorest areas of the world”.

Dr Peter Hotez President of the Sabin Vaccine Institute said, “The Gates Foundation commitment to vaccines will not only lift millions of people out of poverty, it will save countless lives. This investment is truly a shot in the arm to those of us dedicated to vaccine development. We hope it is also a shot in the arm to governments across the country to embrace the importance of getting vaccines to its citizens”.

A letter with influence

In his 18-page letter Bill Gates describes his first year of working full time at the foundation. He speaks of enjoyable visits around the world to talk to scientists, politicians, teachers, farmers and others. He also admits that the work required to reach the foundation’s ambitious goals is proving harder than he expected, citing the six-year goal of getting the retrovirus vaccine to more than half the children who need it as one example. And he refers to malaria as “a particularly tricky disease ... the current tools alone will not be enough to eradicate it, so we are funding new medium and high-risk innovations”. He estimates that “a very effective malaria vaccine” is still 8–15 years away.

Diarrhoeal disease, pneumonia, polio eradication and AIDS are also discussed in the letter, as are the foundation’s activities in agriculture and education.

Referring to the continuing global economic problems, the letter expresses Gates’ concerns that budget deficits in the richest nations could lead to cuts in aid budgets. He praises Canada and Australia for their efforts and names Italy as a country that is not doing enough. He commends President Obama for his proposal to double international aid.

Answering critics who say that the foundation overemphasizes the role of technology, Gates says that the 50% drop in child deaths that has taken place since 1960 is largely the result of new technologies, though he stresses that technology must be adapted to meet the needs of its intended recipients. Such factors as a lack of electricity and trained personnel must be taken into account.

It has surprised many observers that the foundation has not become involved in working to fight climate change, despite its potential impact on the poorest nations. Gates says that the foundation has not yet found a way it can play a unique role in this area. However, outside of the foundation he personally is investing in energy research.

This is the second time that Bill Gates has published an annual letter. It seems likely that these letters will come to be seen as a landmark event for all those concerned with health in the developing world. This is both because the foundation provides some 20% of all funding for research into the development of new tools to fight the infectious diseases of poverty (see TropIKA.net article) and because Gates’ views are so influential. His assessment of the priorities has an impact on what other donors decide to do.

An insight

Critics have spoken of a lack of transparency in the methods the foundation uses to decide on its priorities and actions. The letter does not provide the kind of detail that many would like to see but it is nevertheless an insight into the foundation’s decision making process. Two criteria emerge as especially important. Successful innovations must cost less to use and maintain than the benefits they deliver; they should be capable of attracting alternative sources of funding once the foundation ends its support. Another consideration is “the ability to find partners with excellent teams of people who will benefit from significant resources over a period of 5 to 15 years”.

Bill Gates also explains that the foundation has a framework that involves funding a range of ideas with different levels of risk that they could fail. “The ones with low risk are where the innovation has been proven at a small scale and the challenge is to scale up the delivery. High-risk innovations require the invention of new tools. Some are at the frontiers of science, such as finding a new drug and running a large trial to see how well it works”. For example, he regards investing in distributing vaccines for pneumonia and rotavirus to 135m children a year as low-risk, inventing a pill or gel to reduce the risk of getting HIV as medium-risk, and inventing a highly effective malaria vaccine as high-risk.