Advancing global health through enlightened philanthropy

Their formal philanthropy began in 1994, with the establishment of the William H. Gates Foundation. It was run, quite literally, out of the garage of Bill’s father, William Gates Sr., a distinguished lawyer then entering, what would become, a very busy retirement (and who I’m delighted is with us today). From the start, it had a special interest in reproductive health and the well being of children. In 2000, Melinda and Bill brought together their philanthropic interests and initiatives into a single entity, the Bill and Melinda Gates Foundation, which they co-chair today.

Together, they have taken on issues of ‘global health’ with a vengeance, propelling the field to new and previously unimaginable prominence. While they didn’t actually invent the term global health, they gave it urgency, visibility, and validity. The last time I searched the term global health, Google identified over 14 million independent citations. There is hardly an academic institution worth its salt today that does not have a school, institute, department, or center for global health. It’s of enormous interest and immediacy to undergraduates everywhere; indeed, it is now the single most popular undergraduate major at the Johns Hopkins University.

As the term implies, global health recognizes that any disease can strike any population, anywhere in the world; no population is safe when other populations are at risk. Diseases do not respect national borders; the health of every population affects us all. This is as true of traditionally communicable diseases caused by microbes, as it is of culturally communicable diseases like obesity, diabetes, and lung cancer.

Since diseases and conditions of ill health common in wealthy countries already receive considerable funding and attention, Melinda and Bill have focused their attention on the over-burden of disease among neglected populations. This focus mirrors the interests of a previously formidable philanthropist: J.D. Rockefeller, who successfully tackled hook worm in poor populations of the southern United States, malaria and yellow fever in South America, and the training of health care professionals in China.

But Bill and Melinda have taken a more multi-faceted approach, in both form and focus. What drives them is perhaps best captured in two phrases they repeatedly invoke: “every life has equal value,” and “every person deserves the chance to live a healthy, productive life.”

When Albert Lasker asked Mary what she would most like him to do for her, she replied, “fund medical research.” Being the astute advertising executive that he was, Albert replied that his wealth, significant as it was, paled in comparison to that of governments, and urged Mary to leverage his largesse by advocating for increased federal investments in biomedical research.

Melinda and Bill Gates have been great advocates, and funders, of medical research and health interventions, but they, too, recognize the need for leverage, as the resources of governments vastly exceed those of any private source.

A particularly effective means of leverage they’ve employed are public-private partnerships. A prime, early example is GAVI: originally an acronym for the “Global Alliance for Vaccines and Immunization.” Founded in 1999, GAVI provides significant financial assistance to those governments that are in real need and that demonstrate they can effectively deliver vaccines to their populations. Equally importantly, GAVI negotiates with suppliers for reduced costs.

This can entail sophisticated marketing and persuasion, especially when it involves new vaccines, where the goal is to dramatically reduce the 15-year delay between the time new vaccines are widely deployed in wealthy countries and finally make their way to low-income countries.

Putting effective solutions to use in countries that traditionally couldn’t afford them is but one arrow in Bill and Melinda’s collective quiver. Another is stimulating the development of health solutions that don’t presently exist, or that poor countries could never afford. These “Grand Challenges” run the gamut from inexpensive privies and smokeless stoves, to heat-stabilized vaccines that don’t require refrigeration — a major impediment to effective immunization programs in poor, rural communities that lack ice or electricity. These grand health challenges extend to the development of, and I quote,”the next generation of condoms.” And, that holy grail of tropical diseases, an effective vaccine against malaria. All submissions are rigorously reviewed, outcomes evaluated, and decisions for support evidence based.

Thus, they deconstruct a problem, identify the myriad contributory factors, stimulate the pursuit of practical tools, and advocate for their thoughtful deployment.

But Melinda and Bill don’t always follow this carefully orchestrated script. When the opportunity and need is great, and urgent, they are known to jump right in, with all four feet.

As most of you know, polio is, hopefully, in its end-game. A little over two decades ago, 125 countries experienced nearly 400,000 cases of paralytic polio every year. Because of the global Polio Eradication Program, there were fewer than 223 cases last year, and the disease is now deeply endemic in only three countries: Nigeria, Pakistan, and Afghanistan. But ridding the world of those last few sources of infection is proving problematic, because of political and cultural impediments to mass immunization. “So near, and yet, so far.”

Abandoning the fight at this point would let the virus run rampant, resulting in a resurgence of disease and suffering. An estimated $5.5 billion is needed to complete the task by 2018. Bill and Melinda have risen to the challenge — not only by making their own financial commitment, but by calling upon their philanthropic colleagues in arms — as in the case of Mayor Michael Bloomberg, who is with us today — and enrolling them in the cause.

A simple but impassioned tw0-minute phone call from Bill caused Mike Bloomberg to respond, “count me in,” to the tune of $100 million.

Bill and Melinda Gates are responsible for a rich pipeline of initiatives that are creating new tools, and new alliances for implementing them, to the enormous benefit of global public health. Please join me in congratulating them on their richly deserved receipt of the 2013 Lasker~Bloomberg Public Service Award.