The basic problem is that vaccines, which typically offer long-term immunity from one battery of shots, aren't nearly as profitable as drugs that are taken daily. Pfizer's cholesterol-lowering Lipitor, for example, with $10 billion in global sales, grosse

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Gates' huge donations causes ripple effect in global health

BY FRANK GREVE

Knight Ridder Newspapers

WASHINGTON - (KRT) - John D. Rockefeller was a piker compared with Bill
Gates.

The Microsoft magnate, who's 49, has spent nearly as much in the past
five years just to improve global health - $5.4 billion - as Rockefeller
gave to all causes in his 97-year lifetime.

That largess has made Gates the world leader in the main area that his
foundation funds: vaccines and childhood immunizations for the
developing world. The United Nations World Health Organization credits
the Seattle-based Bill and Melinda Gates Foundation - the world's
richest, with an endowment of $28.8 billion - with helping to save
670,000 lives.

Using his "superpower access without superpower baggage," as James
Sherry of the advocacy group Global Health Council put it, Gates is
convincing rich and poor countries, international health organizations
and drug makers to do more to prevent Third World diseases. Typically,
they're organized into new Gates-funded global coalitions with single
goals: a malaria vaccine, for example, or a spermicide for women that
also can ward off AIDS.

Donors from the singer Bono to the Bush administration have followed
Gates' lead, multiplying the effects of his donations. It helps that
many see the Gates Foundation's giving as not just massive but also
shrewd.

This week's Gates donation of $250 million, for example, announced
Monday at the World Health Assembly in Geneva, backs research on tough
technical problems that, if solved, would greatly improve global health.
One challenge is to devise vaccines that don't require refrigeration.
Another is to create vaccines that can be administered without needles.
A third pays for genetic research to incapacitate disease-carrying
insects.

Gates is also the world's leading supporter of research into vaccines
for malaria and tuberculosis and the biggest nongovernment funder of
AIDS-vaccine research. This trio causes more than 6 million deaths a
year worldwide, according to the WHO. Another 2.1 million people -
two-thirds of them younger than 5 - die of infectious diseases that
already available vaccines could avert.

For various reasons, mainly the indifference or distraction of U.S. and
international global-health agencies, Third World preventive medicine
"stagnated and regressed" in the 1990s after big improvements in
inoculation rates in the 1980s, according to Dean Jamison of the
National Institutes of Health's Disease Control Priorities Project and
other experts.

The Gates-led revival has a legion of grant recipients saying nicer
things about Microsoft's founder than many users of his software.

"The Gates Foundation introduced a lot of optimism into the field of
global health at a time when there was real and growing despair," said
Ruth Levine of the Center for Global Development, a Washington-based
group that fights rich-poor inequalities. "We got an explosion of
interest and money and work from the Gates Foundation, but the optimism
was probably the most important thing. It's the original can-do
foundation."

Take the case of researcher Scott Halstead, who's spent 40-some years
seeking a dengue-fever vaccine. Dengue, an infectious mosquito-borne
tropical disease of the joints that kills about 3,000 South American and
Asian children a year, also afflicts developing-world economies because
outbreaks sideline workers, deter trade and discourage tourism.

The U.S. military sustained dengue research for years, but it's been
flat since the early '90s, according to Halstead. Drug companies have
done modest, uncoordinated research. U.S. and international agencies
showed more interest in African diseases, especially AIDS.

Then, last year, $55 million from the Gates Foundation doubled the
worldwide dengue-research budget to $10 million a year. Halstead's
research teams, which suddenly controlled the lion's share of the money,
were positioned to run a coordinated global campaign against dengue.

"This is like a new dawn," Halstead said. "The money allows us to
organize and focus a serious program. Every day we're talking to lab
researchers capable of doing something important who wouldn't have been
talking with us a year ago."

Other donors - the WHO, the European Union and the Swiss drug company
Novartis - followed Gates with new commitments to fight dengue.

The Rockefeller Foundation, whose roughly $20 million a year in grants
had made it the dominant private global-health donor until Gates came
along, played a bit part. Its small grant helped Halstead design his
Gates Foundation proposal.

Gates, his wife, Melinda, and his father, Bill Sr., are hands-on
managers of the foundation, which was created after Gates' mother, Mary,
died in 1994. The fourth principal is foundation President Patty
Stonesifer, a former Microsoft executive and close family friend. Since
1999, they've focused mainly on global health and on education, where
the Gates foundation is one of many players.

All three Gates family members have spoken out against disparities in
preventive health between rich and poor countries. Gates himself, who
wasn't available to be interviewed for this story, has said he got into
the issue by reading a 1993 World Bank report titled "Investing in
Health."

"Every page screamed out that human life was not being treated as nearly
as valuable in the world at large as it should be," Gates told a Seattle
AIDS conference in 2003.

The basic problem is that vaccines, which typically offer long-term
immunity from one battery of shots, aren't nearly as profitable as drugs
that are taken daily. Pfizer's cholesterol-lowering Lipitor, for
example, with $10 billion in global sales, grosses more than all the
world's vaccines combined.

To compensate, the Gates Foundation picks up research costs and helps
with clinical trials in return for cut-rate sales to poor countries. It
pools potential buyers to create and guarantee drug-makers the largest
possible vaccine markets. It's assembled an international public-private
consortium, the Global Alliance for Vaccines and Immunization, to bring
cheaper, better preventive health to the world's 75 poorest countries.

The alliance's money comes from The Vaccine Fund, mainly $1.5 billion in
Gates Foundation grants and pledges. Norway and the United States, the
next biggest donors, chip in about $660 million. By comparison, WHO's
entire annual budget is about $800 million.

For all its generosity, the Gates Foundation draws some complaints these
days. Once famously fast and informal at awarding grants, its system now
takes 18 months from proposal to check. Its once-lean staff of about 20
has grown to about 200. The four top decision-makers may be walled off
from the open debate about grants and direction that a larger board
might provide.

There's also a challenge to Gates' overall strategy of stoking research
and development rather than trying to improve conditions in Third World
countries, a strategy that's also proved to deliver big gains in health.

Anne-Emanuelle Birn, a Canadian public-health scientist, made that
argument in the British medical journal The Lancet in March. She said
Gates' bets on technology "share an assumption that scientific and
technical aspects of health improvement can be separated from political,
social and economic aspects."

She favors "support for universal, accessible and comprehensive
public-health systems (to ensure vaccine coverage, among many
activities) in the context of overall improvements in living and working
conditions."

Gates, in announcing his $250 million grant in Geneva this week,
addressed her argument.

"The world didn't have to eliminate poverty in order to eliminate
smallpox," he said, "and we don't have to reduce poverty before we
reduce malaria."

---

To read Bill Gates' May 16 speech on global health, go to
www.gatesfoundation.org, where it's the lead story, and click on "View
speech." For more information, click on "Global Health" on the Gates
home page.

For a primer on vaccine economics, go to the Center for Global
Development site, www.cgdev.org, and click on "Making Markets for
Vaccines."

For more on Gates' global vaccine consortium go to
www.vaccinealliance.org.

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