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Gates' donations causes ripple effect in global health

WASHINGTON—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.

Last week's Gates donation of $250 million, for example, announced 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 ྖs, 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 last 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, 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,, and click on "Making Markets for Vaccines."

For more on Gates' global vaccine consortium go to


(c) 2005, Knight Ridder/Tribune Information Services.

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