We have been working in global health for almost a decade. The results we are seeing from our investments—and from the investments of other funders, who are focusing more than ever before on the health of people in poor countries—prove one thing: Global health spending works.
Given the right approaches, it is possible to save hundreds of thousands of lives in a remarkably short period of time. For example, in the past nine years, measles deaths have dropped by more than 74 percent, thanks to a concerted effort to vaccinate children in hard-hit regions. In our 2005 Annual Report, we wrote about the Malaria Control and Evaluation Partnership in Africa (MACEPA) program in Zambia. Now, results show that by increasing the distribution of bed nets, spraying with insecticides, and providing greater access to prevention and treatment services, Zambia has cut malaria cases in half.
In addition to the foundation’s investments, governments and organizations around the world are working together in new ways to save lives. For example, an international public-private institution called The Global Fund to Fight AIDS, Tuberculosis, and Malaria has helped detect and treat 4.6 million cases of tuberculosis worldwide and delivered 70 million insecticide-treated bed nets and 74 million malaria drug treatments.
Global health is a complex and vast undertaking, however, and there are many urgent issues that still haven’t received the attention they deserve. For example, the diagnostic test for tuberculosis doesn’t work very well, but there hasn’t been a new one developed for more than 100 years. With sufficient investments, we can develop an accurate and rapid test for TB that will dramatically reduce transmission of a disease that kills 1.7 million people every year. These are the sorts of opportunities we tried to capitalize on in 2008.
Goals for Malaria Eradication
Building on recent successes in malaria control—like those in Zambia—we have, with our partners, set the long-term ambition of eradicating the disease altogether. At the
United Nations Millennium Development Goals Malaria Summit in September, world leaders endorsed the
Global Malaria Action Plan (GMAP), which lays out a comprehensive, multibillion dollar strategy to help reduce malaria in the short term and also to help move toward eradication in the long term.
The GMAP's roadmap to eradication includes increasing access to currently available interventions and funding the research and development of new interventions.
The GMAP was created with input from more than 250 experts from 65 international institutions and 30 countries and regions where malaria is endemic. The scope of the collaboration and the GMAP’s ambitious targets are unprecedented in the field.
Progress in Vaccines
Vaccines are one of the most effective health interventions ever developed. However, in the past, new vaccines have not reached poor countries until a decade or more after they’re introduced in rich countries. With our partners, we have made historic progress toward closing that gap.
In 2006, a new rotavirus vaccine was introduced in developed countries and, with a donation from Merck & Co., in Nicaragua as well. This marked the first time a vaccine was introduced in developed and developing countries in the same year, and it represented a major breakthrough for health equity. One of our partners, the GAVI Alliance, announced in November that it will continue to support rotavirus vaccination in Nicaragua, and it is expanding the program to other low-income countries.
The world is also making progress in preventing pneumococcal disease (pneumonia, meningitis, and sepsis), the leading cause of vaccine-preventable death for children under 5. Earlier this year, with a vaccine donation from Wyeth, Rwanda became the first low-income country to introduce the pneumococcal vaccine. The list of developing countries approved by GAVI for pneumococcal vaccine is now at 11, and 30 more have expressed interest in partnering with GAVI to introduce the vaccine.
Through expansive partnerships involving many governments and international organizations, many millions of children in the developing world will have access to the same vaccines as children in rich countries, and many of the 2 million lives now lost to rotavirus and pneumococcal disease will be saved.
Better Vaccines Through Advanced Market Commitments
We expect even more progress on the pneumococcal vaccine in particular. A new health financing tool, called
Advanced Market Commitments (AMC), is designed to lead to the development of an even better vaccine against pneumococcal disease. (The current vaccine protects against seven strains of the disease, which is effective in many countries, but the AMC targets a vaccine that will address 10 to 13 strains.)
AMCs are a creative response to the fact that there aren’t vaccines for many diseases that affect poorer countries, in large part because governments and people living there often can’t pay for them. Without a market, there’s no incentive for pharmaceutical companies to research and develop these products.
Under an AMC, donors commit money to guarantee the price of vaccines once they’ve been developed. An independent advisory group makes decisions in advance of the AMC about which diseases to target, the criteria for effectiveness, and how much the vaccine will cost.
In 2007, we joined the governments of Canada, Italy, Norway, Russia, and the United Kingdom to pledge $1.5 billion for the pneumococcal AMC—the first ever AMC—which will launch later this year.
The lessons learned from the pneumococcal AMC will guide decisions about potential future AMCs for other diseases, such as malaria and tuberculosis.