The foundation’s aggressive goals for our health and development work are only realistic because of the basic scientific advances that have been made recently and continue to be made. Investments in research and development by large governments and private companies drive this rapid increase in understanding of medicine and agriculture. The U.S. National Institutes of Health spend about $30 billion per year on biological research. American pharmaceutical, biotech, and crop science companies spend an additional $60 billion. Genome sequencing is a great example of how research by the private and public sectors can benefit the very poor. Scientists, including many funded by the foundation, are using the data from genomic sequencing to design new drugs and vaccines. Our role as a foundation is to help make sure the new science is applied to the needs of the poor, because the marketplace doesn’t respond when buyers have almost no money.
Polio is another good example of what can happen when you take innovations that benefit the rich world and apply them in the poor world. The book Polio: An American Story, by David Oshinsky, tells the story of how Franklin Delano Roosevelt’s polio raised public awareness of the disease and made it possible to raise money for research into a vaccine. The vaccine work was done in the United States in the 1950s, supported by the March of Dimes. Polio was eliminated from the United States in 1979.
Because of that success, in 1988 the world adopted a goal of making polio the second disease to be eliminated, after smallpox. The United Nations Fund for Children and the World Health Organization led the charge. Rotary International has been a primary supporter of the work, and we wouldn’t be anywhere on this without their efforts.
Many people probably think polio has already been eradicated, because it gets so little press coverage, especially in rich countries. But there is still a significant amount of polio in four countries, with most of the cases coming from India and Nigeria. Eliminating it will require continued investment. Many people had hoped that it would be eradicated by now, but it has proven more difficult than expected. Researchers have learned that in some parts of India kids need to receive more than eight doses of the vaccine before they are protected. The government of India has done a very good job distributing it, but with the limited power of the vaccine they will have to add some new tactics and keep up the effort for several more years. Given all of their health priorities this is not easy. I met with the Indian prime minister and health minister this past November and feel sure they will do their part. The picture on the lower left shows a beautiful and happy 9-month-old girl named Hashmin, whom I met last year in a slum in New Delhi. She had recently gotten polio. It was tragic to see the muscles in her legs wasting away. Now she will never be able to walk normally. When you meet children like Hashmin, you are reminded why eliminating polio is so important.
The most difficult place to achieve success will be northern Nigeria, where the vaccine is still not being given to enough children. In order to convince enough families to participate in the polio campaign, you need not only dedicated teams that track down all the children but also a clear message from political, tribal, and religious leaders that the vaccine is safe and should be taken. An intense effort is being applied to get all these factors to come together in northern Nigeria. I’m making a visit there next month. With a few more years of investment and hard work the world will have a success with polio, which will invigorate the whole field of global health.
Polio is a good example of why the foundation needs to be flexible in our strategies and budgets. Last year, Melinda and I met with our polio team to get an update on progress against the disease. The team was asking us to approve the same amount of money we had been spending for years, but they kept talking about the many challenges of eradicating polio. Melinda and I probed to understand if they were saying that the world needed to spend more, and whether our leading by example could help make it happen. They said yes, and within a month they had put together a more aggressive plan that involved us spending hundreds of millions more and getting other donors to step up as well. We approved the plan. Rotary International and other donors are doing a great job so far coming up with the extra resources that are needed. Just this month I went to a Rotary meeting and helped announce more than $600 million in new money from various sources that will go toward eradicating polio. But none of this would have been possible if we didn’t keep flexibility in our budget and stay open to changing our approach.
On the AIDS front, you have probably read articles talking about failed trials of vaccines and microbicides. (A microbicide is a gel that a woman can use to protect herself from getting infected.) Although these results are setbacks, in each case we are learning and moving ahead with improved approaches. I am quite hopeful that in the next four to six years we will have either a pill or a microbicide that people can use to protect themselves temporarily from getting HIV. When used on a large scale they will dramatically reduce the annual rate of infection, which is currently 2.7 million. I feel a huge sense of urgency to make sure a pill or microbicide is developed as soon as possible. There are some great scientists working on this, and I am spending lots of time asking them what the bottlenecks are and understanding how we can make faster progress. The intensity reminds me of my time at Microsoft, when we were competing with other companies to make the best database or word processor. However, in this case the competitor is a virus and all of humanity is on the same team, wanting to work together to defeat the virus.
When we get a vaccine it will be even more impactful than a pill or a microbicide, because a vaccine will protect people for much longer. But given the complexities involved, even with the great work being done, it is very likely to be more than 10 years before we have one in widespread use.
To stay alive, people with HIV need to start using anti-retroviral drugs before their immune systems become weakened, usually within five years of becoming infected. In 2003, only 400,000 people were being treated, and now some 3 million are. That is a phenomenal increase. The biggest reason for it is that the United States funded the President’s Emergency Plan for AIDS Relief and managed the effort very well. In addition the United States, along with a number of other countries, has funded the Global Fund for AIDS, Tuberculosis, and Malaria. This is a good example of how scientific innovations, in this case the invention of anti-retroviral drugs, can reach the poorest with help from governments, foundations, and drug companies. Although less than 5 percent of people with HIV/AIDS live in rich countries, it was the market demand from these wealthier patients that drove the large R&D investment in these drugs.
Malaria kills nearly 1 million children per year, but companies and governments have invested very little in new drugs and vaccines because the disease has been eliminated from rich countries. Malaria has a fascinating history. Several Nobel prizes were given to scientists who helped us understand key facts about it—in 1902, 1907, 1927, and 1948. Malaria used to be a serious problem in large parts of the United States, but it was eliminated here by 1951 by large-scale campaigns to kill the mosquitoes that transmit the disease.
Fortunately, the past five years have seen a huge increase in the level of interest and investment in malaria. The foundation can probably take some credit for the increased level of interest in global health in general and malaria in particular. Bono also deserves a lot of credit for his work through ONE. I remember talking with him in 2004 about whether we could ever hope to have candidates discussing these issues during a political campaign. So during the recent U.S. presidential campaign it was fantastic that both Barack Obama and John McCain spoke out on how they would increase funding for global health, including specific commitments on malaria. It is also very exciting that donations from individuals to buy life-saving bed nets have soared.
Malaria is a very tricky disease. The world hoped in the 1950s and 1960s that it could be eliminated by killing mosquitoes with DDT, but that tactic failed when the mosquitoes evolved to be resistant to the chemical. Today a number of new tools are being developed—better bed nets, better drugs, better insecticides, and a number of vaccine candidates. One of the vaccines will go into the last phase of human trials this year and could be ready for wide use by 2014. None of these tools is perfect. To understand how we should combine them, we brought in an expert in mathematical modeling who is applying a technique called Monte Carlo Simulations. This modeling work, which will show where we can eliminate malaria and where we can just reduce the disease burden, is a wonderful use of advanced mathematics to save lives, and if it goes as well as I expect, we will apply it to other diseases. The malaria community has a goal to reduce deaths by over half by 2015, which is aggressive, but it is in line with the results in communities where bed nets and other tools have been rolled out.