The Gates Foundation approach to the world's health problems has its critics

May 16 2005

A recent article in The Lancet criticized the premise that a Grand Challenge to scientific and technological know-how is the best route to combating malaria, HIV/AIDS, tuberculosis and other diseases that kills millions of people each year.

Anne-Emanuelle Birn, an associate professor with the Department of Public Health Sciences at the University of Toronto, argued that many of the 14 Grand Challenges failed to incorporate economic, social and political context in seeking solutions and were shortsighted and even potentially harmful.

For instance, Birn said developing single-dose or needle-free vaccines might reduce the number of well-baby visits, which are essential for monitoring a child's growth. Or developing a genetic or chemical strategy to wipe out mosquitoes or other disease-carrying insects might make extending clean water and sanitation services to poor areas less urgent.

Birn urged Bill Gates to adopt a broader approach to global health problems than just searching for a scientific solution.

In his speech in Geneva, Gates was unapologetic about his foundation's focus on health breakthroughs.

He noted that some patients with AIDS used to take 20 pills daily, now they might take three.

"Today, we have tuberculosis drugs that you have to take for nine months. Why can't we find one that works in three days?

"Some point to the better health in the developed world and say we can only improve health when we eliminate poverty. And eliminating poverty is an important goal. But we have a different view. The world didn't have to eliminate poverty in order to eliminate smallpox - and we don't have to eliminate poverty before we reduce malaria."

Ann Marie Kimball, professor of epidemiology at the University of Washington, said legitimate debate exists about the Gates Foundation approach. But she said any criticisms should not overshadow its deep financial commitment to often-neglected parts of the world.

"The fact that these investments are being made is extraordinarily important," Kimball said.

Since its creation in January 2000, the Bill & Melinda Gates Foundation has pledged nearly $8 billion in grants for global health, education and public libraries as well as community programs in the Pacific Northwest. The foundation, the world's largest, has nearly $29 billion in endowments, bankrolled by Microsoft stock.