Bill Gates is opening windows on world health

LONDON, August 7 (Science Analysed) Just three experts with worldwide contacts are making the key recommendations in distributing some US$550 million a year from the Bill & Melinda Gates Foundation (BMGF) to deserving causes in global health.And one of those recommendations recently (31 July) was to give the London School of Hygiene & Tropical Medicine (LSHTM) US$40 million for work in malaria, a grant which was "twenty times bigger than what we'd normally call a large grant, which is typically US$1-2 million" said Professor Eleanor Riley of the LSHTM, co-director of the malaria project. The funding is so large that the School will have to employ more people with financial and administrative skills to handle the project."First it's for field trials of new drugs, vaccines and insecticides against malaria" said Riley. "The problem has been that trial moneys were always spread over many different institutions, and it's always taken a long time to get the money together to move ahead. We've always had to go back to the drawing board and get together a new consortium each time." Secondly, the grant will pay for regional centres in Africa for training in malaria research and control; and third to support a policy initiative "to make sure the results of the research we do actually get translated into changes in health policy in endemic countries" said Riley.So what is this powerful body, the BMGF, which seems to be able to make such a difference? Clearly it is an organization with money and muscle, and which seems to act much more like an entrepreneurial investor, backing hunches confidently with serious money, than a typical philanthropic organization serving small beer to quench small thirsts. But despite this power the BMGF is truly trim and slim — with only six staff in its Global Health Division of whom just three take the major decisions: the Director, Gordon W. Perkin; Senior Health Advisor William H. Foege; and Senior Programme Officer Sally K. Stansfield.Perkin is medical doctor who has focused on reproductive health and population issues. He was President of the Program for Appropriate Technology in Health (PATH), an international, non-profit dedicated to improving health, especially of women and children, was 14 years with the Ford Foundation in international health and population projects, and served as a long-term consultant to the World Health Organization (WHO) on the design and research strategy of the Special Programme in Human Reproduction. Foege is an epidemiologist who came to world fame in the smallpox eradication campaign in the 1970s. He became Chief of the US Centres for Disease Control (CDC) Smallpox Eradication Program, and was appointed Director of the CDC in 1977. Stansfield also was in child health with the CDC, with lengthy field experience in Cambodia and elsewhere."Our staff have been out in the field a long time and have a pretty good idea of who's doing what," Annemarie Hou, BMGF International Spokesperson, told BioMed Central. Even if they don't have expertise in absolutely every area, they know who to call who does, Hou said. "They've chosen priority areas [vaccine preventable diseases, reproductive and child health, and conditions associated with poverty], then they look at the needs, at the benefactors' interests, and identify where the resources could go to make the biggest difference."Many philanthropic foundations have large networks of committees and advisors but "we have nothing formal" said Hou. "But there's definitely an informal network. That's demonstrated by our recent 'vaccine leadership' meeting this June, with 30 of the most interesting people working in vaccines right now to get their ideas." Attendees included: Seth Berkley, President of the International AIDS Vaccine Institute (IAVI); Barry Bloom, Dean of the School of Public Health at Harvard University; Felicity Cutts of the Department of Infectious and Tropical Diseases at the LSHTM; and Steve Landry of the US Agency for International Development. The meeting was internal, not press released or reported, but it aimed at defining leadership roles in vaccine development and distribution, what needs to be done and who should do what.With this small in-house team, its international advice, and a US$17 billion gift contributed last year by Microsoft chief executive Bill Gates and his wife, Melinda, the BMGF in the last 18 months has become arguably the leading player in global health and health research funding.To give a taste of their activity, just last month, among other gifts the Foundation gave the London School US$40 million to combat malaria, awarded US$44.7 million to Harvard Medical School to control multidrug-resistant tuberculosis worldwide, gave US$20 million to Johns Hopkins School of Public Health to improve Third World maternal and child health, gave US$25 million to the CONRAD Program's Consortium for Industrial Collaboration in Contraceptive Research to expand and accelerate the development and clinical testing of new non-irritating microbicides that will protect women against sexually transmitted diseases, gave Childreach a US$1 million grant to bring education and medical help to African children living with, or orphaned by, HIV/AIDS, awarded US$15 Million to the Elizabeth Glaser Pediatric AIDS Foundation to improve access to retroviral drugs during labour and immediately after birth to prevent mother-to-child transmission of HIV, and launched a health initiative with the Republic of Botswana and Merck & Co., to improve the overall state of HIV/AIDS prevention, care and treatment in the country.If much of this relates to AIDS, that's partly because of the World AIDS Conference in Durban last month but also because AIDS is high on the BMGF agenda. The International AIDS Vaccine Initiative (IAVI) was one of the Foundation's first major AIDS grantees, receiving US$25 million in 1999.How do these decisions arise? "Take our strategy for Botswana" explained Hou. "That arose out of a meeting we held on who's doing what in HIV/AIDS, with CDC, the US National Institutes of Health (NIH), USAID and UN agencies. We convene meetings to find out what is currently happening, what is projected to be happening, and what the current needs might be."The BMGF identifies where its substantial finds might make a real difference — and then it applies them, no holds barred. "We're giving large amounts and aiming to accelerate progress," said Hou. "I think IAVI is a pretty good example of that ... They were languishing somewhat, there were several candidate vaccines, and we thought what could we do to accelerate the process. So last year we gave them US$25 million, and they've been able to leverage that to a hundred million. It's galvanized the entire industry."Take the US$40 million for the LSHTM for malaria research and training. "Isn't this a real vote of confidence in what they are doing?" BioMed Central asked. "Right," said Hou. "As contractors we are looking for the best cabinet maker. We give them the resources to accelerate, and expect them to do a great job, and get out of their way so they can do that." Table 1

Data compiled from the European Foundation Centre and the US-based journal Chronicle of Philanthropy, The Wellcome Trust still tops the scale of assets among European and US philanthropic foundations. According to these sources the top 15 in assets are:1. The Wellcome Trust (London)US$19.2 billion2. Bill & Melinda Gates Foundation (Seattle)US$17.1 billion3. David and Lucile Packard Foundation (Los Altos, Cal.)US$13.0 billion4. Ford Foundation (New York)US$11.4 billion5. Lilly Endowment (Indianapolis)US$11.1 billion6. Caripolo Foundation (Milan)US$9.5 billion7. Robert Wood Johnson Foundation (Princeton, N.J.)US$8.1 billion8. Compagnia di San Paolo (Turin, Italy)US$7.4 billion9. W.K. Kellogg Foundation (Battle Creek, Mich.)US$6.2 billion10. Pew Charitable Trusts (Philadelphia)US$4.8 billion11. MacArthur Foundation (Chicago)US$4.2 billion12. Andrew W. Mellon Foundation (New York)US$3.54 billion13. Rockefeller Foundation (New York)US$3.50 billion14. Knut och Alice Wallenbergs Stiftelse (Stockholm)US$3.2 billion15. Fundação Calouste Gulbenkian (Lisbon)US$2.4 billion

Bill Gates is opening windows on world health

Tropical Medicine for malaria was 20 times the size of the School's usual receipts.

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