The biomedical and pharmaceutical powerhouses of North America and Europe disproportionately focus their resources on the mostly chronic diseases affecting the relatively well-to-do. Of the $70 billion (US) the international health community spends on research, only 10% goes toward diseases responsible for 90% of the international health burden; it's called the 10/90 gap1 and it's deadly for poor countries. So, when an American private foundation announces a major investment in global health research, the structure and goals of such an investment deserve attention and discussion.

The Bill & Melinda Gates Foundation announced a $200 million gift to the National Institutes of Health Foundation to establish the Grand Challenges in Global Health Initiative. It is impossible not to laud any attempt to redress the enormous toll infectious diseases extracts from people living in the Third World, and Bill and Melinda Gates deserve kudos for their courage and commitment to global...

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