News: Saving The World From Real Viruses

25 January 2005

SAN FRANCISCO-- When Microsoft co-founder Bill Gates set out his vision for the future in his first book, The Road Ahead, back in 1995, he imagined computers at everyone's fingertips. These days, he has a much more fundamental vision: vaccines for every child.

Today, the Bill and Melinda Gates Foundation is announcing that it will give $750 million over the next ten years to the Global Alliance for Vaccines and Immunization to help pay for vaccines for children in developing nations. The government of Norway is chipping in another $290 million to GAVI.

"The Gates Foundation's goal is to reduce the inequities in health between rich and poor countries," says Melinda Gates, co-founder of the foundation. In 2002, 1.4 million children under the age of 5 died from preventable diseases, including measles, diphtheria, polio and tetanus, she points out. "Every one of those deaths is totally unacceptable when we have an affordable and effective means to prevent those deaths," she adds.

In 2000, the Gates Foundation gave a $750-million, five-year grant to help start GAVI, a private-public partnership aimed at significantly boosting vaccination rates in developing countries. So far, the program has been a success: By the end of 2003, GAVI had provided routine immunizations for 4 million children, hepatitis B shots for 42 million children, and immunization against yellow fever and Haemophilus influenzae type B for 8 million children. In Uganda alone, routine immunizations rose to 81% of all children in 2003, from 53% in 2000.

"That original grant was the largest grant we've made in world health, and yet we can say very strongly that we've never made a better investment," says Bill Gates. All told, GAVI estimates that it has saved 670,000 lives.

But even a billion dollars doesn't go a long way when you want to vaccinate the entire world. Bill Gates points out that GAVI aims to vaccinate 90% of the children in the world's poorest countries by 2015, a task that will cost between $8 billion and $12 billion. So far, nine nations, including the United States, have ponied up another $870 million to support GAVI. Gates says that he has been talking to the leaders of England and France about establishing an "international finance facility" that will help developing nations get funding to pay for vaccines.

"GAVI has made the transition from a startup to something that really works," says David Fleming, director of global health strategies at the Gates Foundation in Seattle. The foundation felt that it was important to give the same dollar amount--$750 million--as it did five years ago, but to acknowledge that GAVI will need more funding sources to widen the sweep of its vaccination program, he says. The Gates money has demonstrated that the program can effectively vaccinate millions of children, and that kind of track record should make it easier to attract new donors, Fleming adds.

In the past, all kinds of roadblocks have stopped vaccines from reaching children in need, Fleming says. It's hard to deliver the right medicine to the right clinic. Too frequently, rural clinics lack the refrigeration and other equipment needed to store temperature-sensitive vaccines. To run effective immunization programs, Fleming says, GAVI has taken a business-oriented perspective: It analyzes the capital investment needed (to provide transportation and refrigeration of vaccines), in addition to forecasting the demand for vaccines and likely supplies. "You can really think of the delivery of immunization as a business," Fleming says, "but instead of profit, our bottom line is 'lives saved.'"

At the same time, GAVI works closely with the governments of countries receiving its support to develop business plans for how to spend the money. "GAVI is a model for donor assistance," said Yoweri Museveni, president of Uganda, in a statement. "We as a nation have the flexibility to determine how to best spend funds to achieve results. Some ask, 'what works?' in foreign aid--here is your answer," he said.

That businesslike perspective has been a boon for pharmaceutical firms such as GlaxoSmithKline (nyse: GSK - news - people ) and Merck (nyse: MRK - news - people ). "GAVI plays an important role by providing a steady understanding of what the market for vaccines will be," notes Debbie Myers, director of external government affairs and public partnerships for Glaxo.

Even though Glaxo and others have had vaccine development projects for decades, immunization had fallen off the international public health agenda before GAVI, Myers says. Donors became focused on other health issues, and vaccination rates began to slip. Countries like Sierra Leone and the Congo, where roughly 85% of the children received the basic tuberculosis vaccine in the mid-1980s, saw that percentage slip down to one-third of the population by the late 1990s.

"GAVI and the Gates Foundation got vaccines back on the radar screen," Myers says. Bill Gates seems intent on keeping it there. At the annual World Economic Conference--the glitzy confab of world leaders in Davos, Switzerland, which begins on Wednesday--Gates is devoting his time to talking about poverty and the developing world. He is slated to appear on two panels on the subject. Among the other panelists are former U.S. President Bill Clinton; Thabo Mbeki, the president of South Africa; and musician Bono, who is also outspoken on world poverty.

"There are many ways to look at the impact of GAVI," Gates says. "The supply chain for vaccines is handled better. It's driven innovation. But most importantly, it's saving lives."

http://www.forbes.com/healthcare/2005/01/25/cz_ec_0125gates.html

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