Interview Wealth for health — a Gates perspective

The Bill & Melinda Gates Foundation is one of the largest philanthropic organizations in the world. Since its creation in 1999, it has donated over US$ 1.6 billion to health and learning. One of the people in the foundation’s driving seat is William H. Gates II, its co-chair and chief executive officer. After nearly 50 years of practising law, ‘‘Bill Senior’’ spends much of his retirement overseeing the foundation. He gives Barry Whyte some insights into how the foundation chooses the recipients of its largesse.

who played a pivotal role in eradicating BW Do you believe there are specific and has been a director of the sectors in society that could do more US Centers for Disease Control and for global health? Prevention. These experts, along with Gates I think we can all do better — the rest of the global health staff, actively governments, businesses, and private citi- seek out proposals, which are vetted and zens. The amounts spent by industrialized sent to Ms Patty Stonesifer, the other countries on global health problems can’t co-chair at the foundation, and myself. begin to meet the needs. Yet, together, we have the compassion and the resources BW What do you look for in to bring to an end the disparity in health a successful application? between populations. Gates We are pleased when organizations work together to secure a grant from the BW Do you think pharmaceutical foundation. The Global Alliance for Vac- companies could be more committed cines and Immunization (GAVI) and the to developing drugs for diseases Global Fund for Children’s Vaccines are prevalent in developing countries? good examples. GAVI and the global fund Gates There is a handful of programmes that were formed to save the lives of some William H. Gates II are working — Merck and its ivermectin three million children every year by making for river blindness (); Smith sure all children have access to life-saving Kline Beecham, now Glaxo-SmithKline, Barry Whyte Last year the foundation vaccines. and its albendazole for lymphatic filariasis, gave away nearly US$ 1 billion, for example. But it shouldn’t be a handful of which about US$ 550 million BW What are the roles of Bill — it can and should be hundreds of to initiatives. What and Melinda Gates in the selection successful programmes. Other options are its priority health targets? process? exist. For example, the International AIDS Gates Vaccine-preventable diseases, Gates Bill and Melinda are very involved Vaccine Initiative (IAVI), which relies on reproductive health and child health, and in the funding process: all grant proposals social venture capital, aims to accelerate conditions associated with poverty, such over US$ 1 million go to them. They really the development of an HIV/AIDS vaccine as , or guinea-worm disease, keep the global health staff on their toes. that will be accessible and tailored to and lymphatic filariasis, two largely The staff just finished a 30-page email developing countries. neglected diseases. We look mostly for of answers to some of the questions Bill preventive solutions, such as vaccines. had. Both Bill and Melinda were in India BW Which projects funded by Developing just one new vaccine — while recently and were deeply moved at seeing the foundation are you particularly difficult and costly — can have a gigantic how health workers are devoting their pleased about? impact. If I were a betting man, I’d put lives to the fight against HIV/AIDS, Gates In April, vaccines arrived in most of my money on what would have poliomyelitis, and other global health Mozambique — the first of several dozen the greatest impact over time, and I problems. that had little or no access to children’s believe that impact will come from the vaccines before. This was one of our very vaccine grants. BW How do you monitor first big grants, US$ 750 million, that performance once a grant has went to the Global Fund for Children’s BW How do you choose who been issued? Vaccines. Children in developing countries gets the grants? Gates Our staff is trying to find appropriate have often had to wait 10 to 15 years Gates We get experts together from around evaluation tools. Since we look for centres before they could have access to the same the world and from different organizations. of excellence during the grant-making vaccines that are protecting children in They convene meetings, talk to others in process, we hope for good results. That’s the United States. That’s changing, and the field and then seek out proposals. We not to say we won’t fall flat on our faces — it couldn’t have happened without a are also lucky to have outstanding experts that’s part of taking risks. However, if concerted effort by governments and on our staff, such as Dr Gordon Perkin, one of the groups we’ve funded finds a organizations to make access to vaccines director of our global health programme, vaccine for HIV/AIDS or malaria, a priority. Together we could help save and Dr William Foege, our senior adviser, the payoff will be large and may save the lives of at least three million children millions — even billions — of lives. every year. Now that’s pretty awesome! n

488 # World Health Organization 2001 Bulletin of the World Health Organization, 2001, 79 (5)