How Bill Gates caught the global health bug

Reading the newspaper more than a decade ago, Bill and Melinda Gates learned how something called rotavirus killed hundreds of thousands of children — and global health became their urgent mission. Ample difficulties remain, but last week, because of the Gates Foundation, the World Health Organization approved a rotavirus vaccine.

In the mid-1990s, Bill Gates was, as he put it, “exclusively focused” on Microsoft. But a New York Times article on rotavirus radically transformed that arrangement. The Times reported the widespread death of children in developing countries from diarrhea caused by the virus. Gates, staring at the page, thought, “That can't be right. I read the news all the time. I read about plane crashes and freak accidents. Where is the news about these half-million kids dying?” The mission of the Bill and Melinda Gates Foundation shifted dramatically to global health with Gates himself eventually deciding to work nearly full-time at the foundation, starting this year.

So it is perhaps especially gratifying for them to read the news last Friday (June 5) that the World Health Organization has just approved a rotavirus vaccine for global use. The role (indeed ubiquity) of the Gates Foundation is not immediately apparent. Besides drug maker GlaxoSmithKline, the press release credits the Global Alliance for Vaccines Initiative (GAVI) and the Seattle-based PATH for helping shepherd the vaccine forward. But GAVI largely owes its existence to the Gates Foundation and, like PATH, receives very substantial funding from it.

While logistical and cost obstacles remain, the new vaccine holds the promise of pushing the annual death toll from rotavirus into free fall. The vaccine also serves as a handy defense for the long-running criticism of the foundation’s technology-centric approach.

As Gates has said, “There really isn't anything like vaccines, where you can so simply save so many millions of lives.” But alas, rotavirus is not the only cause of diarrhea. Even the WHO, in announcing the rotavirus vaccine approval, cited a need for “a comprehensive diarrheal disease control strategy, including improvement of water quality, hygiene, and sanitation.”

However, while the Gates Foundation recognizes the centrality of clean water, it couldn’t begin to fund Roman-scale waterworks, although arguably the greatest public health intervention of all time is simple, clean water. The foundation did begin funding research on water issues in 2006, but it won’t go down in history for aqueducts or mass-scale domestic plumbing.

Rather, Gates seeks for the technology breakthroughs. He believes that “Never before in history has innovation offered promise of so much to so many in so short a time.” Short a time? The rotavirus vaccine took about 25 years — not exactly an overnight phenomenon. And Gates recently conjectured that, after more than 25 years of effort, a vaccine for HIV wouldn’t arrive for another 10 to 15 years.

But, for a few days in the news cycle, these debates can rest.