Politics & Policy


Bill Gates has a model for WHO.

If you are going to give a speech and want people to pay attention, it helps if you bring a check for a quarter of a billion dollars.

Bill Gates addressed the delegates at the opening session of the 58th World Health Assembly, the World Health Organization’s (WHO) annual rule-making confab. He came bearing gifts. But he also came bearing a message, one that offers a vision for tackling global health problems and stands in striking contrast to the way global-health bureaucrats have routinely conducted business.

In recent years Gates has expressed a keen concern for global health issues and made that interest manifest through the Bill and Melinda Gates Foundation. Gates believes in the power of human ingenuity to develop products that address the “staggering disease burden unknown in the rich world.” Many global health problems–from HIV/AIDS to malaria to tuberculosis–can only be tackled with ingenious technologies. Gates aims, through his philanthropy, to provide incentives for their development, providing the capital necessary to unlock the creative, entrepreneurial genius within the world’s science community.

Unlike many activists and bureaucrats who simply hector the world’s wealthy nations for more aid, Gates put his money where his mouth is, and this week he pledged $250 million–on top of the $200 million he has already committed–to the Grand Challenges Initiative, an effort launched in 2003 to pursue scientific advances beneficial to global health. He has already given over $4 billion to global health efforts out of an endowment of nearly $30 billion.

Most of these funds are not typical aid grants. They are carefully designed to spur innovation by offering incentives for scientists and engineers to develop “breakthroughs you can use.”

Typically at these U.N.-sponsored events, the rich nations of the world–particularly the U.S–are painted as the bad guys. And while Gates prodded the rich countries to do more, refreshingly he highlighted the disastrous response to epidemic disease from developing-country governments. “Countries in sub-Saharan Africa,” Gates said, “spend a smaller percentage of their GDP on health than any other region in the world.”

This constructive criticism of poor country governance is bolstered by new research from the Joint Center for Regulatory Studies of the American Enterprise Institute and the Brookings Institute. In a paper titled “Taxed to Death” the researchers find that many developing-world countries place significant import taxes and tariffs on drugs and other essential medical technologies and devices, making it more difficult for poor people to access the healthcare they need.

In his talk, Gates called for “a dramatic increase in the efforts of developing countries to fight diseases that affect their people.” Halting the parasitic practice of governments’ generating revenue by taxing the products needed by their desperate, sick, and dying citizens is a good place to start.

While Gates is right to focus on major scientific breakthroughs–or what he likes to call “deliverable technologies”–he too quickly dismissed the role that poverty plays in poor public health. A World Bank report released last month determined that while various aid agencies were flush with commitments for hundreds of millions of dollars in aid money to spend on treatment of infectious disease, they were frequently able to disperse less than 50 percent of those funds. The inability to put available money to use is due largely to poverty and an absence of the medical infrastructure and capacity needed in poor countries to make use of aid.

Despite the challenges posed by dehumanizing poverty, Gates’s emphasis on scientific innovation as the key to tackling global-health problems is particularly welcome at the WHO, a U.N. body that has too often put politics and posturing above public health.

For example, as Gates waited to deliver his address on cutting-edge science and incentives for innovation, the Assembly was bogged down in hours of political bickering, debating for the eighth assembly in a row whether Taiwan, which may face an avian flu outbreak, deserves official recognition by the U.N. health body. A majority of the members once again said no.

And when not considering ill-conceived regulatory schemes such as a global-patent pool or global regulation of alcohol consumption, two of the topics here this week, the WHO is badly managing its fights against deadly infectious diseases.

For example, in an effort to be seen as doing something significant to combat the HIV epidemic, the WHO initiated its so-called “3 by 5 program,” a tragic fantasy to treat three million HIV victims in the developing world by the end of 2005. With just a few months remaining, it’s increasingly clear the program has failed and will not come close to meeting its targets, running the risk of irritating donors to whom they promised too much, too fast.

In its zeal to scale up treatment rapidly, the WHO promoted the use of untested AIDS medicines. By doing so, they risked a costly and deadly heightening of drug resistance. In an embarrassing reversal, the WHO has since had to remove several of the medicines from its list of sanctioned treatments after learning that they were of questionable quality.

The WHO has also badly bungled its responsibility for fighting malaria, a disease that kills over one million people a year. The British medical journal The Lancet recently editorialized that the WHO was guilty of “malpractice” for dispersing faulty anti-malaria medicines.

Despite the bureaucratic bungling of the WHO, Gates was an optimist before its assembled members. He is emerging as something of a venture capitalist for the developing world’s healthcare, although the returns on investment will go not to him but to the world’s poorest people. Let’s hope the U.N. health bodies applaud not just his money, as they did on Monday, but some of his ideas as well.

Nick Schulz is editor of TechCentralStation.com.


The Latest