Why is the Gates Foundation still in China?

The China office of the Bill & Melinda Gates Foundation is one of its biggest – second only, in size and staffing, to that of the philanthropy’s India office.

China and India GDP
China and India GDP

Yet China, compared to India and other poor or middle-income nations hamstrung by many living in extreme poverty, seems capable of taking care of itself.

China is home to the world’s second largest and fastest growing economy. Its, so far, successful brand of communistic capitalism continues to worry America Firsters that we will be soon permanently displaced as global number one.

India’s economy is big and growing as well; but India is also still home to hundreds of millions of very poor people. The estimates vary, but anywhere from 12 to 25 percent of Indians live in extreme poverty. However you count it, India is today home to most of the world’s extremely poor.

In contrast, China has, in the past 15 years and according to the World Bank, reduced the number of its citizens living in severe poverty down to about one percent of its population.

Some Chinese have gotten so wealthy Bill Gates recently urged them to start thinking like philanthropists.

So why is the world’s biggest philanthropy devoted to fighting poverty and inequity even in China?

Ray Yip
Ray Yip

“We want to help make China a global center for research and development,” said Ray Yip, long-time director of the China program for the Gates Foundation. “It’s a 180-degree change from what we were doing originally.”

The philanthropy, in its early days, approached China as another low- or middle-income country that could use some help fighting diseases of poverty and maybe with agricultural productivity.

“But we’ve evolved in our approach, partly because trying to assist China in that traditional philanthropic way is sort of like giving money to a rich person,” chuckled Yip, who was in Seattle recently for a Gates Foundation meeting on global product development. Or well, not sort of at all.

As China has rapidly developed economically, it has also made significant progress in reducing poverty and some of the attendant ills of being poor like child malnutrition or maternal mortality.

So why not just close up the Gates Foundation’s shop in China given its focus is supposed to be on helping the poor and move the talent and resources to a poor country that needs the help much more?

“We think we can still help, but in a different way,” said Yip. China has become relatively wealthy, he said, and is moving more toward becoming a donor of aid and development rather than a recipient. One of its biggest potential contributions, he said, could be in the development of new drugs and vaccines for poor countries.

Many, if not most of the world’s most effective medications against malaria stem from China’s discovery and development of anti-parasitic drugs based on plant extracts of artemisinin, sweet wormwood, or Qinghaosu.

And then there’s the story of the Japanese encephalitis vaccine, which we’ll get to in a minute.

“In the beginning in China, we were operating more like a public health agency focused on implementation and delivery of services,” said Yip, a pediatrician who got his medical degree in Minnesota, served in China on AIDS issues for the U.S. Centers for Disease Control and Prevention and has generally spent most of his career focused on getting health care to the poor.

Early on, the Gates Foundation offered China direct assistance on a number of health fronts – mostly against HIV and TB, which it does still to some extent. The Chinese, as noted above, already had a pretty handle on malaria. But as China has rapidly become wealthier, Yip said, it clearly didn’t make sense to keep doing that. But just packing up and leaving also didn’t make sense, he said.

“The Gates Foundation global health program today is migrating towards becoming a virtual pharma (drug company),” he noted. “China is also growing in its capacity for medical R&D and we think it is in everyone’s interests to help facilitate this.”

While the foundation still does a lot aimed at getting existing health services and products to the poor (polio and other child vaccines, etc), the global health program under Trevor Mundel has been narrowed in scope to focus on helping the biomedical and drug industry develop new products specifically tailored to meet needs in poor parts of the world.

Julie Jacobson
Julie Jacobson

“In a sense, we are just shining a light on what they are doing already,” said Julie Jacobson, who heads up global health product development team focused on especially neglected diseases.

Jacobson, first while at Seattle-based PATH and then later with Gates, helped coordinate a decade-long effort aimed at enlisting China’s help with a disease few Americans have even heard of – Japanese encephalitis virus.

A cousin to West Nile, JE is much deadlier – killing one in four it infects – and much more widespread in India. Millions of people, mostly in Asia, get infected by this mosquito-borne virus, most of them poor and lacking in access to life-saving treatments. Many die and the survivors often end up mentally and physically disabled.

“It’s a horrible disease,” said Jacobson.

She and PATH discovered this massive, neglected disease when working in the Indian state of Andhra Pradesh on a Gates Foundation project aimed at improving a number of immunization programs for children. They had come intending to expand basic immunizations and also introduce a new hepatitis B vaccine, but soon discovered the Indians were much more concerned with JE.

A young boy infected with JE languishes in a hospital in the south Indian state of Andhra Pradesh
A young boy infected with JE languishes in a hospital in the south Indian state of Andhra Pradesh
Mike Urban

There was a JE vaccine, Jacobson said, but it was expensive, in short supply and had some quality issues. So Jacobson and the PATH gang, supported by the Gates Foundation, did their version of an Asia pivot and decided to include a new effort to get a better, cheaper vaccine against this big, neglected killer.

“We soon learned that China had its own vaccine, which was of very high quality,” she said. But it was not approved for use outside of China and the Chinese drug industry had its own way of doing things.

“In order for other people outside China to benefit from this vaccine, they had to be able to create a product that meets the global standards,” said Yip. PATH and Gates began working with the Chinese to help them improve their processes so they could meet international standards for the JE vaccine.

“We had to convince them that their system had some serious gaps, that even their own people are not as well-protected as they thought,” Yip said. “We helped them to improve their manufacturing and regulatory process in a way that will benefit their citizens, but also the rest of the world.”

And last fall, thanks in large part to this help from PATH and the Gates Foundation, the World Health Organization approved China’s JE vaccine for worldwide use.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom-at-humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.