No home runs yet for the Gates Grand Challenges

Bill Gates speaking at the 2014 Grand Challenges conference in Seattle, joined by Alain Beaudet, Canadian Institutes of Health Research, Raj Shah, USAID chief and Melinda Gates.

Bill and Melinda Gates like science and technology, and believe innovation is the key to solving some of the world’s most intractable problems.

That’s why, ten years ago, they launched an initiative called Grand Challenges, initially focused on funding high-risk research projects aimed at solving problems in global health and diseases of poverty. The program has since expanded its portfolio to include agricultural productivity, access to financial services and other areas identified as key problems that contribute to global poverty and inequity.

Bill and Melinda Gates also like to say they are optimists, frequently choosing to emphasize the success stories of aid and development rather than focus on the failures. So it may have been a little jarring to the thousand or so scientists, inventors and innovators gathered for the 2014 Grand Challenges conference this week in Seattle to hear Gates repeatedly talk about failure – the good kind and the not so good kind.

“We were comfortable with a high rate of failure,” Gates said. High risk projects mean high failure rates. Lots of failed projects were to be expected, he said, as part of the process of testing out long-shot ideas or proposals that most other research funding organizations would be loathe to take on. The idea was that from out of the many failures a powerful and innovative solution to a grand challenge would emerge.

“But I was pretty naive about how long that process would take,” Bill Gates told the crowd gathered at the Westin Hotel for the meeting, which ended Wednesday. Gates repeatedly used the word ‘naive’ when talking about the philanthropy’s original expectations for this initiative.

The foundation’s metrics for assessing success or failure within the Grand Challenges program have not been made public. But after a decade and nearly a billion dollars spent on more than 1500 projects aimed at solving the philanthropy’s select Grand Challenges, not a single project has been judged a Grand Slam, or even a home run.

“We were naive about how specific we had to be about costs and ease of delivery,” Gates said. One of the biggest ‘learnings’ (another word, or not, he likes to use) is that just funding scientists and innovators to explore far-fetched but promising ideas is not sufficient, he said. Going forward, Gates told the crowd, they will be requiring most innovators requesting a grant to partner with manufacturers, biomedical companies or others with expertise in product development before they’ll fund a project.

“We vastly underestimated how important that is,” Gates said.

Chris Wilson

Chris Wilson

All this doesn’t mean the program has not hit some doubles, or even a few triples, said Chris Wilson, director of the global health discovery and translational sciences team for the Gates Foundation and the point man for the Grand Challenges initiative.

“Take the Wolbachia project, for example,” Wilson said.

As the BBC reported a few weeks ago, Brazilian scientists recently released into the wild mosquitoes that had been infected with the natural-occurring bacteria Wolbachia as a novel means to combat dengue fever. Dengue is a mosquito-borne disease (sometimes called break-bone fever) that is literally exploding around the world, now threatening nearly half the planet, and has no effective treatment.

Brazil has some of the worst outbreaks anywhere, with millions of cases and hundreds of deaths reported over the last five years or so. The Wolbachia bacteria, which naturally infect many insects, prevents the dengue virus from replicating inside the mosquitoes.

The project was launched by some Australian scientists in 2008 thanks to a Grand Challenges grant from the Gates Foundation. At the time, Wilson noted, the research looked too far-fetched for many of the standard research funding organizations. That’s a good example of a solid hit, he said, and the kind of research the Gates Grand Challenges program was set up to support.

Another less quantifiable benefit of the Grand Challenges program Gates and others mentioned at the conference is the effect the approach, however naive at the outset, has had on the scientific enterprise. As Humanosphere noted earlier, the approach has spawned all sorts of copycat initiatives around the world and even within the normally highly non-creative confines of the U.S. government. And many praised the open and collaborative dialogue it has promoted among teams and organizations used to competing with each other.

At the Seattle conference, Raj Shah, administrator of the U.S. Agency for International Development (USAID), credited the foundation (where he once worked, it should be noted) with prompting that agency to do its own Grand Challenges for Development program, one which arguably took the concept in some new directions focused on behavior change and democracy building. At the meeting, Shah announced a new $5 million grant program to create better gear for health worker protection against Ebola and $50 million in new funding for its Savings Lives at Birth challenge.

The Gates Foundation also announced, with its partner organizations like USAID, Britain’s Department for International Development (DfID), Grand Challenges Canada and others around the world, an expansion of what constitutes a grand challenge:

  • All Children Thriving – finding new tools and holistic approaches to help mothers and children thrive.
  • Putting Women and Girls at the Center of Development – finding new approaches to empowering women and girls.
  • Creating New Interventions for Global Health – just what it says.

Hmmm, that last one sounds familiar – much like the original GC for Global Health that Bill described as a bit ‘naive.’ Maybe this is the sophisticated version. But the first two, focused on women and children, appear to represent a shift in emphasis and an expanded vision.

“We know how critical women and girls are to the health and economic prosperity of their families and communities, but we don’t have all the answers yet,” said Melinda Gates in heralding these new additions to the GC program. 

Vasee Sathiyamoorthy of WHO address the Seattle crowd

Vasee Sathiyamoorthy of WHO address the Seattle crowd

Ebola got special attention at the end of the conference in a panel discussion moderated by Chris Elias, head of development at the Gates Foundation. Much of the conversation was about efforts to develop an Ebola vaccine, and the controversial decision made by the World Health Organization to stick with standard scientific protocol and test the vaccine in a randomized controlled trial – meaning some in West Africa would get the Ebola vaccine and others would not.

Cyber-panelist Vasee Sathiyamoorthy of the WHO explained by a video link from Geneva that the scientific urgency of testing the experimental Ebola vaccine, made by GSK, was judged more important than those who opposed this approach on ethical grounds.

That was the right decision, said Francis Collins of the National Institutes of Health, who was also on the panel.

“There can be negative consequences from distributing a vaccine that hasn’t shown efficacy yet,” Collins said. People may let down their guard assuming they are protected when they are not, he said, or the vaccine may cause harm or even, as in a HIV vaccine trial called the STEP trial, somehow increase a person’s risk of infection.

Others spoke of efforts aimed at developing new drugs, or expanding the production of the one experimental drug, ZMapp, that some have heralded (without sufficient scientific evidence) as the best treatment for Ebola. For the Grand Challenges meeting, devoted as it is to science and invention, it makes sense that the focus on Ebola would be a focus on finding new drugs or vaccines. But to some, it sounded a bit off target.

“A vaccine is not likely to be useful in this outbreak,” said panelist Neil Ferguson, an epidemiologist from Imperial College London.

The reason Ebola has spread out of control, Ferguson said, is lack of enough trained health care workers, inadequate health services and an inability to properly identify and isolate those who are infected. Finding an effective vaccine is important for the future, he said, but what’s needed right now to stem the catastrophe in West Africa is not some new invention or innovation. What’s needed now, Ferguson said, is for the international community to rapidly scale up the public health and support systems in the affected countries (something WHO said will cost more than $1 billion, which it has not yet received).

That’s a different kind of grand challenge.

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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 or follow him on Twitter @tompaulson.