The Bill & Melinda Gates Foundation’s biggest, and arguably most successful, project in global health has announced a new deal with vaccine manufacturers aimed at combatting one of the biggest killers of women in the developing world, cervical cancer.
“This is a disease that is killing women in the prime of their life,” said Seth Berkley, CEO of the Global Alliance for Vaccines and Immunization (GAVI), an initiative launched by the Gates Foundation in 2000 which has in the last dozen or so years prevented millions of deaths in children by expanding access to new vaccines in poor countries.
Most cervical cancer is caused by a virus, human papillomoa virus or HPV, and the drug industry has developed a number of HPV vaccines. But these new vaccines are expensive (more than $100 per dose) and have been out-of-reach for most poor countries. Women in rich countries have access to cervical cancer screening (Pap tests) and curative treatment, but women in poor countries generally do not.
“As a result, we see an estimated 275,000 women dying from cervical cancer in these countries every year,” Berkley said. Girls and women in poor countries are hit by a ‘triple whammy,’ he said, of higher disease incidence, lack of diagnosis and lack of treatment. Without access to a preventive vaccine, Berkley said, that death toll will only increase.
GAVI will begin support for HPV vaccines in Kenya as early as this month followed by Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzania. – See more at: http://www.gavialliance.org/library/news/press-releases/2013/hpv-price-announcement/#sthash.gDPujj1x.dpuf
He says so all the time. The media, as well as the social media hipsterverse, regularly report on this love affair, usually cheering along with Gates in favor of the cause of polio eradication — a cause which was advanced recently at a meeting he and other glitterati convened in Abu Dhabi, the world’s richest city.
Gates says the very foundation of his foundation comes from his realization in the 1990s that kids were dying for lack of access to a vaccine we in the rich world take for granted. As a result, boosting vaccination worldwide became the prime mover, the raison d’être, for what would soon be the world’s biggest philanthropy.
Yet few appreciate today just how revolutionary, and unlikely, was the start of this love affair.
Promoting this powerful, fundamental tool for children’s health may look now like an obvious humanitarian thing for a philanthropist to do. But it wasn’t either obvious or that celebrated when the Bill & Melinda Gates Foundation started down this path (pun intended) in the 1990s.
The Gates Foundation’s push for a revolution in immunization was greeted, from the outset, by a weird combination of controversy and apathy. Continue reading →
The global health strategy to expand childhood immunizations, largely backed by the Bill & Melinda Gates Foundation, is too focused on new vaccines and neglects the fundamental need to improve basic public health and immunization programs in poor countries.
MSF says it favors expanding access to new vaccines — just not at the expense of basic immunizations.
“Twenty percent of the world’s children aren’t even getting the basic vaccines,” said Kate Elder, MSF vaccine policy adviser. The Gates Foundation is driving much of the global health policy decisions around vaccinations, Elder noted, and “Bill Gates’ priority is new vaccines.” The philanthropy’s influence is distorting the agenda to favor new vaccines over basic improvements, she said.
Daniel Berman, MSF’s deputy director for access, cited a recent initiative to distribute a new $7-per-dose pneumococcal vaccine in DR Congo in the middle of a measles outbreak. Why, Berman asked, are donors and health agencies pushing this new, expensive vaccine in Congo if Congolese children still aren’t getting a 30-cent measles vaccine?
The approach appears aimed more at supporting drug industry desires to promote new products than at finding the most efficient and sustainable means for fighting the diseases of poverty, he said.
The Seattle philanthropy, though contacted in advance of the report’s release, declined to comment or respond today to the MSF criticism – or to the group’s call for a new global strategy with more emphasis on beefing up basic, routine immunizations. The organization sponsored by the foundation to promote the new global strategy, the Decade of Vaccines collaboration, also did not respond.
Troubled seems to be part of the Global Fund’s official title these days.
Yesterday, Reuters reported that the head of the Global Fund, Michel Kazatchine, quit due to funding cuts. That’s not quite right. It is true that this initiative created to fight AIDS, TB and malaria has seen funding decline as donors have reneged on their promised pledges.
Kazatchine appears to have resigned largely due to the allegations of mismanagement and tolerance of corruption in an internal shake-up. Some accused donors of using these allegations — which seemed to me a bit hyped as I wrote here and here — as an excuse not to come through with the promised funds.
The subsequent failure of donors and governments to follow through on funding to the Global Fund following this flap made Canadian politician and former UN AIDS ambassador Stephen Lewis absolutely apoplectic.
All this makes the announcement today by Bill Gates at the World Economic Forum in Davos, Switzerland very welcome news to many in the global health community. Davos is the same place he and Melinda announced more than a decade ago that they were giving the same amount of money to launch the Global Alliance for Vaccines and Immunization (GAVI).
There just seems to be something the Gateses like about announcing global funds at Davos and giving that $750 million figure. Some saw GAVI as a model for the later creation of the Global Fund.
Both are collaborative international projects that award grants to poor countries based on their performance in combating diseases of poverty — one aimed at fighting the top three killers and the other aimed at boosting childhood vaccinations in poor countries.
Both have trouble with “fraud and mismanagement” which, to some extent, comes from them handing over more control of in-country operations to, uh, countries not known for doing too well at combating fraud and mismanagement. But if the subcontractor shirks on the plumbing, the contractor pays for the leaks.
With the Gates Foundation stepping in where the international community has stepped back, Boseley asks if the Global Fund risks becoming a bit too unilateral, less European. That may sound petty from an American perspective, but it’s not. These initiatives really can only succeed if they are truly multilateral.
Politics aside: Between these two funds over the past decade, more than 10 million deaths have been prevented and some disease rates in poor countries have been significantly reduced. Not a bad return.
Here’s a pretty good video from the Global Fund making its case with a little help from Bono, Bill Gates, Bill Clinton and others (many of whom who are probably now in Davos):
The Queen of England has bestowed an exalted honor on PATH’s top gizmo guy.
“She said global health was a rather big subject and must involve a lot of travel,” said Michael Free, chief of technology for PATH, who had in fact stopped off in London to be received by the Queen before embarking on a month-long trip of global health travel.
Last week, Free was made an Officer of the Order of the British Empire in recognition of his team’s many inventions and innovative approaches aimed at helping solve health problems in the developing world. It’s not quite as prestigious as a Knighthood but better than a sharp poke in the helmet.
One of Free’s inventions was the single-use, auto-disabling syringe — a device now in common use worldwide, here in the U.S. as well, aimed at reducing the transmission of disease through accidental needle sticks.
But Free was also likely honored for his much broader and critical role in helping give birth to PATH in the 1970s.
How this British farm boy, raised in creamy Devonshire, ended up in Seattle working on some of the most innovative solutions to developing world health problems offers insight into the evolution of PATH and, to some extent, the entire field of global health.
“In the beginning, our approach was not well-received by either the public or private sectors,” said Free. “It was a bit out-of-the-box.”
Nelson Zambrana cradles his child sick from rotavirus in Nicaraguan hospital
It kills anywhere from a quarter-million to half-a-million kids every year and is one of the world’s leading causes of child mortality.
But it wasn’t too long ago hardly anybody had even heard of it.
Rotavirus — the killer bug that set off Bill Gates and gave direction to his philanthropy.
“No matter where we looked in the world, about 40 percent of all kids under 5 years old in hospitals for severe and life-threatening diarrhea had rotavirus,” said John Wecker, head of Seattle-based PATH’s vaccine access and delivery program. PATH has a long history advocating for a rotavirus vaccine.
“We’d go into these countries where huge numbers of kids were dying from diarrhea and they’d say ‘Rota what?” Wecker said. “We don’t have that here. Nobody had ever heard of it.”
Today, an international group that represents the Bill & Melinda Gates Foundation‘s single largest philanthropic project aimed at expanding children’s vaccinations announced it was launching a major new global jab against rotavirus and another big killer of young children, pneumococcal disease. The campaign focuses on Africa, where these two infectious diseases are rampant.
“The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived,” said Seth Berkley, CEO of this group known as GAVI, the Global Alliance for Vaccines and Immunization.
It’s a major milestone for GAVI, for a number of reasons, but in a way just another big step forward in a decade of significant progress for this alliance created to expand access to childhood immunizations in poor countries.
Since it was launched, hundreds of millions of children have been vaccinated and an estimated 5 million deaths prevented.
The aim of this week’s special session on global health at the UN General Assembly meeting is potentially even more significant than it may sound.
On the surface, it was a call to expand the already strained global health agenda to include non-infectious killers like cancer, diabetes and heart disease — the NCDs (or non-communicable diseases). That’s a big deal because it adds a lot to the agenda, given that chronic diseases kill more people (about 36 million per year) than AIDS, TB and malaria combined.
But it may be even bigger than that.
If you dig a little deeper here, this is the big — mostly unspoken — question: Is this move to get chronic disease on the agenda actually a move away from the standard disease-oriented approach to global health — and toward a more “systems” approach? Continue reading →