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The obscure bug that set off Bill Gates, awakening a geeky giant

Bill Gates at Davos

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.

That’s more deaths averted than has so far been credited to the much-larger Global Fund for Fighting AIDS, TB and Malaria — or any other single project in the global health arena, for that matter. Based on the statistics alone, you could say that GAVI is perhaps the biggest success story in global health you’ve never heard of. With the charismatic Berkley at the helm, expect to hear more.

Rotavirus vaccine given to child in Sudan

Today, GAVI announced that it will provide $1 billion in new funding for 37 countries to introduce rotavirus and pneumococcal vaccines — a roll-out that has already begun in Sudan. Here are some good news reports on the roll-out of these two vaccines from The Guardian and Forbes.

More than 70 poor or middle-income nations competed to get the funding. Berkley said the 37 countries that are receiving the support for new vaccines were selected based on evidence they have the ability — in terms of health care workers and necessary infrastructure — to make the best use of this expansion in their basic public health system.

“And we will continue to evaluate those countries’ vaccine management,” Berkley said. GAVI, he noted spends about 10 percent of its funding to assist poor countries improve health systems.

One of the fundamental assumptions behind GAVI is that by competitively offering funds to boost a basic health service like immunization in poor countries, governments will be motivated to invest in their basic public health system.

Whether that’s actually been demonstrated is unclear. Some critics of these vaccination pushes contend such disease-targeting programs actually disrupt the fragile and under-resourced health systems of poor countries. The new funds divert attention and health workers away from other problems like maternal health and so on. So far as I can tell, this is a debate without any hard evidence on either side.

Pneumococcal disease is thought to be a bigger killer than rotavirus. The mortality statistics on both are relatively fuzzy due to the fact that the deaths usually occur in places without many basic health services, let alone reliable record-keeping. But both are clearly leading killers of children.

Rotavirus perhaps deserves the most attention in today’s announcement.

That’s because rotavirus is, reportedly, the bug that got Bill and Melinda Gates started on their global health bent way back in the late 1990s, which led them to launch GAVI in 2000 as the flagship project of the still relatively new Bill & Melinda Gates Foundation.

I’ve heard Bill tell this story many times, of reading a report (usually he recalls reading about it in the New York Times; but has also said he ran across it in a 1993 World Bank report) stating that rotavirus killed half a million kids every year.

Huh? Rota-what?

Bill Gates at Davos

As this 2009 article by Bob Fortner at Crosscut noted, Gates says he said to himself:

“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?”

Gates was stunned he hadn’t even heard of this virus that killed so many children. This, he says, led him to look more deeply into vaccination as a solution to this problem — and to discover the “market failure” that his philanthropy has ever since sought to correct.

To some extent, it was also market failure that explains why it has taken so long to get a rotavirus vaccine out to these poor countries. An earlier version of the vaccine, originally developed for rich countries, fell out favor when it was determined (some said unfairly) to have caused bowel obstructions in a small number of children who got the vaccine.

Kids who get rotavirus in the U.S. usually don’t die thanks to hospital care, and the media coverage of the bowel problems dampened the market for the earlier vaccine. Many in the drug industry weren’t keen on trying to develop a new vaccine just for poor countries because of the uncertainty they could charge enough to recoup research and development costs.

These kinds of “market failures” are what led the Gates Foundation to launch GAVI, to both work more closely with industry and provide some certainty that there was money behind these new vaccines.

(The newer and safer vaccine became routine in the U.S. in 2007, and it’s reduced hospitalizations dramatically.)

According to GAVI, rotavirus is the leading cause of severe diarrhoea in children under five years of age, killing more than half a million children each year worldwide and causing illness in several million more. Nearly 50% of all rotavirus deaths occur in Africa, where access to treatment for severe rotavirus diarrhoea is limited or unavailable.

By 2015, GAVI and its partners plan to support more than 40 of the world’s poorest countries to rollout rotavirus vaccines and immunise more than 50 million children. In addition to Sudan, NicaraguaBolivia, Guyana, and Honduras have already introduced rotavirus vaccines with GAVI’s support.

“The high number of approved applications for funding for new vaccines in this latest round is yet another milestone in the fight to prevent child deaths from vaccine-preventable diseases,” said Dr Margaret Chan, WHO Director-General. “As demand for new vaccines increases further, WHO will continue providing critical support to countries for decision-making on new vaccines, surveillance, and immunization programme planning, training, and evaluation.”


About Author

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] or follow him on Twitter @tompaulson.