HOW BILL GATES HAS BEEN QUIETLY TRYING TO TRANSFORM GLOBAL HEALTH

BY ON OCTOBER 14, 2014

You’re probably lucky. You probably don’t have to worry about how clean your water is, if you’ll be able to get vaccinated this year, or if you’ll ever get to see a doctor. You’re lucky, but much of the world isn’t. Many parts of the globe still lack the infrastructure and resources to get on par with modern health care. Bill Gates – Microsoft monolith turned philanthropist – wants to change that.

Ten years ago, Bill and his wife Melinda Gates launched the Grand Challenges in Global Health initiative. Initially bolstered by 450 million dollars from their nonprofit foundation, this initiative was set up to give a monetary incentive for scientists and researchers to pursue radical or transformative ideas in public health.

“That’s the idea behind Grand Challenges—to focus bright scientists on the problems of the poorest, take some risks, and deliver results,” Gates said in a press release.

Since 2005, the Grand Challenges in Global Health grant program has delivered 458 million dollars to researchers from 33 countries. And these grants have been focused on issues the Gates Foundation believes to be fundamental in bringing the rest of the world up to the medical standard. Of the 16 overarching challenges listed by the foundation, many focus on vaccination — one of if not the most cost effective disease prevention program we have. Grants have been awarded for projects trying to develop needless delivery systems, vaccine formulas that do not require refrigeration, and single-dose vaccines for use shortly after birth.

Other challenges have encouraged researchers to tackle another scourge – the winged disease vectors called mosquitoes. The buzzing vampires transmit devastating pathogens like Dengue fever and malaria. If researchers can come up with a way to destroy the insects’ ability to replicate, or even introduce other pathogens that make it harder for a mosquito to infect a person, it would prevent hundreds of thousands of deaths a year.

Dengue fever affects up to 400 million people around the world each year. One very promising grant that Grand Challenges awarded was to a project to shorten the lifespan of the mosquitoes that carry Dengue. We’ve known for some time that older mosquitoes are very effective at spreading around the fever, so by killing the pests before they mature enough to do so – by using a modified version of a symbiotic bacteria called Wolbachia – the incidence of Dengue fever should decrease. That project is still in testing.

In the spirit of encouraging novel ideas, in 2008, the Gates Foundation set up another 100 million dollar grant program. Called Grand Challenges Explorations, these grants are open to everyone, from students to professors to government labs and for-profit companies. There is no preliminary data required, just a two-page summary of the project. Accepted proposals can get as much as $100,000 a year. (The latest round is currently open, and you can apply here.)

Gates’ Grand Challenges seems like it can’t go wrong. In an environment of shrinking science funding, of course another large source of grant funding will make a difference, right?

Well, it’s complicated.

Gates Challenges PICBill Gates speaks at the October Grand Challenges conference in Seattle.

When I visited the Gates Foundation’s tenth anniversary Grand Challenges meeting earlier in Seattle this month, I met with Dr. Steven Buchsbaum, deputy director of the foundation’s Discovery & Translational Sciences, and asked where a decade of funding new and under-studied ideas has gotten us. Can you really just throw money at a problem?

“The money is just one piece of it,” Buchsbaum told me. “We are trying to change the equation.”

Providing money to researchers is the most basic aim of the Grand Challenges. In practice, having a large outside funder like the Gates Foundation may change the way that some researchers approach problems. Perhaps they will pursue the idea that they are unsure will work – maybe they will be more willing to fail. That kind of business model would be hard for any private organization to absorb, but it’s ultimately how science moves forward.

“The foundation is in a unique position. Bill and Melinda are very tolerant of risk,” Buchsbaum said. “A vaccine for kids who can’t afford to buy the vaccine is not something that industry is going to jump into.”

But being tolerant of risk also means being tolerant of slow starts and failure. In the ten years since the Grand Challenges began, there haven’t been any marketable results or major breakthroughs just yet. Last year, 11 different research teamsreceived exploration grants to create a better condom, and the quest quickly became the foundation’s most publicized project. However, though research is still progressing, the next condom innovation is likely still years away. That doesn’t faze Buchsbaum. “Some grants have worked very well, some have worked less well,” he told me. “But we’re building up an experience base.”

“Bill and Melinda are very intolerant of making an investment and making a mistake and not learning anything from it.”

So far, ten years into the Gates Foundation’s radical approach to funding science, there aren’t any projects you can point to which have impacted that ultimate goal – saving lives. But that doesn’t mean that there hasn’t been progress, or that the approach is a bad one. In truth, changing the way science is funded will take time, and the experience base that the Foundation is creating will be invaluable to other researchers. After all, science isn’t a business; it’s a way of looking at the world.

The project to use bacteria to our advantage in the fight against the mosquito/Dengue Fever menace — involving researchers from Australia, Japan, the US, Thailand, and Vietnam – is one of the most promising in the portfolio of grant awardees, Buchsbaum says. The grand idea to use bacteria already found in mosquitoes against them, in the hopes of curtailing a global and deadly pathogen, wasn’t on the radar of standard funding organizations. Now, with the Gates Foundation’s help, the research has a promising footing.

“It’s really close. I can tell you that it wouldn’t have happened otherwise.”

Kyle Hill is the Science Editor of Nerdist Industries. Follow on Twitter @Sci_Phile.

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