On Sunday, the Bill and Melinda Gates Foundation announced a gift of $200 million to develop ways to prevent the diseases that afflict poor people living in developing countries. This gift is in the tradition of private philanthropy that has boosted medical science throughout the last century years. For example, the polio vaccine was developed with the support of private philanthropy.
But what is going on in the developing world, where infectious diseases run rampant? Antibiotics like penicillin were the medical miracles of the middle of the 20th century, but as the toll taken by infectious diseases began to fall in rich countries, research by pharmaceutical companies and government agencies turned to the chronic diseases that afflict old rich people—for example, cancer, arthritis, atherosclerosis. In the rich developed countries, pharmaceutical companies have made enormous strides in developing medicines for diseases and discomforts that afflict relatively well-off people living in developed countries. For example, as The New York Times recently reported, "Statisticians at the [National Heart, Lung and Blood] institute calculate that if death rates were the same as those of 30 years ago, 815,000 more Americans a year would be dying of heart disease and 250,000 more of strokes."
The Gates Foundation gift fills a market gap. Profit-making corporations cannot justify spending research dollars to develop treatments the poor cannot afford. While companies like Merck have donated medicines to fight diseases like river blindness, there is still a research gap that needs to be filled. In the past the gap between the requirement to make profitable products and the needs of the poor has often been met by private philanthropy. For example, the Rockefeller Foundation backed the research that launched the "Green Revolution," which, by dramatically boosting crop productivity, probably spared the lives of hundreds of millions of people from famine in the last half of the 20th century.
The Gates Foundation plans to support research on the "Grand Challenges in Global Health." These challenges include finding novel approaches to preventing and treating HIV/AIDS, which has already infected nearly 60 million people globally. Another challenge is to uncover a way to block reactivation of latent tuberculosis in the billion people who carry the bacterium. The Gates Foundation has already donated millions for malaria research and now is supporting studies to make mosquitoes incapable of transmitting diseases such as malaria, dengue, and West Nile virus. Malaria infects 300 million to 500 million people annually; at least 1 million die of the infection. Another challenge is finding innovative approaches to preventing the life-threatening diarrhea and respiratory infections that kill 12 million children under 5 each year. And the final grand challenge will be to identify inexpensive ways to deliver vitamins to malnourished poor children.
Columbia University economist Jeffrey Sachs argues that high disease burdens in poor countries create a significant drag on economic development. Once the incomes of people in developing countries rise, they can begin to afford the medicines developed by vibrant for-profit pharmaceutical industries in rich countries. As rich as Bill Gates is, he cannot shoulder this burden alone. The potential of saving tens of millions of lives at relatively low cost should inspire other philanthropists to emulate Gates' efforts.