In conversation with Harvard Chan School Dean Michelle Williams, Gates calls for innovative ideas to combat infectious disease outbreaks
May 2, 2018 – Innovative new treatments, improved health care delivery systems, and a coordinated global response are among the strategies needed to help the world prepare for future pandemics, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, told Michelle A. Williams, Dean of the Faculty at Harvard T.H. Chan School of Public Health, on April 27, 2018 during a Q&A before a packed audience at the World Trade Center in Boston.
The conversation followed his announcement of the Bill & Melinda Gates Foundation’s plan to award a $12 million Grand Challenge, in partnership with the Page family, to accelerate the development of a universal flu vaccine. “The goal is to encourage bold thinking by the world’s best scientists across disciplines, including those new to the field,” he said.
The Microsoft co-founder was in Boston to deliver the 128th annual Shattuck Lecture, “Epidemics Going Viral: Innovation vs. Nature.” The event was sponsored by the Massachusetts Medical Society and the New England Journal of Medicine.
The Gates Foundation aims to prevent more than 11 million deaths, 3.9 million disabilities, and 264 million illnesses by 2020 through vaccine coverage and support for polio eradication. Immunization has led to the eradication of smallpox, a 74% reduction in childhood deaths from measles over the past decade, and the near-eradication of polio, according to the organization. Yet one in five children worldwide are not fully protected with even basic vaccines. As a result, an estimated 1.5 million children die each year—one every 20 seconds—from vaccine-preventable diseases such as diarrhea and pneumonia.
Two-pronged approach
In response to a question from Williams about what he looks for when assessing big ideas, Gates said he began to focus on global health in the late 1990s after the World Bank reported that a relatively small number of diseases were responsible for a large proportion of deaths in developing countries, and not in countries in the developed world. He learned that medications and other tools already existed to treat many of the diseases, but that poorly functioning health delivery systems in many developing nations kept treatments from reaching the populations. “We took a two-pronged approach, funding both the ‘upstream’ areas of research—promising research that wasn’t getting much funding—and ‘downstream’ areas,” such as improving primary care delivery systems in nations like Nigeria, he said.
Gates noted that progress is being made in reducing child mortality. Increased understanding of the important role of nutrition, maternal and infant care, as well as a better understanding of the immune system are among the factors helping to reduce mortality in some areas. He cited a recent clinical trial in which a few doses of an inexpensive antibiotic given over two years reduced childhood deaths from diarrhea and other diseases. “It’s a very promising example of working upstream and downstream and really solving the problem here and now while thinking about how to work out the mechanisms,” Williams said.
When asked how to “close the deal” on malaria, Gates said antibiotic resistance in recent years has contributed to a resurgence of the disease after progress had been made. Nevertheless, he said he is very hopeful about malaria because of digital tracking of mosquitoes and other promising research efforts underway. “Centers like Harvard and Oxford using low-cost digital technology are making us a lot smarter about what’s going on with this disease,” he said.
Referring to the role of mosquitos in transmitting malaria, Williams said, “These bugs are making us have to work harder and deploy tools and think about behaviors in ways that we wouldn’t otherwise.”
Coordinated global approach
In his lecture Gates said, “The global community eradicated smallpox, a disease that killed an estimated 300 million people in the 20th century alone. We are on the verge of eradicating polio, a disease that 30 years ago was endemic in 125 countries and that paralyzed or killed 350,000 people a year. And today, nearly 21 million people are receiving lifesaving HIV treatment, thanks primarily to the support of the world community,” he said. “America’s global HIV initiative, PEPFAR, was the catalyst for world action on the AIDS crisis. It’s an example of the kind of leadership we need from the U.S. [as part of a] broader effort to make the world safer from other infectious disease threats. “With strong bipartisan support, PEPFAR has saved millions of lives and shown that national governments can work together to address pandemics,” he said.
Gates stressed that the world needs to prepare for infectious disease outbreaks as it does for war. “What the world needs—and what our safety, if not survival, demands—is a coordinated global approach. Specifically, we need better tools, an early detection system, and a global response system.” This includes doing simulations, war games, and preparedness exercises to better understand how diseases will spread, and how to deal with things like quarantine and communications to minimize panic, he said. Better coordination with military forces is needed to move people, equipment, and supplies on a mass scale during an outbreak. In addition, the pharmaceutical industry needs to step up efforts to get new treatments out more quickly, he said.
“Somewhere in the history of these collective efforts is a roadmap to create a comprehensive pandemic preparedness and response system. We must find it and follow it because lives—in numbers too great to comprehend—depend on it,” Gates said.
photo: Douglas Bradshaw
Watch a video of the event on NEJM’s Facebook page (Gates’s Shattuck Lecture begins at about the 11-minute mark, Dean William’s conversation with Gates at about the 32-minute mark)
Read Gates’ Shattuck Lecture
Read a STAT article about Gates’ grant announcement: With cash and a call for new ideas, Bill Gates tries to boost the campaign for a universal flu vaccine