SAN FRANCISCO — On Monday, Bill Gates spoke with an audience of health care professionals, and made the business case for pursuing breakthroughs in global health.
The chair of the Bill & Melinda Gates Foundation was a keynote speaker at the first day of the J.P. Morgan Healthcare Conference, the largest health care industry gathering. He outlined ambitious goals for global health, such as cutting the number of annual deaths of children under five down to 2.5 million in the next 15 years. And as he asked the private sector to join the Gates Foundation and its partners in this work, which is the key priority of the largest foundation in the world, he made the case not in terms of corporate social responsibility, but rather because it makes good business sense.
“It’s really the private sector that has the skills, experience, the capacity to turn discoveries into the viable products,” he said at the San Francisco event. “And so that’s why this engagement is so critical.”
Gates discussed the growing convergence between philanthropy and industry in developing solutions for diseases in rich countries as well as poor countries. He talked about advances against diseases such as obesity, Alzheimer’s, and cancer, and explained how they could translate to solutions for infectious diseases. His talk was a call to action for the audience to take some of the health care innovations like those featured on the agenda at the J.P. Morgan conference and apply them to diseases facing the world’s poor, as part of the guiding belief of the Gates Foundation that all lives have equal value.
A call for innovation
Gates discussed progress against diseases including malaria, HIV, and tuberculosis, going so far as to say that almost half of neglected tropical diseases are no longer neglected, as several of them are on the pathway to elimination.
“What we need is more innovation, and of course that’s why I’m here today,” he said.
The billionaire philanthropist went on to talk about how the foundation has partnered with other institutions, including universities, biotechnology startups, pharmaceutical companies, all with the goal of accelerating this global health progress.
“The goal is to get medicines and vaccines out to everybody who needs them and so that’s a case of innovating and it’s a case of being able to finance those and having the delivery systems,” he said.
While the foundation is involved in each of these areas, the bottleneck is on the innovation side, Gates said, explaining that the tools and discoveries private sector companies are working on can make a huge difference in public health.
“The market isn’t naturally going to create a malaria vaccine. There’s just no financial reward for doing that. And yet the private sector expertise has been key to the progress we’ve made in doing that.”— Bill Gates, co-founder and chair of the Bill & Melinda Gates Foundation
Much of the conversation centered around the important role of government funding for basic research on diseases of the poor, in the United States, Europe, and China, which he called a particular focus for the Gates Foundation. When it comes to backing high risk science and staying patient, philanthropy can complement the government, and serve as a bridge to the private sector, he said. Academic insights are not enough, Gates continued, noting the importance of biotechnology expertise from manufacturability to cost reduction.
The market opportunity
Gates went on to describe the poor countries where his foundation focuses its work as markets where drugmakers might make profits while saving lives.
As the world goes from 7.4 billion to 11 billion people, all of that increase except for a billion in Asia will be in Africa, he said, explaining that developing countries in Asia and Africa will be by far “the largest patient pools in the world.”
Gates presented the foundation as a partner to these companies, noting their work in complementary areas like sanitation, financial services, and agricultural development, and making it clear that the foundation’s political relationships and distribution networks could set these companies up for success. He explained that the Gates Foundation works mostly through grants, with more than $12 billion over the last 5 years distributed to a range of institutions including pharmaceutical companies. Gates also talked about a growing emphasis at the foundation on program-related investments, including equity investments and price and volume guarantees, explaining that this has gone from 5 percent of what they do up to 15 percent, and adding that he sees this growing.
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“The creativity of how we can get in at an early stage, find platforms that are of common value for rich world health and developing world health, that’s really the ideal for us,” he said.
These investments have led to new drugs and vector control work and accelerated the introduction of vaccines, which Gates called the one category where the foundation has had the greatest success.
In the afternoon, Gates Foundation directors Andrin Oswald, who leads Life Sciences Partnerships, and Andrew Farnum, director of its Program Related Investments, held a session at the J.P. Morgan conference, offering further details on opportunities for partnership with the Gates Foundation in a session called “Reaching More Patients Through Innovation.”
Breakthroughs across borders
Cancer immunotherapy, which harnesses the immune system to treat cancer, is the best example of the overlap between the research agendas in biotech, pharma and global health, Gates said. He also noted the interplay between the gut microbiome and nutrition, another priority of the foundation. Gates said his foundation wants to partner at an early stage to see whether products developed for rich countries can save lives in poor countries.
“The breakthroughs that are happening in your labs not only can be an economic success and help in the developed countries,” he said. “They literally have a chance to accelerate this idea of health equity and saving literally millions of lives.”
He mentioned this Wall Street Journal headline that caught his eye: “How HIV became a cancer cure.” He said he hopes for an opposite headline in the next decade, that immuno oncology can lead to a cure for HIV. The global health community is holding the line on HIV, but “without breakthroughs and continued generosity,” the world could return to peak levels of infections and deaths.
“In infectious disease though, there is a a lot of low hanging fruit,” he said. “Many of these diseases, there just hasn’t been that much work done, so if we can get the latest tools involved, we have a good chance of success.”
Staff at the Bill & Melinda Gates Foundation and J.P. Morgan said they hope the Global Health Investment Fund will demonstrate that it is possible to generate social impact, reduce costs to health care systems and deliver financial returns to investors at the same time.
Gates pointed to past examples of the private sector taking on the cause of public health, like when venture capitalists Bob Nelsen and Bob More helped raise $500 million from groups including the Gates Foundation for VIR Biotechnology, which is focused on taking on infectious diseases. Devex has also reported on a collaboration between J.P. Morgan and the Gates Foundation called the Global Health Investment Fund, which seeks a traditional return and grantlike impact for global health research and development. Other examples of these public private partnerships appear in this blog post from Gates featuring his remarks as prepared for delivery.
“The reason that our foundation focuses on global health is we saw it as the place that we could have the greatest impact,” Gates said. “The market isn’t naturally going to create a malaria vaccine. There’s just no financial reward for doing that. And yet the private sector expertise has been key to the progress we’ve made in doing that. So we saw philanthropy as the thing that could come in and help reduce that gap.”
The role of philanthropy
Gates talked about the $1.5 billion Advance Market Commitment for the pneumococcus vaccine, which targets pneumonia. The foundation helped to launch this effort that brought other donors together to get manufacturers to compete for the money in order to ensure a high volume, low-cost supply of the vaccine. He called the pneumococcus vaccine an amazing success story because it is getting to most children in the world, explaining that the foundation did something similar with rotavirus, in an approach that could be applied to other medicines.
“Things like: Can we ever use genetic editing to create an HIV cure? Clearly that’s not something that’s going to happen anytime soon,” he said. “But we can afford to invest tens or even hundreds of millions in that if it’s a promising approach because it would be so phenomenal in changing the course of that disease.”
While it is not alone among institutions ranging from the Rockefeller Foundation to the Chan Zuckerberg Initiative in its work with the private sector on public health challenges, the Gates Foundation is “in a unique position to take on long-term problems,” Gates said, noting that a combination of growing spending and accelerating scientific understanding is creating major potential for impact.
He emphasized that the foundation comes in not just with money, but with technical expertise, like scientists who understand vaccinology, and can be long term partners and advisers. The Gates Foundation can provide more predictability to companies that are looking to enter new markets, he said. To make sure these drugs cost less in countries that are more price sensitive, the foundation can make volume and price guarantees, and negotiate access agreements as part of the partnership, he added.
Gates often calls himself an impatient optimist, and his remarks on the private sector opportunity in public health pointed to why, when he said the last 25 years have been great for global health, but he hopes to see the same type of reduction of disease in the next 15 years.
“Achieving health equity in our lifetime is not just a possibility. It’s almost an imperative because everyone deserves a chance to live a healthy and productive life. And we look forward to working with you to make that a reality,” he said.
Read more Devex coverage on global health.