Gates Foundation head of global health talks WHO, Chan Zuckerberg Initiative

The spread of Zika across the Americas, on the heels of the devastation caused by the Ebola virus in West Africa in 2015, has many wondering how global health institutions are adapting to combat pandemics.

Trevor Mundel, president of global health at the Bill & Melinda Gates Foundation, said “a lot needs to be done” to prepare now for the next global crisis. From rethinking the World Health Organization’s role and funding to embracing health innovations such as the Chan Zuckerberg Initiative, Mundel, who oversees the Gates Foundation’s work in vaccine and diagnostic innovation, is looking for new ideas.

Devex spoke with Mundel on the sidelines of the 2016 Grand Challenges annual meeting in London last month. Below is our conversation, lightly edited for length and clarity.

How do you feel the Ebola response has shaped the response to Zika? How do you balance funding for pandemic response and longer-term work on health systems?

One thing that comes up with Zika following Ebola is how do we have a better system for pandemic response? Yes, people are more focused on this issue, but nevertheless there’s a lot that needs to be done in the event that we have a real global pandemic and would need to respond to that.

We’ve been working with a couple of groups — the Wellcome Trust, with Norway, the government of India — in terms of doing very specific things that are in some ways “no regrets moves” and which need to be done. They also have a long lead time so you can’t just do them in an emergency. This leads from the fact that, as tragic as the whole Ebola crisis was, it did demonstrate a few things that were quite positive. There had been some pre-investments, some partial investments in vaccines for instance. The communities that were involved were able to advance those vaccines remarkably quickly, cutting years off the usual development time.

To get two vaccines out in the period of two years is remarkable, so that gives us the hope that if we could be a little bit better prepared, if we took a little bit more time to figure out what needs to be done, we could be that much better off for the next problem that comes along.

There is also an effort called the Coalition for Epidemic Preparedness Innovations. The idea is that there is a list of problem infections out there that people are looking at — things such as the Middle East respiratory syndrome virus for which there are no vaccines right now. [The initiative hopes to] advance some candidate vaccines, so if there is a much larger outbreak we could deploy them rapidly.

How would you like to see the new WHO chief tackle that agency’s role in pandemic response in the global health space? Is there a good balance between the WHO’s traditional role and one geared more toward pandemic response?

WHO certainly has a central role, and I think in terms of many issues related to the structuring of WHO and its funding, we need to look at that very seriously. If you think about the responsibilities the WHO has, and then the complaints they get if they don’t fulfill their responsibilities adequately; their resources are really restricted.

I think that the global community, the G-20 really needs to look at the WHO funding. We are also looking to groups such as the G-20 to be the kind of source of funding and support for these kind of pandemic response efforts.

What’s your take on the new $3 billion Chan Zuckerberg Initiative’s mandate to “end all diseases?” Some are critical of such a broad approach, as it could expand the funding divide between NCDs and illnesses that affect developed countries such as cancer and underfunded diseases mostly found in the developing world.

Well you might say it’s a ridiculous take on all disease, but we’ve seen some of the tools become available. We’re becoming very interested in, for instance, this tool called liquid biopsies, which is being used to screen for cancer. They can take a small amount of your blood and they can detect very early cancers. Even if you had cancer [already], they can sometimes get a more accurate analysis of your cancer than if they took a direct biopsy, just from a blood sample using the next generation sequencing techniques.

We think that can be applied to pretty much any infectious disease; it hasn’t been so far. We want to take that technology, which is being pushed along by the immense efforts and funding that goes toward cancer research, and apply it to global health and infectious diseases. That can be all of them. People who die from unknown causes, you could get a small sample of blood now and analyze 200 different potential infections it could’ve been, and we can get results within a day.

Another [tool centers] around getting better data across a range of different diseases. Lots of people do analysis of the various data sets that are out there, but we want to get better primary data — to know why people are getting ill [for example, and] what infections are important. It’s a changing picture, and with vaccinations coming in that changes it as well.

There really isn’t a good system in sub-Saharan Africa and parts of South Asia for collecting that data. We launched the Child Health and Mortality Prevention Surveillance Network initiatives around setting up centers of excellence that have all the technologies to gather that data. It’s starting out in Africa and South Asia and we’re looking for partners. Because it’s a hugely expensive enterprise, we can probably fund a couple of reference sectors, maybe six ourselves, but we think we need 15-20 to get a good coverage.

There are some partners who are interested to engage with us, [The Wellcome Trust] has got some sites of excellence, Institute Pasteur has certainly got some centers, but governments and other funders probably need to step in, because it intersects with many other issues, such as antimicrobial resistance, surveillance, pandemic surveillance — many things could be layered on to the same sort of system.

This is really important for us: both the collection of real primary data and its analysis, because just as a principle, if you don’t understand what’s going on, how do you plan anything? You can be attacking yesterday’s diseases. We had one vaccine project, which was based on analysis of the causes of diarrhea, but when we projected what was happening with vaccinations and where we would be in 10 years, which is when that new vaccines would be available, the projection was that actually some of the strains in the vaccine wouldn’t even exist anymore. So you can do the wrong things just by not understanding the current status and where it’s likely to evolve.

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