How should Mark Zuckerberg and Priscilla Chan spend $3B to end disease?

Facebook CEO Mark Zuckerberg and Priscilla Chan’s $3 billion commitment to cure, manage, or end all disease by the end of the century has sparked the imaginations of the global public health community.

For now, details on the Chan Zuckerberg Initiative, which was launched in December are still limited. But its ambitions from education to global health have launched new conversations about where funds are most needed. Chan Zuckerberg Science will take a unique approach by committing significant financial resources to basic science research over the next decade.

The commitment is noteworthy not only because of its dollar figure but “because of its focus on basic science research, rather than applied or translational research, its intent to develop tools and technology for the use of scientists everywhere, and its facilitation of interdisciplinary collaboration such as that between engineering and the life sciences,” Marc Kastner, the president of the Science Philanthropy Alliance, told Devex. “These strategies can help accelerate discoveries around the world to cure, prevent and manage disease.”

Experts who spoke with Devex welcomed the ambition of Chan Zuckerberg Science and outlined how they hope to see the money spent.

What we know so far

CZI will focus on the leading causes of death: heart disease, infectious disease, neurological disease and cancer. To do so, CZI will support building the foundation of biological knowledge. Recent progress on cancer, for example, has only resulted from understanding its genetic underpinnings — researchers hope the same will be true for far more conditions.

Chan Zuckerberg Science has determined that $600 million of the $3 billion for science research will be spent on the Chan Zuckerberg Biohub, a collaboration between the University of California at Berkeley, Stanford University and the University of California at San Francisco, where Zuckerberg and Chan made the announcement last week.

"This donation to building a biohub in the bay area can uniquely enable great minds at these three schools to go for the high risk, nontraditionally funded idea to better global health,” Michele Barry, director of the Center for Innovation in Global Health at Stanford University, told Devex.

Led by Stephen Quake of Stanford and Joe DeRisi of the University of California San Francisco, Biohub scientists will work on two major overarching projects: a comprehensive data set cataloging the characteristics of every cell type as well as a project focused on microbial diseases, including emerging pandemics. As of next month, faculty at the three partner universities will also be able to apply for funding for projects that are too exploratory for other sources of capital.

Chan and Zuckerberg selected Cori Bargmann, a neuroscientist and geneticist at Rockefeller University, to lead their science research beyond this initial investment of $600 million. Her say in deciding how the remainder of the $3 billion will be spent has made her one of the most influential scientists on earth. She recently told CNN that she views technology and collaboration as essential to her mandate of building new weapons against disease.

While the $3 billion commitment is significant, it does not come close to other efforts to tackle disease, such as the National Institutes of Health, the biggest funder of medical research in the world, with a budget of $32 billion a year focused on the United States.

Still, CZI can play an important role in complementing existing global health efforts, for example by supporting research that increasingly risk averse government funding does not support, Kastner said.

“Many disease related charities and foundations support efforts at short term impacts rather than trying to understand the underlying causes of disease,” he added. “Many of us believe that basic research into human biology will be more effective, although it will take much longer for its influence to be seen.”

Filling the gaps

Public health officials told Devex they hope CZI will help fill some of the gaps in funding for disease, while also building on what has been proven to work.

“The announcement is most welcome,” Mario Raviglione, who heads the tuberculosis program at the World Health Organization, told Devex. “What we’re dealing with though is infectious diseases that people don’t want to fund research for.”

He explained how “diseases of the north” such as heart disease dominate research; drug companies are far more inclined to develop drugs when they stand to profit. Even organizations working on infectious disease, such as The Global Fund, follow this trend to a certain degree, with more funding for AIDS than tuberculosis.

“I hope they won’t put their money into fields that are well resourced like [noncommunicable diseases] or diseases oriented to the north,” he said. “I hope they will fund research in the underrepresented diseases and the invisible diseases.”

Seth Faison, head of communications at The Global Fund, urged Chan and Zuckerberg to remember that health issues are still human issues, and scientific and technological breakthroughs will not take hold unless they are coupled with policies and services that are sensitive to the needs of those most affected by the diseases.

“It could link up with other work on global health in many ways,” he said of CZI. “For instance, it could link up with existing efforts on developing a vaccine for HIV, where a lot of progress has been made, but there is still a long way to go. More broadly, working in partnership with governments, civil society, the private sector and people affected by diseases is essential to finding the best solutions.”

How to move the needle

There’s no one right way to invest when you’re aiming at truly transformative impact, said Steve Davis, the chief executive officer of PATH, an international nonprofit organization based based in Seattle.

Targeted investments in specific diseases, such as malaria eradication, can have immense and immediate impact, and investments addressing emerging challenges including noncommunicable diseases in low- to middle-income countries are foundational for the future, he said. But the approach is key, he added. He urged the initiative to think both in the short and long term, allowing scientific breakthroughs from Silicon Valley to translate into very different settings in the field.

“Disease elimination means knitting together innovative solutions from drugs and devices to diagnostics and vaccines — and then doing the hard work of strengthening health systems and services and building cross-sector partnerships to get them to those who need them most,” he told Devex. “To truly move the needle on health equity requires innovation and access — we need to push all the way from development to integration on a global scale.”

Chan and Zuckerberg are also joining the fight against disease at a time that innovations are being conceived, developed, and delivered by countries once considered only beneficiaries, Davis said.

“We encourage CZI to use these emerging capacities to think creatively and globally about where they source innovation and scientific ingenuity,” he said.

So far, it appears that CZI is interested in directly funding the development of new tools and empowering scientists from around the world to think big.

“It’s actually pretty easy to imagine what new tools we need to develop to make progress on the four major disease categories,” Zuckerberg said at the UCSF event last week, mentioning how technologies such as artificial intelligence and machine learning can be applied to these global health challenges.

"Throughout history, most scientific breakthroughs have been preceded by the invention of new tools to help us see problems in new ways — like the telescope, the microscope and DNA sequencing,” Zuckerberg wrote in a Facebook post announcing Chan Zuckerberg Science. “We’re going to focus on bringing scientists and engineers together to build these new tools and technologies."

Support from the sector

Before the launch of CZI, Chan and Zuckerberg consulted a number of big players in global health philanthropy — and acknowledged that this kind of input will continue to be essential to the initiative’s success.

Kastner and the Science Philanthropy Alliance provided advice to Chan and Zuckerberg over the past year regarding the models and mechanisms for philanthropic support of basic science research, while also connecting CZI with scientists and philanthropists, and organizing events focused on best practices.

Chan and Zuckerberg also sought advice from Bill Gates, co-chair of the Bill & Melinda Gates Foundation, who took the stage at UCSF to congratulate the couple on “their vision and generosity.”

The couple has signed his Giving Pledge, which asks billionaires to pledge the majority of their wealth to philanthropy. The Pledge community also offers thought partners — from Facebook co-founder Dustin Moskovitz to Microsoft co-founder Paul Allen — as Chan and Zuckerberg determine the next steps for the limited liability company through which they plan to devote 99 percent of their Facebook stock.

Melinda Gates, co-chair of the Gates Foundation, joined the list of high profile figures applauding the $3 billion announcement when she joined in on a back and forth with Zuckerberg on Facebook: “Thank you, Priscilla and Mark, for daring to set such bold, ambitious goals — and for matching that bold ambition with such a smart plan of action,” she wrote in a reply to Zuckerberg’s status update. “We can’t wait to see what you accomplish.”

“Thanks Melinda!” Zuckerberg wrote. “Your work with Bill on eradicating polio and malaria inspired us to believe that together we can cure all diseases in our children's lifetime. The data suggests this should be possible, it is examples like yours that give us confidence we can make a difference.”

Devex reporter Molly Anders contributed to this story.

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