The Gates Foundation leans into disease modeling

SACRAMENTO, Calif. — The Institute for Disease Modeling, a research organization that develops and shares modeling tools to facilitate disease eradication, got its start after philanthropists Bill and Melinda Gates announced their ambition to eradicate malaria.

IDM was part of Global Good, a fund supported by Bill Gates and housed within the patent-holding and technology company Intellectual Ventures to support inventions for low-resource settings.

But what began as a project focused on modeling the eradication of malaria has since evolved into a team of nearly 100 people supporting a range of public health interventions, including the COVID-19 response.

In July, IDM joined the global health division of the Bill & Melinda Gates Foundation. The move was part of a larger reorganization of Global Good projects into the foundation and Gates Ventures, the private office of Bill Gates. IDM staff members have long collaborated with the foundation, but by joining the team, they are likely to make disease modeling more of a focus across global health priorities, according to Trevor Mundel, president of global health at the Gates Foundation.

Like other applications of computer modeling, disease modeling involves a range of variables, which are adjusted alone or in combination with each other to simulate and study how these changes affect outcomes. The IDM team models the spread of diseases, as well as other factors including societal and economic issues and the government response. This work supports quantitative decision-making regarding the most effective strategies to eradicate disease and improve public health.

When IDM was part of Intellectual Ventures, Bill Gates and other key staff members from the foundation would participate in quarterly reviews that took upward of five hours, where IDM staffers would present their new findings.

“I came to the conclusion very early on that those quarterly reviews with IDM were the most productive and deepest dives into the foundation’s strategies that occur anywhere,” Mundel said.

With these simulations, the foundation could model health at a country level with high granularity, rather than conducting studies on the country level and getting answers three to five years later, he said.

“It was controversial,” Mundel added. “Because IDM had the models, they could of course change the parameters. The program team has chosen one set of parameters — ‘We’re going to do this’; the IDM team could ask the counterfactual, which is, ‘What if you do that?’”

In 2018, Mundel recruited Philip Welkhoff, previously director of research at IDM, to become director for malaria at the Gates Foundation.

“The model-based approach to program development and testing has been vastly underutilized,” he said. “Malaria was far and away the most evolved.”

Mundel said that having Welkhoff join the foundation was one factor that led to the ultimate integration of IDM with the foundation. But there were a number of reasons it made sense for the Gates Foundation to bring IDM into the fold.

When IDM was under the Intellectual Ventures umbrella, people unfamiliar with its work would confuse IDM’s mission with that of the company, which buys and licenses patents.

Bob Hart, vice president and general manager of IDM, said he was often asked, even by people at the Gates Foundation, whether his team aimed to patent a cure for the disease.

At the same time that the Gates Foundation was working to become more data-driven, the IDM team was expanding its focus from infectious disease to other areas of global health, including maternal and child health and family planning.

Hart learned in January that IDM would be joining the Gates Foundation, and the team formally joined the staff in July.

“The decision was Bill’s, obviously,” he said. “It was really just, you know, ‘This seems like the right time.’”

The integration of IDM into the Gates Foundation is good news for the global health community, said Ali Mokdad, professor of health metrics sciences at the Institute for Health Metrics and Evaluation, which is funded by the Gates Foundation and based at the University of Washington.

“Working with the Gates Foundation, in terms of where to invest, what to do, it’s very powerful to inform the policy and strategy at the Gates Foundation,” he said.

Mokdad said he sees value in having IDM researchers working alongside the Gates Foundation staff, but he also noted the importance of disease modeling work independent from the foundation.

“Being independent outside the Gates Foundation allows us to do a lot of things that people within the Gates Foundation cannot do,” he said.

For example, IHME has published research that was critical of some of the work of Gavi, the Vaccine Alliance — another entity funded by the Gates Foundation.

As the details of IDM’s integration were sorted out, both the Gates Foundation and IDM devoted a large share of staff time to the COVID-19 response. The pandemic forced the field of disease modeling, which typically focused on diseases among low-income people, into the spotlight as simulations informed decisions on how to “flatten the curve.”

Due to the pandemic, IDM staff members have not been able to move into the foundation headquarters and work with their new colleagues in person. And the staffers are still figuring out how they will operate within the foundation, given that IDM is a research organization rather than a grant-making entity.

“What we do is very different than what the rest of the foundation does,” Hart said. “Trevor and I and others are working on smoothing those edges for how we plug in.”

Mundel said he wants IDM to maintain the “spirit of independent exploration” it has always had.

“We don’t want IDM to be lockstep with program teams just to support what they’re currently doing,” he said.