Posts Tagged 'Bill and Melinda Gates Foundation'

Drug Resistant Malaria

Malaria Deaths

The New York Times reports today on the growing resistance to first line antimalarial drug artemisinin in fighting malaria, especially in and around Cambodia:

Combination treatments using artemisinin, an antimalaria drug extracted from a plant used in traditional Chinese medicine, have been hailed in recent years as the biggest hope for eradicating malaria from Africa, where more than 2,000 children die from the disease each day.

Now a series of studies, including one recently published in The New England Journal of Medicine and one due out soon, have cemented a consensus among researchers that artemisinin is losing its potency here and that increased efforts are needed to prevent the drug-resistant malaria from leaving here and spreading across the globe.

Luckily, the Bill and Melinda Gates Foundation is making innovation in malaria vaccines and treatment a priority as reported in Gates’ First Annual Letter:

Today a number of new tools are being developed—better bed nets, better drugs, better insecticides, and a number of vaccine candidates. One of the vaccines will go into the last phase of human trials this year and could be ready for wide use by 2014. None of these tools is perfect. To understand how we should combine them, we brought in an expert in mathematical modeling who is applying a technique called Monte Carlo Simulations. This modeling work, which will show where we can eliminate malaria and where we can just reduce the disease burden, is a wonderful use of advanced mathematics to save lives, and if it goes as well as I expect, we will apply it to other diseases.

Definitely, advances in epidemiological science, vaccine technology, and pharmeceuticals will be crutial to controlling this disease. But, I also think that it is telling that:

The mosquito responsible for transmission of malaria is still endemic in the United States. But modern housing, better access to health care and the use of insecticides have virtually eradicated the disease in wealthier countries.

Once again, poverty is the main structural force shaping the risk of acquiring and dying from malaria. Shouldn’t we address the root cause – inequity – before pumping out technologies? Or, should it be a parallel process?

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Public health needs the private sector?

In response to the news of the Bill and Melinda Gates Foundations massive investment in the eradication of polio this week, Terry Kosdrosky at the University of Michigan Ross School of Business wrote an interesting piece about the important role that private corporations can have in investing in health as a public good. Kosdrosky quotes Dr. Tachi Yamada, the president of the Bill and Melinda Gates Foundation Global Health Program:

“If we can’t think of this problem in terms of a moral tragedy, we can think of self-interest,” Yamada said. “From a commercial standpoint, the emerging world is the emerging market. Real opportunity for industries, stable industries throughout the world, is in the developing world — south Asia, Africa.”

Kosdrosky goes on:

“From an economic perspective, not solving these problems will deprive businesses of a huge market, now and in the future, as mature markets see slower growth.

…there are limits to what even well-funded government programs can do. For example, Yamada recently visited a clinic in a remote part of Ghana. It was well-staffed, the professionals were well-educated, and it was fully equipped with medicine. The county has a national health insurance plan. But the clinic was only seeing about 150 people a month, or five a day.

A visit to a nearby village showed him why. The people there said very few of them went to the clinic for several reasons. For one, it took a long time to be seen because of red tape associated with the national health insurance program. If you pay cash, you can be seen right away, but the cost is prohibitive. Second, a medicine seller came by the village every so often. People would report their symptoms and he’d sell them medicine at low prices.

It tells you the public sector by itself can’t do it,” Yamada said. “It’s necessary, but not sufficient, to deliver care… The delivery channels for care are there for the private sector in a way they’re not available to the public sector.”

Of course, coming from a business school,  Terry Kosdrosky emphasizes using market forces to drive the creation of efficient health systems. I have no doubt that engaging the private sector and leveraging massive corporate resources will be essential to building true global health equity. But, I think that the fundamental position that patient = customer, or that we are all consumers of health care as a product, is fundamentally flawed. In my mind it conflicts directly with the notion that health is a fundamental human right.

How can we use market forces to drive the efficiency and quality of health systems without erroding our ultimate goal of equity?

Gates and Rotary Pair for Polio Eradication

Recently, the Bill and Melinda Gates Foundation announced that it would be donating $630 million towards finally eradicating the polio virus. They will be working primarily with Rotary International, a service organization with chapters in nearly every country in the world and over 1.2 million members as well as the UK and German governments. Together, they represent an amazing example of how the public and private sectors can effectively work together to achieve shared goals.

The effort to eradicate polio began in the 1980’s and has been largely successful, save a few trouble spots such as Afghanistan and Nigeria. Unfortunately, due to many factors such as cultural resistance to western intervention, these polio hot spots have persisted over the past two decades. The danger now is that the virus could spread out of these trouble spots and begin to enter populations who have not been vaccinated. By driving home the eradication of polio, not only will a major scourge be removed from the earth, but also the costs associated with  polio vaccination can be diverted to more pressing health issues.


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