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In their 2015 annual letter, Bill and Melinda Gates say that polio, Guinea worm, elephantiasis (lymphatic filariasis) and river blindness (onchocerciasis) could be eliminated within 15 years. This will be achieved by scaling up mass treatments and drug administration, and by developing better drugs and vaccines, they say in their letter, which was published last week (21 January).
Bill Gates also told the World Economic Forum in Davos, Switzerland, last week (23 January) that a vaccine and new intensive drug treatments for HIV and tools to eliminate malaria could become available by 2030 through the foundation’s funding.
But his foundation, which has an endowment of more than US$42 billion, has been attacked for its technological style of addressing major diseases affecting developing countries. Critics have said that this approach is failing to deliver within the timescales originally envisaged in the Grand Challenges programme: a group of innovation initiatives intended to solve key global health and development problems that are funded by the Gates Foundation and various governments.
The importance of such scrutiny is growing as other donors, including the Canadian and South African governments, are adopting the Grand Challenges approach to accelerate the pace of research.
“Although individual projects made a lot of progress, for a large part they are not on a path to changing the vaccine supply chain as of today.”
Steven Buchsbaum, Bill & Melinda Gates Foundation
“There has been very little in the way of any independent evaluation of the Grand Challenges programme,” says David McCoy, a public health researcher at Queen Mary, University of London, United Kingdom.
In October, Gates himself acknowledged the foundation’s struggles in a speech at an event in Seattle, United States, marking the tenth anniversary of the launch of the Grand Challenges in Global Health initiative. He said that, on the measure of “which of these inventions would go on over time to actually save lives, I have to say at the time I was pretty naive about how long that process would take”.
Underestimating the challenge
The foundation also underestimated the effort required to implement new technologies in countries without basic services, including clean water and reasonable medical care, Gates said.
According to Steven Buchsbaum, deputy director of translational sciences who leads the foundation’s work to expand the Grand Challenges programmes, Gates “is always challenging and pushing us to accelerate our work, and I think it is not completely unfair to say that in the early days there was a tremendous pressure to solve many of these problems faster”.
The foundation has spent around US$1 billion on global health research teams developing AIDS and tuberculosis drugs, and to fight malaria. But Gates admitted in his October speech that it could be another decade before even the most promising initiatives bear fruit.
Vaccines that do not require refrigeration in infrastructure-poor tropical climates were one technology that failed to materialise. A lot of work was done on the thermostability of vaccines in the early stages of the Grand Challenges, Buchsbaum tells SciDev.Net.
“Although individual projects made a lot of progress, for a large part they are not on a path to changing the vaccine supply chain as of today.” In part, he says, this is because “we had not been precise enough in asking how thermostable does a vaccine have to be to change the market conditions under which it is delivered”.
A flagship Grand Challenge project looking to create three new tuberculosis drug candidates also failed to find new drugs. But this has “transformed the way the tuberculosis field thinks about the pathway biology of the disease and created a number of tools that are critical to our vaccine and drug discovery efforts now”, says Buchsbaum.
These ‘failings’ would be seen as normal outside the foundation, adds McCoy. “It is well known that science progresses as much through its failures as through its sporadic successes,” he says. “Science and technology rarely progresses through single-minded, solution-driven and focused funding.”
But with such short-term, self-imposed deadlines, the foundation often claims credit for success although “in all the individual Grand Challenges, there would be many current and past streams of funding contributing to the eventual solution”, says McCoy.
Others have highlighted a fixation on technology, particularly vaccines and drugs, a criticism some within the foundation are only now beginning to acknowledge.
“We do feel that technology can be transformative, but the science is challenging,” says Samia Saad, a senior programme officer in the foundation’s global health research and development policy division. “The reason why these are ‘grand challenges’ is that they are complex questions, and complex problems actually need multidisciplinary approaches and multiple players to address them.”
The transition from looking more at technology to looking more at delivery “has not occurred more broadly within the foundation”, Buchsbaum admits. But he says there is a shift in the Grand Challenges.
“We recently started to look at challenges … not only in the basic sciences but also in the social sciences and in the delivery area,” says Buchsbaum, pointing to a Grand Challenge focusing on gender inequality announced by Bill and Melinda Gates in October.
Another Grand Challenge unveiled then — All Children Thriving, which targets maternal and infant health — also looks beyond technological solutions. In addition, the two new challenges address another criticism, namely that much of the foundation’s research funding goes to US-based researchers rather than those in developing countries.
“We have said that those new challenges have to have the lead investigator from a low- or middle-income country,” says Buchsbaum. “We’re still very enthusiastic about deep expertise from leading institutes in the United States, Canada, Europe, but if a large part of the problem we are trying to solve is both scientific and also social and cultural, we would want to start with investigators from those countries.”