Bill Gates gives $10 billion to childhood vaccines; challenges others to join him

A decade ago, Bill Gates made his first major foray into the world of global health with a $750 million grant to boost immunization of the planet's poorest children.

On Friday, the Microsoft co-founder and his wife, Melinda, re-upped for the battle in a big way. The $10 billion, 10-year commitment to childhood vaccines they announced at the World Economic Forum in Davos, Switzerland, ranks as the biggest philanthropic pledge ever to a single cause.

But despite the staggering amount of cash he's putting on the table, Gates was really making a plea for others to ante up.

The world's richest man has become adept at parlaying his superstar status and access to the corridors of power into gains for global health funding, and he leaned hard on world leaders gathered in Davos.

"Our commitment alone isn't enough," Gates said in a news conference. "We need the increased generosity of the rich world governments."

Sweden, which is among the world's most generous nations, earned a place in the spotlight with the co-chairs of the Bill & Melinda Gates Foundation. Italy, which halved its foreign-aid funding last year, got a verbal slap from Gates.

Gates also applied his carrot-and-stick approach to the pharmaceutical industry, acknowledging the contributions of many companies but calling for more. His foundation helps fund the Access to Medicine Index, which rates drug companies on their performance in poor nations. The rankings motivate companies at the top to stay there and those at the bottom to work harder, Gates said.

Saving lives is the goal behind the Gateses' cheerful pressure and posturing. If funding is sufficient to immunize 90 percent of children in the developing world, more than 8 million deaths can be averted over the next decade, according to an analysis conducted for the Gates Foundation by researchers at Johns Hopkins Bloomberg School of Public Health.

"We think the stage is set for extraordinary progress," said Melinda Gates.

The $10 billion pledge represents a doubling of Gates Foundation spending on vaccines. The Chronicle of Philanthropy said the amount is more than the entire assets of the Ford Foundation, America's second wealthiest foundation — after Gates.

"Basically, my reaction is: 'Wow,' " said Melinda Moree, former director of a Gates-funded project to develop a malaria vaccine. But governments have been slow to match the foundation's largesse, she pointed out.

"Does this challenge them to step up, or does this allow them to step back further?" asked Moree, now chief executive for BIO Ventures for Global Health.

The foundation's initial vaccine investments created a organization called GAVI, or the Global Alliance for Vaccines and Immunisation.

In an example of Gates' leveraging power, GAVI now gets funding from 17 nations. Its programs helped boost global rates of vaccination against diphtheria, tetanus and whooping cough from 66 to 79 percent. Along with the introduction of other vaccines in the developing world, the World Health Organization estimates those efforts have prevented about 5 million child deaths.

But pushing further will tax the health systems of developing nations, where many villages lack clinics, doctors, or even refrigerators to keep vaccines cold.

The optimistic projection of saving more than 8 million lives would require widespread introduction of vaccines against diarrhea and pneumonia, two leading child killers. It also banks on a malaria vaccine that's still in clinical trials.

Such vaccines cost far more than most developing countries can afford. The GAVI Alliance absorbs some of the cost, but its budget depends on donations from national governments.

At a time when foreign-aid budgets are stretched, many different issues are competing for funding. Gates warned that increases in spending to address climate change might come at the expense of money for vaccines.

The Gates Foundation includes provisions to make the vaccines affordably priced in its agreements with pharmaceutical companies such as GlaxoSmithKline, which developed the rotavirus diarrhea vaccine and malaria vaccines, but the foundation doesn't stipulate prices, said Dr. Rajeev Venkayya, director of global-health vaccine delivery for the Gates Foundation.

Recently GlaxoSmithKline committed to making its malaria vaccine available at a small margin over the cost. Eventually, market forces will help drive down prices, Venkayya said.

One of the major criticisms leveled at the Gates Foundation is its emphasis on new drugs and technology, rather than bolstering basic sanitation and health systems and finding ways to get existing drugs to the people who need them. A vaccine against one cause of diarrhea may not do much good if a child's water source is heavily contaminated or she lacks proper nutrition or vitamins.

But Venkayya pointed out that his 30-person department was formed two years ago to focus on the regulatory, technical and bureaucratic hurdles that can block introduction of new drugs.

Gates remains committed to a technological approach, though. After his first year of full-time work on philanthropy, he said he sees the foundation's focus as investing in "big breakthroughs" others are not funding.

"This draws not only on our backgrounds in technology," he said, "but also on the foundation's size and ability to take a long-term view and take large risks on new approaches."

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com

Kristi Heim: 206-464-2718 or kheim@seattletimes.com