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Analysis: The business of improving global health

Technologist, business leader, and philanthropist Bill Gates explains why global health needs the private sector.

No matter where I go, no matter whom I talk to, there’s one point I always try to get across. It’s been my key message for more than a decade. It’s that health is getting better, and it’s getting better faster than ever before.

Since 1990, the world has cut child mortality in half. HIV is no longer a certain death sentence. Many of the so-called neglected diseases that affect a billion people every year aren’t neglected anymore.

I talk about what we’ve accomplished in the past because it makes me optimistic about what we can accomplish in the future. But there’s still a lot of room for improvement. This year, 5 million children under the age of five will die, mostly in poor countries. And hundreds of millions of others will suffer from diseases and malnutrition that sap them, and their countries, of their strength and their potential.

Some of this can be addressed by doing a better job of getting lifesaving drugs and vaccines to the people who need them. But there is still a substantial gap between the tools we have and the tools we need to eliminate the most persistent diseases of poverty.

The way to fill that gap is to innovate, and that’s why I’m excited to be here today. Because the tools and discoveries your companies are working on can also lead to breakthrough solutions that save millions of lives in the world’s poorest countries.

It’s true that government-funded basic science research shines a light on promising pathways to health advances.

Philanthropy can help nurture the best ideas through discovery and development, and balance the risk-reward equation for private-sector partners.

But industry has the skills, experience, and capacity necessary to turn discoveries into commercially viable products.

The fact is that global health needs the private sector. And, frankly, the private sector has much to gain from pursuing breakthroughs in global health.

Over the next few decades, developing economies will continue to expand. By 2050, the population of Africa will more than double to almost 2.5 billion. That’s more than twice the forecasted population of the US and Europe combined.

But we don’t have to wait 20 or 30 years. Even in the shorter term, impact and earnings are not mutually exclusive for the private-sector.

As you probably know, global health is our primary focus at the Gates Foundation. Over the last five years, we have invested nearly US$12 billion in global health.

This includes grants and equity investments in companies with promising technologies that have potential application in global health. We also use creative price and volume guarantees that help the private sector mitigate the risk in developing a new product for which demand is unproven.

We are also working with the WHO and regulatory entities in China and Africa to eliminate systemic barriers that slow development of new products and access to new markets. A few years ago, we looked at the data, which showed that in high-income countries it took 6-12 months to get a product registered – compared to four to seven years in low-income countries. We realized this was as big a challenge as anything else in getting new health solutions to the people who need them.

I’m particularly excited about our work with the Chinese FDA to provide a more efficient and consistent mechanism for testing, review, and approval of medicines and vaccines – using international standards. This would be a game changer in getting quality products into and out of China.

Of course, fighting infectious disease is only one of the global health challenges that demand our attention. Another is newborn health. Despite the great progress in reducing child mortality, nearly five million children under the age of five will die this year—close to half in the first 28 days of life.

To make inroads against neonatal mortality, we first have to understand and address the underlying vulnerabilities of newborns, especially in poor countries. Right now, we don’t know exactly why many newborns in poor countries die, which makes it very difficult to save them.

But we’re enthusiastic about leveraging the tools of genetics and other research the private sector is working on to help children survive birth, fend off deadly infections, and thrive both physically and cognitively.

I’m also excited about a 20-year study we’re funding in southeast Asia and sub-Saharan Africa that will give us epidemiological data about what is causing stillbirths and child deaths.

We have a lot to learn from the data, but we already know that one critical factor is the prevalence of preterm birth. It is the single largest cause of newborn deaths, and the children who survive it often face serious and lifelong health problems. Although most premature births occur in Africa and Asia, this remains a problem in rich countries, too.

One of every 10 infants in the US is born preterm, which threatens the health and wellbeing of those children and significantly drives up healthcare costs.

We are just now getting the first effective diagnostic test to identify women at risk for early delivery. A company called Sera Prognostics developed a blood-based diagnostic that recently went on the market in the US.

We’re supporting their work on a low-cost version for use in poor countries. By itself, this won’t solve the problem. But it will give healthcare providers a way to identify women at risk and provide care that extends their pregnancy toward full-term.

We also need to better understand the biological mechanisms that underpin preterm birth, starting with the health of the mother during pregnancy. We recently co-funded a genome wide association study that illuminated a correlation between selenium deficiency in pregnant women and preterm birth. More research is needed, but the hope is that dietary supplements could help reduce the incidence of preterm births and newborn deaths.

People often ask why Melinda and I decided to focus so much of our philanthropy on global health. It started with a simple question we asked ourselves: how could we do the most good for the greatest number of people?

When we looked at it that way, the answer quickly became clear. The health disparity between rich and poor countries was a big problem. We saw a gap that wasn’t being filled by others. And we believed that our investments in global health could be catalytic. By helping poor countries ease the devastating burden of disease, we could help ease the burden of poverty, too.

One of the major obstacles we faced early on is that in health – as in many other aspects of life – the free market tends to work well for people who can pay… and not so well for people who can’t. But over the last decade, our experience has shown that we can stretch the reach of market forces so the private sector’s most exciting innovations also benefit people with the most urgent needs. And with creative thinking, we can do it in ways that are both sustainable and profitable.

Our foundation is in a unique position to share the risk on promising bets that can lead to important new discoveries. And we can help provide more predictability to companies interested in entering new markets that present real challenges – but also tremendous opportunities.

We all share the goal of improving the health and well-being of people globally. Imagine what’s possible if we work together.

Consider a world where the age-old scourge of malaria is finally eradicated… where hundreds of millions of people no longer suffer from tuberculosis… and where we have a cure for HIV.

In a quarter century, we cut childhood mortality in half. With the passion, expertise, and resources of the people in this room, we can cut child mortality in half again by 2030.

There are many technical challenges to overcome. But when I think about the breathtaking pace of innovation in just the last 10 or 20 years, I believe that even more extraordinary things are possible in our lifetime.

I can think of no more noble purpose than erasing the divide between those who suffer the relentlessness of disease and poverty – and those of us who enjoy good health and prosperity.

Achieving health equity in our lifetime is not only a possibility. It is an imperative, because everyone – no matter where they live – deserves the chance to live a healthy and productive life.

This article is an edited version of a speech given in San Francisco at JP Morgan’s 36th Annual Healthcare Conference.

Posted on: 18/01/2018 UTC+08:00


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