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Bill Gates Speaks in Tokyo on Vaccine Development, Building the Global Computer Industry, and Innovative Philanthropy

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Building Microsoft, Vaccine Development and Philanthropy

After receiving the Goi Peace Foundation's Award in Tokyo last week, Bill Gates spoke about his second career in global philanthropy focused on health, agriculture, and his first -- software development that went to create the worldwide personal computer industry and built the fortune that finances his current endeavour. He described how he and Kazuhiko Nishi and other pioneers in Microsoft spent considerable time in Japan in the 1980s and worked round the clock, consuming "shabu-shabu" and conveyor-belt sushi ("grabbed more tuna sushi") while attempting to reach innovative companies like Logic Systems and Sord, and giant Japanese companies like NEC, Toshiba, Sony, and Matsushita. Gates explained how the opportunity to build Microsoft came at a very early age and that he spent the past 33 years giving most of his time and energy toward that cause of empowering the individual through personal computer (PC) software. Without the Microsoft software fueling the PC revolution, the Internet revolution may have taken more time to blossom, even though the TCP/IP protocol that is at the heart of the Internet was built by others for DARPA in the 1970s to ensure that universities and government institutions could communicate in the event of a nuclear attack. It was Bill Gates who challenged the then-prevalent notion allegedly espoused by another pioneer, Ken Olsen, that not everyone needed a personal computer (there are many variants of that much reported quote, including that no one needed a computer in his/her home, etc). I can personally attest to prominent international development agency executives confidently predicting as late as 1993 that the Internet would "never spread to Africa."

Overall, the message was a hopeful one that "in terms of millennia, centuries, or decades, the world is getting better: healthier, wealthier, more educated, and more peaceful." Gates described how innovation underpins this trend, and indicated his keen interest in vaccine development and cited the example of malaria vaccine R&D. The GlaxoSmithKline malaria vaccine work had been underway for decades when it received a shot-in-the-arm with the arrival of Bill & Melinda Gates, and William Gates, Sr., and their staff to the philanthropy world in the mid-1990s. Malaria kills about a million children every year. Dr. Tachi Yamada, who runs Gates' Global Heath Program is the former research chief for Glaxo. While Plasmodium falciparum is a canny and deadly parasite with its existence estimated since the dawn of time, and its Anopheles mosquito vector from fossils records being at least 30 million years old, it is hoped that a vaccine can cut down the morbidity and mortality.

In a published clinical trial, the GSK vaccine RTS,S/AS02A has been shown to confer partial protection in African children aged 1-4 years living in rural endemic areas against a range of clinical disease caused by P. falciparum for at least 18 months, and confirms the potential of malaria vaccines to become control tools for public-health use. GSK's malaria vaccine likely will enter the market first, although there are about 16 candidate vaccines in clinical development. Some predictions have the GSK vaccine becoming available in Africa in about a year or so.

The Bill & Melinda Gates Foundation has financed several other development efforts as well for other vaccines -- notably Tuberculosis and mostly for HIV/AIDS. Despite the challenges in designing a vaccine against a highly mutating organism -- the HIV virus, Bill Gates and his foundation poured hundreds of millions into vaccine design and development against HIV/AIDS. Bill Gates' faith in vaccines stems from the fact that in 1960, 70 million babies were born and 20 million children died, but last year 130 million babies were born and 10 million children died -- a dramatic cutting in half the number of child deaths despite the near-doubling of births. But vaccines can also prevent major suffering in mothers and children too. One that has not featured in many foundations' priority-lists is a vaccine against Chlamydia trachomatis that had been highlighted as a high priority by the Institute of Medicine/National Academy of Sciences priority-setting exercise for new vaccines. It is a serious problem for the poorest people in the world, for women's health and is the largest bacterial cause of maternal deaths through ectopic pregnancies, and the largest bacterial cause of painful, debilitating pelvic inflammatory disease. 100 million cases of Chlamydia trachomatis sexually-transmitted infections (STI) occur and it is a known co-factor for HIV/AIDS transmission, multiplying the risk of HIV infection, especially for women. 55 million people remain infected with (ocular) Chlamydia trachomatis, and 3 million are visually impaired or blind because of trachoma. The total at-risk population is approximately 500 million. One reason why Chlamydia trachomatis does not appear on too many radar screens is that the disease burden affecting chidren: blinding trachoma and that affecting adults (STI, and trachoma) are treated quite separately in burden of disease studies, but the causative organism is the same Chlamydia trachomatis, although the serovars concerned are different. But candidate vaccines have shown promise in covering both ranges of serovars. The Foundation has previousy supported treatment programs for trachoma through the distribution of azithromycin donated by Pfizer.

Another Neglected Area: Food & Nutrition as Complements to Infectious Diseases Control Medications

Bill Gates spoke about his foundation's global focus on heath and agriculture/food.
Quality nutrition is undoubtedly vital for infectious diseases control, beyond delivering chemical drugs to emaciated patients who are unable to work and have no social safety net, and has been a grossly neglected area in public policy internationally over the years. Dr. Kiyoshi Kurokawa, Science Advisor to Japan's Prime Minister, has explained Japan's experience in TB control -- how quality nutrition made a big difference as a complement to medicines in Japan's own efforts as a country recovering from war and poverty in the 1950s.

New, Innovative Global Philanthropy

Mr. and Mrs. Saionji, promoters of the Goi Foundation, did a credible job of questioning Bill Gates and Bill, Sr., even touching on a few "raw" areas such as Bill Gates' departure from Harvard University to build Microsoft, never to return thereafter as a student, something that Bill Sr. conceded caused much consternation in his family at the time.

Queried on "new innovative philanthropy" Bill Gates expressed his view that expertise in companies and universities should be tapped by philanthropy for new medicines, vaccines and diagnostics development. Governments must lead, especially in financing, he said. In the past, there appeared to have been a misunderstanding of the original intention of Congress on the mixing of philanthropic (tax-exempt) resources and the so-called for-profit sector especially on ensuring hope for the poorest. But with Wall Street and Main Street now vociferously urging equity participation by the US government in the most for-profit industries (widely described as the $700 Billion bailout), there should be a welcome change in access to resources wherever they originate from, especially for a chronically resource-starved sector like public health. Rarely has simple analysis been done of total requirements and available resources for specific sub-sector needs. When such estimate is made, it can reveal an alarmingly low sum such as a few cents for each person, which is inadequate to purchase even one course of antibiotics. The ludicrousness of the old rigidities is highlighted especially in the case of Bill Gates. When Bill made his fortune from Microsoft, it was from the "for-profit" sector, even though the most non-profit clinic on a dirt-poor-road in the poorest country aspires to use Microsoft Excel to keep track of patients' information, inventory, and cash resources. Now that Bill has made his donations to his foundation, the very same resources become "non-profit." And, those resources finance the lifeblood of many universities, research institutions and non-governmental organizations - even those faculty and managers who are paid more than the President of the US. The point of the Goi Foundation event could well be to formally put an end to the unnecessary barriers and inefficiencies of the past through recognition of the path-breaking nature of new innovative philanthropy. And, it is a trend that should be encouraged in more countries and with more of those on the Forbes Global List.