BOSTON – In remarks made at the opening of the inaugural ASM Microbe 2016, Bill Gates said that polio eradication goals are in sight, he stated that children in poor nations remain 50 times more likely to die than children in rich nations, and declared that solving the problem of nutrition is the greatest health concern facing the world today.
Since 2000, the Bill and Melinda Gates Foundation has worked to improve health care and reduce extreme poverty worldwide. In his role as co-chairman of the $36.8 billion organization, Gates spoke at the opening of the ASM Microbe meeting and sat for an onstage interview with Richard Besser, MD, the former interim director of the Centers for Disease Control and Prevention (CDC) and currently the chief health and medical editor for ABC News.
“If I had one wand to solve a medical problem, it would be to solve nutrition,” Gates said in response to a question from one of the estimated 7000 attendees. “The impact on these countries, particularly in Africa, of kids who don’t grow up and develop physically and mentally is really unbelievable. That’s a greater imposition on Africa and its ability to develop and support itself than any other thing.”
He also listed HIV, malaria, and tuberculosis as some of the world’s greatest health challenges. He said medical science can develop the tools to solve those issues within the next 20 years. “I’m hopeful the foundation will see the end of most of the problems we’ve made a priority,” he noted.
He said the foundation was close to achieving its goal of eradicating polio. The disease only exists in parts of India and Taliban-controlled areas of Pakistan at present. Gates said “the last 1% is the hardest” but hopes to achieve 100% worldwide vaccination in 2017.
Dr Besser noted that polio is a less pressing issue than diseases such as pneumonia or rotavirus, and asked if the foundation was pursuing a flawed strategy in spending so many resources on eradicating a relatively low-priority disease.
“In eradication, if you succeed, you get to zero. Zero is the magic number,” Gates said. “When you get to zero, you’re not only saving the costs of treating people and the lifelong effects of, in this case, paralysis, you’re also saving all the intervention costs. The world today spends over a billion dollars a year on polio prevention. If we get to zero . . . then the returns are unbelievable. Probably the highest return ever in global health was smallpox eradication, and in the last year, they spent $100 million to eradicate 30 cases. But every year since then, the lack disease, the lack of even having think about vaccination, has meant a mind-blowing return.”
Gates said the foundation is turning its focus toward malaria. The World Health Organization says that there were approximately 214 million cases of malaria and an estimated 438 000 deaths in 2015.
Gates cited malaria as one area where innovation could be key to addressing disease. Dr Besser specifically mentioned CRISPR, gene editing technology that, combined with gene drives, could create a gene that could destroy the mosquito species that spreads malaria. He asked Gates if medical science would eliminate the disease with existing tools like bed nets and vaccines, or if malaria eradication required new technology.
“We need new technology,” Gates said. “The 2 [innovations] that would be most impactful would be a new vaccine–the vaccine we have today has a modest duration so unless we can find some new dosing strategy, we’re going to need a next-generation vaccine. The second is this tool which would drop the anopheline vector, either modify it genetically so it can’t carry the parasite or drop the population. Particularly in the very high-prevalence areas, parts of Africa, it’s just so difficult to stop the rebound, that dropping the population is going to be part of eradication.”
1. Gates B. Opening Keynote Session. Presented at: ASM Microbe 2016. June 17-20, 2016. Boston.