Saying money is no object, he urges vaccine experts to think very, very big

Thursday, March 22, 2001

By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER

The developing world's best hope for saving the lives of millions of children took shape at a dinner of squash soup and lamb chops overlooking Lake Washington.

The diners had gathered the evening of Nov. 5, 1998, at the home of Microsoft co-founder Bill Gates. The dozen-and-a-half guests were international experts in vaccines, including public health luminaries from Australia, India, Tanzania, France and South Korea.

Two months before, the Gates Foundation had donated a stunning $100 million -- the foundation's largest ever health-related gift -- to create the Children's Vaccine Program primarily for respiratory and diarrheal diseases, two of the leading killers of children worldwide.

The experts in their suits and ties came to the table with Gates, wearing rumpled corduroys and a five o'clock shadow, assuming they had been invited to suggest the best ways to spend the money and to pitch their favorite programs.

They were wrong.

"They thought they had come to the dinner just to say thanks," Gates said. "But I was interested in what more could we do in the area."

It was a difficult concept for doctors whose careers largely had been defined by making do with scarce resources. They kept proposing disease-specific initiatives that Gates challenged as too limited in scope.

"I think we were thinking to ourselves, 'Well, he just doesn't understand. It's more complicated than he realizes,'" said Dr. Mark Kane, head of Gates' Children's Vaccine Program.

But Gates, who earlier had offered a tour of his domed circular library housing original manuscripts from Sir Isaac Newton and Louis Pasteur, continued to press.

"He told them to think big," said his father, Bill Gates Sr. "'Think BIG!' he kept saying."

Dr. Richard Mahoney of the International Vaccine Institute in Seoul, South Korea, finally asked the younger Gates if he intended to donate more for childhood vaccines.

The answer stunned everyone. Gates told his guests the $100 million was just an "initial investment" to which he intended to "add significant additional funds," Mahoney recalled.

It was clear Gates was offering a challenge: Lack of money no longer was going to be an excuse for children dying of preventable diseases.

"It just blew our minds," Kane said. "Most of us had spent our whole lives trying to make things happen with very few resources. The whole thing was absolutely electric. We all left the Gates home that night tingling."

A year later, in November 1999, Gates kept his word by announcing he would give $750 million to set up a Global Fund for Children's Vaccines -- an amount that has since grown to more than $1 billion as other donors jumped on board.

In January 2000, with many of his dinner guests at his side, he and other world health leaders announced the creation of a new, international collaborative effort called the Global Alliance for Vaccines and Immunization.

GAVI brought the World Health Organization, UNICEF, the World Bank and other key players under one tent for a coordinated vaccine development and delivery program. And it expanded that tent to include private pharmaceutical companies.

The creation of GAVI was not a hostile takeover of existing world health programs. Coordination and collaboration among all the players will be a key to its success.

But Gates' monetary muscle gave his foundation the clout to quietly insist on a new, incentive-driven set of rules.

To qualify for grants from GAVI, countries have to show, upfront, that they have invested in their own health care system.

And to keep the money flowing, vaccination rates have to improve or the aid goes elsewhere.

"Over the last few years, we've seen immunization rates stagnate and decline," Kane said.

"The reasons for this are complex and not always just a matter of resources. We needed to build a new architecture for the delivery of vaccines in the world."

The new global vaccine alliance remains mostly an untested idea with a task that has proven highly elusive in the past. But if it works, the payoff is potentially enormous.

"It's staggering to think of the lives that will be saved by this," said Dr. Richard Feachem, former chief of health policy for the World Bank and now director of a global health program at the University of California-San Francisco.

"This will be the biggest international health effort the world has ever seen."