Copyright 2000 Gannett Company, Inc.
USA TODAY
March 24, 2000, Friday, FINAL EDITION
SECTION: NEWS; Pg. 1A
LENGTH: 1773 words
HEADLINE:
Diseases tighten grip worldwide Health grants fight rising tide around the globe
BYLINE: Steve Sternberg; Anita Manning
BODY:
Microsoft's Bill Gates, whose family
foundation has pledged $ 1
billion to supply vaccines to
the poor worldwide, will announce
a new series of health grants today worth
$ 133 million, including
$ 25 million to promote the development of new
tuberculosis drugs.
The donation coincides with the release today of
a dramatic World
Health Organization report that finds that the most
dangerous
strains of TB, those that are resistant to conventional drug
treatment,
are gaining a foothold even in wealthy countries.
"TB
is a good example of how, if we don't pay attention to these
diseases, we'll
go backward," Gates says.
Gates' gift, along with the latest series
of grants announced
by foundation president Patty Stonesifer in India,
boosts hopes
among experts that it might be possible to make substantial
progress
against killer diseases worldwide. They say now is the time to
strike.
After decades of limping along, hobbled by political
indifference
and a lack of funding, global health officials are rushing to
save whole populations.
An unprecedented confluence of factors,
from an energized World
Health Organization to the generosity of the Bill
and Melinda
Gates Foundation, has created a rare "window of opportunity to
defeat tuberculosis, malaria and drug-resistant microbes with
the tools
we have at hand," says Nils Daulaire, president of
the Global Health
Council, an advocacy group. "In 10 to 15 years,
it may be too late."
Public health authorities offer many explanations for the relative
neglect of global health problems in the past 20 years, including
economic insecurity at home to the feeling that the world's health
problems were too vast even for history's richest nation to tackle.
Pessimism gripped even the idealists dispensing medicine and
wielding
syringes. "The sense cultivated in the '80s and '90s was often
one of hopelessness," Daulaire says.
Gates' contributions and
active concern over the plight of children
and the poorest of the poor have
proved infectious. His influence
is hard to overstate, says Richard Feachem,
director of the Institute
for Global Health at the University of California,
San Francisco.
"The immunization programs in many
countries were faltering.
The industry was not investing in new
vaccines, and the whole
international picture was
deteriorating," Feachem says. "In
18 months, that has been transformed into
dynamism, major new
flows of money, new energy, new programs, new commitment
and a
sense we're on a new path of optimism. It's been a spectacular
change."
Gates says he has always been interested in science and
medicine,
but he has recently recognized that medical advances have bypassed
millions of people worldwide. "Three million children die each
year of
vaccine preventable diseases," Gates says. "When I first
started reading about this stuff, I said, 'Three million? It blows
your
mind.'
"Why isn't this getting more attention?"
The key
reason is money, some experts say. "Global public health
has become
conventional, in the sense that its logic has become
economic: How much can
you do in a time of limited resources?"
says Paul Farmer, an AIDS and TB
expert at the Harvard Medical
School. "People neglect to add that resources
happen to be less
limited now than ever before in human history.
"The immensity of Gates' wealth serves as a reminder that the
pie isn't as small as we've made it out to be -- and that has
led to a
much-needed infusion of imagination in our ranks."
"This may be the
best thing I've seen in public health," says
William Foege, Gates' adviser
and a veteran of the campaign that
led to the eradication of smallpox in
1977. "The excitement levels
I've seen in people working in public health
remind me of the
heady days when we were working on smallpox eradication.
Suddenly,
no one wants to be left behind."
Answering the
challenge
The bandwagon is filling up:
* The Clinton
administration has earmarked more than $ 100
million for the global fight
against AIDS. Clinton also has proposed
offering drug firms$ 1 billion in
tax incentives over 10 years
to develop vaccines for
malaria, TB and AIDS.
* Several drug firms, responding to Clinton's
challenge,
offered millions of doses of vaccines for
hepatitis B and haemophilus
influenza B. SmithKline Beecham agreed to expand
its malaria vaccine
program and begin a trial in Gambia
this fall.
* The Senate Foreign Relations Committee approved a
public
health bill Thursday sponsored by Sens. John Kerry, D-Mass., and
Bill Frist, R-Tenn. The bill, partly drafted by Patty Murray,
D-Wash.,
and Jesse Helms, R-N.C., would provide $ 300 million for
AIDS prevention in
Africa and $ 50 million for the newly organized
Global
Alliance for Vaccines and Immunization (GAVI). GAVI
was
jump-started by a $ 750 million fund established by Gates.
The bill also would enable the United States to take a lead role
in setting up a multinational vaccine-purchase fund to
create
a market for new vaccines once they are developed.
* In the House, Sherrod Brown, D-Ohio, and Connie Morella,
R-Md., will introduce a bill today that would provide $ 100 million
this
year for TB treatment and prevention.
* Rep. Joseph Crowley, D-N.Y.,
who represents the district
in Queens where the West Nile virus emerged, has
introduced the
Global Health Act of 2000. It would allot $ 1 billion for
infectious
disease, AIDS, child health, maternal health and family planning.
* The World Health Organization, newly energized by Director
general Gro Harlem Brundtland, launched a Roll Back Malaria campaign
in
1998 that seeks to combat a disease that afflicts 500 million
people a year
and kills 3,000 a day. Gates' funding will play
a role.
* In
June, Queen Noor of Jordan will serve as chair of
the Global Health
Council's annual meeting in Arlington, Va. The
theme is "A century of health
for the children of 2000." In
Jordan, Noor heads a foundation to address the
health needs of
women and children.
* Foreign policy experts
have begun to view global illness
as a national security concern. U.N.
Ambassador Richard Holbrooke
has stated that AIDS could destabilize many
African nations. The
CIA's advisory National Intelligence Council asserts in
a newly
declassified report that infectious diseases "will complicate
U.S. and global security over the next 20 years."
All this
attention couldn't come at a better time, Daulaire says.
America may be
coasting into the 21st century on the updraft of
a hot economy and dazzling
scientific breakthroughs, but for people
in developing countries, it's still
the 19th century. And for
them, time is moving backward.
"What's
sobering is that the trends are moving in the wrong direction,"
Daulaire
says. He cites declines in life expectancy and rising
death rates because of
AIDS, TB and malaria. Six million die of
malaria, TB and AIDS each year, he
says.
The goal of the new dynamism in public health is to make
inroads
into the challenging problems of world health before they grow
even worse, Daulaire says.
Domino effect of diseases
Consider: If HIV had begun spreading before smallpox was eradicated
in 1977, smallpox would still be spreading. The reason: Smallpox
vaccine would have been too dangerous to use in countries
with
HIV because it can actually cause a fatal smallpox-like disease
in
people whose resistance is low.
The picture isn't entirely bleak,
however. This year, 74% of the
world's children will receive the standard
vaccines recommended
by WHO. The vaccines
will save an estimated 3 million lives and
prevent disabilities in 750,000
children, though this figure has
remained static since the 1980s.
Narrowing the focus may help get a handle on these seemingly
overwhelming
problems, Daulaire says. "Eighty percent of the health
differential
between poor and rich nations is really due to eight
conditions,"
he says. "Instead of dealing with 1,000 things, we need to deal
with only eight to address this health gap."
Six of the eight
are infectious diseases: TB, malaria, childhood
pneumonia, diarrhea, measles
and HIV/AIDS. The other two are reproductive
health issues: millions of
unintended pregnancies and the risks
posed by pregnancy and childbirth in
poor nations.
Solving most of these problems would cost $ 13 to $ 15
a year per
person worldwide, Daulaire says. "It's one of the great bargains
of the century," he says, but far more than the $ 3 to $ 5 a year
now
being spent on health care for people in poor countries.
Many health
experts believe these problems can be solved. "In
the past, we might have
been able to hide behind an attitude of
'It's too difficult; the scientists
can't solve it, we can't crack
that problem,' " Feachem says. "But it's very
hard to take that
view now."
An investment in global health
Advances in biotechnology and medical science make it possible
to tackle problems that might have seemed insurmountable just
a decade
ago, he says, and new incentives offered to vaccine
manufacturers
by the U.S. government are fueling research into
vaccines against
malaria, TB and AIDS.
The
United States is encouraging an investment in global health
for good reason,
Daulaire says. Though developed countries are
benefiting from a
"revolutionary shift" in health care because
of technological advances,
poorer countries are about a century
behind.
"As we are making
this rapid leap into the 21st century, we have
this huge body of human
beings -- 2 billion people living in the
poorest countries of the world --
whose health conditions are
more akin to the 19th century," he says.
Though the moral questions of ignoring the health needs of the
poor can be debated, Daulaire and others believe there's a more
urgent
force at work: "There is no longer a physical divide that
can leave us safe
on one side of the pool," he says. "If we
were to abandon those 2 billion
people, it would lead to a world
of chaos, a breakdown of social and
political order and ultimately
war."
What affects Africa and
India affects Western Europe and the United
States, he says, pointing to the
emergence of mutant tuberculosis,
malaria and other organisms that are
impervious to one or more
drugs that used to be effective.
"If
we leave those (poor nations) as a petri dish for the development
of these
modified organisms, we're all at risk," he says. If
we get to a point where
the bugs are resistant to all antibiotics,
"it will pull all of us back to
the 20th century."
GRAPHIC: GRAPHIC, B/W, Suzy
Parker, USA TODAY, Source: World Health Organization (Bar graph); PHOTO, Color,
Samar Jodha, Gates Foundation; PHOTO, B/W, Gates Foundation; Gift of health:
Women and their children line up for immunization shots
Wednesday in Kanchanpuri, India. The power of vaccines: A boy
waits for immunization shots Wednesday at a clinic in
Kanchanpuri, India.
LOAD-DATE: March 24, 2000
