2013 Lasker~Bloomberg Public Service Award

Advancing global health through enlightened philanthropy

Grand things come to mind when musing about the great 20th century philanthropists. Andrew Carnegie is famous for his libraries, educational institutions, and music hall. The Rockefellers are celebrated for revitalizing New York City, founding a University, building a Center, and donating land for the United Nations headquarters. Andrew Mellon is renowned for establishing the National Gallery of Art.

In the 21st century and beyond, Bill and Melinda Gates will be legendary for transforming the quality of life for millions of Earth's neediest citizens. The 2013 Lasker~Bloomberg Public Service Award honors these two individuals, who have catalyzed immense interest in and improvements to public health around the world. Through inspired leadership and generous philanthropy, the Gateses have spurred initiatives and research that tackle some of the planet's toughest health problems. Their work has popularized and intensified concern about previously neglected areas. Guided by the belief that all people deserve a chance to live a healthy, productive life, these visionaries have put global health on the map.

Responding to inequity's siren

In 1997, Bill and Melinda Gates saw a pie chart in a newspaper that displayed the major causes of deaths among children worldwide. A large slice — representing 500,000 youngsters — said "rotavirus."

The Gateses had never heard of rotavirus.

This infectious agent killed few people in the United States and other industrialized nations. Even in developing countries, it didn't have to kill. Remote clinics could easily save lives if their shelves held oral rehydration salts. This simple intervention replaces fluids lost from the massive diarrhea that the microbe triggers.

The realization that hundreds of thousands of children each year were succumbing to a treatable disease crystallized the Gateses' goal for their subsequent philanthropic activities. Clearly, rotavirus was not a priority for governments and others charged with safeguarding populations. Yet the couple believed — and believes — that all lives have equal value.

This new lens focused their future work. Mindful that huge sums alone cannot cure the world's ills, they often magnify their impact by teaming up with agencies that hold diverse expertise and resources. For example, in 1999, the Bill & Melinda Gates Foundation provided the seed money to launch the GAVI Alliance, an organization that aims to increase access to immunization in poor countries. The GAVI partnership includes UNICEF, the World Health Organization, and the World Bank, as well as pharmaceutical companies and governments of developing and developed nations. GAVI has supported the immunization of hundreds of million of children against some of the biggest killers, including rotavirus (for which a vaccine now exists) and a pneumonia-causing bacterium. In so doing, the Alliance is closing the 10- to 15-year gap between a new vaccine's arrival in high- and low-income countries. In its fight against lethal germs, the Gates Foundation cultivated another collaborative project that not only generated a low-cost way to protect inhabitants of sub-Saharan Africa from epidemic meningitis, but also sculpted a novel model for developing and delivering vaccines at a fraction of the usual cost.

One of Bill Gates's current priorities is the eradication of polio, a scourge that the industrialized world has relegated to a paralyzing disease of the past. The vaccine has almost wiped it from the globe, but in three countries — Afghanistan, Pakistan, and Nigeria — it still strikes today. Unlike smallpox, whose telltale rash identifies infectious cases, polio frequently simmers quietly. As a result, the classic strategy for eliminating a contagious disease — which relies on quick identification of new cases — isn't feasible. The Global Polio Eradication Initiative (GPEI) faces a colossal challenge as it tries to uproot the polio microbe's last strongholds. In its substantial support for GPEI, the Gates Foundation is stimulating technology that targets specific problems — for example, a satellite imagery system that allows the GPEI to create high-resolution maps that are crucial for locating as-yet unimmunized populations.

Bill Gates with community-level mobilizers for the polio eradication program at Guleria village, Khagaria District, Bihar, India in May 2010. Photo courtesy of Bill & Melinda Gates Foundation

The Gates Foundation attacks health-related disparities that reach beyond those associated with infectious disease. Melinda Gates has recently been championing the importance of easily available family-planning information and services. Putting contraceptives within reach reduces maternal and newborn deaths, upgrades nutritional status, increases school attendance, and boosts prosperity for families and nations. The Foundation also fosters sustainable improvements in agricultural productivity, expands access to crucial nutrients, and promotes novel schemes for safe disposal of human waste. In 2012, it announced the first-round results of its "Reinvent the Toilet Challenge;" the winning prototype was a solar-powered toilet that generates electricity.

Melinda Gates in the maternity waiting room at Dowa District Hospital in Dowa, Malawi in January 2010. Photo courtesy of Bill & Melinda Gates Foundation

The Gateses have repeatedly prompted fresh thinking among researchers. Their iconic "Grand Challenges in Public Health" program identifies the tightest bottlenecks to progress in global health and calls for innovative solutions. One study aimed to thwart mosquitoes' ability to smell human beings. If the insects can't locate potential hosts, they can't spread the malaria parasite that they carry. Having recognized that the boldest and most creative ideas do not always come from well-established labs, the Gateses designed one arm of the Grand Challenges enterprise to engage those who have not traditionally participated in health research.

Wielding influence

Between 1994 and 2006, the Gateses gave their Foundation more than $26 billion. In addition to donating their own resources, they have invited other billionaires to do the same. For example, in 2010, Bill and Melinda Gates partnered with Warren Buffett to announce "The Giving Pledge," which encourages the world's richest families to donate the majority of their wealth to philanthropic causes.

The couple contributes far more than money. In his efforts to stamp out polio, Bill Gates met with Nigerian religious leaders; they were in a good position, he realized, to counteract widespread rumors that the vaccine is part of a plot to sterilize Muslim girls. Last year, Melinda Gates played a key role in organizing the London Summit on Family Planning, which secured numerous commitments to advance this endeavor and re-energized the field.

When the Gateses visit far-flung corners of Earth, they illuminate the plight of people who normally subsist far from the developed world's sight. Their moral compass, persuasiveness, imagination, and generosity unite to propagate the idea of "impatient optimism." They believe they can instigate positive change, and they are doing it now.

by Evelyn Strauss 

Award presentation by Alfred Sommer

This year's Lasker~Bloomberg Public Service Award celebrates innovation, advocacy, perseverance, and dedication to improving the health of the world's most destitute and disease ravaged populations — particularly its women and children.

We are recognizing Bill and Melinda Gates —

Not because they are wealthy, or have funded a mega-philanthropy, though wealthy they are, and the Bill and Melinda Gates Foundation has net assets in excess of $36 billion.

Not because they live in "the big house on the hill" — though they do live in a big house on a hill.

Not because of their lineage, though their parents are supportive and loving, and Bill Sr. is the living embodiment of the term 'mensch' — those of you who are not from New York can find the definition of 'mensch' in today's program.

Bill and Melinda are, of course, the ultimate 'power couple': partners in life, in work, and in dramatically improving the lives of impoverished populations around the globe, not just by 'giving', but by giving in ways that are extraordinarily rigorous, thoughtful, innovative, and evidence-based.

Their formal philanthropy began in 1994, with the establishment of the William H. Gates Foundation. It was run, quite literally, out of the garage of Bill's father, William Gates Sr., a distinguished lawyer then entering, what would become, a very busy retirement (and who I'm delighted is with us today). From the start, it had a special interest in reproductive health and the well being of children. In 2000, Melinda and Bill brought together their philanthropic interests and initiatives into a single entity, the Bill and Melinda Gates Foundation, which they co-chair today.

Together, they have taken on issues of 'global health' with a vengeance, propelling the field to new and previously unimaginable prominence. While they didn't actually invent the term global health, they gave it urgency, visibility, and validity. The last time I searched the term global health, Google identified over 14 million independent citations. There is hardly an academic institution worth its salt today that does not have a school, institute, department, or center for global health. It's of enormous interest and immediacy to undergraduates everywhere; indeed, it is now the single most popular undergraduate major at the Johns Hopkins University.

As the term implies, global health recognizes that any disease can strike any population, anywhere in the world; no population is safe when other populations are at risk. Diseases do not respect national borders; the health of every population affects us all. This is as true of traditionally communicable diseases caused by microbes, as it is of culturally communicable diseases like obesity, diabetes, and lung cancer.

Since diseases and conditions of ill health common in wealthy countries already receive considerable funding and attention, Melinda and Bill have focused their attention on the over-burden of disease among neglected populations. This focus mirrors the interests of a previously formidable philanthropist: J.D. Rockefeller, who successfully tackled hook worm in poor populations of the southern United States, malaria and yellow fever in South America, and the training of health care professionals in China.

But Bill and Melinda have taken a more multi-faceted approach, in both form and focus. What drives them is perhaps best captured in two phrases they repeatedly invoke: "every life has equal value," and "every person deserves the chance to live a healthy, productive life."

When Albert Lasker asked Mary what she would most like him to do for her, she replied, "fund medical research." Being the astute advertising executive that he was, Albert replied that his wealth, significant as it was, paled in comparison to that of governments, and urged Mary to leverage his largesse by advocating for increased federal investments in biomedical research.

Melinda and Bill Gates have been great advocates, and funders, of medical research and health interventions, but they, too, recognize the need for leverage, as the resources of governments vastly exceed those of any private source.

A particularly effective means of leverage they've employed are public-private partnerships. A prime, early example is GAVI: originally an acronym for the "Global Alliance for Vaccines and Immunization." Founded in 1999, GAVI provides significant financial assistance to those governments that are in real need and that demonstrate they can effectively deliver vaccines to their populations. Equally importantly, GAVI negotiates with suppliers for reduced costs.

This can entail sophisticated marketing and persuasion, especially when it involves new vaccines, where the goal is to dramatically reduce the 15-year delay between the time new vaccines are widely deployed in wealthy countries and finally make their way to low-income countries.

Putting effective solutions to use in countries that traditionally couldn't afford them is but one arrow in Bill and Melinda's collective quiver. Another is stimulating the development of health solutions that don't presently exist, or that poor countries could never afford. These "Grand Challenges" run the gamut from inexpensive privies and smokeless stoves, to heat-stabilized vaccines that don't require refrigeration — a major impediment to effective immunization programs in poor, rural communities that lack ice or electricity. These grand health challenges extend to the development of, and I quote,"the next generation of condoms." And, that holy grail of tropical diseases, an effective vaccine against malaria. All submissions are rigorously reviewed, outcomes evaluated, and decisions for support evidence based.

Thus, they deconstruct a problem, identify the myriad contributory factors, stimulate the pursuit of practical tools, and advocate for their thoughtful deployment.

But Melinda and Bill don't always follow this carefully orchestrated script. When the opportunity and need is great, and urgent, they are known to jump right in, with all four feet.

As most of you know, polio is, hopefully, in its end-game. A little over two decades ago, 125 countries experienced nearly 400,000 cases of paralytic polio every year. Because of the global Polio Eradication Program, there were fewer than 223 cases last year, and the disease is now deeply endemic in only three countries: Nigeria, Pakistan, and Afghanistan. But ridding the world of those last few sources of infection is proving problematic, because of political and cultural impediments to mass immunization. "So near, and yet, so far."

Abandoning the fight at this point would let the virus run rampant, resulting in a resurgence of disease and suffering. An estimated $5.5 billion is needed to complete the task by 2018. Bill and Melinda have risen to the challenge — not only by making their own financial commitment, but by calling upon their philanthropic colleagues in arms — as in the case of Mayor Michael Bloomberg, who is with us today — and enrolling them in the cause.

A simple but impassioned tw0-minute phone call from Bill caused Mike Bloomberg to respond, "count me in," to the tune of $100 million.

Bill and Melinda Gates are responsible for a rich pipeline of initiatives that are creating new tools, and new alliances for implementing them, to the enormous benefit of global public health. Please join me in congratulating them on their richly deserved receipt of the 2013 Lasker~Bloomberg Public Service Award.

Bill Gates

Acceptance remarks, 2013 Lasker Awards Ceremony

Nature Medicine Interview

Thank you. It is a great honor to receive this award for public service.

I know we have a lot of eminent scientists here, people who have remarkable credentials. I want you to know that, between the two of us, Melinda and I have two degrees... both of them hers.

Melinda and I grew up in families that taught us the importance of giving back to society. These values were the foundation for own our thinking about philanthropy. When Melinda and I got married, we knew we would eventually give the bulk of our resources back to society. But we intended to wait until I was in my 60s.

Then we began to learn more about poverty and disease around the world. We learned that children were dying from diseases that had been cured in this country long ago. We traveled to Africa and saw farmers who were working hard, but could not get a good harvest.

Most of all, we saw that many life-saving discoveries were not shared very widely in the world. Those who had the most to gain from new advances were often the last to get them. It didn't fit our belief that science is for everyone — that the whole world should benefit from innovation.

And so we started our foundation, with the goal of reducing inequity by ensuring that innovation reaches the poor as well as the rich. As the world enters a new age of scientific opportunity, driven by new ways to collaborate, genomics, and other advances, the prospects for solving the oldest human problems have never been greater-so long as science is aimed at the problems of the poor.

This new age is only possible because the American people have been investing in basic scientific research for decades. And it won't come to pass unless we continue that support. It's one of the best investments we can make for saving and improving lives. As Mary Lasker said, "If you think research is expensive, try disease."

So we are grateful for this award, and for the efforts of scientists everywhere who have dedicated their lives to fighting disease, hunger, and poverty. It is your work that makes us deeply optimistic about the future.

Melinda Gates

Acceptance remarks, 2013 Lasker Awards Ceremony

Nature Medicine Interview

As Bill said, we were motivated by the idea of inequity — the fact that billions of poor people were suffering and millions were dying simply because they were poor. In the years since then, we've met many people in developing countries struggling to make a better life, and we've spent time with the innovators working alongside them. We've seen the impact that innovation has on the everyday lives of poor people.

Sometimes, a new technology can change the calculus of a poor person's life, turning scarcity into surplus. In Tanzania, I met a farmer, Joyce, who takes care of four children, one cow, two goats, some chickens, banana trees, and a couple acres of land. Last year, Joyce planted a new variety of maize that's able to tolerate pests and drought. The weather was awful, and her vegetables simply didn't grow. Her maize, however, grew taller than ever before, and she had enough to eat and some left over to sell. She used the cash to pay her children's school fees.

I've also seen the impact of non-technological innovations, like a brand new supply chain for contraceptives in Senegal. It used to be that women traveled many miles to the health clinic and found, half the time, that what they wanted wasn't in stock. Now, because of a new system modeled after the retail sector, stockouts are being eliminated in clinics across the country. Now, when women ask for the contraceptives they need to plan their families, they know they will get them.

These individual successes — farmers who can grow enough to feed their families; mothers who are able to decide when to have children — add up to large-scale progress around the world. Poverty cut in half since 1990. Child mortality almost cut in half since 1990. If you count all the children saved in the past 22 years, the total is 90 million, or more than the population of Germany.

This large-scale progress is part of the legacy of science, yet the general public and even the scientific community doesn't know as much about this story as they should.

The idea that drives our foundation — that all lives have equal value — can seem abstract. The impact your work has on billions of people struggling for a better future is as concrete as it gets. Science and scientific thinking have a powerful role to play in guaranteeing that their struggles lead to healthier, more productive lives.

So thank you for this award. It is an honor to be associated with courageous leaders like Mary Lasker and Mayor Mike Bloomberg.

And thank you all for the work you do to create a better future for us all.

Interview with Bill Gates and Melinda Gates

Video Credit: Susan Hadary