In 2003, the Gates Foundation launched a project called Grand Challenges in Global Health. What I like about it is the way the Gates Foundation approached solving this problem. They didn't say, “We, the rich Western foundation, will now deliver you the solution,” and then issue instructions and write some checks. They said, “Let's collaborate horizontally on defining both the problem and the solutions-let's create value that way-and then [the foundation] will invest our money in the solutions we both define.” So the Gates Foundation placed ads on the Web and in more conventional channels across both the developed and the developing worlds, asking scientists to respond to one big question: What are the biggest problems that, if science attended to them and solved them, could most dramatically change the fate of the several billion people trapped in the vicious cycle of infant mortality, low life expectancy, and disease? The foundation got about eight thousand pages of ideas from hundreds of scientists from around the world, including Nobel laureates. It then culled through them and distilled them down to a list of fourteen Grand Challenges-challenges where a technological innovation could remove a critical barrier to the solving of an important health problem in the developing world. In the fall of 2003, it announced these fourteen Grand Challenges worldwide. They include the following: How to create effective single-dose vaccines that can be used soon after birth, how to prepare vaccines that do not require refrigeration, how to develop needle-free delivery systems for vaccines, how to better understand which immunological responses provide protective immunity, how to better control insects that transmit agents of disease, how to develop a genetic or chemical strategy to incapacitate a disease-transmitting insect population, how to create a full range of optimal bioavailable nutrients in a single staple plant species, and how to create immunological methods that can cure chronic infections. Within a year, the foundation received sixteen hundred proposals for ways to meet these challenges from scientists in seventy-five countries, and the foundation is now in the process of funding the best proposals with $250 million in cash.
“We're trying to accomplish two things with this program,” explained Rick Klausner, a former head of the National Cancer Institute who now runs the global health programs for the Gates Foundation. “The first is [to make] a moral appeal to the scientific imagination, [pointing out] that there are great problems to be solved that we, the scientific community, have ignored, even though we pride ourselves in how international we are. We have not taken our responsibilities as global problem solvers as seriously as our self-identity as an international community. We wanted the Grand Challenges to say these are the most exciting, sexy, scientific things that anyone in the world could work on right now... The idea was to fire the imagination. The second thing is to actually direct some of the foundation's resources to see if we could do it.”
Given the phenomenal advances in technology in the last twenty years, it is easy to assume that we already have all the tools to address some of these challenges and that the only thing lacking is money. I wish that were the case. But it is not. In the instance of malaria, for example, it isn't just the drugs that are missing. As anyone who has visited Africa or rural India knows, the health-care systems in these areas are often broken or functioning at a very low level. So the Gates Foundation is trying to stimulate the development of drugs and delivery systems that presume a broken health-care system and therefore can be safely self-administered by ordinary people in the field. That may be the grandest challenge of all: to use the tools of the flat world to design tools that work in an unflat world. “The most important health-care system in the world is a mother,” said Klausner. “How do you get things in her hands that she understands and can afford and can use?”