STOP FUNDING MAJOR HEALTH ISSUES AT YOUR PERIL, WARNS BILL GATES
Cases of disease like HIV and malaria have the potential to regress back to above peak levels in just over a decade if governments and other major funders become complacent in tackling the world’s biggest health issues, according to a new report by the Bill & Melinda Gates Foundation.
Released today, the first Goalkeepers report tracks 18 data points from the UN Sustainable Development Goals that show the progress of world health issues such as malaria, child and maternal mortality, HIV and AIDS, and stunting. It also shows current projections to 2030 alongside what is likely to happen if even further progress and innovation is made, or on the flip side, if governments and organisations stopped or cut down on supporting these causes.
One example shows how the rate of new HIV cases per 1,000 people was drastically brought down in the early 2000s when the Global Fund, PEPFAR, and domestic spending in endemic countries focused in on the cause, but as the sense of crisis dissipated this decline slowed. The projections show there’s a possibility to speed up the decline once again to reach 0.10 deaths per 1,000 people, but if there are cutbacks they could shoot back up to near peak levels of 0.50.
“The world really did step up with an incredible level of generosity which has meant that AIDS related deaths have fallen by almost half since the peak in 2005,” Bill Gates says. “We see countries that are considering possible funding cuts. And so we’re talking about, hey that would be a big setback, particularly because we have this huge increase in the number of people in the age group that’s at risk, which is 16-24. So in the worst case, we actually go back and have a lot more AIDS deaths than we had even back at the peak.”
The setbacks he’s talking about include those to the Global Health Fund being debated in the United States congress, which would see US aid for international family planning eliminated, HIV/AIDS programs in the world’s poorest currents cut by 17 per cent and an 11 per cent cut to efforts fighting malaria.
While Gates thinks it’s unlikely these cuts will be approved, it does mean these issues still hang in the balance. In the case of HIV, the report shows what would happen with a 10 per cent cut to programs working to combat the disease – an additional five million deaths, overwhelmingly concentrated in Africa. “It’s very difficult when you underfund health things because there’s often a temptation to try and stretch. And what you end up with is that you don’t have enough medicine or enough capacity to do continual treatment,” Gates says. “In the case of HIV, if you are only taking your pills two thirds of the time instead of 100 per cent of the time, it’s almost as though you’re getting no medicine at all. You’re greatly at risk of not only the diseases that come along because your immune system is so weak but also a huge risk of death. So depending on how people deal with cuts, it could be even worse than we modelled. Unless we maintain funding and we get smarter about those efficiencies, we’re not able to continue the reduction which we’ve been able to achieve over the last 15 years,” he says.
The projections for malaria are just as stark. In the decades before the early 2000s, malaria deaths surged. But, new tools like insecticide treated bed nets and improved anti-malaria drugs that came about around the time of the establishment of the Global Fund became a catalyst for its decline; deaths decreased by 60 per cent between 2000 and 2015. The current trend, as shown in the report, predicts new cases of malaria per 1,000 people would drop from 29 to 28 if there’s no new innovation, but with new tools and strategies, that could be reduced to five. On the other hand, with a regression due to factors such as funding cutbacks that number could rise to 39, above the peak of around 38 in 2005.
In releasing the report, the foundation wants to highlight the progress that’s being made, which has been thanks to continued funding and innovation in areas such as new medicine. The foundation plans to release the report each year until 2030. “Part of this Goalkeepers goal is to have a yearly check point where we will say okay, this did not do as well this year as we expected. You know, here’s what those setbacks were. But also have a chance to say look, here’s what the report card looks like, and in fact there was continued progress in most of these different areas,” Gates says.
Outside of the US, Gates says that it’s encouraging that even with the change of Prime Minister, the UK has re-committed to the 0.7 per cent UN aid spending target. Countries like Sweden, Norway, the UAE go above this, while France is looking to increase on their 0.55 by 2020. “I’d feel very good about the UK on a bipartisan basis has been very generous,” Gates says.
But, he hopes scientific funding isn’t slowed down as a result of Brexit. “We’re hoping that the great scientific cooperation between the UK and the rest of Europe, where the research budget at the European community level, the UK was a net beneficiary of that,” he says. “We have a lot of grantees in the UK, because there’s great science that goes on there. We hope that that’s not slowed down in any way by the difficulty of people moving around or how the various science funding things work. But there’s a lot that’s not known about how that will be managed going forward.”
Since its inception in 2000 through to the end of 2016, the Gates’ foundation has made $41 billion in total grant payments. Its three trustees – Warren Buffet, Bill and Melinda Gates are, in that order, the top three most generous philanthropists in America. Just this year, Bill Gates made his largest donation in 17 years – giving 64 million Microsoft shares, valued at $4.6 billion, to what is still an unnamed recipient but mostly likely the foundation.
The foundation’s goal is ambitious: to reduce world poverty to zero. And while this isn’t in the report’s projections for the next 13 years, with the right funding, innovation, and systemic changes Gates is optimistic that even the best projections could be surpassed. He says new tools – like vaccines – and other factors such as a better understanding of immunology will help them get there. “We didn’t assume in our forecasts the very best case, which is that we get those new tools,” Gates says. “We could actually do better than the best case we showed, if we got one of those breakthrough tools very early on.”