WASHINGTON, DC—Describing the current state of global health as a "moral tragedy," Tadataka Yamada, MD, urged rheumatologists to pay more attention to the current global health crisis and to aid in the efforts to bring life-saving tools to the developing world. Dr. Yamada, executive director of the Bill and Melinda Gates Foundation's Global Health Program, which potentially controls more public health funding than the World Health Organization, delivered the keynote address at the opening ceremony of the 70th Annual Meeting of the American College of Rheumatology in Washington, DC.1
"There is a sense of urgency. People are dying and they really can't wait. The time is now and that's why I am here." —Tadataka Yamada, MD, executive director of the Bill and Melinda Gates Foundation's Global Health Program in Seattle, WA.
Billions and billions of dollars—and more needed
"Disparity and inequity should not exist in health care, and [the Gates Foundation] has contributed the greater part of a huge fortune to research and creating solutions," Dr. Yamada said. The Gates Foundation has funded $1 billion in new grants to improve global health, and this figure will double in the next few years. The ultimate goal is to reach as much as $70 billion, according to Dr. Yamada.
According to Dr. Yamada, the life expectancy in sub-Saharan Africa is 46 years old, compared with 79 in developed countries. In developing countries, 11 million babies die each year and four million die during their first year of life; a vast majority of these deaths are due to preventable diseases including HIV, tuberculosis, and malaria. "Industry has a relatively poor record here, and the medical establishment is not without some responsibility," he said. Of all the new drugs developed and marketed in developed countries, only 30 medications could be sent to or applied to diseases in the developing world.
"We need sustainable solutions, [and] we have to create infrastructure," Dr. Yamada said. To eradicate this disparity and inequity, "we must involve the very best minds available throughout the world, and they must be proactive, not reactive," he said. "We need to think big and take risks and enforce cross-discipline thinking and insist on sharing information."
Need to recognize failures early, redirect resources
Programs need to be designed with patients in mind. Importantly, "we need to recognize failure when it occurs and be willing to cut bait quickly, [and] when we see success, we must be prepared to put everything into it," Dr. Yamada said. Having the courage to fail is important, he added. "That sounds strange, but if we are not failing and failing relatively frequently, we are not pushing the envelope and taking the risks we need to take," he said.
For example, creating a vaccine against HIV may seem like hubris, "but if we don't take that risk, it will never happen."
Not a lost cause
"Simple tools work," he stressed, citing the smallpox eradication, the near eradication of polio, and strides in eradicating river blindness.
The Global Alliance for Vaccines and Immunization (GAVI), a public-private partnership focused on increasing access to vaccines among children in the poorest countries, has greatly increased the number of children vaccinated against hepatitis B, Haemophilus influenzae type b, yellow fever, diphtheria toxoid, tetanus toxoid, and pertussis in developing countries. The Bill and Melinda Gates' Foundation helps fund GAVI.
"There is a rich pipeline of new medicine evolving," Dr. Yamada said. "There are about 20 drugs for malaria in the clinic or soon to be in the clinic and nine vaccines in development."
What's more, many medical students are considering global health.
"Something must be done for patients all over the world who are suffering this way, and the challenges are many, but they can be met," Dr. Yamada said.
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Reference
1. Yamada T. Opening lecture. Presented at: American College of Rheumatology Meeting; November 11, 2006; Washington, DC.