Global health and the Bill and Melinda Gates Foundation

[Guest guest]

Global health and the Bill & Melinda Gates Foundation

Correspondence: The Lancet, Volume 373, Issue 9682, Pages 2195 - 2196, 27 June

2009. doi:10.1016/S0140-6736(09)61183-1

 

Original Text

Gopal Dabade a, Puliyel b

McCoy and colleagues1 note that half of all Gates Foundation funding goes

towards vaccination. US$1·5 billion provided by the Gates Foundation and some

donor countries go to fund the GAVI Alliance's “advance marketing

commitments†to purchase vaccines and provide them at subsidised costs in

developing countries.2

 

The advance marketing commitments for pneumococcal vaccine illustrate the

problem with this policy quite lucidly. Madhi and colleagues3 have calculated

that 1000 children have to be vaccinated to prevent approximately four cases of

pneumonia. Given that the vaccine costs $250 per child, $250 000 will be spent

to prevent these four cases of pneumonia. Treatment of four children with

pneumonia with oral cotrimoxazole, in accordance with the WHO protocol,4 will

cost $1 in India.

The hope that GAVI's funding of vaccines would push down their prices has been

belied. One review found that prices actually went up after GAVI funding,5

meaning that the higher costs are borne by poor nations when GAVI funding is

withdrawn. Entering into advance commitments to market this vaccine in

developing countries allows GAVI to divert Gates Foundation money to vaccine

manufacturers, without providing commensurate benefits to the children it is

supposed to help.

 

We agree with McCoy and colleagues that, given the substantial public subsidies

that the foundation receives in the form of tax exemptions, its programmes must

be subjected to public scrutiny.

We declare that we have no conflicts of interest.

References

1 McCoy D, Kembhavi G, Patel J, Luintel A. The Bill and Melinda Gates

Foundation's grant-making programme for global health. Lancet 2009; 373:

1645-1653. Summary | Full Text | PDF(185KB) | CrossRef | PubMed

 

2 GAVI Alliance. The GAVI Alliance welcomes World Bank decision on Advance

Market Commitment initiative.

http://www.gavialliance.org/media_centre/statements/2009_04_06__World_Bank_suppo\

rt_for_AMC.php. (accessed May 10, 2009).

 

3 Madhi SA, Levine OS, Cherian T. Pneumococcal conjugate vaccine is efficacious

and effective in reducing the burden of pneumonia. Bull World Health Organ 2008;

86: A-B. PubMed

 

4 WHO, UNICEF. Handbook: integrated management of childhood illness. Geneva:

WHO, 2005. http://whqlibdoc.who.int/publications/2005/9241546441.pdf. (accessed

May 10, 2009).

 

5 Kamara L, Milstien JB, Patyna M, Lydon P, Levin A, Brenzel L. Strategies for

financial sustainability of immunization programs: a review of the strategies

from 50 national immunization program financial sustainability plans.. Vaccine

2008; 26: 6717-6726. CrossRef | PubMed

 

a 57 Tejaswinagar, Dharwad, India

b St s Hospital, Delhi 110054, India