A Call for Crazy Ideas

This month, Melinda and I joined hundreds of scientists for a meeting in Seattle. The topic we discussed is something we’re all passionate about: how to harness the advances of science in ways that benefit the poor.

The occasion is the 10th anniversary of our foundation’s Grand Challenges in GlobalHealth program, which we launched with the goal of identifying the biggest problems in health and giving grants to researchers who might solve them. To be honest, we’re not as far along as I hoped a decade ago; the process of developing and perfecting new tools—going from proof-of-concept through clinical trials, regulatory approval, manufacturing, and distribution—is even slower and harder than I thought. But we've learned a lot, and we've made some promising progress.

Grand Challenges has its roots in what I call catalytic philanthropy. It’s designed to fix market failures—places where capitalism fails to meet the needs of the poor. Why is there so much more research done on baldness than on malaria? Because rich people go bald, and they don’t die of malaria. Grand Challenges is like a venture capital fund in the sense that it backs a lot of ideas, knowing that many will fail, but a few could have a big impact. I’ll be delighted if five years from now, 20 percent of the initial projects are being deployed and saving lives.

The Grand Challenges run the gamut from making staple crops more nutritious to creating vaccines that won’t spoil when they get warm. The Wolbachia project that Iwrote about in April—trying to stop dengue fever by infecting mosquitoes with a particular bacterium—also came out of a Grand Challenge.

We've made short videos about two other examples: an effort to identify HIV at the moment of infection…

There’s another Grand Challenge that illustrates both what’s exciting and what’s hard about catalytic philanthropy: making the diagnosis of disease faster and more accurate.
Health clinics in many poor countries don’t have the same kind of sophisticated tools for diagnosing disease that many of us take for granted. If they do have access, it’s often a laborious process that involves mailing samples to a faraway lab and waiting for the results. The result: missed or delayed diagnoses and incorrect treatment plans. The evidence suggests that this problem has tragic consequences; in Tanzania and Nigeria, for example, studies found that misdiagnosis causes 25 percent of preventable deaths in children.

Imagine what would happen if American children were dying at that rate. The health-care market would spring into action, as dozens of companies went to work on new diagnostic tools. Yet because this was a problem of the poor world, companies were ignoring it. The market was failing.

So we challenged researchers: Can you create a new device that quickly diagnoses HIV, TB, malaria, and other diseases… accepts different samples, like blood, saliva, and sputum… is affordable… and reliable… and will work in a small clinic that has only a few hours of electricity a day?

Today, five public-private partnerships have taken up the challenge. The journey from idea to reality is a long one. For one thing, the partners had to figure out whether making such a machine was even technically feasible. It is—several of them have working prototypes. This is one of them, the Stratos, which our foundation is developing with a Seattle-based medical engineering company:

The groups also had to find commercial partners—companies that design and build diagnostic devices—that would help bear the cost of developing and delivering a new tool.

Today we know that it’s technically possible to build a device and that there are partners ready to help. But there are other questions that we can’t answer yet. For example, we don’t fully understand the magnitude of the problem and haven’t quantified the impact of solving it. How much does it help to diagnose a disease if the patient can’t be treated right away? Can a new diagnostic tool be made cheaply enough for poor countries? Will it provide enough of a health benefit to justify R&D costs that could run in the hundreds of millions of dollars? We’re studying these questions now and expect to have an answer by the middle of next year.

This is a fact of life in catalytic philanthropy. Experts identify a problem and start the long, difficult journey of solving it. Even after you get something built—and it looks pretty promising—there may not be a cost-effective way to get it to the people who really need it.

If this idea succeeds, that will be fantastic. If it doesn't, we’ll all be disappointed. But, as Thomas Edison famously said, “I have not failed 10,000 times. I've successfully found 10,000 ways that will not work.” That spirit guides our foundation’s work in Grand Challenges and all our grantmaking. If one avenue turns out to be a dead end, there are always many more waiting to be explored.