The Bill & Melinda Gates Foundation has made global health one of its top priorities, awarding myriad multimillion-dollar grants to health institutions worldwide, including a number of U.S. academic medical centers.

To learn more about the foundation’s goals, funding objectives, and how medical schools and teaching hospitals can better address international health, the AAMC Reporter talked to Gordon Perkin, M.D., director of global health programs at the Gates Foundation.

Q: Why has the Gates Foundation chosen to focus on global health?

A: Disease burden significantly impacts people’s ability to adequately provide and care for their families. Disparities in economic achievement and quality of life will only continue to increase until people can be offered more assurance of a healthy future. The dichotomy between the health of people living in developing and developed countries — especially the health of children — has been a concern and focus of the foundation’s benefactors, Bill and Melinda Gates, from the very beginning of their philanthropic activity.

The Global Health Program at the foundation, guided by Bill and Melinda’s vision and hope, is committed to reducing the disparity in health status in the developing world. A goal of global health equity guides all funding decisions. Although the foundation cannot effectively address each and every opportunity for health improvement, a sharp focus on a limited number of issues enables the foundation to have a more substantial impact.

We are concentrating on the diseases that exact the greatest burden on people in developing countries. We are targeting diseases such as AIDS and malaria, which — along with measles, tuberculosis, diarrhea, and acute respiratory infections — make up the list of the "six big killers."

Specifically, the Global Health Program has selected three priority areas, the first of which is vaccine preventable disease. Existing vaccines must be made available to those in developing countries who need them most, and new vaccines must be developed to make more diseases preventable through immunization.

Our second focus area is reproductive and child health because women and children suffer disproportionately from poor health and its social effects. Our third focus area is conditions associated with poverty, which addresses the health burden carried by the poorest of the poor in developing countries and includes bacterial and parasitic infections and nutritional deficiencies.

Q: What are some of the key elements you look for in evaluating a proposal?

A: Proposals are considered for funding only if they offer a substantial contribution toward the goal of global health equity. We evaluate proposals for their ability to address our three focus areas by achieving the following strategic results:

• Strengthened leadership, through training and policy change, to enable the development of new interventions and tools and strategies for their delivery;

• Improved intervention tools, such as new vaccines, contraceptives, drugs for malaria and tuberculosis, and tools for changing health behaviors; and

• Increased access to intervention, to ensure cost-effective delivery and use of both old and new intervention technologies.

We also evaluate proposals for evidence of collaboration. The foundation firmly believes that the challenge posed by many diseases — especially when it comes to disease eradication — requires the commitment and support of a variety of partners.

Q: What are the largest threats to global health? What will happen in the U.S. if we fail to address global health?

A: One major threat to global health is lack of political commitment and will to address health inequities. Time and again it has been shown that the health status of a country and its people can be improved if those in a position to direct resources and attention recognize the urgency. A lack of resources to support health is also a large threat.

We are all members of the global community and therefore have a responsibility to invest and support the health of populations outside of our national borders. In the past there has been a failure to recognize the global nature of disease. Borders are artificial boundaries ineffective in walling off disease, and the ease of international travel means that those of us in the U.S. are at just as much risk of multidrug-resistant tuberculosis as are those in Eastern Europe. Millions of women and children are dying prematurely only because of a failure to commit adequate resources.

Last year, the U.S. government stepped up its commitments to global health. I am hopeful that the new administration will continue in this positive direction. Previously unattainable goals are very much within reach as the grants made by the foundation, along with the support of many others, have created new momentum, catalyzed the formation of new partnerships, and leveraged new resources for global health. Over the past year we have witnessed the beginning of a new era in which resources, research, tools, and personnel will find a new appreciation in the global health arena. The U.S. should take responsibility for its privileged position and act as a leader and advocate of improving global health.

Q: What more can academic medical centers do to improve global health, in partnership with the Gates Foundation or otherwise?

A: We have identified a number of academic "centers of excellence" in the U.S. and Europe that are working to implement major research initiatives. One example is the Malaria Center at the London School of Hygiene and Tropical Medicine. The foundation granted the center $40 million to support its program of research and training aimed at developing and evaluating tools for the treatment and control of malaria and to strengthen malaria research capacities in Africa. Another example is the Gates Micronutrient Initiative established at Johns Hopkins University with $20 million to provide the coordination, leadership, and research needed to attain a global goal of eliminating vitamin A and related micronutrient deficiencies.

We welcome the participation of these medical and research centers and their ability not only to research solutions to reduce morbidity and mortality from diseases like malaria and malnutrition but also to train the next generation of global health leaders.