March 24, 2000, Friday, FINAL EDITION
SECTION: NEWS; Pg. 1A
HEADLINE: Diseases tighten grip worldwide Health grants fight rising tide around the globe BYLINE: Steve Sternberg; Anita Manning

Microsoft's Bill Gates, whose family foundation has pledged $ 1 billion to supply vaccines to the poor worldwide, will announce a new series of health grants today worth $ 133 million, including $ 25 million to promote the development of new tuberculosis drugs.

The donation coincides with the release today of a dramatic World Health Organization report that finds that the most dangerous strains of TB, those that are resistant to conventional drug treatment, are gaining a foothold even in wealthy countries.

"TB is a good example of how, if we don't pay attention to these diseases, we'll go backward," Gates says.

Gates' gift, along with the latest series of grants announced by foundation president Patty Stonesifer in India, boosts hopes among experts that it might be possible to make substantial progress against killer diseases worldwide. They say now is the time to strike.

After decades of limping along, hobbled by political indifference and a lack of funding, global health officials are rushing to save whole populations.

An unprecedented confluence of factors, from an energized World Health Organization to the generosity of the Bill and Melinda Gates Foundation, has created a rare "window of opportunity to defeat tuberculosis, malaria and drug-resistant microbes with the tools we have at hand," says Nils Daulaire, president of the Global Health Council, an advocacy group. "In 10 to 15 years, it may be too late."

Public health authorities offer many explanations for the relative neglect of global health problems in the past 20 years, including economic insecurity at home to the feeling that the world's health problems were too vast even for history's richest nation to tackle.

Pessimism gripped even the idealists dispensing medicine and wielding syringes. "The sense cultivated in the '80s and '90s was often one of hopelessness," Daulaire says.

Gates' contributions and active concern over the plight of children and the poorest of the poor have proved infectious. His influence is hard to overstate, says Richard Feachem, director of the Institute for Global Health at the University of California, San Francisco.

"The immunization programs in many countries were faltering. The industry was not investing in new vaccines, and the whole international picture was deteriorating," Feachem says. "In 18 months, that has been transformed into dynamism, major new flows of money, new energy, new programs, new commitment and a sense we're on a new path of optimism. It's been a spectacular change."

Gates says he has always been interested in science and medicine, but he has recently recognized that medical advances have bypassed millions of people worldwide. "Three million children die each year of vaccine preventable diseases," Gates says. "When I first started reading about this stuff, I said, 'Three million? It blows your mind.'

"Why isn't this getting more attention?"

The key reason is money, some experts say. "Global public health has become conventional, in the sense that its logic has become economic: How much can you do in a time of limited resources?" says Paul Farmer, an AIDS and TB expert at the Harvard Medical School. "People neglect to add that resources happen to be less limited now than ever before in human history.

"The immensity of Gates' wealth serves as a reminder that the pie isn't as small as we've made it out to be -- and that has led to a much-needed infusion of imagination in our ranks."

"This may be the best thing I've seen in public health," says William Foege, Gates' adviser and a veteran of the campaign that led to the eradication of smallpox in 1977. "The excitement levels I've seen in people working in public health remind me of the heady days when we were working on smallpox eradication. Suddenly, no one wants to be left behind."

Answering the challenge

The bandwagon is filling up:

* The Clinton administration has earmarked more than $ 100 million for the global fight against AIDS. Clinton also has proposed offering drug firms$ 1 billion in tax incentives over 10 years to develop vaccines for malaria, TB and AIDS.

* Several drug firms, responding to Clinton's challenge, offered millions of doses of vaccines for hepatitis B and haemophilus influenza B. SmithKline Beecham agreed to expand its malaria vaccine program and begin a trial in Gambia this fall.

* The Senate Foreign Relations Committee approved a public health bill Thursday sponsored by Sens. John Kerry, D-Mass., and Bill Frist, R-Tenn. The bill, partly drafted by Patty Murray, D-Wash., and Jesse Helms, R-N.C., would provide $ 300 million for AIDS prevention in Africa and $ 50 million for the newly organized Global Alliance for Vaccines and Immunization (GAVI). GAVI was jump-started by a $ 750 million fund established by Gates.

The bill also would enable the United States to take a lead role in setting up a multinational vaccine-purchase fund to create a market for new vaccines once they are developed.

* In the House, Sherrod Brown, D-Ohio, and Connie Morella, R-Md., will introduce a bill today that would provide $ 100 million this year for TB treatment and prevention.

* Rep. Joseph Crowley, D-N.Y., who represents the district in Queens where the West Nile virus emerged, has introduced the Global Health Act of 2000. It would allot $ 1 billion for infectious disease, AIDS, child health, maternal health and family planning.

* The World Health Organization, newly energized by Director general Gro Harlem Brundtland, launched a Roll Back Malaria campaign in 1998 that seeks to combat a disease that afflicts 500 million people a year and kills 3,000 a day. Gates' funding will play a role.

* In June, Queen Noor of Jordan will serve as chair of the Global Health Council's annual meeting in Arlington, Va. The theme is "A century of health for the children of 2000." In

Jordan, Noor heads a foundation to address the health needs of women and children.

* Foreign policy experts have begun to view global illness as a national security concern. U.N. Ambassador Richard Holbrooke has stated that AIDS could destabilize many African nations. The CIA's advisory National Intelligence Council asserts in a newly declassified report that infectious diseases "will complicate U.S. and global security over the next 20 years."

All this attention couldn't come at a better time, Daulaire says. America may be coasting into the 21st century on the updraft of a hot economy and dazzling scientific breakthroughs, but for people in developing countries, it's still the 19th century. And for them, time is moving backward.

"What's sobering is that the trends are moving in the wrong direction," Daulaire says. He cites declines in life expectancy and rising death rates because of AIDS, TB and malaria. Six million die of malaria, TB and AIDS each year, he says.

The goal of the new dynamism in public health is to make inroads into the challenging problems of world health before they grow even worse, Daulaire says.

Domino effect of diseases

Consider: If HIV had begun spreading before smallpox was eradicated in 1977, smallpox would still be spreading. The reason: Smallpox vaccine would have been too dangerous to use in countries with HIV because it can actually cause a fatal smallpox-like disease in people whose resistance is low.

The picture isn't entirely bleak, however. This year, 74% of the world's children will receive the standard vaccines recommended by WHO. The vaccines will save an estimated 3 million lives and prevent disabilities in 750,000 children, though this figure has remained static since the 1980s.

Narrowing the focus may help get a handle on these seemingly overwhelming problems, Daulaire says. "Eighty percent of the health differential between poor and rich nations is really due to eight conditions," he says. "Instead of dealing with 1,000 things, we need to deal with only eight to address this health gap."

Six of the eight are infectious diseases: TB, malaria, childhood pneumonia, diarrhea, measles and HIV/AIDS. The other two are reproductive health issues: millions of unintended pregnancies and the risks posed by pregnancy and childbirth in poor nations.

Solving most of these problems would cost $ 13 to $ 15 a year per person worldwide, Daulaire says. "It's one of the great bargains of the century," he says, but far more than the $ 3 to $ 5 a year now being spent on health care for people in poor countries.

Many health experts believe these problems can be solved. "In the past, we might have been able to hide behind an attitude of 'It's too difficult; the scientists can't solve it, we can't crack that problem,' " Feachem says. "But it's very hard to take that view now."

An investment in global health

Advances in biotechnology and medical science make it possible to tackle problems that might have seemed insurmountable just a decade ago, he says, and new incentives offered to vaccine manufacturers by the U.S. government are fueling research into vaccines against malaria, TB and AIDS.

The United States is encouraging an investment in global health for good reason, Daulaire says. Though developed countries are benefiting from a "revolutionary shift" in health care because of technological advances, poorer countries are about a century behind.

"As we are making this rapid leap into the 21st century, we have this huge body of human beings -- 2 billion people living in the poorest countries of the world -- whose health conditions are more akin to the 19th century," he says.

Though the moral questions of ignoring the health needs of the poor can be debated, Daulaire and others believe there's a more urgent force at work: "There is no longer a physical divide that can leave us safe on one side of the pool," he says. "If we were to abandon those 2 billion people, it would lead to a world of chaos, a breakdown of social and political order and ultimately war."

What affects Africa and India affects Western Europe and the United States, he says, pointing to the emergence of mutant tuberculosis, malaria and other organisms that are impervious to one or more drugs that used to be effective.

"If we leave those (poor nations) as a petri dish for the development of these modified organisms, we're all at risk," he says. If we get to a point where the bugs are resistant to all antibiotics, "it will pull all of us back to the 20th century."

GRAPHIC: GRAPHIC, B/W, Suzy Parker, USA TODAY, Source: World Health Organization (Bar graph); PHOTO, Color, Samar Jodha, Gates Foundation; PHOTO, B/W, Gates Foundation; Gift of health: Women and their children line up for immunization shots Wednesday in Kanchanpuri, India. The power of vaccines: A boy waits for immunization shots Wednesday at a clinic in Kanchanpuri, India.

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