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Gates in India: making a difference

In an exclusive interview,BillandMelinda Gatesshare their thoughts on their commitments to furthering health equity in India withJaya Shreedhar. Excerpts:

Bill and Melinda Gates: "There's a chance to make a real difference in saving newborn lives." — Photo: A. Muralitharan

What is it about India that draws you here?

Bill Gates: The first is that a lot of the inequities in the world in health are here in India — malaria, TB, VL — most of the top 20 diseases. It's not surprising; there are a lot of people! Secondly a lot of the solutions will come from here and that's why. We are also here to meet some of the grantees and got updated on the work that we are doing.

Melinda Gates: The one thing I would like to say about Indian people that also draws us here is not only the disease inequities, but just like anywhere else I've seen the mothers and what lengths they'll go to save their children. In the vaccination programmes that we do, I've just been blown away when you go into the slums and see how long women will wait or from how far they will come to get their children vaccinated. There's a chance to make a real difference in saving newborn lives here because I think moms will do a lot to lift themselves and their children if you give them the tools and the chance.

What do you perceive as the biggest challenge to the work of the Foundation in India?

Bill Gates: The challenge here in India is the limited resources applied to health and there's a commitment now to increase that. Our commitment is quite necessary, but even with drug breakthroughs you need people like the link workers we saw here in Delhi or their equivalents out there in the rural areas... Science is on our side but it's going to take more — in terms of resources. The doubling that's been discussed will make a huge, huge difference. I hope that can happen soon and that hopefully we can be a partner in making sure that the investment is effective. We've done pilot programmes to help that money be particularly effective.

Melinda Gates: I think there are also challenges at certain stages. We know that the immunisation rate is quite low in some States and in other States it's gotten quite good. But in a State like Bihar where we work, the immunisations rate is still very low. As far as polio in the world is concerned, there are still some pockets of polio that remain in India and so that remains a challenge. There are a few States that make things particularly challenging but we are still very optimistic overall.

Bill Gates: Yeah ... everybody says if they were like that State it would be an amazing thing.

So does that interest you? To see peninsular India emerging as a distinct, more developed, responsive subregional entity within India?

Bill Gates: We are not really `regional' in what we do. We believe that human lives are of equal value. Some of the things we are going after in India are of personal interest. But Visceral Leishmaniasis [kala azar] — we went after that because of the disease burden, not because we have some particular region. Malaria is in different parts of India and JE [Japanese Encephalitis] — that's also in different regions. We go wherever the need is. Infectious diseases are not in the U.S., one doesn't need to go there. We end up mostly in Asia and Africa.

HIV/AIDS was partly responsible for re-igniting greater interest and investment in basic science research. To what extent does the Foundation see itself contributing in that area?

Bill Gates: By necessity, some of the things we are doing have been basic science. There's no good line between basic science and ... it's all immunology...

The research budget for medicine and basic science has gone up every year. The primary basic research budget for the world is the NIH [The U.S. National Institutes of Health] budget. Six years ago it was $14 billion and it's $30 billion now. It never went down, it always goes up. It's a phenomenal thing. The European equivalent is less than a tenth of that and if you could take all the countries in the world it would still not add up to that. And that creates a foundation. We take that foundation and use it to go after developing world unique things. Big pharma and biotech take that and go after the diseases burden, where there is a market for their drugs.

Do you see the Foundation helping countries — particularly those in this part of the world — with epidemic outbreak preparedness such as surveillance systems, in view of recent outbreaks such as SARS that have had a serious economic fallout?

Bill Gates: No, not really, that's WHO's job and the job of the people at the CDC [Centres for Disease Control]. We are still focussed on the big challenges such as TB and malaria.

But as someone committed to working towards greater global equity in health and with global cooperation becoming an increasingly decisive factor in determining our response to epidemic outbreaks, how do you envision the role your Foundation will play in furthering such cooperation?

Bill Gates: I will help WHO hire the very best people and have the very best tools — this is WHO's job supplemented by the strongest national organisations. The CDC in many respects is the best at some of those things and it does not make sense to have multiple organisations trying to do disease tracking. You want one organisation that's clearly responsible for reporting standards and systems and can galvanise the resources.

What impressions did you come away with following your meeting with Health Minister Anbumani Ramadoss?

Bill Gates: I still remember going into that meeting and thinking how much the Minister himself was knowing all the specific things we are doing in India. I was really pleased at his interest in the broad set of things we are doing and his awareness of how we are working together. We talked around a little bit about can Visceral Leishmaniasis really be eliminated by 2008... we're the best partners to make that as likely as possible but it may take a little while longer than that. You had all these key people there [at the meeting] and they made it clear that we have a lot of shared goals.

Melinda Gates: I don't think that we are focussed on a lot of the same things but they seem to have their specific goals now that they are trying to achieve in some health topics. Sometimes you go into a Minister's meeting and they don't have very concrete goals. In this case it felt like they did.

The Health Minister seems keen on building Indian Institutes of Health across India, similar to the Indian Institutes of Technology and Indian Institutes of Management in approach and commitment to excellence. Would you consider supporting such an endeavour?

Bill Gates: Well we are looking at it and I've asked Ashok [Alexander, Project Director of Avahan] to talk about this with Rajat Gupta [Mckinsey] and we would take a look at the proposal.

To end with my first question, what quality or qualities would you says defines India for you?

Melinda Gates: I think it's the amazing human spirit here; people want to lift themselves up.

Bill Gates: In some ways you think of it in terms of historical things and then in terms of new approaches for ITE, or embracing the future in this big way... in some ways it's the most futuristic and in some ways most historical country in the world and this aspect has a certain beauty to it because you don't want to really give up either one of those things.

(Dr. Jaya Shreedhar is Technical Health Adviser, Internews Network.)

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