Global Health — The Gates–Buffett Effect, by Susan Okie, M.D. NEJM

[applegrove]

Global Health — The Gates–Buffett Effect
Susan Okie, M.D.
New England Journal of Medicine


"Standing before a giant AIDS ribbon, Bill and Melinda Gates greeted some 26,000 researchers and public health workers on the opening night of last month's conference hosted by the International AIDS Society in Toronto. Bill Gates's voice echoed through the stadium as he assured the conference delegates, "Melinda and I have made stopping AIDS the top priority of our foundation." The Gateses spoke in turn, revealing both their passion and their clear-eyed intellectual engagement. Bill Gates talked of the new optimism he senses in Africa with the increased availability of antiretroviral drugs, but he warned that without increased prevention efforts, the provision of long-term treatment for infected persons is "simply unsustainable." Melinda Gates spoke of the stigmas that limit efforts to control AIDS, noting that government officials in many countries refuse to accompany them when they meet with sex workers. The philanthropists promised to increase their foundation's funding for research on new prevention tools for women and called for expanded access to proven measures such as condoms, clean needles, and HIV testing. The demonstrators who had heckled previous speakers were silent; the Gateses were interrupted only by cheers.

In a world with many celebrities but few heroes, Bill Gates has attained heroic status by committing much of his enormous fortune to the advancement of global equity. He and his wife have targeted the causes of health disparities between rich and poor, and their foundation has become a driving force in international aid and in research on AIDS and other diseases. In June, the Bill and Melinda Gates Foundation's likely impact on global health was amplified when Warren Buffett, the world's second-richest man, announced plans to give most of his fortune to the foundation established by the richest one.

Buffett's gift, worth about $37 billion, will double the foundation's endowment from $29 billion to approximately $60 billion, making it by far the world's largest charitable foundation. The gift will also increase the foundation's annual giving from $1.36 billion last year to about $3 billion, or approximately $1 per year for every person in the poorer half of the world's population. By comparison, the World Bank estimates that total health-related aid to developing countries in 2004 (from governments, international organizations, and private sources) was about $12.7 billion (see graph).


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"Bilateral agencies" include those in Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom, and the United States (including the U.S. Agency for International Development). "Multilateral agencies" include United Nations agencies (the World Health Organization, the Joint Programme on HIV–AIDS, the Children's Fund, and the Population Fund), development banks (the World Bank, the Inter-American Development Bank, the Asian Development Bank, the African Development Bank, and the African Development Fund), and the European Union. "Public–private partnerships" include the Global Alliance for Vaccine and Immunization and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Data are from Catherine Michaud of the Harvard Initiative for Global Health, Cambridge, MA.

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http://content.nejm.org/cgi/content/full/355/11/1084