Bill Gates is a remarkable man, now noted not only for his success in business but for his decision to devote so much of his wealth to global health and development, through the Bill & Melinda Gates Foundation. The Foundation and the way it works is now, however, the subject of controversy following an analysis published in the Lancet and featured on TropIKA.net.

The Gates Foundation gives particular emphasis to finding new technological solutions – inevitable perhaps as Bill Gates made his money through technology. (We can only speculate what his approach to global health would have been had he become wealthy as a result of a career in the media, finance, energy or some other sector.) However, critics are asking whether the Foundation’s technological emphasis detracts attention from the social determinants of health, and from efforts to improve the delivery of existing interventions of proven effectiveness. Critics have also commented on the Foundation’s tendency to prioritise support for a small number of diseases; in particular there is a poor correlation between Foundation funding and the childhood disease burden. The Foundation not only provides a significant proportion of global health funding but also plays a part in setting priorities more widely. Perhaps the most important criticism is that it provides no information as to the processes it uses in deciding upon those priorities.

Priority setting has also created controversy elsewhere. A renewed appeal has been made, in another article in the Lancet, for the control of “neglected tropical diseases” (NTDs) to receive more funding. The authors particularly emphasise seven of the long list of NTDs that they consider to be both the most widespread and the most amenable to control. The seven include schistosomiasis; new research on the prevalence of this condition in Mali demonstrates that if successful programmes are not sustained then progress can easily be reversed.

Meanwhile, others make the point that diarrhoeal diseases are amongst the very biggest killers of poor children but have lost the position they once held on the priority list. Can we now say that they should therefore be added to the “neglected” category? A new report marks the start of attempts to restart international action against these diseases. We also carry news of a project which may lead to new treatments for diarrhoea but see, however, the cautionary note sounded in a TropIKA.net blog .

The last few days, have seen the emergence or re-emergence of other controversies. The use of DDT as part of malaria control efforts – see our news story – is an issue where passions have often run high. Also in the news and also likely to be controversial is the decision of an Indian company to continue the development of a new malaria drug, despite the fact that the Medicines for Malaria Venture with which it was in partnership decided to withdraw its collaboration following disappointing trial results.

And in America, details are awaited of what support the Obama administration [9] will give to global health. Announcements made from the White House have led some critics to accuse Obama of failing to deliver on his pre-election promises on, most notably, AIDS. However, the President has said that his new approach will be ‘comprehensive’. Whatever he decides will be controversial but it may be that previously neglected areas will receive more attention and that his priority setting will be more in line with the disease burden.

Perhaps then it is good that the infectious diseases of poverty have lately become the subject of so much controversy. It is an indication that the issue is now receiving attention at senior levels and that efforts are being made to identify the best ways forward. Controversy, however, should not be allowed to drag on for too long. Words must give way to action.

Paul Chinnock
Editor-in-Chief, TropIKA.net