April 26; Wall Street Journal | When Patti Stonesifer ran the Bill and Melinda Gates Foundation, she made a big commitment about the foundation’s openness to learning, to hearing feedback from grantees and the field about whether its programs were working or not. Apparently, the foundation’s programs to eradicate polio aren’t working all that well. Polio appears to be spreading across Africa, despite the foundation’s commitment of $700 million to fight polio on the continent, and is showing up in countries which had been polio-free for decades. The health philosophy of the foundation has always reflected its founder, with a commitment to technical and scientific responses to diseases such as new vaccines.

With polio, the Gates Foundation along with partner organizations such as the World Health Organization, UNICEF, and Rotary International are going to announce a major change in their anti-polio strategy. Gates plans to add a strategy that we and many others have long suggested, that its technical, scientific responses to individual diseases like polio or malaria (a “vertical strategy”) have to be accompanied by investment in broader health goals, including improved hygiene and the provision of clean drinking water (a “horizontal strategy”). If you don’t improve the basics of health in poor countries, you lack the platform for fighting individual diseases. The Wall Street Journal cited a trip Bill Gates took to Nigeria as a telling moment for the billionaire philanthropist. His host, the Sultan of Sokoto, reminded him of the needs for other kinds of health assistance (for example targeting tuberculosis, HIV and AIDS, malaria, and cholera, in addition to polio (Nigeria has half of the world’s 1,600 reported cases of polio, though epidemiological statistics say that for every one person paralyzed, 200 are infected with the disease, which is transmitted through water contaminated by human feces). Visiting a Sokoto clinic, Gates learned that plenty of basics of health treatment were completely missing while the foundation’s polio campaign was barreling along.

A strategic shift like this is hard stuff for a technology-oriented foundation like Gates. It means acknowledging that hundreds of millions of dollars didn’t hit the mark. Moreover, shifting to horizontal strategies means accepting less precise goals and tactics regarding changing public health systems, as opposed to the precise goals of designing, manufacturing, and delivering individual disease vaccines and treatments.—Rick Cohen


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