2007-12-17 13:32:54.0 Stephen: Your lead in the story about a woman who benefited from ARTs thanks Gates but her baby died b/c Gates doesn't also fund the $35 valve that would have saved the child's life was not research. It was a misconstrued comparison that was completely inappropriate and was sadly, sensationalist.
2007-12-17 13:34:19.0 Charles Piller: My sense is that the Gates Foundation will change its approach to these issues over time. PArt of the problem is that they have to give away a lot of money each year, and that in itself can be a challenging burden to do in the most creative ways. As for the comparison of ART treatment and oxygen valves--I take your point. But bear in mind that these are not abstract issues or blind comparisons to the people in those nations whose babies are dying so often.
2007-12-17 13:34:53.0 Charles Piller: They view the comparison is life and death, and eminently fair.
2007-12-17 13:35:07.0 Stephen: Indeed, but thank goodness that Gates is trying to at least solve part of the problem.
2007-12-17 13:35:26.0 Administrator2: How much are they spending annually? And how much of it is directed at Africa specifically?
2007-12-17 13:35:31.0 Michael: They might view the comparison as fair, but I doubt they'd put all of the blame for the lack of a valve on the Gates Foundatoin
2007-12-17 13:35:35.0 Michael: You are the one who chose to do that
2007-12-17 13:36:32.0 Charles Piller: Gates, right now, gives a bit over $1.5 billion annually. It's hard to calculate precisely what goes to Africa, but the continent recieves much of the funding that does not go directly to US or research programs.
2007-12-17 13:37:33.0 NJS: Given that resources, even the Gates Foundation's resources, are finite, are you suggesting that existing money be diverted away from vertical programs in favor of health systems strengthening? Few people would disagree that health systems need to be improved and that more money needs to be invested, but should Gates-funded programs cut back on existing activities? Whereas Nyoba's daughter may not have died in a better health system, Nyoba may not have survived long enough to have a child without her AIDS drugs
2007-12-17 13:39:39.0 Charles Piller: Even the Gates Foundation can't pay for everything. But thinking carefully about what could have the most benefiicial effects is the goal, I think. The point, in part, is that things that don't cost a lot of money are lost in the rush to solve other problems. This is not inevitable--it's a matter of setting up programs more effectively. Few in the world of global healt dispute that point.
2007-12-17 13:40:07.0 pcharles: Having worked in developing countries on issues of vaccine design and testing, I can attest to the difficulty of trying to do "everything." A holistic approach sounds wonderful, but is virtually impossible to achieve in practice. Where do you draw the line? I have visited villages where there was no running water, little food, and virtually no healthcare. If we (as medical researchers) tried to feed, clothe, and provide medication for all of the needs that we saw, there would be no time to or funding to do what we were there in the first place.
2007-12-17 13:41:42.0 Charles Piller: Yes, the probems require tough choices. We tried to point out in the story that some decriptions of the programs benefits have not been demonstrated in the experience of the people, or in the data that are collected.
2007-12-17 13:42:02.0 Administrator2: What first drew your attention to the Gates Foundation and do you plan on expanding the scope of your investigation to include other charities?
2007-12-17 13:42:25.0 Charles Piller: Tough choices don't mean settling for less than a better outcome.
2007-12-17 13:43:08.0 Charles Piller: We chose to look at Gates because it's the biggest and most importnat foundation on the planet. We may look at other philanthropies in future.
2007-12-17 13:43:39.0 pcharles: I think there must be a point at which the world hold the governments in developing countries accountable for their actions. I think it is far more likely that the money that could have been used for a valve was spent on buying machine gun ammunition than that it went away in some sort of brain-drain, higher salary for GF nurses scenario.
2007-12-17 13:45:05.0 Charles Piller: It's a good point, and one the Dr. Yamada of the Gates Foundation also made. The health officials I spoke with in Africa said that they knew that they were responsible for their own nations' improvements. Of course, corruption or ineptitude in government is a problem worldwide.
2007-12-17 13:46:00.0 Administrator2: What was your hope, in writing this story, for the best possible outcome to develop from it? And what can readers to do help, if they're so inclined?
2007-12-17 13:46:19.0 Sarah: why didn't you acknowledge GAVI's $500 million investment in basic health systems announced at Davos last year? That seems to be a perfect example of GAVi and Gates doing exactly what you are claiming they do not do.