[We are reporting this week from the mHealth Summit in Washington DC — a conference covering the integration of mobile technologies with medical research, information, diagnosis, treatment, and care.]]
One of the highlights of this week’s mHealth Summit was the keynote interview of Bill Gates. While inseparable from his history as founder and leader of Microsoft from 1975 to 2008, his current passion is global health. Through the Bill and Melinda Gates Foundation, which has now given 3.8 billion (with a “b’) of targeted philanthropy into global health since 1994, he and his wife Melinda are helping bring about profound change to the lives of millions around the world. In a meeting dedicated to exploring the power of mobile devices to shape health in developed and developing countries, Bill Gates eloquently refocussed our attention towards the real urgency of saving the millions of our fellow humans who die needlessly, for want of vaccinations or the simplest treatments.
He was interviewed by Kristin M. Tolle, Ph.D. Director of Devices, Sensors and Mobility for Healthcare Microsoft Research. The following are excerpts from this fascinating conversation.
Q: You said the mobile phone is not the panacea for health care. Can you elaborate ?
A: Computing technology has been great for health care, but primarily has been useful for research. It has facilitated vaccine research, which is fantastic, that is THE miracle. But it is hard to measure the effect of technologies in general which have changed research. Advances in the field of new drugs in the last decade has not been that great. But in areas of interest to the poor, it has been a period of great productivity.
In the case of the cell phone, it can go beyond research since they are present at the point of care. Still, we have to approach this with some humility. There is not always connectivity, people may be too sick to use phones. We have to hold ourselves to some tough metrics.
Q: Are there key applications for mobile phones ?
A: The question is what is the key metric you are trying to improve? The number of kids globally which die before the age of 5, is now 8.5 million. In 1960, it was 20 million, while the number of people born every year is up by 1.5. So it is a pretty dramatic reduction.
Of this, 1/3 of the reduction is due to improvement in income, but the majority is due to vaccines. Smallpox was killing 2 million per year, now it is zero, measles was killing 1.5 million, now it is around 300,000. Of the mortality under 5 years, mortality in the first 30 days is 1.5 million while the remaining time, it is 3.5 million. Vaccines help in the second half. if you could register every birth on a cellphone, get a location, then you can take these systems and make sure immunizations can occur more effectively. Vaccine coverage in the poorest areas, like northern India, is below 50%. So, there is the potential for huge improvement by reaching these people.
Other impacts could include patient reminders, such as with Tb drugs. This would even be beneficial in rich countries. Improving the supply chain, so vaccine stock is more consistently available would be another benefit. There is a project in India to fingerprint people, we want to make this into a birth registration system.
Since this is new technology, we should let 1000 ideas blossom, there will be some dead ends. But, if you go back to key metrics, which is what the Foundation looks at, that should remain in front at all times
Q: Speak about research and development
A: in general the world underfunds research since the person taking the risk does not capture the benefit. Capitalism has a systemic problem with research, of which it does not do enough. Another is that needs of poorest are not prioritized. But capitalism is still amazing and better than government for most things. Government comes in where the market does not, e.g. basic research. Here, the US is exemplary. The Gates foundation takes the role of research for diseases of the poorest. The internet is a great platform for dissemination of information. Science & engineering students are graduating in great numbers in middle income countries, although not in enough numbers in high income countries.
Q: We say we’re saving these people to have a better quality of life but is that true, or are they meeting harder challenges later ?
A: As the world goes from 6 billion to 9 billion, all that growth will be in urban slums, not in rich cities or rural areas. So, slums are a growth business. We need to make sure water and education is available. But, the most important fact people should know is that as health improves, as children under 5 are saved, that is THE thing that reduces population growth. This sounds paradoxical, that population growth slows with increasing survival. However, within a decade of improved survival, parents start to have fewer children. See Hans Rosling TED talk about birth rates [Ed. this is a great talk]. There s no such thing as a high income, high birth rate country. Even within a single country like India, the varoius regions reflect this correlation.No matter what issue you care about, the environment, schools, unrest, all those problems are insoluable at a 3% population growth. Otherwise, there will be no jobs, no trees. We must avoid those deaths. That’s why our Foundation went to health, we had started in reproductive health as the 1970s academics had concentrated on the “population bomb” and emphasized family planning. All that was wrong.
Q: You said it is important for us to invest wisely. We should continue spending on maternal & neonatal health , vaccines are important. What is the next big challenge ?
A: This is a tough time for foreign aid as budgets in rich countries are being cut. when this happens, the health portion of foreign aid does not have a strong constituency and gets cut non-linearly. The UK is exemplary as they set aside the allocation of aid in their budget, which will grow even as the rest of their budget shrinks. I hope it does not get cut in the US but I’m afraid it might be. Funding for research might get cut.
We are funding new vaccines all the time. In these countries, 1/3 of children have had some insult to brain development due to malnourishment, cerebral malaria and other diseases. The same thing that gets rid of death also gets rid of illness. I go around begging countries to contribute the last part of their commitment of 800m for the polio campaign. Vaccines ought to be high priorities.
Then we go to a culture of savings. The mobile phone is a very interesting thing here. The mPesa success in Kenya has been very interesting, it has caused changes in how seeds are bought, etc. It allows payments to directly to the recipient. Today, government payment systems often stop at the village chief.
Q: Are there parallels for mHealth in this ?
A:- The CEO of SafariCom wanted to solve the problem of trust. he got that, now he wants to do all digital transactions, without cash. There are similar bootstrap problems in health. In order to allow vaccinators to check off kids into a registry, this has to be bootstrapped. Once this is past research stage, we will build it out throughout a country. There are ministers in India & Kenya who want to be showcases for these kinds of projects. A few can be adopted one patient at a time, e.g. Tb drug reminders, malaria diagnosis. The rest have to be adopted system wide