Bill and Melinda Gates Foundation: Tachi Yamanda

Earlier in the week Dr. Tachi Yamada of the Bill and Melinda Gates Foundation presented the work they are doing on health care in developing countries. Some years back Bill Gates gave a similar talk at Microsoft and it was an amazing presentation. Partly due to the depth and breadth of Bill’s understanding of the world health care problem but what impressed me most was the effectiveness of applying business principles to a social problem. Applying capital to the highest leverage opportunities. Don’t just invest in the breakthrough but also in the social and political barriers to uptake. Tailor the solution to the local environment. Work on the supply chain. Influence the economic factors that cause phara companies to invest in a given solution.

The same techniques that allow a company to find success in business can be applied to world healthcare. I love the approach and Dr. Yamada’s talk this week followed a similar theme. My rough notes follow.

–jrh

· Speaker: Dr. Tadataka (Tachi) Yamada

o Excellent presentation. He quitely relays the facts without slides and just lays out a very compelling and very clear picture of their approach to health care.

· About ½ the foundation focuses on health, ¼ on learning in the US, and ¼ on improving economic situation

· 1,000 babies will die during this talk.

· Life expectancy: 50 in sub-Sahara and close to 80 here in North America

· Bill “finally graduated” from Harvard last June and in his commencement address he said:

o humanities great advancements are not the discovery of technology but the application of it to fight inequity.

· $2T spent on healthcare in the US. A few billion from Gates foundation won’t correct the lack of political will in how this is applied. $2B will have a fundamental impact spent in the developing world. This is where we can have the greatest positive impact and that’s why the foundation focuses its healthcare resources in the developing world.

· HIV battle is using prevention. Lifetime cost of treatment makes it very expensive to battle via treatment.

o Circumcision has been shown very effective in reducing the transmission of HIV.

o Long term approach is vaccine (note that 25 years of research haven’t yet found this)

§ We’re investing $500m over 5 years in HIV vaccine research

· We focus on all phases of taking science to improved health outcomes:

o To science, then to local opinion, then to policy, and then to application. Without cover all four, full impact will not be relized.

· In developing world 70% of all care is private, often for profit, health care.

o Individuals purchasing directly from pharmacies (e.g. Malaria treatment)

o Basic point is that you need to understand the entire system (economics, policy, social factors, etc.)

· Mass customization is required for global success in business AND also in not-for-profit. The same ideas apply.

· Yamanda points out that bed nets are effective in the fight against Malaria but aren’t in heavy use. He shows how companies market products and argues that we need to do the same thing in public health care. People have to want a treatment, people have to believe in it or it won’t work.

· Peer reviews kill innovation. Need innovators reviewing innovation. Standard peer review tends to seek out incremental improvements to existing systems.

· 10m children lose their lives each year. Must stay focused on the prize: reduced mortality.

· Quote from one of his ex-managers: “If you aren’t keeping score, you are just practicing”

o Metrics driven approaches are needed

· Birth rates: 30% lack of control and 70% demand side problem.

· We believe that a healthy pharmaceutical industry and believe in IP but need affordable prices in under developed world.

· Pharma makes less than 1% of the profits in the developing world. Selling at cost would drive volume and not impact the profit picture.

James Hamilton, Windows Live Platform Services
Bldg RedW-D/2072, One Microsoft Way, Redmond, Washington, 98052
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JamesRH@microsoft.com

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