Betting on HIV prevention

Abstract

Deciding how to give away US$3 billion a year effectively cannot be easy, but that is the task facing the Bill and Melinda Gates Foundation now that Warren Buffett, the world's second richest man, has pledged to give the charity $37 billion of his fortune. The Gates Foundation has to give away 5% of its assets each year to keep its tax status as a charity, and some insiders say that it is already struggling to find suitable projects to fund. Philanthropists in the past have found it easy to waste their hard-earned cash. Is there a risk that the Gates Foundation might do the same?On July 20, the Foundation announced that it had awarded 16 grants, totalling $287 million over 5 years, to fund the development of an HIV vaccine. So far, the Foundation has invested $528 million and the US National Institutes of Health has spent $3·4 billion to try to develop a vaccine. Despite this huge injection of cash, most experts agree that a viable vaccine is at least 10 years away, and some think that an effective vaccine may be impossible to design given HIV's remarkable biological agility to evade control. The AIDS Vaccine Advocacy Coalition told the Wall Street Journal that more than $1 billion should be spent on AIDS vaccines each year. Would that money be better spent elsewhere?Microbicides are more likely than vaccines to be an effective HIV prevention tool, at least in the short term—it is possible that the first microbicide could be licensed as early as 2010. The International Partnership for Microbicides will call for an immediate doubling of microbicide research funding, from $160 million to $320 million a year, at the AIDS 2006 conference in Toronto, according to the Toronto Star. The Gates Foundation has funded microbicide research, but not to the same degree as it has invested in HIV vaccine research. Only time will tell whether that turns out to be the right bet. We suspect not. Deciding how to give away US$3 billion a year effectively cannot be easy, but that is the task facing the Bill and Melinda Gates Foundation now that Warren Buffett, the world's second richest man, has pledged to give the charity $37 billion of his fortune. The Gates Foundation has to give away 5% of its assets each year to keep its tax status as a charity, and some insiders say that it is already struggling to find suitable projects to fund. Philanthropists in the past have found it easy to waste their hard-earned cash. Is there a risk that the Gates Foundation might do the same? On July 20, the Foundation announced that it had awarded 16 grants, totalling $287 million over 5 years, to fund the development of an HIV vaccine. So far, the Foundation has invested $528 million and the US National Institutes of Health has spent $3·4 billion to try to develop a vaccine. Despite this huge injection of cash, most experts agree that a viable vaccine is at least 10 years away, and some think that an effective vaccine may be impossible to design given HIV's remarkable biological agility to evade control. The AIDS Vaccine Advocacy Coalition told the Wall Street Journal that more than $1 billion should be spent on AIDS vaccines each year. Would that money be better spent elsewhere? Microbicides are more likely than vaccines to be an effective HIV prevention tool, at least in the short term—it is possible that the first microbicide could be licensed as early as 2010. The International Partnership for Microbicides will call for an immediate doubling of microbicide research funding, from $160 million to $320 million a year, at the AIDS 2006 conference in Toronto, according to the Toronto Star. The Gates Foundation has funded microbicide research, but not to the same degree as it has invested in HIV vaccine research. Only time will tell whether that turns out to be the right bet. We suspect not.