The Gates Vaccinations

IT CAN BE frustratingly hard to turn money from the rich world into progress against global poverty. An aid program can finance the purchase of school textbooks or the construction of a well. But the books are lifeless without competent teachers, or if parents depend on child labor and don't want to send their kids to school. Equally, the well won't help much if it's not maintained, or if the politics of the village leave the poorest without access to it. But there's one type of aid that escapes many of these obstacles. Vaccination programs can protect millions of people from debilitating diseases. And once the vaccines are delivered, the gains are locked in: No matter how tough the environment around the vaccinated people, their health will still be protected.

This is why vaccinations offer some of the clearest development wins, and why the Bill and Melinda Gates Foundation is right to devote huge resources to them. (Full disclosure: Melinda Gates is on the board of The Washington Post Co.) More than 2 million people die each year for lack of immunizations that are standard in rich societies. In 1999 the foundation, which is financed by a gift from the Gates Microsoft fortune, made a $750 million grant to address the vaccination shortage in poor countries. Yesterday the foundation followed up with another gift of $750 million.

The Gates grants are cleverly structured. The first one served to launch the Vaccine Fund, the financing wing of the Global Alliance for Vaccines and Immunization, which promotes access to vaccines in poor countries. This transformed the incentives of the pharmaceutical industry. Before, the industry had little reason to manufacture vaccines for which there might be no market; after, a multimillion-dollar pot of cash hung like a carrot in front of drug companies. Moreover, the Gates contribution spurred other donors to contribute, too. Over the past five years, the Vaccine Fund has raised $580 million from other sources, notably $219 million from the United States and $150 million from Norway. Yesterday the announcement of a second Gates grant was accompanied by a promise of a further $290 million from Norway.

Thanks to the Vaccine Fund, an extra 42 million people have already received the hepatitis B vaccine, and vaccines for yellow fever, influenza and other killers have also had their reach extended. As a result, an estimated 670,000 deaths have been prevented. But there remains vast scope for progress. Some 27 million children still aren't immunized each year; the price of this failure was 2.1 million deaths in 2002 alone, according to the World Health Organization. Moreover, new vaccines are in the development pipeline -- for meningococcal disease, pneumococcal disease and rotavirus diarrhea -- and these could save an additional 1 million lives per year or more if donors supply the money to purchase them. The Gateses' smart philanthropy is a wonderful thing. But it would be even better if other donors, public and private, reacted yet more generously to this second grant than they did to the first. The opportunity to prevent needless death awaits them.