Yamada was interviewed by NPR’s Susan Dentzer. The main problem with health is an overall lack of equity—10 million children die each year unnecessarily. We have so many simple solutions, such as a filter. But we lack money, political will and people to solve the health problems of the developing world.

What’s his sense of the scale of the problem?

About $10bn is given now, but we need $25–70 Billion per year. Not that much overall & just the cost of 2 months of the war in Iraq & Afghanistan.

Health care spending in the developing world is low. But much of it is spent out of pocket. Yamada is enthusiastic about the role of private sector organizations supplying services—”you can do good things and profit from them”.

What about public-private partnerships. We provide money to “de-risk risky projects”. Now we ask the private sector to take the vaccine (e.g. malaria) for the rest. Then they offer a guaranteed market commitment. So they want to get private sector companies (pharma) to make a commitment that has a hug potential pay-off—assuming that the odds are 50/50.

He portrays Gates Foundation as small. $1bn or $2bn is not much compared to NIH’s $29bn. So they’re not crowding out other investment, but they’re encouraging other governments and nations to take part too. They try to partner as much as possible.

At his core he’s an optimist. Science has progressed to the point of creating low cost applicable technology, and there’s new money for this. G8 has committed to 0.7% of GDP going to overseas assistance, and there’s huge interest from young people in global health. If you look at lots of examples—Japan post-war, Vietnam in the last 20 years—show that those countries can improve their health and their economy. He thinks China’s investment in Africa is evidence that “smart money” is going there…

Dentzer asked him about the investment philosopy of the Foundation which has money in companies criticized for hurting the environment. Well, a) it’s hard to spread that much money about without upsetting someone, and b) we need strong pharma companies to do our work. But we will not invest in tobacco companies—so we do look at the rationality of the investments being made. But this all involves shades of grey and we do the best we can to ensure safe returns.

[Updated: additional notes provided by Hylton Jolliffe]

Gates Foundation spent $1billion last year on global health. We expect to ramp that up to $2 billion in a few years. The rest of the world contributes about another $10 billion. But experts suggest another $60 billion or so is actually required to address health issues faced in the developing world. It’s also estimated that another 1 million health workers are needed in the developing world.

Question from the audience: What expectations should the developed countries have about what the developing countries should themselves be committing to health care?

Many of these developing countries spend something like 1-2% of their GDP on health care - there’s pressure on them to push that towards %10 of GDP. There are other factors in the equation of course: monetary policies, international grants, etc.

The reality is that 70-80% of health care spend is out of pocket in Asia. In Africa, it’s about 60%. So these countries do need to spend more but their also needs to be private industry to address the issues.

There’s a real opportunity for for-profit health initiatives and ventures in the developing world - I would urge attendees here to explore these opportunities.