Gates Foundation Health Chief on Coaxing Pharma to Do Good

Xconomy National — 

Bill Gates can summon the CEOs of every major global pharmaceutical company, and get them thinking and talking about things that won’t help them make more money. Pharma and biotech companies, cast as the villain pretty much everywhere, certainly like the PR boost they get from working with Gates and putting their immense resources to work for people who live in poverty.

But when the handshakes fade, warm and fuzzy feelings wear off, and people go back to their day jobs, someone needs to ride herd and make sure things get done. Trevor Mundel, president of the foundation’s global health operations, is one of the key people charged with doing that.

Mundel, 53, came to the Seattle-based Bill & Melinda Gates Foundation, the world’s largest charitable foundation, about two years ago. He had a long career in the for-profit pharmaceutical industry, including stints at Parke-Davis, Pfizer, Alkermes, and, finally, as the head of global development at Switzerland-based Novartis. At the Gates Foundation, he oversees a vast global health grant portfolio that seeks to combat diarrheal infections, HIV, tuberculosis, malaria, and many other illnesses that the global capitalist system has largely ignored.

Trevor Mundel, president of global health at the Bill & Melinda Gates Foundation.

Trevor Mundel, president of global health at the Bill & Melinda Gates Foundation.

The foundation, started by a titan of capitalism, understands that if it’s going to make any kind of dent in these huge health problems, it needs to tap into the resources of pharma and biotech. Total funding for global health has flatlined, after a decade of fast growth spurred largely by Gates. Industry spends about $130 billion a year on biomedical R&D—a sum far, far greater than anything Mr. Gates, as rich as he is, will ever be able to put under his own roof.

Since the foundation’s inception in 1994, it has given out $8.8 billion for global health. The U.S. and European pharmaceutical companies collectively employ about 1.35 million people. The Gates Foundation employs a little more than 1,000. What the foundation can do, given Gates’s influence, is push, pull, drag, and lever more people into working on global health. The foundation has about $40 billion in assets, some of which it spreads every year across its portfolio of grants for global health, global development, and education.

I sat down with Mundel in his Seattle office a few weeks ago, and talked with him about what he’s done to shake things up, and what he wants to accomplish in this job. He’s a native of South Africa, with a doctorate in mathematics from the University of Chicago. He comes across as a soft-spoken, slightly shy, and thoughtful individual. He was most animated when we talked about some immunology work being done at a Gates Foundation investment called Atreca, a spinout from Stanford University.

Although I don’t doubt the foundation’s good intentions, I wonder about how sincere and committed its partners are. Just a couple weeks after interviewing Mundel, I met in New York with a scientific leader of one of the world’s top pharma companies. This person was pitching a story about a new humanitarian initiative his company was doing in partnership with the Gates Foundation. When I asked him how many people his organization has working on this global health problem, he stammered, and then volunteered that maybe 20 people were working on it. When I asked how much progress the company had made in a couple years since starting the program, he said the team was still working with collaborators on the best ways to measure that. Suffice to say, I walked away unimpressed. And it made me think back to the kind of organizational inertia Mundel and his colleagues are up against.

With that, here’s an edited version of the conversation with Mundel, which I think will be informative and hopefully useful for many potential partners in biotech and pharma. It’s lengthy, so I’m splitting it into two installments, with the second part coming tomorrow.

Xconomy: What excited you about this job?

Trevor Mundel: Obviously there are many factors. But I was looking at the way the pharmaceutical industry was going. Given the pricing pressures, there was a huge focus in moving towards rare diseases. From a regulatory viewpoint, the programs were much less expensive—they might be accelerated. Particularly, the industry was interested if you could work on a rare disease that could be expanded into other markets.

So I had a team, for instance, a large team, more than 100 people, working on one of these rare diseases, Muckle-Wells Syndrome. At the time we started working, there were about 3,000-4,000 identified families in the world with the disease. We had an antibody that was the sort of magic bullet for this. That antibody, an IL-1 antagonist, has got a lot of other utility.

On the other hand, I was also responsible for Coartim development, around the Coartem Dispersible. I had a team of about five people. We worked on the dispersible form for malaria in kids. It was distributed in West Africa to a huge effect, helping millions of kids who couldn’t take the tablet form.

So I’m looking at an industry that’s facing pricing pressures, rarer diseases, stratifying populations, and massive resources in the area of oncology. It was very much focused on the diseases of the developed world. And then I saw what a small group can do to have a massive impact on a miniscule, shoestring budget by comparison.

You have to think about where you want to go. I always thought I’d want to go back to Africa and do some work over there, having grown up in South Africa. With those thoughts in mind, the Gates opportunity came up. At that point, you have to decide, are you going to jump in or just say ‘Oh, I’ll do that one day.’

X: This is the opposite of the rare disease model, what you’re doing here.

TM: It’s the absolute opposite of rare disease. There’s a community, a public health perspective, which is completely different.

There’s this notion that the Gates Foundation is completely obsessed with technology. And [some say] it should be just focused on deployment of low-cost, simple solutions, in low-resource settings. I thought there’s some validity to that argument. But as I’ve come to understand, the infrastructure deficiencies in some of the areas we work in are so great, you could wait 50 years to have well-functioning healthcare systems.

Because of the deficiencies for the foreseeable future, you actually need more sophisticated technology in some ways. The vaccine you may be making for developing countries needs to meet certain product profile criteria, which are more stringent than what you could deploy here. It doesn’t matter here if you have to come in for three doctor visits, or if you need refrigeration for a vaccine. All of those things are easily taken care of here. It matters hugely whether you have three or one dose of a vaccine for kids in developing countries, or whether you have to put it in the refrigerator, or whether it will be stable on a shelf for two years.

So, contrary to what I thought naively at the start, the technology hurdles are that much higher if you want to have effective interventions in some of these most infrastructure-poor areas.

X: So you jumped in. Like you said earlier, at some point you have to decide whether you really want to jump in and do this. You did. Two years ago. What was that like, getting started? I imagine there’s a lot absorb early on, in terms of figuring out how this place works, what it does well, what it can do better. What were your initial impressions?

TM: A lot of confusion. There are a huge number of projects underway here. How do you make choices? It seems like we have a lot of resources, with … Next Page »

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