I was especially interested in his frank discussion of the Gates Foundation’s mistakes. Admitting to errors in such a high-profile forum is valuable; it can help everyone else learn. In the case of the Gates Foundation, they discovered that vaccinations aren’t the simple solution we’d like them to be. Rotavirus has been hard to distribute, and the polio vaccine needs additional varieties to be fully effective.
On rotavirus “In last year’s letter, I said that I thought we could get the rotavirus vaccine out to over half of the kids who need it within six years. I still think we can achieve this in the five years we have left, but it is going to be a lot harder than I expected. Many countries have not added a new vaccine for over 20 years. Incredibly, some countries don’t even have a process for deciding whether to add a new vaccine. In others, the process is still there on paper, but no one remembers who is supposed to do what.”
On polio “When we increased our investment in polio two years ago, we viewed it as a challenging delivery problem rather than something requiring a new tool, because the oral vaccine worked quite well. Most of our funding has supported innovative approaches to delivery. But when we saw that in some places the oral vaccine wasn’t totally effective, we also funded the creation of new forms of the vaccine, which are targeted at subsets of the three different varieties of polio virus.”