A conversation with the Gates Foundation (Measles) on April 27, 2012

Participants

• Violaine Mitchell — Interim Director, Country Immunization Programs, Bill & Melinda Gates Foundation
• Matt Hanson — Program Officer, Country Immunization Programs, Bill & Melinda Gates Foundation
• Jenna Mulhall-Brereton — Consultant (Geneva Global), Bill & Melinda Gates Foundation
• Cari Tuna — Co-Founder, Good Ventures
• Holden Karnofsky — Co-Executive Director, GiveWell
• Natalie Crispin — Research Analyst, GiveWell

Note: This set of notes gives an overview of the major points made by Violaine Mitchell, Matt Hanson and Jenna Mulhall-Brereton.

Summary

The Bill & Melinda Gates Foundation participants on this call expressed their belief that measles vaccination is a particularly powerful intervention to decrease child mortality. For about US $1.50, a child can be safely and effectively vaccinated against measles and rubella. Founded in 2001, the Measles and Rubella Initiative — a partnership led by the American Red Cross, United Nations Foundation, U.S. Centers for Disease Control and Prevention, UNICEF, and the World Health Organization — has provided support to countries in their efforts to reduce measles morbidity and mortality.

The foundation considers the Measles and Rubella Initiative a committed partner and has contributed to this initiative in the past. The foundation would be happy to see Good Ventures/GiveWell participate in this effort.

Global measles vaccines funding

• Two doses of measles vaccine provide lifelong protection against the disease. The first dose is often provided at age nine months through routine immunization, funded largely by country governments. However, as not every child has access to routine healthcare, some miss this opportunity. In some cases, it has been noted that countries may spend less on routine immunization in favor of running more campaigns, which are externally funded.
• To date, the Measles and Rubella Initiative has invested more than US $875 million in measles control activities in more than 80 countries.
• The GAVI Alliance provided funding to the Measles and Rubella Initiative between 2004 and 2007, through the International Finance Facility for Immunisation (IFFIm).
• GAVI has also supported measles control through offering countries the opportunity to introduce a second dose of measles vaccine into their routine immunization program (provided they've reached 80% coverage for the first dose). From 2004 to 2007, only the Democratic People’s Republic of Korea and Vietnam applied for and received this support. This year nine more countries have applied and been accepted. Countries receive full support for three years and then they are expected to continue the program on their own.
• GAVI has approved funding for “2nd dose” measles/rubella campaigns and is considering additional funding for measles follow-up campaigns for a small number of GAVI-eligible countries, as well as funding for an outbreak response fund.

Gates Foundation approach to measles/rubella control

• The Gates Foundation is currently in the midst of discussions about how it will contribute to measles control. The foundation will likely focus its measles efforts on sub-Saharan Africa, given that this is the area with the greatest unmet need.
• There are some outstanding questions regarding the use of rubella vaccination, but the Gates Foundation believes that introducing this vaccine is worthwhile. However, there should be a learning agenda for rubella vaccination that attempts to address the outstanding questions.
• The foundation has limited resources available for new vaccination commitments, given its very significant current commitments to the polio eradication effort and GAVI.