The foundation hopes that, once put in place, the surveillance system can be repurposed to detect and respond to new outbreaks. According to many global health experts, including Bill Gates, one reason why Ebola wreaked so much damage in West Africa was that the affected countries lacked good healthcare infrastructure.
I spoke with Gates recently about how he hopes to cut child deaths, once again, in half by 2040. A lightly edited transcript of our conversation follows.
Olga Khazan: One thing that surprised me as I was learning about your current initiatives, and the situation on the ground in some of these countries, is that we don’t actually always know when a child dies and why. Why does that happen, and how does it foil our attempts to reduce childhood mortality?
Bill Gates: Our uncertainty about our disease estimates is pretty high. When you look at what are kids dying of in the [Democratic Republic of Congo] ... what they're doing is simply asking mothers what they saw, and that's called a verbal autopsy, and that doesn't really tell you what caused the diarrhea, or what caused the fever. And so we're relying on very, very few cases where we're going out to get samples to figure out what the exact cause was.
In some ways, when we were going after the biggest killers that are everywhere, like pneumococcus for respiratory and rotavirus for diarrhea, we didn't need very precise figures. But now that those are going to be knocked down, depending on the vaccine coverage, to almost zero, the remaining pieces [are things like] where is cholera, where is typhoid? Should you do a vaccine for that or not? Cholera continues to be very episodic over time in different locations.
We've added in these six centers that we're funding, we have two things. One is the latest genetic tools so that any samples we have we can figure out what's going on. The second is, instead of doing verbal autopsies, when we get permission, which we hope will be for five to ten percent of the deaths, we go in and get a minimally invasive autopsy. Then you can go in and using the genetic tools, you can get a sense of what's going on. And so we can take our error bars about these different causes of death and start to resolve those so that the global health community is well-directed. We would make this investment just for the ongoing death-reduction agenda, but this is kind of a dual benefit that we've designed so that these lab tools and expertise could both see an epidemic earlier on and could deploy to nearby areas to make sure that we're a lot smarter than we were in the Ebola epidemic.
Khazan: How will tracking childhood deaths through something like CHAMPS help prevent them? What do you plan to do once you have the information?
Gates: What it will show us is the changes in different locations. We have early work going on for vaccines for respiratory diseases, diarrheal diseases, typhoid, which is both a respiratory and intestinal disease. We need to know how to prioritize the creation and the volume procurement and delivery of these additional vaccines.