Dear Bill

Just as Ted Turner with his one time gift of US$ 34 million to the US State Department has recently bailed out the US government with regard to its outstanding dues to the UN (supposedly negotiated in 10 minutes between him and Richard Holbrooke) so have you bailed out global health. In the short period of three years your Bill and Melinda Gates Foundation has supported global health development in your areas of choice (vaccine development and maternal and child health). The budget of the World Health Organisation pales in comparison. You should be praised for this commitment. One of my students suggested that you get the Nobel Peace Prize, together perhaps with George Soros and other global health philanthropists. But the news is not just positive and that is why I am writing this new year's note.

Global health challenges are no longer the exception they are the rule. An ad hoc response system run on good will and philanthropic largesse like yours can only be an intermediary step. Already the law of unintended consequences is starting to have its effect. Newly established global disease investment funds, run from office suites in New York, Washington, Geneva and Brussels are set to fund raise, compete and conquer, each seeking contributions in the billions of dollars from the same sources for “their” disease. Their start up venture capital usually comes from your foundation. Perhaps the public health community needs to get used to the fact that the best way to fight the diseases of the poor is to allow a lot of people to get rich while doing it. Lets commodify it and make it really attractive for investors by making it really threatening.

I agree that urgency, flexibility, marketing and innovation are indeed crucial to solve the global health challenges, and it was really high time that some high power energy entered the global health arena. But, like Macchiavelli, I still believe in the importance of foresight and good governance. Global health also needs transparency, accountability, legitimacy and respect for due process. And some of those processes are downright tedious, boring and very long term as the World Health Organisation can testify. Yet they need to be done.

I know you don't like being bored. But I need to say it all the same. We need an operating system for global public health that allows us to do both the tedious and the exciting things without getting in each others way too much. At present we lack a global public policy on health, we lack an effective and participatory governance structure and most importantly we lack a financing mechanism that ensures continuity and allows large scale impact. All the things I guess a big global company worries about all the time. That explains my wish for the new year. The next big challenge for global health is not yet another disease initiatitive. John Maynard Keynes helped invent the United Nations. Bill, go the next step and invest your creativity, resources and influence to help create a financially viable network structure fit for global public health in the 21st century it. Then you would really deserve the Nobel Peace Prize.