On October 18, Bill & Melinda Gates Foundation Co-Chair Bill Gates and National Institutes of Health (NIH) Director Francis Collins had lively and wide-ranging conversations about genetics and human health. The setting was the Presidential Symposium at the American Society of Human Genetics (ASHG) annual meeting in Orlando.
In his opening talk, Gates outlined a range of global health conditions the foundation is addressing – from HIV to malaria to polio – and the role that genetics play in achieving those goals. “In global health, we still have many mysteries, things that are not well understood,” Gates said.
The Gates Foundation has extensively examined genomes on the African continent, looking for variants that either protect or cause disease. While Sickle cell disease is an incredible burden in Africa, “There’s a chance, in terms of genetic diseases, that it will be one of the first where some form of gene therapy might be practical,” Gates said.
Gates noted that pre-term birth is the leading single cause of death of children under five in Africa. The foundation conducted a genome-wide association study to look at underlying mechanisms. “Researchers were able to identify three highly significant genetic factors associated with pre-term birth,” he said.
One factor is a deficit of the dietary mineral selenium, required in trace amounts for normal health. Once identified, the foundation conducted an intervention study that provides selenium supplements to women during pregnancy.
The genome study also saw a strong association between pre-term birth and an irregular maternal reproductive biome. “Gene sequencing and sophisticated bioinformatics analysis allowed us to look at changes in the microbiome during pregnancy,” Gates said. Again, additional intervention, this time providing probiotic or synbiotic supplements to women, will significantly reduce the chance of preterm birth.
The foundation is close to a near-victory in wiping out polio. Because of the identification of genetic markers in polio, fewer than 40 cases exist worldwide. “We can see from our genetic trees that we’re very close to eradication,” Gates said. The number of identified remaining genetic variants is very small, and polio will become the second disease after smallpox to be eradicated. “We are really in the end game.”
Gates concluded his remarks with a discussion of vaccines. “In order to achieve our ambitious goals, we’ll definitely have to have great advances in vaccines.” Gates talked about the foundation’s collaboration with industry on vaccine development. The foundation will provide research funding; companies in exchange agree to cost-based pricing for very poor countries. Companies can then recoup investment costs by selling new vaccines to developed countries, “a significant win-win where we’re willing to take some of that up-front risk,” Gates said.
Two Powerhouse Institutions
Gates was then joined on the dais by Francis Collins. Their conversation included a discussion of an HIV vaccine and the HVTN 702 study, funded in part by NIH and the Gates Foundation. The study, being conducted in South Africa, involves the only vaccine candidate ever shown to provide some protection against HIV. In South Africa, more than 1,000 people a day are infected with HIV.
Gates and Collins also fielded questions submitted by meeting attendees. One addressed to Gates: what’s your “next big thing?” Gates responded that, when his foundation and other U.S.-based entities make significant progress on a global health concern, the ways the U.S. health system can expand and amplify that progress in poor countries must be identified – and acted upon.
Vaccines, for example. “Vaccines used to take 30 years between when they’re available in the U.S. to when they’re available in Africa,” he noted. But that’s changing. He gave the example of the HPV vaccine, and the fact that one African country, Rawanda, is ahead of the U.S. in uptake of the vaccine.
In his concluding remarks, Collins made a pointed plea to the assembled geneticists: meet one-on-one with members of Congress and share scientific stories. “I can’t tell you how important it is, that when those [funding] decisions are made, that the members of Congress actually have some sense about what’s being done,” Collins said. “And that it’s being done not just in Bethesda, Maryland, but it’s being done in every state and every district around this whole country.”
Collins estimates that he’s met one-on-one with over 400 Members of Congress in recent years. “It always goes well because the story is so compelling. What you all do, what we all do, is the most amazing story that they’ve heard that day.”
Video footage of the Gates and Collins portion of the symposium is available here.