The numbers are as plain as 1-2-3. Over one million
annual deaths from malaria, almost two million from
tuberculosis, and more than three million from
HIV/AIDS, most of which occur in underdeveloped
countries.1 Among the young, the situation is even more
jarring: 2·4 million children dead from perinatal causes,
another 1·9 million from lower respiratory infections,
1·6 million from diarrhoeal diseases. And on and on.
At the same time, the approximately US$75 billion a
year globally spent on medical research all but ignores
the problems of the developing world, as expressed in
the so-called 10/90 gap, whereby only 10% of health
sciences’ research dollars address the health problems of
90% of the world’s population.2,3 Moreover, only a small
portion of this research is published in major medical
Enter the Bill and Melinda Gates Foundation,
endowed with 26 billion and a larger annual global
health budget than WHO. In January, 2003, the
Foundation launched a “Grand Challenges in Global
Health” initiative to stimulate scientific researchers to
develop “solutions to critical scientific and technological
problems that, if solved, could lead to important
advances against diseases of the developing world”
(http://www.grandchallengesgh.org). Administered by
the Foundation of the National Institutes of Health, the
Grand Challenges initiative issued an open call to
investigators from anywhere in the world to propose
ideas to an international scientific board. In October,
2003, the first 14 Grand Challenges were announced
(panel 1)—selected from more than 1000 submissions—
and readied for research proposals,5 which are currently
competing for $200 million in research grants. Grouped
into seven goals, ranging from improving the
measurement of health status to bettering nutrition,
vaccines, and treatments for infections, and control of
vector-borne diseases, the Grand Challenges appear
poised to improve the health of the underdeveloped
world. But can they?
One way to answer this question is
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