Bill Gates, co-founder of Microsoft and the Bill and Melinda Gates Foundation, came to Boston last Thursday to open the ASM Microbe 2016 conference. As the wealthiest person in the world, Gates has been able to make his foundation a major player in improving global health and poverty. Their grand challenges and targeted funding have helped push the needed innovation toward their strategic goals.
ASM Microbe brought Bill Gates to talk about global health and particularly the contribution of microbial sciences innovations and understanding that can improve healthcare. Richard Besser, currently ABC’s chief health and medical editor and former acting head of CDC, interviewed Gates on stage as some 7,000 conference attendees gathered in the Boston Convention and Exhibition Center. From the start, Gates made it clear that he sees new biotechnology as a major part of their efforts to eradicate diseases.
Eradicating an infectious disease means that zero people have that disease to cause another outbreak. Gates described that zero as a magic number because it saves money and in treatment and prevention due to the “years of zero in the future”. Right now, the foundation sees saving a life for around $1,000 as the best spot in the tradeoff of disease priorities, but new technology can potentially change that formula with future payoffs.
The conversation quickly went to malaria and the new technologies that could drive it to zero as is being done with Polio. This deadly disease is caused by the Plasmodium parasites that are transmitted by mosquitoes when they bite humans. The transfer of parasite from mosquitoes’ saliva to humans’ blood can be difficult to stop as there is not proper infrastructure in many affected areas to contain mosquitoes. Gates said he still wants to see a better vaccine, but embraced the more controversial technology of gene drives. These gene drives essentially bias the inheritance of a certain gene so that a gene spreads through a population better than random chance and natural selection would normally allow.
Gene drives have been enabled by gene editing technologies like CRISPR-Cas9. Gene drives work by copying over a gene drive sequence to replace a normal host gene after engineered organisms mate with wild organisms. Therefore if the newborn organism inherits just one copy of the gene drive, it will get copied over and all offspring become homozygous for the gene drive. For instance, a gene drive could include Cas9, a guide RNA that targets a host gene whose activity determines disease spreading, and an inactive gene with homologous ends to the site of the genome being cut. Even if the inactivated gene causes a fitness cost it can spread through the population since it is inherited with greater probability than normal Mendelian genetics would predict. A version of this could be used to modify or wipe out a mosquito population by making female mosquitoes infertile. For a more in-depth explanation see this Vox explainer on the gene drive technology, applications, and risks.
The power and novelty of a technology that drastically reshapes ecology and evolution in such an engineered way raises many questions of regulation. Besser asked who would decide if/when gene drives could be released into the wild. Gates joked that mosquitoes certainly “won’t get a vote”, but “sovereign nations decide” on an issue like gene drives. Besser pressed him on the fact that mosquitoes don’t respect borders and can have a global impact, but Gates pointed out that many issues now affect global safety including climate change, epidemics, and war all of which are decided by individual or collaborating countries. Overall, Gates seemed optimistic on gene drives becoming approved stating that his “guess is that this tool will find use”.
In response to an audience question, he also addressed technologies like engineered probiotics that may face new regulatory challenges. He had met with the company SynLogic that is engineered a probiotic E. coli to treat metabolic diseases. Since the bacteria do not effectively colonize the gut, the treatment would be re-dosed every few days and avoid long term risks of evolving away its intended function or becoming difficult to remove. Gates sees a reasonable regulatory approach for a new biotechnology like engineered probiotics and said that it will probably get out there in the next few years.
The discussion ended with the wide view that the Gates Foundation often takes toward global health. When asked about the presidential campaign, he said they will continue to work with every U.S. administration in addition to foreign governments to improve global healthcare. He did admit that some U.S. candidates haven’t shown a “full understanding of vaccines” which prompted chuckles from the audience. Finally, of the many applications available under their broad scope, he gave special mention to understanding both over and under nutrition, diagnostics at point of care, and understanding the microbiome.