Gates, Doudna Address Global Health Challenges, Solutions

Neil Osterweil

June 20, 2016

BOSTON — There has been a huge reduction in childhood deaths during the past 25 years, philanthropist and Microsoft cofounder Bill Gates told a crowd of more than 7000 packed into a cavernous hall at the Boston Convention and Exhibition Center. "We've gone from about 9% of children under 5 dying to now 4.3%," said Gates, speaking here at the American Society for Microbiology (ASM) Microbe 2016.

"That is really phenomenal — that's a faster decline than ever in the history of the world — but it's still almost 6 million children a year. So we have a lot of work to do to take the latest in science and the resources of the world and cut that number even more dramatically," he said.

Reducing childhood mortality is one of the priorities of the Bill and Melinda Gates Foundation. The goal, Gates said, is to promote global health equity, so that "a child in a poor country has no more of a chance of dying than a child in a rich country."

According to the World Health Organization, the leading causes of death among children younger than 5 years are pneumonia, malaria, and diarrhea. The largest proportion of childhood deaths occur within the first 30 days of life, the neonatal period. Half occur during the first 7 days of life, and half of those occur in a child's first and only day on earth, said Gates.

Bill Gates (Source: AP Photo/Christophe Ena, Pool)

Addressing deaths from infectious diseases is challenging but straightforward, he explained. It involves a combination of vaccination programs; better, cheaper, and more accessible drugs; and public health and hygiene programs backed by financial resources.

But tackling the causes of neonatal mortality will be much harder.

"It's fair to say that we actually know far less about that than we need to," said Gates.

"Unlike in the other cases, where the kinds of tools and things we need to do are clear, in this case we need a lot more discovery to understand what the elements are and how we can drive that down."

To support these ambitious goals, the foundation launched the Child Health and Mortality Prevention Surveillance Network (CHAMPS), a network of disease surveillance sites in developing countries. The network is designed to gather data quickly and accurately to support public health interventions in areas of high mortality, focusing on preventable deaths, including neonatal deaths and stillbirths.

The Gates Foundation also underwrites efforts to reduce or eliminate malaria transmission through genetic manipulation of mosquitoes to either prevent them from reproducing or to cripple the malaria parasite in its ability to infect the biting insects and exploit them as disease vectors.

CRISPR/Cas9

CRISPR/Cas9 technology, pioneered by Jennifer Doudna, PhD, professor of biochemistry and molecular biology at the University of California, Berkeley, and her former research partner Emmanuelle Charpentier, PhD, now a professor at the Max Planck Institute for Infection Biology in Berlin, Germany, is a vital technology used in these efforts.

Dr Jennifer Doudna (Source: AP Photo/Susan Walsh)

As outlined in their seminal article in Science , Dr Doudna and Dr Charpentier discovered that clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated systems provide bacteria with a form of adaptive immunity against viruses and plasmids that allows them to prevent the activation of invading nucleic acids.

It is exciting "to be working on a microbial system that still has, I think, many interesting mysteries yet to be revealed," said Dr Doudna, who also addressed the crowds here at Microbe 2016.

"What I think is so fascinating about this system is that it's effectively a bacterial adaptive immune system, a way that bacteria can pry away genetic material from their infectious agents, store bits of that material in the genome, and then generate RNA copies of that material that can be employed in the future to protect the cell from those same invaders should they try to infect the cell again," she said.

The technology is currently being used in myriad applications running from the serious to the seemingly frivolous.

For example, toward the lofty goal of eradicating malaria, investigators at the University of California, Irvine, have created a line of mosquitoes altered to carry a malaria resistance gene, and researchers at University College in London, United Kingdom, have described using CRISPR/Cas9 to insert three genes conferring sterility on female mosquitoes of the species Anopheles gambiae, the main vector for malaria.

Other groups are looking into the use of the technology to improve muscle function in mouse models of muscular dystrophy, to create a line of less allergenic chicken eggs, to prevent colony collapse disorder among honeybees, to create edible mushrooms that don't brown readily when cut, and even, in China, to create specialized pets that can be customized to buyers' preferences.

"Within only a few years, CRISPR/Cas genome editing has become transformative technology that is revolutionizing the fields of genetics, molecular biology, and medicine," commented Nicole Dubilier, PhD, director of the Max Planck Institute of Marine Microbiology, in Bremen, Germany, who introduced Dr Doudna.

Dr Doudna said that the power of the technology has generated in her "a sense of responsibility to be involved in at least explaining the science behind it and in helping to educate people so that they can think about the ethical implications of this kind of use and this technology."

American Society for Microbiology (ASM) Microbe 2016: Presented June 17 and 18, 2016.

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