Daring to think big

Zuckerberg and Chan’s bold medical research funding pledge could have a huge impact, says Tom Whipple.

When, in the early 20th century, American industrialist Andrew Carnegie set up an endowment to ‘‘hasten the abolition of international war’’, he had a niggling concern. What if it was successful too soon?

He hastily added a clause to deal with the problem of achieving world peace before the funds ran out – stipulating that any remaining monies could be spent on banishing ‘‘the next most degrading remaining evil’’.

Carnegie’s philanthropic successor, Mark Zuckerberg, has offered a similarly soaring vision. He and wife Priscilla Chan have pledged US$3 billion to be spent not just on medical research but, specifically, to ‘‘cure, prevent or manage all disease by the end of this century’’.

The announcement that they will use a large chunk of the Facebook founder’s money to achieve a goal that has eluded humanity since Hippocrates has attracted a certain amount of scepticism – and not just because, unlike Carnegie, they haven’t specified what they will do if they succeed before the money runs out.

The pledge has also attracted a lot of praise, however. Bill Gates said it would ‘‘literally save millions of lives and make the world a better place’’. An editorial in the journal Science, while accepting it would ‘‘raise some eyebrows’’, congratulated them for ‘‘daring to think big’’.

The Wellcome Trust, the secondhighest-spending charitable foundation, after the Bill and Melinda Gates Foundation, also said it was delighted to see a new entrant to the field. ‘‘I’d like to congratulate Mark and Priscilla for starting such an ambitious venture to understand health and disease,’’ said Jeremy Farrar, its director. His statement did add, though, that the trust was itself planning on spending double that over the next five years.

So even as the applause receded for Chan and Zuckerberg, there were mutterings about the hubris of Silicon Valley.

It is not just that people have been trying to cure disease for quite some time now, with only incremental success. Others identified a more fundamental problem: ultimately, human beings have to die of something.

‘‘They are not going to do this with US$3b,’’ said Tarit Mukhopadhyay, a vaccine researcher at University College London.

True, US$3b is a lot of money, but the United States National Institutes of Health, a government research agency, spends 10 times that each year – half of which goes on the basic fundamental research of the kind Zuckerberg and Chan are funding.

Even with the can-do chutzpah of Silicon Valley, Mukhopadhyay says there are expensive practicalities that cannot be circumvented.

‘‘Take a vaccine: you have to scale up manufacture, get enough doses, put it through three phases of a clinical trial. That’s maybe half a billion on one product. And that’s before you have to implement and deliver it.’’

Others would argue, however, that this may be precisely the sort of There’s a long tradition in philanthropy of grand ambitions. problem that Silicon Valley is good at disrupting and solving, and that the current paradigm of medical research is failing.

Put simply, drugs cost too much. To get a single workable drug takes more than a decade and close to a billion dollars. Maybe precisely what is needed is the sort of vision provided by internet companies that in the past decade have transformed staid industries, from hotels to taxis.

Benjamin Soskis, a fellow at the Centre for Non-Profit Management, Philanthropy and Policy at George Mason University in Virginia, says that sometimes, big goals are useful.

‘‘There’s a long tradition in philanthropy of grand ambitions. In a way, this fits into an early 20th century scientific philanthropy mindset, which represented the first sustained effort to eradicate particular diseases.

‘‘The difference is now we have the ambition filtered through an engineering mindset, and even more ambitious.’’

Soskis says one of the notable aspects of this gift is that by investing in fundamental research – rather than public health measures or applied research – it represents a far more longterm investment.

The Science Philanthropy Alliance, an organisation that has been advising Zuckerberg and Chan, has been pushing for more money for this kind of work.

Much of the money will be spent on a US$600 million ‘‘Biohub’’, bringing together scientists from Stanford, Berkeley and the University of California, San Francisco to collaborate in new ways.

Steve Caddick from the Wellcome Trust says this is just the sort of innovation that is needed, and saying, even correctly, that the money is not enough to cure all diseases misses the point.

‘‘We have to get past the idea that there’s any amount of money that will solve a problem,’’ he says.

‘‘What solves a problem is a combination of inspiration and dedication, supported by the right resources and environment.’’