Approaching mhealth with humility: Guest Opinion by Bill Gates

November/December 2010 | Volume 9, Issue 6

Computing technology has been great for health care, but primarily on the research side. Anything that facilitates new vaccines is fantastic; that is the miracle intervention in health care on a worldwide basis. Although it would be hard to measure, some combination of the internet, digital databases and collaboration tools really have changed medical research.

In the case of the cell phone, there’s a chance to go beyond that and actually be there with the patient, there in the clinic, which might not be staffed with a fully trained doctor. There are a lot of opportunities. I think we have to approach these things with some humility, though.

I think we have to hold ourselves to some pretty tough metrics to see if we’re really making a difference or not. I think it’s always valuable to go back to “what is the key metric you’re trying to improve?” Maybe the simplest one is the number of kids who die under the age of five, which is about eight and a half million now. If you go back as far as 1960, that was 20 million, so it’s a pretty dramatic reduction. About a third of it is by increase in income, which gives you better nutrition and better living conditions. The majority of it has been done through vaccines. Smallpox was killing two million per year, now it kills zero per year. Measles was killing a million and a half, now it kills about 300,000 a year.

So when we say to ourselves what can we do on this eight and a half million, that actually partitions into two parts. There’s the first 30 days of life, which is about three and a half million of it, then there’s 30 days to five years, which is about five million. There again, vaccines are going to be key: malarial, respiratory, diarrheal.

So how would cell phones fit in? If you knew, if you could register every birth on the cell phone, get fingerprints, get a location, then you could take these systems where you go around and make sure the immunizations happen and run them in a more effective way. Vaccine coverage in the very poorest regions, like the north of Nigeria or north of India are below 50 percent, and so you’d get a huge improvement if you could just take the vaccines we have today and get those delivered.

When I think about the biggest impacts, I think of patient reminders, not clear but if you could get people to take TB drugs regularly, if you could get them, even in the rich world to take medicines regularly, remind mothers to do various things, particularly in that first year of life. That’s a huge one. The supply chain for all of the goods, making sure there are no counterfeits and no stock-outs and making sure people know what’s available, there’s a quite a bit that could be done there. Finally, online digital records where the high payoff for that is vaccination coverage, which means you have to get in at a fairly early age. Those are some of the higher payoff things.

Because it’s new technology we should let 1,000 ideas blossom. But if we go back to the key metrics, can we drop the number of children who die per year in half, and get the reduction in sickness and population growth that comes with that? That is front of mind all the time.

Bill Gates is co-chair and trustee of the Bill & Melinda Gates Foundation. He delivered an expanded version of these remarks at the 2010 mHealth Summit.

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