Matthew Basilico and Connie Chen
The New Gates in Harvard Yard
A Students’ Response to the
Philanthropist’s Call to Action
Comment on Address at Harvard by Bill Gates
Bill Gates stood in front of the Class of 2007 as a member of a minority. Much like
Mr. Gates, the seniors gathered at Tercentenary Theatre were certainly well-accus-
tomed to excellence and success. But in believing that “reducing inequity is the
highest human achievement” Mr. Gates likely found himself with scarce company
amid a class that had been cultivated in a collegiate environment oriented toward
the achievement of financial success and prestige. Though Mr. Gates is correct in
noting that among our peers, recognition of global inequities far exceeds that of
previous generations, such knowledge levels have not yet transcended a vague
awareness of global disparities in wealth and human rights.
It certainly has not
yet produced a general consensus that fighting inequity is the greatest form of
human achievement. Nor has it compelled undergraduates to believe that, both in
their current roles as students and in their lives beyond, they should care more
about inequity given how well placed they are to chip away global disparities.
Above Dexter Gate, through which students pass on a daily basis en route to
their classes within Harvard Yard lies the inscription “Enter to grow in wisdom.”
Upon exiting the Yard, students are in turn called to utilize this newly acquired wis-
dom in “depart[ing] to serve better thy country and thy kind.” Though university
mission statements generally call for knowledge generation and the inculcation of
social responsibility among student constituents, Gates’ speech highlights the con-
tinuing poor performance of elite universities in what Gates deems the most
important measure of a modern public institution: impact on social inequity.
Despite Gates’ hopeful remarks that we have attained an increased awareness of
current social inequities, our experience has strongly suggested that Harvard as
well as its peer universities have largely failed to challenge their students to grow in
their understanding of and desire to ameliorate the causal roots of poverty and
inequality.
Knowledge about inequity represents a critical first step in improving our-
selves and our institution against Gates’ criteria for two reasons. Primo, an under-
Matthew Basilico and Connie Chen are members of the Harvard College class of
2008.
© 2008 Matthew Basilico and Connie Chen
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The New Gates in Harvard Yard
combined
standing of inequity begets a deeper moral concern about inequity. As freshman,
we were lucky enough to find ourselves challenged by Dr. Paul Farmer, the Presley
Professor of Medical Anthropology at Harvard Medical School and co-founder of
the renowned medical non-profit Partners in Health. Asked to deliberate upon the
primary risk factor for contracting HIV, we debated the relative contributions of
“high sexual activity,” “intravenous drug use,” “homosexuality,” “living in a high
HIV prevalence area,” not recognizing for a moment the role of “restricted materi-
al agency.” It was through this realization of how intimately intertwined poverty is
with the inequitable distribution of disease risk, access to treatment, and likelihood
of recovery that we came to see
that inequities in heath simply
mirrored
fundamental social
injustices. This newfound under-
standing
con
increased insight into how such
disparities could be ameliorated
through comprehensive commu-
nity-based interventions galva-
nized us to action.
Secondo,
Harvard as well as its peer
universities have largely failed
to challenge their students to
grow in their understanding
of and desire to ameliorate
the causal roots of poverty
and inequality.
understanding
inequity is crucial to fighting
If we fail to contextu-
inequity.
alize, we cannot succeed in com-
ing up with the best answers to
the problems of global inequity. Andrew Natsios, the former director of the U.S.
Agency for International Development (USAID), despite his academic credentials
and impressive public health career, once proclaimed that Africans could not be
put on AIDS treatment because they “do not use western means for telling time. "
Natsios was responding to preliminary indications that adherence to HIV drug
regimens was more difficult in resource-poor settings.
It was only through a
broader understanding of poverty that policymakers came to realize that by pro-
viding only a few extra dollars to alleviate social difficulties including clinic trans-
port, patients in resource-poor settings consistently show adherence rates far high-
er than those in ”Western” settings. Yet it is a problem oft neglected in our class-
rooms, in our curriculum, and in our pre-professional tracks.
Tuttavia, knowledge of inequality will not alone ensure that students of our
generation internalize Gates’ vision of placing the reduction of inequity as our
highest collective priority. Piuttosto, strengthening social ideals—which reinforce the
notion that combating inequality is a worthwhile pursuit—will be critical to
recruiting minds of our generations to social justice. For elite universities, perhaps
the most important challenge is establishing an ethos across the institution which
is passionate about issues of social equity. Seeing role models, including adminis-
trators and professors, deeply concerned with poverty and inequity is likely to leave
a lasting impression that a student should not only seek to understand inequity,
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Matthew Basilico and Connie Chen
but to do something about it.
Nevertheless, though we have begun by contending that Mr. Gates has been
slightly over-optimistic about our current awareness of inequity, we agree with
him that if elite universities are serious about stepping up to the challenge of
inequity, an important first step is that they “will answer with [their] policies.”
These policies must ensure that universities, in their research, teaching and service
activities, address the needs of global poor; they must also serve to cultivate not
just intellectual curiosity but moral consciousness and reflective awareness of
social injustice. We believe that a first step in addressing global inequity would
include adopting the following policies, all of which center around our area of
familiarity, global health disparity.
LEVERAGING UNIVERSITY RESEARCH
Promote Equal Access to Research
In his speech, Gates declared “humanity’s greatest advances are not its discover-
ies—but in how those discoveries are applied to inequity.” In a world of unrelent-
ing biomedical innovation, where stem cells and gene therapy are projected to one
day prolong life almost indefinitely for those with the means and providence of liv-
ing in the developed world, ten million individuals die each year around the world
because they are unable to access the most basic and essential of medicines.1 In
other words, scientific breakthroughs must challenge universities and other public
research institutions to—in tandem—search for ways to distribute the fruits of sci-
ence in an equitable manner.
As the pipeline for novel biomedical therapeutics and devices relies heavily
upon university research and innovation2, out-licensing to biotech and pharma-
ceutical companies for downstream development creates a moment of opportuni-
ty for universities to negotiate licensing terms that will most benefit those in need.
Specifically, when university-owned intellectual property is necessary for the
development of a potential health-related product, universities should require the
inclusion of licensing terms in exclusive technology transfer agreements that
ensure low-cost access to health-related innovations in the developing world. For
technologies such as biologicals and healthcare devices subject to different scien-
tific and technical constraints that might limit generic production, università
should develop a transparent, case-by-case global access strategy to ensure access
when licensing provisions will not serve access objectives. In its Grand Challenges
in Global Health initiative, the Bill and Melinda Gates Foundation already requires
that grantees outline ex ante licensing strategies to ensure that any health products
created with Grand Challenges funds will be available at affordable prices in poor
countries.3
Students, as university constituents, are uniquely positioned to ensure that
their universities take responsibility for their technologies beyond licensing. In
2001, the student advocacy group, Universities Allied for Essential Medicines
(UAEM) as its first campaign successfully convinced Yale University and Bristol-
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The New Gates in Harvard Yard
called
Meyers Squibb to permit generic production of a critical Yale-discovered HIV-
AIDS drug in South Africa, triggering a 96 percent price reduction within a year.
Since then, UAEM has established dialogues with researchers and technology
transfer officials at universities across the United States, Canada, and United
Kingdom, drawn attention to the role of universities in promoting access to
research through numerous publications, and worked closely with Senator Patrick
Leahy (D-VT) in intro-
legislation that
ducing
would mandate humani-
tarian
terms
licensing
modeled on the terms
UAEM is urging universi-
ties to adopt voluntarily.
Last year UAEM released
a statement of policy
principles
IL
“Philadelphia Consensus
Statement”4 that has since
been endorsed by hun-
dreds of luminaries in sci-
ence, medicine,
E
health policy as well as
thousands of other stu-
dent and faculty support-
ers at over a hundred
IL
campuses around
mondo. The Netherlands
and Kenya, on behalf of
IL 46 World Health
Organization
(WHO)
African Region Member
States explicitly referenced UAEM’s statement in their recommendations to the
2007 WHO Intergovermental Working Group on Public Health, Innovation, E
Intellectual Property.
[IO]f elite universities are serious
about stepping up to the challenge
of inequity, an important first step
is that they “will answer with
[their] policies.” These policies
must ensure that universities, In
their research, teaching and
service activities, address the
needs of global poor; they must
also serve to cultivate not just
intellectual curiosity but moral
consciousness and reflective
awareness of social injustice.
This wave of activity has already led to movement by key schools. In March
2007, eleven leading research universities took an important step forward by joint-
ly endorsing a white paper on best licensing practices. The next step to consensus
around the idea that “Universities should strive to construct licensing arrange-
ments in ways that ensure that these underprivileged populations have low- or no-
cost access to adequate quantities of these medical innovations” is concrete policy
change.
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Matthew Basilico and Connie Chen
Increase Research on Neglected Diseases
In the private sector, drug design is guided by market profitability. Tuttavia, under
current market driven research and development systems, tropical infectious dis-
eases find themselves severely neglected in terms of research funding and activity.
Though these ”neglected diseases” are disabling and disfiguring, because they
affect the world’s poorest individuals, the private sector lacks sufficient incentives
to develop safe, effective, and critically needed treatments. For example, nonostante
tuberculosis’ position as the infectious disease killing the highest number of peo-
ple in the world, it is still diagnosed using ineffective tests designed a century ago.
Over half of the basic science research conducted in the United States takes
place within public research institutions. Universities, rooted in the generation and
dissemination of knowledge in the public interest, have an opportunity and
responsibility to take part in alleviating the severe dearth of neglected disease
research. In-house university research and development for neglected diseases
treatments could be achieved through increased administrative support, faculty
development, incubator funding, and physical space. Allo stesso modo, universities could
also engage with non-traditional partners to create new opportunities for neglect-
ed-disease drug development and carve out a neglected-disease research exemp-
tion for any patents held or licenses executed. Supported by funding from founda-
tions such as Gates’, partnerships between product development entities are likely
to yield promising new approaches for neglected disease work. At the University of
California Berkeley, Per esempio, collaboration with the non-profit pharmaceuti-
cal company Institute of OneWorld Health and the small biotech company Amyris
Biotechnologies has allowed the partner organizations to pool their resources and
know-how in developing a new production process for microbial artemisinin, one
of the world’s most effective antimalarial therapy regimens, whose supply has long
been limited by its lengthy agricultural production process.5
EDUCATION
Develop Core Curriculum Offerings focusing on Global Inequity
Elite universities, with their rich financial, intellectual, and technological endow-
menti, boast many of the greatest contemporary thinkers on global inequity—yet
the vast majority of undergraduates are allowed to graduate without ever encoun-
tering them, or their ideas on inequity, in the classroom. For an age in which glob-
al inequity is possible the most important feature of our global landscape, and that
work to combat inequity—according to Gates—is possibly the greatest use of our
efforts, it seems a tragedy that we consistently miss something that matters greatly
in our lives. Infatti, Gates noted that his “one big regret” was that he “left Harvard
with no real awareness of the awful inequalities in the world.”
Though divergent in their scope and mandated areas of study, “core curricula”
remain the cornerstone of education across the majority of elite universities.
Though such curriculum requirements are aimed toward the cultivation of moral
consciousness and intellectual inquiry, it is entirely possible for today’s students to
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The New Gates in Harvard Yard
make their way through their “broad academic exploration”—on, Dire, astronomy,
Bach, Homeric epics and World War II history—without ever encountering the
realities of modern global disparities and the structures which maintain, improve
or exacerbate them. As universities re-work and modernize their curricula, Essi
should make sure to develop a core area solely devoted to inequity, or to stock cur-
rent core areas with many more inequality-focused courses. A simple first step
would be to recruit luminaries such as the Joseph Stiglitzs and Jim Kims of the
world to teach a core course on structural violence, social justice, and global health
inequity.
Expand Options in Career Services
Career services centers play an important role in advising college students on their
vocational choices and making opportunities available for post-graduate work. A
Harvard, the Office of Career Services has an impeccable record at placing students
into lucrative private sector jobs, such as those in investment banking, corporate
finance, and consulting. Throughout junior and senior years, students are flooded
with information sessions hosted by corporations, receive refined advice from a
network of business tutors and career counselors, and have an extremely simpli-
fied online “e-recruiting” application process which puts hundreds of post-gradu-
ate job opportunities at one’s finger tips. It is no surprise then that at Harvard over
half of each senior class has consistently entered private sector employment fol-
lowing graduating.
In contrasto, despite new waves of interest and considerable pressure from stu-
dents, opportunities in global health, remain extremely lacking. Offices of career
services have an opportunity and a responsibility to make positions in global
health equity much more widely available through their systems. Achieving this
goal, Tuttavia, will take significant effort on behalf of the offices, which are typi-
cally accustomed to well-resourced employers beating down their doors in eager-
ness to attract talent. Even the most established of today’s organizations on the
front lines of global health have very constricted budgets for staffing and hiring.
Regardless of their need for new recent graduates, they will never have the capaci-
ty to reach out to University career offices in the same manner as Goldman Sachs.
Therefore, the onus is upon career services offices to adopt proactive strategies in
building adequate capacity in global health opportunities. Through simple part-
nerships with on-campus global health institutions, schools of public health and
alumni working in global health, career service offices should have no problem
organizing career fairs, publicizing informational sessions, educating counselors
on available opportunities, and streamlining opportunities into their on-line data-
base. Global health opportunities highlighted by career services offices should cer-
tainly not be limited to clinic based positions with well-known NGOs such as
‘Medicins San Frontieres’. Grassroots organizations often have greater human
resource needs; neither should it be overlooked that water, sanitation, agriculture,
female empowerment, among many other areas, are also inextricably linked to
health. These efforts would be well-rewarded by Gates’ metric, and would help to
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Matthew Basilico and Connie Chen
send scores of highly capable graduates into the careers directly fighting for glob-
al equity.
Expand Options for Overseas Experience in Education and Service
For those students who are currently considering careers on the front lines of glob-
al health, well-developed internship programs for undergraduates are very difficult
to identify. Where they do exist, they are extremely competitive.
The University, Tuttavia, has the capability to make these types of opportuni-
ties far more accessible to its students. Many of the service providing NGOs that
undergraduates desire to work with do not take students for very rational reasons:
students often do not have cultural competency, practical training, and general
understanding of public health and professionalism. Universities, Tuttavia, can
overcome these gaps by providing targeted training to make their students more
useful to service providing NGOs in resource poor settings.
A possible solution would be to establish two-summer programs in global
health in which students would spend a summer at their home institution receiv-
ing training in practical and theoretical issues—including cultural competency—
as well as professionalism in conduct in order to go serve an NGO overseas in the
second summer. Second summer placements could be made before the beginning
of the first summer, enabling the curriculum to include language, historical and
cultural studies directly relevant to the student’s experience the following year.
Internships are a very important part of career exploration in a student’s life, E
multitudes of opportunities currently exist for paths less related to fulfilling Gates’
criteria of “reducing inequity.” Universities should take the necessary steps to make
these types of opportunities available to their students, and ensure their students
arrive in service positions overseas with the skills, understanding, and maturity
necessary to make a contribution in complex and sensitive settings.
Though record-breaking levels of students are currently studying abroad, IL
percentage of students traveling to developing countries remains low, with only 4
percent of study abroad students, Per esempio, choosing to travel to Africa.6 Even
when students manage to access programs in developing countries, they find it dif-
ficult to escape capital cities where they are frequently surrounded by American
expatriates, diminishing their interaction with local students. Universities should
develop programs that will allow students long-term academic and cultural
immersion in resource-poor settings. Within the sciences, “twinning” with inter-
national research partners would provide researchers with unique exposure to dif-
ferent research resources and systems of science. The Global Science Corps pro-
posed by Nobel prize wining scientist Dr. Harold Varmus in which United States
institutions and foreign universities would implement one-year exchange fellow-
ships for scientists represents one such model.7
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The New Gates in Harvard Yard
GLOBAL SERVICE
In her recent fall welcome address, newly inaugurated Harvard President Drew
Faust reminded the students and parents of the Class of 2011 that universities are
unique because of their “missions of public service.” However, despite President
Faust’s proclamations, universities have long primarily limited their global health
involvement to teaching and research with limited engagement in long-term serv-
ice delivery in developing world settings. Tuttavia, in order to conduct research
and educate students about health delivery, universities must actually engage in
service provision on-the-ground so that students and faculty can learn and address
first hand the practical challenges of global health. As Dr. Paul Farmer has fre-
quented stated, “It’s not as if students who want to do this work want to go and be
spectators to poverty. They want to do something useful to the people they are
around. We need to have “effector arms” so that we can have an impact on poor
communities.” University teaching hospitals are well situated to lending their expe-
rience in establishing increased training and research opportunities in the poorest
of settings.
Where the University is already engaged in service provision on the ground, Esso
is important that indirect overhead costs retrieved by the University remain with-
in appropriate measures. Since most Universities do not presently have a category
for implementation of direct service work when classifying activities, ambiguity
has often lead Universities to extract a significantly higher indirect overhead pre-
mium than non-academic organizations which perform similar services. For
esempio, Harvard University initially negotiated an indirect overhead rate of over
45 percent in a $107 million grant for AIDS treatment from the United States Office of the Global AIDS Coordinator “PEPFAR” program. This exorbitant figure sent tens of millions of dollars intended for AIDS patients in Tanzania, Nigeria, and Botswana to instead fund the maintenance of Harvard’s offices, the adminis- tration of its libraries, and the salaries of its administration. Universities must resist the temptation to leverage their monopsony power as one of only a handful of service providers in many countries overseas, and only charge overhead rates that would be comparable to non-governmental organizations which do similar work. The adoption of a new classification for “off-campus service provision” with an indirect rate of 20 percent or lower would be a positive beginning. AVENUES FOR STUDENT ENGAGEMENT IN GLOBAL HEALTH Earlier this Fall, just under a thousand Boston and Cambridge students and resi- dents gathered inside the John F. Kennedy Forum Room at the Harvard Institute of Politics to hear Dr. Paul Farmer and Mr. Ira Magaziner, Chairman of the Clinton Foundation HIV/AIDS Initiative speak on potential avenues for student engage- ment in global health. Despite the many challenges that remain in global health equity, the mood was one of optimism. The success of the Partners in Health model, its recent expansion into Africa with the Clinton Foundation and its pro- innovazioni / autunno 2007 33 Scaricato da http://direct.mit.edu/itgg/article-pdf/2/4/26/704195/itgg.2007.2.4.26.pdf by guest on 08 settembre 2023 Matthew Basilico and Connie Chen posed scale-up throughout entire countries seemed to be only a glimmer of what is possible in the future of global health. Both Dr. Farmer and Mr. Magaziner emphasized that their scaling these large mountains is not the sole purview of late- career professionals: students not only have a role to play, but their position and influence in the movement has been crucial. From driving support for Presidential candidates platforms on HIV/AIDS through the ’08 StopAIDS Movement, lobby- ing pharmaceutical companies to improve their access policies in developing coun- tries to lobbying Universities to adopt policies similar to those outlined above, stu- dents remain an irreplaceable part of the global movement to make health a human right. As Gates says: “Don’t let complexity stop you. Be activists. Take on the big inequities. It will be one of the great experiences of your lives.” 1. World Health Organization (2004) Equitable access to essential medicines: A framework for col- lective action. Geneva: World Health Organization. Available:
pipeline in the United States. Between 1993 E 2003, the number of patents and license agree-
ments executed by universities approximately doubled, and it is projected that the number of
patents executed by universities for pharmaceutical technologies will only continue to increase
(AUTM, 2003; PhRMa, 2005). Universities hold the patent rights to a number of critical thera-
peutics ranging from HIV drugs such as stavudine (Yale University), abacavir (University of
Minnesota), lamivudine (Emory University), emtricitabine (Emory University), and enfuvirtide
(Duke University) to cancer drugs such cisplatin and carboplatin (Michigan State University),
permetrexed (Princeton University) and cetuximab (University of California, San Diego)
(Kapcyznski et al, 2003). 80% of today’s prescriptions for AIDS medications include at least one
drug covered by Emory’s intellectual property rights (Emory TTO, 2007).
3. Chen I. Thinking big about global health. Cell. 2006;124(4):661-663.
4. http://consensus.essentialmedicine.org
5. For a detailed description of the project and collaboration, see http://oneworldhealth.org/dis-
eases/artemisinin.php.
6. Vedere
7.
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