The Gates War on HPV Leads to Remote Mali and a Novel Way to Educate Women

More than most parts of the world, Mali has been devastated by the HPV virus. Though cervical cancer can be prevented by measures that prevent HPV, and HPV can be prevented by a simple vaccine, the link between HPV and cancer—and the very existence of an HPV vaccine—are recent enough developements that the global public consciousness hasn't quite caught up with medical discovery. Mali, which has the 14th highest rate of HPV infection in the world, and an HPV fatality rate of roughly 50 percent, is in grave need of access to cancer prevention options.

This sounds like a job for the Gates Foundation, right? You bet it does, given that the foundation has a grantmaking basket in its global health program to fight "negelected and infectious diseases." It was out of that basket that the foundation made a $10 million grant just a year ago to reduce both the incidence and mortality from cervical cancer caused by HPV infection "by helping establish routine use of effective HPV-DNA screening tests in countries with high burdens of disease."

Note the focus on "routine use of effective screening tests." The Gates Foundation loves to go after low-hanging fruit when it comes to health challenges—helping bring basic preventive practices to poor countries. That's where it can really get a lot of bang for the buck, although the foundation also spends lavishly to tackle tougher challenges.

Other HPV grants over the years have also often focused on simple solutions, like a $1.9 million grant in 2012 to help make an HPV vaccine "available to the masses at an affordable cost."

The HPV effort also showcases another trademark of the Gates approach: how it plays the long game. That $10 million grant mentioned earlier for screening came 11 years after an earlier grant to the same organization for $12 million to develop rapid tests to screen for HPV. This is a foundation that spends big to develop the solution, and then spends big to deploy it. 

Related: Gates Foundation: Grants for Global Health

Earlier this year, Gates awarded $100,000 to the Mali Health Organizing Project in Cambridge, Massachusetts. With Gates' support, the project is training health clinic staff in Mali on the finer points of patient hospitality. Evidently, the country's clinic staff have been sufficiently unsympathetic that target service populations are foregoing clinic visits at substantial cost to public health.

In another Mali grant, Gates invested in Malian health through a donation to the GAIA Vaccine Foundation. GAIA, which stands for Global Alliance to Immunize against AIDS, is the brainchild of Dr. Anne De Groot, internationally renowned researcher on immune responses to vaccines. 

De Groot has been working to improve immunology scenarios in Mali, with the help of in-country clinics and medical researchers. Alarmed by the prevalence of HPV in Mali, De Groot conducted public health assessments in the country and concluded that fewer than three in 100 Malian women were aware of the association between HPV and cancer. That figure is depressingly low.

Here's where things take an unusual twist: With appreciation for West Africa's history of using colorful, illustrated textiles to tell stories and convey information, De Groot wondered if it would be possible to communicate to Malian women about HPV using this means.  

De Groot recruited Eliza Squibb, recent Rhode Island School of Design graduate and global textiles expert, to help create a storytelling cloths that could accurately and attractively convey linkages between HPV and cancer, and teach Malian women about the benefits of the HPV vaccine. In collaboration with De Groot, Squibb produced a brightly-colored and medically sound storytelling cloth prototype. In blue, yellow, and orange, the cloth illustrates how vaccines prevent HPV infection, and how, unimmunized, women are prone to contracting HPV and potentially developing cancer. 

DeGroot and Squibb traveled to Mali with their instructional fabric to get feedback from in-country doctors about the storytelling cloth's viability as an effective HPV prevention tool. Malian clinic staff were enthusiastic about the potential usefulness of Squibb's design.

With some changes recommended by Malian health professionals and the Gates Foundation's financial support, DeGroot and Squibb will begin reproducing their HPV vaccine storytelling cloth and distributing the fabrics to healthcare workers in Mali.

Gates' grant is going toward the storytelling cloth's printing expenses and the engagement of Malian physicians, musicians, and female leaders in promoting HPV vaccine awareness.