Mark Zuckerberg’s $3 billion donation is generous, but philanthropy won’t compensate for our government’s failures.
By Mike White
Three billion dollars seems like a lot of money. That’s how much Facebook co-founder Mark Zuckerberg and his wife, physician Priscilla Chan, have announced that they’ll give to basic biomedical research over the next decade. With characteristic Silicon Valley audacity, Chan and Zuckerberg see this as a way to catalyze scientific breakthroughs that will allow us to “cure, prevent, or manage all diseases by the end of this century.”
But within the overall scope of biomedical research, $3 billion over a decade is not a lot of money. Each year, the National Institutes of Health, one of the world’s largest funders of biomedical research, spends $30 billion on research — one hundred times the average yearly amount pledged by Chan and Zuckerberg. While we should commend wealthy donors who choose to use their money for good, we also need to recognize that philanthropy alone won’t cut it. If we want to cure or manage today’s major diseases in our children’s lifetimes, there is no substitute for a sustained, deep investment in research by the federal government.
In his message announcing the new initiative, Zuckerberg noted that we can go a long way toward eliminating the burden of disease by tackling four major killers: heart disease, cancer, infectious diseases, and neurological diseases, like Alzheimer’s and stroke. Each year, the NIH spends billions of dollars on research focused on these four areas of disease. In 2015, out of a total budget of $30.3 billion, $5.4 billion was spent on cancer research, $5 billion on infectious diseases, $1.3 billion on heart disease, and $917 million on stroke and Alzheimer’s disease. And over $3 billion was spent on clinical trials to test new treatments and procedures. This is the scale on which modern biomedical research is conducted. Even the world’s wealthiest people — Zuckerberg ranks sixth this year — can’t match it.
If we want to cure or manage today’s major diseases in our children’s lifetimes, there is no substitute for a sustained, deep investment in research by the federal government.
Yet, if we hope to come anywhere close to achieving the goal of curing major diseases by the end of the century, what our government invests is not enough. For more than a decade, our federal investment in biomedical research has steadily declined, even as scientific progress and new biotechnologies have created opportunities to develop better treatments. Congress has proven itself unable to fund even immediately urgent priorities like Zika: A bill to allocate $1.1 billion toward combating the virus went nowhere for months, forcing the NIH to divert over $600 million from other health research, including millions of dollars from cancer, heart disease, and AIDS programs. (Congress finally passed the bill on September 29.)As the directors of the Centers for Disease Control and Prevention and National Institute of Allergy and Infectious Diseases wrote in a recent Washington Post op-ed, the NIH has to resort to “robbing Peter to pay Paul.”
If the federal government had sustained its support of biomedical research over the past decade, we would be investing, each year, more than four times the $3 billion that Chan and Zuckerberg have committed over the next 10. In 2004, the NIH budget was $27.9 billion, or 1.2 percent of the $2.3 trillion federal budget. In 2016, if spending on the NIH had remained at the same fraction of the total budget, the NIH would receive $46.8 billion. Instead, its budget is only $31.4 billion — more than $15 billion less. The story is similar if, instead of the federal budget, we use our national income as the yardstick: The NIH budget represented 0.23 percent of our gross domestic product in 2004; if we maintained that investment, NIH spending would now be $11 billion higher than it actually is. Even the most generous philanthropy can’t make up that shortfall.
Zuckerberg knows this, which is why he is calling on the government to join his commitment to sustained, long-term support of biomedical research. He is urging us as a society to share his ambition:
This is an area where public support matters. The more people believe we can cure all disease in our children’s lifetimes, the more likely the government is to invest in it, and the more likely we are to achieve this goal. This is a place where we need your help, and we can all make a difference together.
I’ve heard some of my colleagues dismiss the idea that we can prevent, manage, or cure all disease in 100 years as just hype, an example of the kind of overconfidence we’ve come to expect from technology entrepreneurs who don’t understand that medical research isn’t anything like coming up with the next great application.
I disagree. Certainly, we do have to be careful not to overpromise — there are tens of thousands of different diseases, and we’re unlikely to cure them all in a century. Furthermore, learning how to treat a disease is one thing; making treatments available to all who need them is something else altogether, and not easily solved.
But we should remember that modern medical science is relatively young. Diseases ultimately play out at the level of molecules and genes; to treat most of them effectively, they must be understood at the molecular and genetic level. But we didn’t even know what a gene was until the middle of the 20th century, and we didn’t know how many genes we have until the beginning of the 21st. There are enormous opportunities for major progress in medicine over the coming century, and they will only happen if we commit to a robust, long-term, public investment in biomedical research. Philanthropy alone won’t get us there.