Gifts of Health
American medical charity has a noble history that extends right to our present moment
For generations, deadly epidemics were a regular occurrence in America. The disease feared perhaps more than any other was yellow fever. Every few years, outbreaks would explode across seaboard regions, killing thousands at random, with victims spewing black vomit and crying out in horrible pangs. People were so frightened that a third or more of the residents of major cities like Philadelphia would flee to the countryside at the first hint of infection—compounding the harm to health with egregious economic damage.
No one had any accurate idea what caused the fever. Not until 1900 did researchers understand that it was caused by a virus (the first human virus ever discovered) and transmitted from person to person by mosquito bites. Even after that discovery, efforts to quench yellow fever floundered. Then in 1915 the Rockefeller Foundation declared war on the illness. A special research station was set up in Nigeria where rhesus monkeys were used to test infection and immunity—dangerous work that killed three of the foundation’s lead researchers. Rockefeller continued its heroic battle in high-security labs in New York City and elsewhere. Despite tight precautions, more researchers died.
In 1931, Rockefeller Institute scientist Bruce Wilson volunteered to be injected with an experimental vaccine. He developed immunity to the illness. It took until 1937 to make the vaccine mass-producible, but in the first seven years it was manufactured the Rockefeller Foundation gave out 28 million doses. One of the world’s most frightening scourges was finally brought under control, and lead Rockefeller researcher Max Theiler was awarded the Nobel Prize in Medicine.
The New York Times reports on the epic philanthropic battle against yellow fever
The polio precedent
A second virus that terrorized Americans, even beyond the middle of the twentieth century, was polio. Every summer there would be alarms in various parts of the U.S.—complete with social distancing, quarantines, and whole families sequestering inside their homes or temporarily moving to rural areas—as epidemics tore through communities. Living Americans can still remember the 1952 polio outbreak that killed 3,145 U.S residents and permanently crippled many more. Every single year, the illness ended lives without warning, and left hundreds of thousands of children and adults clamped into Iron Lung machines, wheelchairs, and permanent leg braces and crutches.
It was swarms of small voluntary donations that finally disabled the polio virus. Millions of families all over the U.S. began making donations to the National Foundation for Infantile Paralysis (known as the March of Dimes because of its reliance on small gifts). At the time of the 1952 pandemic, the charity’s annual budget was almost $500 million in today’s dollars. It provided 25 times more funding for polio research that year than the U.S. National Institutes of Health. The foundation’s money went to fellowships in virology, lab studies, support for stricken families, and public-information efforts. Among many other accomplishments, it funded the lab where the polio virus was first grown in non-neural tissue.
Institutional donors also did their part. The Rockefeller Institute for Medical Research, for instance, funded studies of infantile paralysis. It hosted the vaccine experiments of Albert Sabin.
This combination of mass giving and foundation support eventually put a dagger into polio. Dr. Jonas Salk won a $35,000 grant from the Sarah Scaife Foundation in 1948 that allowed him to equip a modern virus laboratory at the University of Pittsburgh. Scaife subsequently offered follow-up grants. Salk also received support from small donors through the March of Dimes (as did Dr. Sabin).
The philanthropic backing for Salk yielded a medical breakthrough right amidst the 1952 polio terror. The doctor created an experimental polio vaccine made out of killed virus cells, then bravely immunized himself and his family with it. Thanks to rapid field trials paid for by the March of Dimes, the Salk vaccine was soon deemed safe. It went into production in 1955 and was widely administered around the world as the world’s first polio blocker.
By 2019 there were barely 100 polio cases anywhere on the globe, and a set of philanthropies were collaborating to drive the virus to final extinction. Toward that cause the Rotary International Foundation has donated more than $2 billion collected from its 35,000 local chapters, and the Gates Foundation has put up billions more. At the end of 2019 donors pledged an additional $2.6 billion with the aim of turning one of history’s most wounding viruses into a cold memory.
Dr. Jonas Salk in the Pittsburgh laboratory, provided by the
Scaife Foundation where he created the polio vaccine.
Other virus victories
The epic triumphs over polio and yellow fever were continuations of a proud history. The deadliest viral assault in history was the 1918 influenza that killed as many as 50 million people worldwide. At the time, most doctors believed it was caused by bacteria. Eager to avoid repeats of the calamity, researchers spent subsequent years trying to nail down sources and cures. Investigators from the Rockefeller Institute for Medical Research eventually demonstrated that viruses are the actual sources of influenza. This opened the door to lifesaving flu vaccinations.
Another viral panic occurred when HIV started killing thousands of Americans—more than 40,000 deaths per year at the mid-1990s peak—plus millions abroad. Real-estate developer Aaron Diamond and his wife Irene had agreed during their estate planning that as soon as one of them passed away, the other would quickly blast out most of their assets to some urgent charitable cause. After Aaron was struck down by a heart attack in 1983, his widow’s gaze settled on the alarming new HIV-AIDS epidemic. The Aaron Diamond AIDS Research Center was launched, and $220 million of family funds were pushed into urgent research, with the Diamond Foundation expending its last dollar seven years later. The center became one of the most spectacularly productive entities fighting AIDS. Its scientists did important testing at the molecular level, identified a gene mutation that confers immunity to HIV, developed anti-retroviral “cocktails” that eventually brought the epidemic under control, and demonstrated how to almost eliminate transmission of HIV from mothers to babies.
Philanthropists played an important role in quenching another red-hot viral emergency in 2014. That year, nearly 5,000 West Africans perished suddenly and horribly when the Ebola virus swept the region. Paul Allen, who became a major medical donor after retiring from Microsoft, had been funding Ebola studies and vaccine experiments for years, and acted aggressively. Allen offered an immediate $100 million, and inspired additional quick donations from other philanthropists, including $50 million from the Gates Foundation and $25 million from Mark Zuckerberg. These resources made possible the speedy dispatch of 500 crisis health responders and all of their equipment to the hot zone where the disease was raging, smothering the contagion before it spread. The emergency operations director of the U.S. Centers for Disease Control later cited “the huge contribution made by Paul Allen” in controlling the 2014 Ebola flare.
Philanthropic campaigns also put a crimp in tuberculosis. TB accounted for 11 percent of all U.S. deaths in the early twentieth century, sparking an army to fight back. A new National Association for the Study and Prevention of Tuberculosis collected coins from the public, and soon grew to command million-dollar annual budgets. (It eventually became the American Lung Association.) More than 500,000 supporters raised funds for research, sanitariums, and relief for afflicted households, and the number of TB clinics jumped from 18 to 1,324 in a little more than a decade.
This “people’s philanthropy” became a model for subsequent popular crusades against cancer, heart disease, and other ailments. And as with polio, wealthy givers also became involved. The Russell Sage Foundation made tuberculosis one of its main targets, and bankrolled the famed Saranac Sanitarium in New York’s Adirondack mountains. John Rockefeller and his charities took part in gradually driving down cases of TB.
Though it didn’t work against tuberculosis (because of TB’s peculiar molecular structure), miraculous progress was made in breaking the back of diphtheria, meningitis, rheumatic fever, pneumonia, syphilis, gonorrhea, and other communicable diseases when scientists learned how to produce penicillin in large quantities. Penicillin’s therapeutic value was first proven by an Australian scientist named Howard Florey. The Rockefeller Foundation financed part of his scientific training, awarded him a pharmacological fellowship at the University of Pennsylvania, then provided a series of post-doctoral grants for equipment, supplies, and research help. This allowed Florey to assemble a large team of technicians who explored the potential of penicillin and then conducted human drug trials in 1941.
Laborious processes of culturing and concentration prevented easy production of penicillin, but effective means of mass manufacture were eventually developed with Rockefeller assistance. The drug immediately saved hundreds of thousands of lives, revolutionized medicine, and earned Florey and two other scientists the Nobel Prize in Medicine.
Discovering penicillin was just the beginning. Proving its efficacy and safety,
and then figuring out how to culture it in mass quantities, were the hard part.
The Rockefeller Foundation led in this area.
Other philanthropic counterpunches
Amidst rapid improvement of the tools available to doctors, philanthropists next began to focus on bringing more of the miracles of modern medicine to people in very poor countries. The Edna McConnell Clark Foundation (a product of the Avon fortune) resolved in the early 1970s to attack tropical illnesses that were then getting relatively little attention from the medical establishment. At that point tropical maladies represented the vast portion of the world’s infectious disease, yet only a percent or two of all drugs approved for human use were specifically targeted at them.
So from 1974 to 2000, the Clark Foundation pushed more than $90 million into research on afflictions like schistosomiasis (snail fever), onchocerciasis (river blindness), and trachoma (a painful eye disease). These were traumatizing hundreds of millions of people, and Clark became the world’s largest funder, public or private, of countermeasures. Other charities later followed this lead.
The Carter Center, for instance, made plans to wipe out the hideous Guinea worm. Cases have been chopped down from 3.5 million to just a handful today, with complete eradication on the horizon. Bill Gates has funneled billions of dollars into blitzes against neglected tropical diseases, including one that debilitates 200 million people and kills 400,000 every year: malaria. Gates spending against malaria helped cut annual deaths by more than half, and the foundation has pledged to continue crusading for years to come. It is even funding genetically modified sterile mosquitoes aimed at stopping transmission of the malaria parasite from person to person.
Another lifesaving intervention by Bill Gates has been his massive program to bring immunizations to the low-income world. That effort has dramatically expanded access to existing vaccines like DPT, measles, hepatitis, influenza, and polio. It is also pursuing new vaccines, including for diseases for which no immunal shield has previously existed—like malaria, rotavirus, pneumonia, and, very currently, coronavirus. It’s estimated that more than 13 million deaths have so far been prevented as a result of the vaccination program Gates launched in 2000—with most of the beneficiaries being babies and children with full lives ahead of them.
And now coronavirus
Donors are attacking today’s novel coronavirus in a panoply of ways. At the infection’s initial arrival in the U.S., the Chan Zuckerberg Initiative and the Gates Foundation—each based in a disease hotspot—took rapid action to overcome testing bottlenecks. Almost overnight, CZI quadrupled clinical testing capacity in the San Francisco area by purchasing diagnostic machines. Gates created new home testing kits to dramatically improve diagnosis and contact tracing in Seattle, and then the rest of the country.
A savvy instant grant from long-time medical philanthropists Mark and Lisa Schwartz, provided back in February before the scope of our epidemic was even understood, enabled Boston’s Ragon Institute (created by a $100 million gift from Phillip and Susan Ragon) to convene one of the earliest research collaborations of top American and Chinese scientists. Members are now racing to unravel the coronavirus’s secrets, encourage immune responses, and create a vaccine.
To spur the race for drug treatments, the Wellcome Trust medical charity joined with Gates and the Mastercard Impact fund in an instant pledge of $125 million. Multiple corporations then offered $100 million gifts aimed at controlling the virus. Numerous businesses volunteered to manufacture medical material, or donated supplies from their stockpiles. Regional and local charities stepped up in thousands of ways to bolster healthcare responses and support their communities economically and socially during the first shock of infections and quarantining.
Squadrons of other philanthropic responses are now unfolding. Many charities are concentrating on relieving their immediate locality. Some are working nationally or globally. Urgent grants have been pushed out for immediate needs, and other assistance for mid- to long-term priorities is following.
Giving as a backbone of health
Deeper and less obvious contributions to health and healing across the United States have accumulated through centuries of philanthropic activity. Much of our nation’s medical backbone has been laid down and strengthened by private giving. Decades before we were even a nation, back in 1735, our first charity hospital was established by a generous businessman acting in a remote frontier town that had existed for only 18 years (New Orleans). Other hospitals have since been built up in thousands of American communities. Unsurpassed treatment facilities like the Mayo Clinic, Johns Hopkins, Cleveland Clinic, NY-Presbyterian, Cedars-Sinai, Houston Methodist, M. D. Anderson, Langone, Sanford, Huntsman, and hundreds more have been financed by donors.
It was philanthropists who created America’s medical schools, modernized them against much resistance, and made them the best in the world by endowing professorships, labs, and clinics. Private givers established top research institutes (Rockefeller, Sloan Kettering, Broad, Columbia, St. Jude, Allen, Van Andel, Janelia Farm, many others), and offered landmark fellowships (Howard Hughes, Markey, Lasker, etc.) for grooming the most promising medical scientists.
The first schools of public health were created by John Rockefeller, and accelerated by donors like George Eastman. A surge of funding from supporters like Gerald Chan, Michael Bloomberg, the Rollins family, Michael Milken, Joseph Mailman, the Gillings family, and others has propelled public-health education to new levels over the last decade or so. The recent explosion of superb specialized hospitals just for children has likewise been driven by donors.
Today’s vital mechanisms of trauma response, 911 calls, EMT training, ambulance and E.R. coordination were instigated by the Robert Wood Johnson Foundation in the 1970s. Electronic health records, patient surveys, protocols to prevent released patients from relapsing to hospitals, hospice care at the end of life—these and many other innovations were initiated or hurried along by voluntary givers. The very nomenclature with which diseases are categorized and understood was first shepherded into use by the Harkness family.
The John Hartford Foundation brought lifesaving kidney dialysis and transplants to the public, and played a large role in building up the emerging field of geriatric medicine. Uncas Whitaker poured more than $700 million into developing biomedical engineering as a thriving independent discipline, overcoming government and academic inertia to hasten modern miracles like joint replacement, laser surgery, lab-grown organs, and bionic limbs. The Carnegie Corporation saved hundreds of thousands of lives by speeding insulin-replacement therapy to patients.
Important elements of today’s newest departures in genomic medicine, plus entire fields like systems biology and computational medicine have relied heavily on visionary donors like Sol Price, Bill Bowes, James Simons, and the Chan Zuckerberg Initiative. Brain, neurological, and mental-health research has been led by private giving for a couple decades now. Today’s freshest investigations in immunotherapy are racing along thanks to charitable giving. A vast portion of America’s infrastructure for battling cancer has been donor initiated.
Though it comprises only a modest portion of total funding for health, voluntary giving continues to catalyze a great many medical breakthroughs. That’s because it tends to be flexible, risk-tolerant, fast-moving, and offered without either the onerous red tape of government grants or the short time horizon of corporate research. And in addition to sponsoring many hyper-modern therapies, philanthropy has been crucial in carrying medical advances out into the real world—from campaigning against hookworm right up to recent battles with HIV and malaria.
The collective effect of these multifarious gifts is vast. More than any other factor, it is philanthropy that has distinguished America at understanding and fending off threats to human health. Our neighborly traditions of donating and volunteering in support of lifesaving and healing, extending back hundreds of years, continue to be generously adhered to by millions of citizens, with great effects.
And our medical charity does more than just tame disease. It offers us a way to connect and commune, to reduce human suffering and deepen happiness. It does these things not only among assisted populations but also among those who offer the help.
Dr. Karl Menninger, the eminent psychiatrist who practiced in the American Midwest, was once asked after delivering a lecture on mental health, “What would you advise a person to do, if that person felt a nervous breakdown coming on?” Members of the audience expected him to suggest consulting a doctor, entering therapy, getting expert help. But his years of clinical work made him understand that health has many social and moral aspects that cannot be reduced to expertise, that no man or woman is an island when it comes to remaining well, and that offering care can sometimes be as curative as receiving care.
He answered: “Lock up your house. Go across the railroad tracks. Find someone in need. And do something for them.”
This article will be published in a forthcoming issue of Philanthropy magazine.