Fingolimod and sphingosine-1-phosphate--modifiers of lymphocyte migration.

n engl j med 355;11 www.nejm.org september 14, 2006 1088 that in some cases, 5 years of funding for projects was not long enough to deliver results. Although the foundation is known for its “lean” structure, some grantees said that current staff levels are barely adequate to handle the existing workload, and Yamada said that it will have to grow in order to double its spending. Choosing worthy recipients, monitoring projects, and measuring their effects will be especially challenging. “For our largest grants, GAVI and the Global Fund, we know the results that they’ve produced and they’re pretty substantial,” said Yamada. “For others, it’s harder to measure . . . [but] we’re beginning to get some evidence.” In Botswana, for example, where the foundation supports a national HIV–AIDS testing and treatment program, the prevalence of HIV infection among girls 15 to 19 years of age decreased by 22% between 2003 and 2005. Perhaps the Gates Foundation’s greatest influence derives from its assumption that intractable problems can be solved, given enough money and international co operation. For example, as a condition of receiving $287 million in grants for AIDS-vaccine research that were announced in July, 165 scientists in 19 countries will have to share their data in a central repository. Yamada predicted that such collaboration will become more common in the future, even in industry. “We’re trying to deal with very difficult problems that people are suffering from in the developing world,” he said. “The more information sharing there is, the more patients will benefit.”