Sir

Your Editorial “In praise of Gates” (Nature 425, 435; 2003) urged the Bill & Melinda Gates Foundation to fund more upstream areas of basic research. I believe you are off the mark on this one.

The philanthropy of Bill Gates and its initial focus on neglected, high-burden diseases provide an important boost for the developing world. But I believe that the biggest gulf is between what we know and what we do in practice — the 'know–do' gap.

Although I would in no way deny the value of biomedical and upstream basic research, I believe we have placed too much emphasis on that and not enough on the translation of knowledge into actions to improve people's health. Although programmes such as Roll Back Malaria and the Global Fund for TB, Malaria and AIDS are aimed at tackling these issues on the ground, they do not support research in this area. They need to consider the knowledge gaps that have to be addressed so that their programmes have the desired impact.

Research into public-health systems and services and the contribution of the social and behavioural sciences (economics, anthropology, sociology and so on) are neglected fields. This is increasingly being recognized and addressed for specific diseases, but a more systematic approach is needed, which may benefit the entire health sector. Such research is critical in linking basic research to healthcare delivery, and in obtaining the participation and support of the people at whom new interventions are targeted.

For the Bill Gates billions to make a difference, a robust and efficient health system is needed in the countries where he hopes to have an impact. Without this, the multitude of new vaccines and drugs developed will have a negligible effect in reducing disease burdens.

To focus global attention on this neglected area, the World Health Organization will release a major report in 2004 entitled Knowledge for Better Health. The report's release will be linked with a global Summit on Health Research, to be held in Mexico in November 2004. We hope to convene a high-level gathering of leaders from the public, private and non-governmental sectors, the scientific community and the funders of health research to develop an action plan to address the key challenges of translating knowledge into health policy.

You referred to PPPs — public–private partnerships — as a successful means of bringing malaria drugs to market. No arguments there. But PPP could also stand for “publications, patents and professorships” — the mindset of many scientists in basic research.

It is my hope that the philanthropy of Bill Gates, through appropriate funding of research, will help to nurture another PPP mindset of “policy, practice and people”. He should put more of his money into research that will ensure that his laudable investments to date will have a real impact in improving the health and well-being of poor populations in the developing world.