A key effort to track health around the world is getting a massive boost from the Gates Foundation. This month, the charity pledged more than half a billion dollars to the Institute for Health Metrics and Evaluation (IHME), which publishes the Global Burden of Disease (GBD) study, the world’s most expansive data set on diseases and health risks. But the 10 August announcement is also bringing fresh attention to criticisms of IHME, whose conclusions are based on computer models unavailable to outsiders that extrapolate from often very sparse data.
Based at the University of Washington (UW) and long funded by Gates, IHME says it will use the 10-year, $540 million grant—the largest in the university’s history—to boost the precision of the GBD study, increasing the number of locations it evaluates from just over 900 to nearly 5000. It will also expand its global health forecasting project, which helps predict the impact of health policy decisions, and its tracking of global health financing.
The gift is “a good use of Gates money,” says Lincoln Chen, a global health expert and former member of IHME’s board, because the GBD study “is the only truly comprehensive picture of global health that we get on a regular basis.” The most recent report, published in 2025, covers the impacts of 375 diseases and injuries in 204 countries and territories. Because the data help guide health investments, “This sort of investment has disproportionate returns,” says global health expert Tim Evans of Concordia University.
But others in the global health community caution that IHME’s computer models can’t replace efforts to collect information about populations’ health. For many estimates, “they rely on data skewed toward high-income countries and model the heck out of it,” says Ramanan Laxminarayan, president of the One Health Trust. “And their models are opaque and neither easily verifiable nor replicable.”
That has led to some striking errors, notes Prabhat Jha, an epidemiologist at the University of Oxford. The 2015 GBD study, for example, cited cholera as the leading cause of diarrheal deaths in Canada, where that disease is extremely rare and only affects travelers from endemic countries. IHME corrected the report without explaining the error. “We still don’t know how it happened,” Jha says. “What was the underlying problem that led to that misdiagnosis?”
To produce its reports, IHME collects data from millions of sources around the world, including wealthy countries’ health system records, published research papers, and, in poorer countries where health systems are sparse or absent, surveys that attempt to track disease symptoms and mortality. It then uses these data to build models that estimate disability-adjusted life years, a unit that allows researchers to compare the impacts of different diseases in a given region. To avoid errors like the one with cholera, IHME has increased its cooperation with local experts and health authorities who provide checks on its estimates.
The first GBD report was commissioned by the World Health Organization (WHO) in the 1990s. In 2007, the Gates Foundation funded health economist Christopher Murray, who had worked at WHO on the early reports, to launch IHME and expand the study. The biennial GBD reports—each of which is published as a series of papers in The Lancet—have stirred controversy several times. The first one, published in 2013, found that malaria deaths were more than twice as high as WHO estimates, causing serious friction between IHME and WHO. During the COVID-19 pandemic, IHME’s forecasts of infections and deaths were often far too high.
Yet the institute has thrived, thanks largely to the largesse of the Gates Foundation, which has so far spent more than $385 million on IHME’s work and currently supplies 60% of its roughly $90 million annual budget. Murray, whose $855,000 salary makes him the best-paid professor at UW, is close to Bill Gates.
Murray says the new grant will allow IHME to produce more fine-grained data, giving estimates of disease burdens for smaller geographical regions—states, provinces, or even local health authorities instead of countries as a whole. “Governments are very, very interested in the geographic breakdown of their countries,” he says, because it can reveal health disparities and help allocate funding where it is most needed.
That idea in itself is “critically important,” says Lucia D’Ambruoso, an expert on health policy systems at the University of Aberdeen, “but that does not abolish that underlying data problem.” Only about 40% of deaths globally have a medically certified cause recorded, she notes, and in low-income countries that falls to below 10%—which is why the global health community relies so heavily on modeling. D’Ambruoso hopes the new money will allow IHME to help lower income countries “not only to generate these data, but to interpret them and use them.”
Jha cautions IHME’s reports convey a false precision that can make such investments seem unnecessary. “Where they give the sense to policymakers that we actually have data when what they have is guesses, it might well distract from building the kind of essential data systems” that provide more accurate information. Jha would like IHME to shift toward an open-source approach, serving more as a library than as a publisher of results and making both primary data and modeling strategies truly transparent. “It would be an amazing global resource,” he says. “But that’s probably wishful thinking.”
Murray acknowledges that efforts to build up even basic birth and death registries in lower income countries have struggled. But, he says, simple, low-cost information systems are making inroads in some of the poorest countries, and many middle-income countries have instituted electronic health records, which provide more accessible data on conditions for which people seek care.
IHME will also use the new funding to expand models that forecast the impacts of health policies, such as stricter tobacco control or the introduction of a new vaccine, in hopes of “giving a little bit more guidance on what are the 20 leading opportunities to change the arc of health in the future,” Murray says.
A third focus will be the institute’s efforts to monitor global health spending. So far, it has primarily tracked money flowing from high- to low- and middle-income countries, but given recent steep cuts in global health aid, “we need to do a much better job tracking what governments put in of their own money” and how much patients and their families contribute, Murray says.
Evans applauds the expansion of IHME’s work, “especially when more and more countries seem to think it’s more important to invest in war than in health. … Our health is a global public good, and we really need to understand how to do better.”