Estimating the Global Burden of Diarrheal Diseases

Before applying to this Grand Challenges request for proposals (RFP), applicants should familiarize themselves with the supporting documents, including the terms and conditions of the Gates Foundation, the Rules and Guidelines, Application Instructions, and Frequently Asked Questions.

If you plan to apply to this RFP, we will host a dedicated webinar on May 14, 2026, 8:00-9:00 a.m. US PST. The session will provide an overview of the RFP and include time for questions. To attend, please register and submit your questions in advance. A recording will be posted on the challenge page following the session for those unable to join live.

The Gates Foundation invites proposals to generate independent, policy-relevant estimates of the global burden of diarrheal diseases, with a focus on mortality and morbidity in children under five living in low- and middle-income countries (LMICs).

Background

Reliable burden estimates are essential for prioritizing disease syndromes and pathogens and for guiding investments in prevention, treatment, and product development. However, estimating diarrheal mortality and morbidity and pathogen-specific burden remains challenging because direct mortality and morbidity data are limited in many LMIC settings, etiologic data are uneven and often derived from studies of cases rather than deaths, and attribution methods must reconcile imperfect diagnostics, multiple pathogens, incomplete surveillance, and sparse location-specific evidence. Modelled estimates of global burden of disease can help overcome data sparsity, and multiple independent estimates would be valuable for triangulating estimates of burden and understanding key drivers of differences. Differences across existing estimates may arise from variation in data inputs, mortality envelopes, etiologic attribution methods, model structure, and assumptions.

The Foundation seeks to support independent estimation efforts that inform the overall burden of diarrhea and pathogen-specific contributions, clarify key sources of uncertainty, and produce decision-useful estimates for policymakers, researchers, and global health partners.

Multiple burden estimates would help inform the relative importance of diarrhea as a cause of mortality and morbidity in children under five and clarify which pathogens are responsible for the largest share of burden.

The Challenge

Through this Grand Challenge, the Foundation seeks to support organizations with strong epidemiologic and quantitative modeling capabilities to produce credible, transparent, and decision-useful estimates of diarrheal disease burden in LMICs.

Applicants should propose approaches that can generate a minimum core set of estimates for the year 2025 and, where feasible, build longer-term analytic capacity in LMICs.

Scope of Work

Proposals must include plans to generate, at minimum:

• Country-specific estimates of total diarrheal mortality burden in children under five.
• Country-specific pathogen-attributed mortality burden for children under five.
• Estimates reported as both total number of diarrhea-attributed deaths, pathogen-specific fractions, and mortality incidence rates, centered on 2025, using the most recent available data and appropriate methods for projection, interpolation, or extrapolation where needed.
• When possible, country-specific estimates of total and/or pathogen-attributed morbidity burden, measured as all cause or pathogen-specific disease cases, severe disease cases, or hospitalizations and presented as the total numbers, pathogen-specific fractions, and/or incidence rates.
• Estimates reported as point estimates with confidence/uncertainty intervals.
• Geographic scope: may include proposed estimates for a single country, region, all LMICs, or global. While proposals may focus on a single country, region, all LMICs, or global estimates, preference will be given to proposals focused on geographies where diarrheal mortality is expected to be highest or where improved estimates of both mortality and morbidity would have particularly high programmatic relevance, including but not limited to India, Nigeria, and sub-Saharan Africa.

We will consider fully independent modeling frameworks or partial re-estimation based on existing burden estimates and using alternative assumptions or datasets. Proposals must provide sufficient technical documentation for external review and should include planned approaches for etiologic attribution of both disease cases and deaths, including plans for adjudicating coinfections / multiple pathogens detected, at a minimum.

At minimum, proposals should include estimates for the following pathogens:

• Rotavirus
• Shigella
• Adenovirus 40/41
• Norovirus GII
• ST-ETEC
• Cholera (endemic)
• Cryptosporidium
• Campylobacter

Applicants may also propose additional analyses beyond the minimum required set, such as:

• Expansion to broader age groups
• Expansion to additional diarrhea etiologies
• Additional burden outputs, including DALYs or costs
• Historical trend analyses
• Regional or global geographic aggregation

However, all proposals must clearly deliver the minimum required output set above.

Applicants should recognize that this opportunity is intended not only to produce burden estimates, but also to improve confidence in the evidence base used for priority setting. We are seeking outputs that can inform syndrome and pathogen prioritization and that are interpretable by global and country decision-makers. Proposals should therefore address how resulting estimates will be interpreted, compared with existing approaches, and made useful to stakeholders. There should also be clear communication of uncertainty and sensitivity to assumptions.

What we are looking for:

The Foundation is particularly interested in proposals that demonstrate:

• Scientific rigor and methodological transparency
• Credible alternatives or complements to existing estimates (e.g. IHME Global Burden of Disease)
• Strong use of available epidemiologic, surveillance, and etiologic data
• Clear assumptions and sensitivity analyses
• Practical relevance for decision-makers in global health and child survival
• Potential to strengthen analytic and modeling capacity in LMIC institutions or partnerships

We will not fund proposals that:

• Do not focus on diarrheal burden estimation
• Do not include mortality estimates for children under five
• Do not provide a clear methodological approach for pathogen attribution
• Rely primarily on literature review without a substantive analytic plan
• Do not specify underlying data sources and handling of uncertainty
• Are intervention studies or surveillance implementation
• Do not clearly explain how outputs will improve on, complement, or interrogate existing burden estimates
• Are not submitted by an LMIC-based institution, led by an LMIC institution in partnership, or part of a global consortium with meaningful LMIC partner engagement 
• Do not explicitly address how they will generate estimates for the minimum required outputs

Eligibility

This opportunity is open to research institutes, nonprofit organizations, for-profit companies, international organizations, government agencies, and academic institutions. with demonstrated expertise in disease burden estimation, epidemiology, biostatistics, and related quantitative methods.

We welcome proposals from:

• LMIC-based institutions
• Partnerships led by LMIC institutions
• Global consortia that include meaningful LMIC partner engagement and capacity development

Applications that pair high-quality analytic output with intentional LMIC capacity building are especially encouraged.

Funding Level

We will consider applications requesting up to $1.5 million USD per project, with a maximum grant duration of two years. Proposed budgets should be commensurate with the scale and complexity of the work. Indirect costs are allowable and must be included within the total requested funding, in accordance with the Gates Foundation’s indirect cost policy).