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Lancet article criticises Gates Foundation funding pattern

A recent article in The Lancet argues that the sheer reach and size of donations by the Gates Foundation to various health initiatives worldwide gives it enormous policy leverage and power in setting the health agenda in many countries

The Bill and Melinda Gates Foundation, which annually disburses vast sums of money to various health-related initiatives the world over (in 2007 the amount spent by the Gates Foundation on global health was almost as much as the WHO’s annual budget -- approximately $1·65 billion), has been criticised in an article in The Lancet for, among other things, influencing health policies, prioritising some diseases and approaches over others, and over-emphasising technology.

In the course of preparing the paper, David McCoy of the Centre for International Health and Development, and others, analysed all 1,094 grants awarded by the Foundation between 1998 and 2007, totalling $9 billion.

The analysis revealed that $5.82 billion (65%) was shared by 20 organisations, including five global partnerships -- the Global Alliance for Vaccines (GAVI), the Global Fund, the American non-government organisation PATH (Programme for Appropriate Technology in Health) and a selection of US and UK universities.

The WHO is another big receiver of funds. The $336 million it gets is 4% of its funding, making the Foundation a bigger donor than some G20 nations. UN agencies, global health partnerships, the World Bank, universities, and non-profit and non-government organisations -- all of whom are key contributors to global health -- all have a funding arrangement with the Gates Foundation. These relations coupled with the large amount of money involved means that the Foundation has ‘a great deal of influence over both the architecture and policy agenda of global health’.

The Foundation ‘is not a passive donor’, the paper notes, ‘but actively engages in policymaking and agenda-setting activities; it has representatives that sit on the governing structures of many global health partnerships; it is part of a self-appointed group of global health leaders known as the H8… and has been involved in setting the health agenda for the G8’. The paper recalls that the role played by the Foundation in setting the research agenda of several public health priorities was criticised by the former head of the WHO’s malaria programme, ‘who complained that the dominance of the Gates Foundation in malaria research risked stifling the diversity of views among scientists’.

Another ‘striking finding’, says the paper, is the large number of US-based recipients of grants. After supranational recipients, US-based recipients accounted for 82% of the total amount paid out between 1998 and 2007. Quite a substantial portion of this money went to a few universities and NGOs such as the Seattle-based PATH (which was awarded nearly $1 billion). This ‘raises the question as to whether some organisations might be better characterised as agents of the Foundation rather than as independent grantees’.

The paper is critical of funds given to some agencies that suggest a pro-private healthcare agenda. For example, funding for the International Finance Corporation whose mandate is to support private sector development, suggests ‘promotion of private healthcare-providers in low-income and middle-income countries, and is consistent with views that have been expressed by the Foundation and the observation that private foundations generally view the public sector with scepticism and disinterest’.

The paper also finds evidence that the Foundation over-emphasises technology and new vaccine development (37% of funding was for research and development, or basic scientific research) when ‘many existing cost-effective technologies do not reach the people who need them because of poverty or health system failings’. Child deaths, particularly, should not be viewed solely as a clinical problem that needs a vaccine solution but as a ‘public health problem that needs social, economic or political intervention’. The paper acknowledges, though, that solving social and delivery system problems is the work of governments, and that the Foundation does have ‘a separate programme of funding aimed at addressing malnutrition and chronic hunger through various agricultural interventions’.

Source: The Hindu, May 10, 2009
The Lancet, Volume 373, Issue 9675, May 2009