Last week, Laura Freschi and Alanna Shaikh published a piece in Alliance magazine that raised some interesting and thought-provoking question about the role of the Gates Foundation in setting the global health agenda. They conclude that Gates is becoming a “public health dictator” because of his financial resources and the power and influence that come as a result. They are, of course, not the first to complain about Gates’s focus on technological solutions to global health challenges. Some of the most recent grumblings were in response to the Foundation’s “reinvent the toilet” campaign this year, but similar concerns have been voiced for years. The Foundation places too much emphasis on technological innovation and “quick fixes”; their undue influence diverts funding from other priorities; their goals are not realistic. These are all valid concerns which deserve to be voiced (heck, we have already written about it here), particularly in a field where nearly everyone has a different opinion on how problems should be solved.
But a dictator?
But now pundits are demanding accountability from the Foundation, calling on it to justify what it does:
If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will
Gates be accountable for that failure?
We demand accountability from our governments because they spend our money – we have the right to demand that our tax dollars be used effectively. But why, exactly, should Gates be accountable to anyone for wasting his own money? More importantly, why would the “entire global health community” do something just because he told us to?
Dictators are people who arbitrarily enforce laws, throw people in jail for criticizing them, and deny their citizens free and fair elections. Gates does not punish anyone whose global health solutions don’t appeal to him – he just doesn’t give them money. He never lead any kind of “global health coup” or insist that we all adhere to his development philosophy. Yes, the Foundation has lots of money, and would-be philanthropist who wants to launch his NGO would treat Gates like a god if he ever saw him on the street – but that is precisely the point: he has undue influence because we give it to him. To paint Gates as a “global health dictator” because causes are prioritized based on what will get Gates Foundation funding villifies the wrong party. What does it say about us as a body of professionals if we allow ourselves to be led by the nose by the guy with the most money?
The Economist raised another interesting point when it examined the same debate back in 2008:
At least in part, the gripes against the Gates Foundation are the churlish growls of a jealous crowd of bureaucrats and labourers at less influential charities. Some people at the WHO…openly worry that the foundation is setting up a new power centre that may rival their organisation’s authority. Such conspiracy theorists point to the foundation’s recent grant of over $100m to the University of Washington to evaluate health treatments and monitor national health systems—jobs supposed to be done by the UN agency.
Therein lies an irony. The WHO, one of whose captains now calls the Gates Foundation monopolistic, used itself to hold a monopoly in the fight against malaria, and it did a lousy job as a result.
I do think Shaikh and Freschi (and also Tom Paulson of Humanosphere) are on to something when they question the Foundation’s giving money to media organizations to increase coverage of global health topics.
Among the grantees is a growing list of media outlets including the Guardian newspaper (UK), ABC, PBS and the BBC – all to underwrite coverage of global health issues. While these grants all came with assurances of editorial independence, it’s hard to believe that such partnerships won’t influence the nature of the coverage in some way.
Even if it is objective, it never looks good when you fund your own media coverage. Somebody probably should have thought that one through.
At any rate, the debate about what Gates is doing (and what he should be doing) with his money will undoubtedly rage for as long as he has money. But if we believe that the Gates Foundation is distorting global health priorities because of its purchasing power, then we need to take a long, hard look at how we define our priorities.