Lancet Journal critique on Bill & Melinda Gates Foundation grant pattern

[Guest guest]

[This study raised several critical questions about the governance of the Gates

Foundation, with significant implications for health policy in India. A copy of

the Lancet article is available from the editor of AIDS INDIA]

Journal critique on Bill & Melinda Gates Foundation grant pattern

R. Ramachandran

New Delhi: The Bill and Melinda Gates Foundation's pattern of funding in the

form of grants for global health programmes and projects has been criticised in

a research paper in The Lancet.

The paper, by McCoy of the Centre for International Health and

Development, London, and others, is accompanied by a commentary by E.

Black of the s Hopkins Bloomberg School of Public Health, U.S., and others,

and an editorial. Dr. M.K. Bhan, Secretary, Department of Biotechnology, is a

co-author of the commentary in his capacity as a scientist of the All-India

Institute of Medical Sciences, New Delhi.

" Although it is driven by the belief that `all lives have equal value,' it seems

that the Foundation does not believe that every voice has equal value,

especially voices from those it seeks most to assist, " said the editorial. The

commentary said very limited direct funding to low-income and middle-income

countries is " arguably the most unfortunate imbalance in the research portfolio

of the Foundation. "

Response to The Hindu

According to the editorial in its May 9 issue, the medical journal invited the

Gates Foundation for a response but it declined the offer. The Foundation,

however, e-mailed the following response to The Hindu:

" We welcome this article and its findings. We try to be very thoughtful about

how to target our resources, and we constantly seek out feedback from outside

experts and stakeholders. In the end, we use our best judgment to determine

where our funding can achieve the greatest reductions in health inequity around

the world. "

Observing that, while the Foundation's contribution to global health generally

received acclaim, not much was known about its grant-making policy, Mr. McCoy

and colleagues analysed all the 1,094 grants awarded between 1998 and 2007.

These totalled about $9 billion and included individual grants varying from

$3,500 to $750 million.

Limited spread

The analysis revealed that $5.82 billion (65 per cent) was shared by 20

organisations. These included the Global Alliance for Vaccines and Immunisation

(GAVI), the Global Fund, a Seattle-based American non-governmental organisation

PATH (Programme for Appropriate Technology in Health, with a significant Indian

presence) and a selection of U.S. and the U.K. universities. In geographical

terms, 40 per cent of all funding went to `supranational' bodies such as the

World Health Organisation and GAVI.

The Foundation's contribution of $336 million accounts for 4 per cent of the

WHO's funding. It has thus emerged as one of the biggest donors to the WHO,

exceeding the contributions of most G20 governments, the paper has noted. In

particular, the WHO has been funded through as many as 69 separate Gates

Foundation grant agreements between 1998 and 2007. " [This] suggests that the

Foundation is adding to the problem of WHO being largely funded by governments

through conditional, donor-determined grants, " the paper says.

For high-income States

Of the remaining 60 per cent of the grants, the paper says 82 per cent went to

organisations based in the U.S., and 13 per cent to those in Europe and other

high-income countries. Only 5 per cent went to low-income and middle-income

countries. Worldwide, 76 universities received $1.8 billion, but nearly 60 per

cent of this went to eight institutions in the U.S. and the U.K.

Among the 20 largest grants, GAVI received two each, of $750 million, one to

purchase vaccines and the other for general operational support. About 37 per

cent of the funding was towards R & D or basic sciences research. The size of

grants in these increased in recent years as compared with those in healthcare

delivery.

Child health research

With regard to child health research in particular, the analysis found that

funding for the development of technologies was disproportionate in comparison

to support to overcoming barriers to the use of existing technologies. The

commentary noted a poor correlation between the funding pattern and childhood

disease burden.

Of the 659 grants awarded to NGO and non-profit organisations, 560 went to those

in high-income countries, primarily the U.S. Only 37 went to NGO and non-profit

organisations in low-income and middle-income countries. PATH, which has been

quite involved in vaccine related projects globally, was found to be the largest

single recipient in this category. During the period 1998-2007, PATH received

$949 million in 47 projects for medical R & D of the $3.3 billion that was given

to over 100 such organisations. This led the authors to remark: " The finding

that organisation, PATH, was awarded nearly $1billion… raises the question as to

whether some organisations might be better characterised as agents of the

Foundation rather than as independent grantees. "

Private sector skew

Commenting on questionable grants made to the International Finance Corporation,

whose aim is to support private sector development, the authors say this

suggests a keenness to promote the growth of private health-care providers in

low-income and middle-income countries.

" Gates Foundation is not a passive donor, " observes the paper.

" The Foundation actively engages in policy making 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 [that includes the WHO, UNICEF, GAVI and the World

Bank]… and has been involved in setting the health agenda for the G8. "

http://www.hindu.com/2009/05/10/stories/2009051055151000.htm