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 David McCoy of the Centre for International Health and Development, London, and others, is accompanied by a commentary by Robert E. Black of the Johns 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.”