Bill & Melinda Gates Foundation

Global health governance has been changing in nature as private actors have been increasingly more involved in shaping the public health agenda. Modern international health traces its history to the first International Sanitary Conference held in Paris in 1851. Despite the European parties’ initiative in promoting international surveillance and infectious disease reporting for epidemic security, some countries, notably the U.S. and Mexico, developed their own international health system through sanitary consults, paid informants, and public health officers stationed in key ports worldwide (Birn, 2014). Agencies like the International Sanitary Bureau (later Pan American Sanitary Bureau, which became PAHO) and the International Committee of the Red Cross followed this effort.

Among these institutions emerged a new player, the Rockefeller Foundation (RF), in 1913 by an American oil industry magnate and a philanthropist, John D. Rockefeller. In the 1920s, the RF funded a global health campaign to eradicate hookworm, a soil-transmitted helminthic disease, which had long plagued rural areas of the American South (Cueto, 1994). Through this campaign, the foundation collaborated between healthcare workers and government officials in Latin American countries (Ettling, 1981). The foundation’s prevalence in global health allowed it to take an informal role in American foreign policy in the southern American hemisphere (Kassalow, 2001). RF expanded its effort in the region with campaigns to reduce the spread of yellow fever and malaria.

Today, one of the leading private actors in global health is the Bill and Melinda Gates Foundation, established in 1997. Bill Gates was inspired by a newspaper article about children in developing countries who still die from diseases eliminated in the U.S. a long time ago (Gates, 1999). Since then, the Gates Foundation, following in the footsteps of the RF, has been actively funding global health projects and collaborating with international health organizations and foreign governments (Cueto & Palmer, 2014; Birn, 2014). Scholars of global health see the Gates Foundation as the RF of our time, as it primarily aims to tackle disease in the global South and fund research opportunities for scientists and physicians. The foundation also has been working within the country to increase access to education and technology for children (Gates, 1999).

In 2017, the Gates Foundation provided 3.3 billion dollars to the world’s global health funding, tying in second with the United Kingdom for development assistance for health (Bruek, 2019). The Gates Foundation’s major investments in the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and GAVI, the Vaccine Alliance make clear in budgetary terms how influential the Gates Foundation is in setting the agenda and in managing the world’s health (Gates, 2009). The foundation has also helped to establish global health partnerships such as the Primary Health Care Performance Initiative and the Global Financing Facility, and has gained much control over the production of global health data. Applying its corporate, business model to try to solve public health problems, the Gates Foundation did bring innovation, technology, and fresh political commitment to the table along with its many fellow “social investors” (Bishop & Green, 2008).

However, such a corporate model that emphasizes quantifiable, short-term “results” is appearing more and more intrusive to the realm of public health and disturbing to different experts from researchers, scientists to other public health institutions (Corporation and Health Watch, 2015). A researcher commented on the way their research programs are pinned to the interests of one very rich man: “what happens if Bill Gates comes out tomorrow and says, ‘I’ve just read a book on global warming,’ and this whole global-health thing is done?” (Doughton, 2010). The main concern is that the Foundation’s research and funding interests are beginning to direct the health agendas of the world. While infectious diseases have gained ground as global health priorities, non-communicable diseases and the broader issues of health systems development have been neglected (Birn, 2014; Ollila, 2005).

The Gates Foundation’s predominance in the private sector’s participation in global health has raised concerns among scholars and physicians. In 2009, The Lancet journal published the editorial “What has the Gates Foundation done for global health?”, evaluating the grants allocated by the foundation from 1998 to 2007 (McCoy, 2009). The Gates Foundation has granted funding to Latin American organizations that serve various aspects of health. In 2006, the foundation invested $3.1 million to Pro Mujer, a Latin American microfinance network that pioneered in combining financial services with healthcare for the poorest women entrepreneurs. The organization planned to use the grants for clients in Bolivia, Nicaragua, Peru, and Mexico (PND, 2006). More recently, the foundation has funded the Fundacion Universidad de Antioquia in Colombia to facilitate the exchange of scientific information and to foster collaboration among Latin American immunologists and the regional immunology societies (Gates, 2015). While the Foundation’s generous funding has pushed numerous health organizations to take their responsibilities to international health more seriously, the journal exposes how its money has received little external scrutiny and most of the grants have been given to high-income countries (Sridhar & Batniji, 2008; GRAIN, 2014).

As private foundations and corporations find investment opportunities in the realm of health, the issue of accountability has become another major problem. Sridhar and Tichenor, global health governance fellows at the University of Edinburgh, expressed similar concern about the expansion of private interests into public domains and the imminent need to question “the influence of private actors, the effects of the monopolization of data, and the nature of accountability in global health governance” (2018). By partnering with international health organizations and research institutes, the Gates Foundation has a stronger grip on global health data collection and its dissemination. Even health experts are finding methods used by the foundation to organize the collected data too complex and incomprehensible (Sridhar & Tichenor, 2018). Birn, a professor of public health at the University of Toronto, also points out the pervasive nature of the Gates Foundation’s role in public health sector (2014). Despite the biomedical, technological advances the foundation is capable of achieving, the foundation does perceive the issue of health, where one must always remain impartial and independent, as an investment opportunity. Though Birn recognizes the scientific achievements of the RF and the Gates Foundation to promote global health, she also reminds of the private sectors’ tendency to maximize profit in all directions, using the term “philanthrocapitalism” to explain the phenomenon. As a matter of fact, when the Gates Foundation was criticized for its investments in pharmaceutical companies, it sold off almost all of its pharmaceutical, biotechnology, and healthcare investments in 2009 (Hodgson, 2009).

Compared to the Rockefeller Foundation, the Gates Foundation’s involvement in the Latin American region today has been less direct. Though the ultimate grantees of its funding are in Latin American countries, from the surface, the foundation’s grants are given to educational institutions or U.S. based companies that invest in the South American market. Nevertheless, the foundation’s large influence in health issues of the global south needs to be accounted for more closely, because the RF’s initial presence in Latin America has given rise to the private sector’s role in global health.

Related Articles

• Biomedical Research in Latin America
• Pan American Health Organization

Additional Resources

Bala, P. (2008). Biomedicine as a Contested Site: Some Revelations in Imperial Contexts. Lanham, MD: Lexington Books.

Birn, A-E., Pillay, Y. & Holtz, T. H. (2009). Textbook of International Health: Global Health in a Dynamic World. Oxford, NY: Oxford University Press.

McCoy, D. & McGoey, L. (2011). Global Health and the Gates Foundation - In Perspective. In S. Rushton & O. D. Williams (Eds.), Partnerships and Foundations in Global Health Governance. London: Palgrave Macmillan.

Richter, J. (2004). “Public-private Partnerships for Health: A trend with no alternatives?” Development, 47(2): pp. 43-48.

Stuckler, D., Basu, S., McKee, M. (2011). “Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed?” PLOS Medicine 8(4).

References

Birn, A-E. (2014). Philanthrocapitalism, past and present: The Rockefeller Foundation, the Gates Foundation, and the setting(s) of the international/global health agenda. Hypothesis, 12(1).

Bishop, M. & Green, M. (2008). Philanthrocapitalism: How Giving Can Save the World. New York, NY: Bloomsbury Press.

Brueck, H. (2019, January 17). Bill Gates says investing in 4 simple plans has saved millions of lives and provided a better return on investment than the stock market. Retrieved from www.businessinsider.com

Cueto, M. (1994). Missionaries of Science the Rockefeller Foundation and Latin America. Bloomington: Indiana University Press.

Cueto, M & Palmer, S. (2014). Making National and International Health. In S. Schwartz (Eds.), Medicine and Public Health in Latin America (pp.106-156). Cambridge University Press.

Doughton, S. (2010, November 3). Gates Foundation scales back ‘grand’ plan for global health. The Seattle Times. Retrieved from www.seattletimes.com

Ettling, John. (1981). The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South. Harvard University Press.

Gates, B.& Gates, M. “Who We Are: Letter from Bill and Melinda Gates,” “What We Do,” “How We Work”. Retrieved from https://www.gatesfoundation.org

Hodgson, J. (2009, August 14). Gates Foundation Sells Off Most Health-Care, Pharmaceutical Holdings. Retrieved from www.wsj.com

Kassalow, J. S. (2001). Why Health Is Important U.S. Foreign Policy. Council on Foreign Relations.

McCoy, D. (2009). What has the Gates Foundation done for global health? The Lancet, 373(9675).

Ollila, E. (2005). Global health priorities - priorities of the wealthy? Globalization and Health, 1(6).

Sridhar, D. & Batniji, R. (2008). Misfinancing global health: a case for transparency in disbursements and decision making. Health Policy, 372(9644).

Tichenor, M., & Sridhar, D. (2018, November 28). Global health disruptors: The Bill and Melinda Gates Foundation. Retrieved from https://blogs.bmj.com

PND (2006, May 4). Gates Foundation Invests $3.1 Million to Develop Microfinance Products for Latin America. Retrieved from www.philanthropynewsdigest.org

GRAIN (2014, October 29). How does the Gates Foundation spend its money to feed the world? Retrieved from www.grain.org

Corporations and Health Watch: Tracking the effects of corporate practices on health. (2015, April 15). Philanthropic Foundations and the Public Health Agenda. Retrieved from www.corporationsandhealth.org/