Questioning Gates

Bill Gates is unquestionably shaping the face of global health. The Bill and Melinda Gates Foundation has given over 9 billion in grants over the past 10 years, and shaping research and delivery of medicine across the world. Like Microsoft before it, whatever the Gates Foundation funds - and the initiatives it takes on board - effect policy makers, researchers, and ultimately people's health the world over. But this week, the widely respected medical journal the Lancet took a serious look at what Gates is funding, and found it lacking. In particular, the 'Global Fund' gives 65% of its funds to only 20 institutions, and a mere 5% of those funds go to capable Southern-based organizations.

It's interest in certain diseases like Malaria take the eyes off other diseases that may be more important to address; and their focus on under-funded diseases, while valuable, has the disadvantage of at times taking funding away from those diseases where there are good, simple and already known cures and solutions. The Lancet is daring, saying that the foundation is driven by the 'whimsical' views of the Gates Family, rather than by careful, scientific, transparent and peer-reviewed processes. Like many foundations, Gates talks of the importance of accountability, but who is it really accountable to? No one in the foundation is elected. So who determines its accountability?

These bring up larger questions about the role of philanthropy - and if a few families who have done well in the capitalist system should have as much impact as they do on the millions (billions) who haven't done so well. What's the role of the rich in determining the future of everyone else?

I'm not totally bashing the brilliance and the good intentions of Mr. Bill. But it should be interesting to see the results of the Lancet's study - and if it makes an impact. One thing Gates Foundation (even more than Microsoft) has shown is a willingness to learn - which is more than can be said for many other international institutions.