Study of Gates Foundation shows global influence

A new study of the Bill and Melinda Gates Foundation illustrates its global reach with spending on health issues, but notes a need for accountability on whether the money is being spent in the most effective way.

The world's largest philanthropic foundation focuses its global health giving on eradicating diseases such as malaria and AIDS. It also works to aid agricultural development in Africa and Asia and improve education in the United States.

"What we have is a private actor with a huge degree of influence, but not really a mechanism by which that influence is held to public account," said Dr. David McCoy, the primary author of the study being published Friday in the medical journal Lancet.

The entire global health community needs to think more about the issues of transparency and accountability, said McCoy, senior clinical associate at University College London, who also works the Centre for International Health and Development in London.

"It's really important to evaluate and critique the Gates Foundation, not just on its own but in relation to what's being funded by other agencies," McCoy said in a recent interview. "It's part of a bigger picture - a very influential part."

The director of a London-based think tank called the study an interesting paper on a pertinent topic, but said it is ruined by the ideological assumptions it manages to smuggle in.

Philip Stevens, director of health policy at the International Policy Network, said McCoy was a health activist who has written many pieces attacking the principle of private involvement in health.

The Gates Foundation itself didn't seem to have a problem with McCoy's report, according to its written response to a request for comment.

"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," the foundation said in an unsigned statement. "In the end, we use our best judgment to determine where our funding can achieve the greatest reductions in health inequity around the world."

McCoy's statistical analysis of the way the foundation gave away $8.95 billion in 1,094 global health grants between January 1998 and December 2007 comes to some interesting conclusions.

For example, $4.82 billion - 65 percent of its total global health grants - went to only 20 organizations, most of which are based in the United States and some within miles of the foundation's Seattle headquarters.

The study acknowledges, however, that it doesn't account for sub-recipients, many of which are located in other parts of the world.

About 10 percent of the global health grants went to one organization, the Program for Appropriate Technology in Health, which was awarded 47 grants worth a total of $949 million during the time period of the study.

The next three largest recipients were OneWorld Health, a nonprofit pharmaceutical company, the Save the Children Federation and the Aeras Global TB Vaccine Foundation.

"All the key contributors to global health have an association with the Gates Foundation through some sort of funding arrangement," the study notes. "Coupled with the large amount of money involved, these relations give the foundation a great degree of influence over both the architecture and policy agenda of global health."

McCoy said it's not unusual for people in the international health community to complain about the Gates Foundation and the way it makes its decisions, but most are reluctant to raise these issues in public. His goal in doing the study was to start a more public discussion about the foundation.

Stevens doesn't think much of McCoy's suggestion that the World Health Organization is a better choice to manage world health efforts.

He said the WHO spends too much of its money on "politically correct health nannying, such as healthy eating and seat belt campaigns - mainly aimed at wealthy countries."

The emergence of the Gates Foundation and others is partly in response to the failures of the WHO, Stevens said.

McCoy said he has no personal ax to grind, but acknowledges he has a different view on how the world should be addressing global health challenges.

"I'm not sure the way the Gates Foundation is going about it is as effective a way as it could be," he said.

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The Lancet: http://www.thelancet.com/