King Bill

The leaders of the G20 major economies are going to have lots to talk about at their summit meeting in Cannes at the end of this week: saving the Euro, preventing a meltdown in the global economy and, at the request of summit host Nicolas Sarkozy, the thoughts of Bill Gates on how to finance the fight against poverty. In these cash-strapped times as rich countries look likely to take a hatchet to aid budgets, ideas for financing development are welcome and we look forward to Mr Gates’s report with interest. (And some concern, too, if the rumours are true that he is going to come out in favour of the well-intentioned but muddle-headed ‘Robin Hood Tax’.) Yet such is his influence, as a mere private citizen, that some in the worlds of philanthropy and aid are worrying that Mr Gates is getting too big for his boots.

The difference between Mr Gates’ philanthropy and other foundations was well captured by Ed Skloot, director of Duke University’s Center for Strategic Philanthropy and Civil Society, in the latest edition of Alliance magazine. The article makes rather depressing reading, not for what it says about the Gates Foundation, but because of what it says about the rest of the foundation sector. The scale of Mr Gates philanthropy, running at $3 billion a year, is just one of its distinctive characteristics, Mr Skloot argues. “It differs from the institutional norm in almost every way: in size, ambition, high-level connections, proactivity, long-term commitment, operational engagement, and public leadership.” To us, these all seem like laudable features of philanthrocapitalism. Others in the foundation world seem less sure.

One of the mistakes that critics of the Gates Foundation make is to compare its scale and influence with that of other foundations. It is better, we believe, to look at the role that Mr Gates and other philanthropists are playing in the whole system, including government and private sector, where its size is far from remarkable. If philanthropy does not leverage change in public and private decision-making, it is unlikely to have much influence on the world.

Yet it is the Gates Foundation’s influence on the debate about aid and development that worries others most. This was evident last week at the Humanitarian Congress held in Berlin last week, where Michael debated the role of foundations with David McCoy, who has been a major critic of the Gates Foundation’s role in public health because of its focus on tackling communicable diseases, like malaria, through ‘vertical’ interventions like bednets and (hopefully) vaccination, rather than (he claims, somewhat outdatedly) taking on the underlying causes of ill health, like sanitation, and building the capacity of health systems. More fundamentally, Mr McCoy and others at Global Health Watch warn that so much of the global health sector is now dependent on Mr Gates’ money that critical voices are being stifled.

Doctors, as much as lawyers and other professions, will often resist outsiders who want to disrupt and challenge their expert view. But this critique should not be too easily dismissed. Indeed, as we argue in the book, rather than giving the lion’s share of his cash to the Gates Foundation, Warren Buffett might have been better to divide it between two or three foundations to create a bit of competition and diversify his philanthropic portfolio. There are two important issues that are worth debating:

First, what is the right division of labour between public and private actors? The Gates Foundation’s grant-making in global health puts it on a par with government donors like USAID or Britain’s Department for International Development (DFID) but that does not mean that they should all be doing the same things. Government donors will always find it more difficult to fund controversial high-risk projects but are better placed than private donors to support programmes to reform public health systems. Attacking the Gates Foundation for not behaving like, say, the World Health Organisation, is missing the point.

Second, how to ensure the accountability of private donors. One of the benefits that Mr Gates has brought to global health is his celebrity and, as we have seen, quite a lot of criticism. More and better debate is to be welcomed. The Gates Foundation says it welcomes this debate and prides itself on its willingness to learn. Mr Gates has also tried to make his own thinking more transparent.

Just because Mr Gates does not agree with his critics does not mean that he is unaccountable and does not listen. (Indeed, one of the weaknesses of government donors is their tendency to spread the money too thinly across different programmes to satisfy different lobby groups in the name of accountability.) Yet the risk that the scale of his foundation’s funding is stifling debate needs to be taken seriously. The Gates Foundation needs to show that it is ready to participate in the debate with its critics and to demonstrate that it is not just funding yes-men. Given how fearful those who are receiving his money are to be perceived as biting the hand that feeds them, the Gates Foundation probably needs to go out of its way to encourage debate and discover what these folk really say about it in private, to people like us!

Still, this creates a high-leverage opportunity for another foundation to support that debate. To do so would be risky and controversial, which sounds like a good idea. If only Steve Jobs, before his untimely death, had opted to stop sneering at Mr Gates’ philanthropy and instead extended their business rivalry into a full-on competition in giving to public health. But hopefully some other billionaire will rise to the challenge.