The Gates Debate

“What has the Gates Foundation done for global health?”, was the topic of a debate at Britain’s Royal Society of the Arts on May 28th. The debate was inspired by a series of articles in the medical journal The Lancet (registration required) that highlighted the growing number of criticisms of the Gates Foundation’s efforts from the global public health establishment.

The debate was kicked of by David McCoy, the lead author of one of the Lancet articles, which analyses the $8 billion plus of grants made by the foundation to global health over the past decade. As Matthew, responding to McCoy, pointed out, this paper is a welcome contribution to a much needed debate – which has been under way for a while, including here and here on this website and on the GatesKeepers website. Even the Gates Foundation says it has found McCoy’s work helpful: a spokeswoman told Matthew that the foundation has grown so fast it has struggled to systematically keep track of where its money has gone – so it learnt a lot from the article. Moreover, the foundation’s health chief, Tachi Yamada, spoke at length with McCoy after the article appeared – a conversation that both sides say was positive and promises to be the start of a useful ongoing dialogue.

There is a fair account of the debate here by Richard Smith, a blogger for the British Medical Journal. As we wrote at length in the book, and have argued many times since, philanthrocapitalism of the sort practised by Bill Gates and others has huge potential and indeed is already making a big, positive difference; yet it can only acheive its full potential if it is accountable to the public and engaged in the sort of vigorous public debate that took place at the RSA.

The most surprising moment in the debate came at the very end, during the summing up by the hitherto fair and balanced chairman, Lancet editor Richard Horton. He launched an attack on Bill Gates, saying that in recent months he has been reversing many grants approved by Yamada that would have taken the foundation beyond the narrow technological approach criticised by the Lancet, among others, into a broader strategy of building health systems approved of by the global health establishment. These reversals, Horton claimed, amounted to the “constructive dismissal” of Yamada by his philanthrocapitalist boss.

This is a big claim, and we eagerly await a substantial article in the Lancet explaining it. We are ready to be proved wrong – but we will not be surprised if it turns out that Yamada is not the only senior Gates Foundation executive who has found his or her decisions revisited and even reversed in the past few months. That is because Gates is now full time at his foundation, and applying his mind a lot more diligently to the problems he is trying to solve – a process which, hopefully for the better, might be expected to challenge past thinking and policy at the foundation.

When Matthew visited the foundation in January to interview Bill Gates for The Economist about his first annual letter, various foundation executives told him privately that since going full time he had been “too nice”. Instead, they wanted more of the sometimes disagreable, argumentative “real Bill” of Microsoft fame. Maybe they are now getting what they asked for.