From: Shridhar Kadam
Posted At: dimanche 10 mai 2009 15:21
Conversation: nternational Health Policies in Lancet today – #14 – 8 May 09

Dear David and Wim,

Thanks for sharing the Lancet articles.
The Hindu, one of the leading English news paper in India has given wide coverage for Lancet articles on Gates Foundation funding in its todays edition.

Shridhar Kadam, India

Journal critique on Bill & Melinda Gates Foundation
grant pattern

R. Ramachandran
New Delhi: The Bill and Melinda Gates Foundation’s pattern of funding in the form of grants for global health programmes and projects has been criticised in a research paper in The Lancet.
The paper, by David McCoy of the Centre for International Health and Development, London, and others, is accompanied by a commentary by Robert E. Black of the Johns Hopkins Bloomberg School of Public Health, U.S., and others, and an editorial. Dr. M.K. Bhan, Secretary, Department of Biotechnology, is a co-author of the commentary in his capacity as a scientist of the All-India Institute of Medical Sciences, New Delhi.
Although it is driven by the belief that %u2018all lives have equal value,%u2019 it seems that the Foundation does not believe that every voice has equal value, especially voices from those it seeks most to assist,%u201D said the editorial. The commentary said very limited direct funding to low-income and middle-income countries is arguably the most unfortunate imbalance in the research portfolio
of the Foundation.

Response to The Hindu

According to the editorial in its May 9 issue, the medical journal invited the Gates Foundation for a response but it declined the offer. The Foundation, however, e-mailed the following response to The Hindu:

%u201CWe 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. In the end, we use our best judgment to determine where our funding can achieve the greatest reductions in health inequity around the world.

Observing that, while the Foundation%u2019s contribution to
global health generally received acclaim, not much was known about its
grant-making policy, Mr. McCoy and colleagues analysed all the 1,094
grants awarded between 1998 and 2007. These totalled about $9 billion
and included individual grants varying from $3,500 to $750 million.

Limited spread

The analysis revealed that $5.82 billion (65 per cent) was
shared by 20 organisations. These included the Global Alliance for
Vaccines and Immunisation (GAVI), the Global Fund, a Seattle-based
American non-governmental organisation PATH (Programme for Appropriate
Technology in Health, with a significant Indian presence) and a
selection of U.S. and the U.K. universities. In geographical terms, 40
per cent of all funding went to %u2018supranational%u2019 bodies such
as the World Health Organisation and GAVI.

The Foundation%u2019s contribution of $336 million accounts
for 4 per cent of the WHO%u2019s funding. It has thus emerged as one of
the biggest donors to the WHO, exceeding the contributions of most G20
governments, the paper has noted. In particular, the WHO has been
funded through as many as 69 separate Gates Foundation grant agreements
between 1998 and 2007. %u201C[This] suggests that the Foundation is
adding to the problem of WHO being largely funded by governments
through conditional, donor-determined grants,%u201D the paper says.

For high-income States

Of the remaining 60 per cent of the grants, the paper says 82
per cent went to organisations based in the U.S., and 13 per cent to
those in Europe and other high-income countries. Only 5 per cent went
to low-income and middle-income countries. Worldwide, 76 universities
received $1.8 billion, but nearly 60 per cent of this went to eight
institutions in the U.S. and the U.K.

Among the 20 largest grants, GAVI received two each, of $750
million, one to purchase vaccines and the other for general operational
support. About 37 per cent of the funding was towards R&D or
basic sciences research. The size of grants in these increased in
recent years as compared with those in healthcare delivery.

Child health research

With regard to child health research in particular, the analysis found
that funding for the development of technologies was disproportionate
in comparison to support to overcoming barriers to the use of existing
technologies. The commentary noted a poor correlation between the
funding pattern and childhood disease burden.

Of the 659 grants awarded to NGO and non-profit organisations,
560 went to those in high-income countries, primarily the U.S. Only 37
went to NGO and non-profit organisations in low-income and
middle-income countries. PATH, which has been quite involved in vaccine
related projects globally, was found to be the largest single recipient
in this category. During the period 1998-2007, PATH received $949
million in 47 projects for medical R&D of the $3.3 billion that
was given to over 100 such organisations. This led the authors to
remark: %u201CThe finding that organisation, PATH, was awarded nearly
$1billion%u2026 raises the question as to whether some organisations
might be better characterised as agents of the Foundation rather than
as independent grantees.%u201D

Private sector skew

Commenting on questionable grants made to the International
Finance Corporation, whose aim is to support private sector
development, the authors say this suggests a keenness to promote the
growth of private health-care providers in low-income and middle-income

%u201CGates Foundation is not a passive donor,%u201D observes
the paper.

%u201CThe Foundation actively engages in policy making and
agenda setting activities; it has representatives that sit on the
governing structures of many global health partnerships; it is part of
a self-appointed group of global health leaders known as the H8 [that
includes the WHO, UNICEF, GAVI and the World Bank]%u2026 and has been
involved in setting the health agenda for the G8.%u201D

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