[Link] Criticism of the Gates Foundation

A recent Vox article puts together some criticism of the Gates foundation. Their main points:

• Poor accountability. I have no idea how to evaluate this one or how accountable Gates is compared to other aid organizations. In terms of making individual charity more accountable or effective, I can’t help but think that there have to be better places to start—like the numerous recent high-profile billionaire donations to Ivy League schools. If academics complain about Gates’ accountability and not about Paulson’s, it’s hard not to see it as simply a ploy to increase their own control over global health spending.

• Potential misprioritization (eg focusing richer countries or infectious diseases over obesity/cancer/diabetes). They cite these two Lancet articles for this.

  The accusation that BMGF supports rich countries seems to be based on the fact that they make research grants. Well, duh. Most of the research happens in the US because that’s where the good universities and doctors are. That doesn’t mean it’s not helpful to poorer countries.

  The accusation that they support infectious diseases disproportionately seems to be based on a plot of DALY burden versus spending for various categories, and pointing to various outliers (polio has high spending per DALY burden, while “non-communicable disease” has very low spending per DALY burden, etc.) Again this seems pretty bogus, as not every DALY is equally expensive to avert; it may be that the lower-DALY causes are nevertheless more tractable. This is especially true for non-communicable diseases, which have a bunch of funding from places other than Gates (e.g. NIH) because they’re also rich people problems.

• Too much emphasis on technology.

  Another concern that comes up in the academic literature is that the Gates Foundation is too focused on drugs, vaccines, and other technological solutions for global health problems. But many researchers, by contrast, would prefer a focus on the less exciting but crucial work of strengthening the health systems of poorer countries.

  I can’t comment much on this, except to note that so far the most cost-effective global health intervention I’m aware of is the eradication of smallpox. If Gates is shooting for another case of that (e.g. malaria eradication), it could be tremendously effective in the future, but much of their research funding here has yet to bear fruit. On the other hand, strengthening local health systems also seems super useful, but I’m very unfamiliar with what types of interventions this would comprise or what kind of results.

• Support for strict IP rules, which prevent poor countries from making cheap generic drugs. From my limited knowledge, this just seems to be Gates being dumb. Possibly related to Microsoft’s former CTO running a patent troll (Myhrvold and Gates are buddies).

All in all, I find this moderately convincing. Gates should probably just shut up about IP law, and maybe work more in infrastructure, not just tech. But claiming they’re “misfinancing global health” based on the kind of superficial analysis in those Lancet articles is pretty BS.