The Real Agenda of the Gates Foundation

— Jacob Levich*

“You're trying to find the places where the money will have the most leverage, how you can save the most lives for the dollar, so to speak,” Pelley remarked. “Right. And transform the societies,” Gates replied.1
In 2009 the self-designated “Good Club” – a gathering of the world’s wealthiest people whose collective net worth then totaled some $125 billion – met behind closed doors in New York City to discuss a coordinated response to threats posed by the global financial crisis. Led by Bill Gates, Warren Buffett, and David Rockefeller, the group resolved to find new ways of addressing sources of discontent in the developing world, in particular “overpopulation” and infectious diseases.2 The billionaires in attendance committed to massive spending in areas of interest to themselves, heedless of the priorities of national governments and existing aid organizations.3

Details of the secret summit were leaked to the press and hailed as a turning point for Big Philanthropy. Traditional bureaucratic foundations like Ford, Rockefeller, and Carnegie were said to be giving way to “philanthrocapitalism,” a muscular new approach to charity in which the presumed entrepreneurial skills of billionaires would be applied directly to the world’s most pressing challenges:

Today’s philanthrocapitalists see a world full of big problems that they, and perhaps only they, can and must put right. … Their philanthropy is “strategic,” “market conscious,” “impact oriented,” “knowledge based,” often “high engagement,” and always driven by the goal of maximizing the “leverage” of the donor’s money. … [P]hilanthrocapitalists are increasingly trying to find ways of harnessing the profit motive to achieve social good.4
Wielding “huge power that could reshape nations according to their will,”5 billionaire donors would now openly embrace not only the market-based theory, but also the practices and organizational norms, of corporate capitalism. Yet the overall thrust of their charitable interventions would remain consistent with longstanding traditions of Big Philanthropy, as discussed below:



I. The World’s Largest Private Foundation
II. Foundations and Imperialism
III.Gates and Big Pharma
IV. A Broader Agenda

I. The World’s Largest Private Foundation

“A new form of multilateral organization”
The most prominent of the philanthrocapitalists is Bill Gates, co-founder of Microsoft Corp. and as of this writing the richest man in the world. (Despite the carefully cultivated impression that Gates is “giving away” his fortune to charity, his estimated net worth has increased every year since 2009 and now amounts to $72 billion. 6) Gates owes his fortune not to making technological contributions but to acquiring and enforcing a fabulously lucrative monopoly in computer operating systems:

Microsoft’s greatest strength has always been its monopoly position in the PC chain. Its exclusionary licensing agreement with PC manufacturers mandated a payment for an MS-DOS license whether or not a Microsoft operating system was used. … By the time the company settled with the Justice Department in 1994 over this illegal arrangement, Microsoft had garnered a dominant market share of all operating systems sold.7

Microsoft employs the standard repertoire of business strategies in defense of its monopoly power – preferential pricing, lawsuits, acquisitions of competitors, lobbying for patent protection – but relies ultimately, like other US-based monopolies, on the dominant position of the US worldwide. As former US Secretary of Defense William Cohen observed in 1999, “the prosperity that companies like Microsoft now enjoy could not occur without having the strong military that we have.”8

Gates remains chairman of Microsoft but now devotes the bulk of his time to running The Bill and Melinda Gates Foundation (BMGF), the largest private foundation in the world and easily the most powerful. With an endowment of $38 billion, BMGF dwarfs once-dominant players such as Ford ($10 billion), Rockefeller ($3 billion), and Carnegie ($2.7 billion).9 These elite charitable funds are attractive to the super-rich not only as alternative channels of influencing policy, but also as a legal means of tax avoidance. Under US law, investments in charitable foundations are tax-free; moreover, investors are not required to sell their stock positions and may continue to vote their shares without restriction.10 By sheltering foundations, the US Treasury effectively co-finances the activities of BMGF and its investors, supplying a substantial part of the “leverage” lauded above.

Even in a field dominated by the world’s richest, the Gates Foundation has acquired a reputation for exceptional high-handedness. It is “driven by the interests and passions of the Gates family,” evasive about its financials, and accountable to no one except its founder, who “shapes and approves foundation strategies, advocates for the foundation’s issues, and sets the organization’s overall direction.”11

Gates’ approach to charity is presumably rooted in his attitude toward democracy:

The closer you get to [Government] and see how the sausage is made, the more you go, oh my God! These guys don’t even actually know the budget. … The idea that all these people are going to vote and have an opinion about subjects that are increasingly complex – where what seems, you might think … the easy answer [is] not the real answer. It’s a very interesting problem. Do democracies faced with these current problems do these things well?12

The Gates charitable empire is vast and growing. Within the US, BMGF focuses primarily on “education reform,” providing support for efforts to privatize public schools and subordinate teachers’ unions. Its much larger international divisions target the developing world and are geared toward infectious diseases, agricultural policy, reproductive health, and population control. In 2009 alone, BMGF spent more than $1.8 billion on global health projects.13

The Gates Foundation exercises power not only via its own spending, but more broadly through an elaborate network of “partner organizations” including non-profits, government agencies, and private corporations. As the third largest donor to the UN's World Health Organization (WHO), it is a dominant player in the formation of global health policy.14 It orchestrates vast elaborate public-private partnerships – charitable salmagundis that tend to blur distinctions between states, which are at least theoretically accountable to citizens, and profit-seeking businesses that are accountable only to their shareholders. For example, a 2012 initiative aimed at combatting neglected tropical diseases listed among its affiliates USAID, the World Bank, the governments of Brazil, Bangladesh, UAE et al., and a consortium of 13 drug firms comprising the most notorious powers in Big Pharma, including Merck, GlaxoSmithKline, and Pfizer.15

BMGF is the prime mover behind prominent “multi-stakeholder initiatives” such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance (a “public-private partnership” between the World Health Organization and the vaccine industry). Such arrangements allow BMGF to leverage its stake in allied enterprises, much as private businesses enhance power and profits through strategic investment schemes. The Foundation also intervenes directly in the agendas and activities of national governments, ranging from its financing of the development of municipal infrastructure in Uganda,16 to its recently announced collaboration with the Indian Ministry of Science to “Reinvent the Toilet.”17 At the same time the Foundation supports NGOs that lobby governments to increase spending on the initiatives it sponsors.18

The Gates operation resembles nothing so much as a massive, vertically integrated multinational corporation (MNC), controlling every step in a supply chain that reaches from its Seattle-based boardroom, through various stages of procurement, production, and distribution, to millions of nameless, impoverished “end-users” in the villages of Africa and South Asia. Emulating his own strategies for cornering the software market, Gates has created a virtual monopoly in the field of public health. In the words of one NGO official, “[y]ou can’t cough, scratch your head or sneeze in health without coming to the Gates Foundation.”19 The Foundation's global influence is now so great that former CEO Jeff Raikes was obliged to declare: “We are not replacing the UN. But some people would say we’re a new form of multilateral organization.”20



NEXT: II. Foundations and Imperialism


Notes:

6. “Bill Gates,” Forbes.com, Sept. 2013, http://www.forbes.com/profile/bill-gates/. (back)

7. Barry Ritholtz, “What's Behind Microsoft’s Fall from Dominance,” Washington Post, Sept. 26, 2013, http://www.washingtonpost.com/business/whats-behind-microsofts-fall-from-dominance/2013/09/05/b0e5e91e-157b-11e3-804b-d3a1a3a18f2c_story_1.html. (back)

8. Quoted in Michael Perelman, “The Political Economy of Intellectual Property,” Monthly Review, vol. 54, no. 8, January, 2003, http://monthlyreview.org/2003/01/01/the-political-economy-of-intellectual-property. (back)

9. The Foundation Center, Top Funders, http://foundationcenter.org/findfunders/topfunders/top100assets.html. (back)

10. Sheldon Drobny, “The Gates and Buffett Foundation Shell Game,” CommonDreams.org, April 26, 2006, http://www.commondreams.org/views06/0823-26.htm. (back)

11. BMGF website, http://www.gatesfoundation.org/Who-We-Are/General-Information/Leadership/Management-Committee. (back)

12. Richard Waters, “An exclusive interview with Bill Gates,” Financial Times, Nov. 1, 2013, http://www.ft.com/intl/cms/s/2/dacd1f84-41bf-11e3-b064-00144feabdc0.html#axzz2q0sgejl. (back)

13. Noel Salazar, “Top 10 philanthropic foundations: A primer,” Devex, Aug. 1, 2011, https://www.devex.com/en/news/top-10-philanthropic-foundations-what-you-need-to/75508. (back)

14. Global Health Watch, Global Health Watch 2: An Alternative World Health Report, 2008, p. 250, http://www.ghwatch.org/sites/www.ghwatch.org/files/ghw2.pdf. In a 2008 memo leaked to the press, Arata Kochi, chief of the malaria program at the World Health Organization, charged that “the growing dominance of malaria research by the Bill and Melinda Gates Foundation risks stifling a diversity of views among scientists and wiping out the health agency’s policy-making function.” Donald G. McNeil Jr., “WHO official complains about Gates Foundation's dominance in malaria fight,” NY Times, Nov. 7, 2008, http://www.nytimes.com/2008/02/17/world/americas/17iht-gates.4.10120087.html. (back)

15. “Private and Public Partners Unite to Combat 10 Neglected Tropical Diseases by 2020,” BMGF press release, Jan. 2012, http://www.gatesfoundation.org/media-center/press-releases/2012/01/private-and-public-partners-unite-to-combat-10-neglected-tropical-diseases-by-2020. (back)

16. Grant to Ministry of Lands, Housing and Urban Development; Government of Uganda, July, 2012, http://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database/Grants/2012/07/OPP1053920 . (back)

17. “The Next Grand Challenge in India: Reinvent the Toilet,” BMGF press release, Oct. 2013, http://www.gatesfoundation.org/Media-Center/Press-Releases/2013/10/The-Next-Grand-Challenge-in-India. The Foundation also feels free to “sit down with the Pakistan government” to demand security measures in support of its operations. See Neil Tweedie, “Bill Gates Interview: I Have No Use for Money. This is God’s Work,” The Telegraph, Jan. 18, 2013, http://www.telegraph.co.uk/technology/bill-gates/9812672/Bill-Gates-interview-I-have-no-use-for-money.-This-is-Gods-work.html. (back)

18. Global Health Watch, op. cit., p. 251. (back)

19. Ibid. (back)

20. Gabrielle Pickard, “Will Gates Foundation Replace the UN?” UN Post, 2010, http://www.unpost.org/will-gates-foundation-replace-the-un/#ixzz2pjv08DJr. (back)

II. Foundations and Imperialism

When those who have aggressively established and maintained monopolies in order to accumulate vast capital turn to charitable activities, we need not assume their motives are humanitarian.21 Indeed, on occasion these ‘philanthropists’ define their aims more bluntly as making the world safe for their kind. In a letter published on the Foundation's website, Bill Gates invokes “the rich world's enlightened self-interest” and warns that “[i]f societies can’t provide for people’s basic health, if they can’t feed and educate people, then their populations and problems will grow and the world will be a less stable place.”22

The pattern of such ‘philanthropic’ activities was set in the US about a century ago, when industrial barons such as Rockefeller and Carnegie set up the foundations that bear their names, to be followed in 1936 by Ford. As Joan Roelofs has argued,23 during the past century large-scale private philanthropy has played a critical worldwide role in ensuring the hegemony of neoliberal institutions while reinforcing the ideology of the Western ruling class. Interlocking networks of foundations, foundation-sponsored NGOs, and US government institutions like the National Endowment for Democracy (NED) – notorious as a “pass-through” for CIA funds – work hand-in-hand with imperialism, subverting people-friendly states and social movements by co-opting institutions deemed helpful to US global strategy. In extreme but not infrequent cases, foundations have actively collaborated in regime change ops managed by US intelligence.24

The role of Big Philanthropy, however, is broader. Even seemingly benign endeavors by foundations, such as the fight against infectious diseases, can best be understood when located in their specific historical and social contexts. Recall that schools of tropical medicine were established in and the US in the late 19th Century with the explicit goal of increasing the productivity of colonized laborers while insuring the safety of their white overseers. As a journalist wrote in 1907:

Disease still decimates native populations and sends men home from the tropics prematurely old and broken down. Until the white man has the key to the problem, this blot must remain. To bring large tracts of the globe under the white man's rule has a grandiloquent ring; but unless we have the means of improving the conditions of the inhabitants, it is scarcely more than an empty boast.25

Precisely this reasoning underlay the formation of the Rockefeller Foundation, which was incorporated in 1913 with the initial goal of eradicating hookworm, malaria, and yellow fever.26 In the colonized world public health measures encouraged by Rockefeller’s International Health Commission yielded increases in profit extraction, as each worker could now be paid less per unit of work, “but with increased strength was able to work harder and longer and received more money in his pay envelope.”27 In addition to enhanced labour efficiency – which was not necessarily a critical challenge to capital in regions where vast pools of underemployed labour were available for exploitation – Rockefeller’s research programs promised greater scope for future US military adventures in the Global South, where occupying armies had often been hamstrung by tropical diseases.28

As Rockefeller expanded its international health programs in concert with US agencies and other organizations, additional advantages to the imperial core were realized. Modern medicine advertised the benefits of capitalism to “backward” people, undermining their resistance to domination by imperialist powers while creating a native professional class increasingly receptive to neocolonialism and dependent on foreign largesse. Rockefeller's president observed in 1916: “[F]or purposes of placating primitive and suspicious peoples medicines have some advantages over machine guns.”29

In the aftermath of World War II, public health philanthropy became closely aligned with US foreign policy as neocolonialism embraced the rhetoric, if not always the substance, of “development.” Foundations collaborated with the US Agency for International Development (USAID) in support of interventions aimed at increasing production of raw materials while creating new markets for Western manufactured goods. A section of the US ruling class, represented most prominently by Secretary of State George Marshall, argued that “increases in the productivity of tropical labor would require investments in social and economic infrastructure including greater investments in public health.”30

Meanwhile, the seminal Gaither Report, commissioned in 1949 by the Ford Foundation, had charged Big Philanthropy with advancing “human welfare” in order to resist the “tide of Communism … in Asia and Europe.”31 By 1956, a report to the US president by the International Development Administration Board openly framed public health assistance as a tactic in aid of Western military aggression in Indochina:

[A]reas rendered inaccessible at night by Viet Minh activity, during the day welcomed DDT-residual spray teams combating malaria. … In the Philippines, similar programs make possible colonization of many previously uninhabited areas, and contribute greatly to the conversion of Huk terrorists to peaceful landowners.32

For a time, therefore, Western philanthropy worked to shape public health systems in poor countries, sometimes condescending to relinquish control of infrastructure and trained personnel to national health ministries.33 Although actual investment in Third World healthcare was meager by comparison with the extravagant promises of Cold War rhetoric, some response to health crises in poor countries was deemed necessary in the context of the postwar struggle for “hearts and minds.”

The fall of the Soviet Union ushered in the present phase of public health philanthropy, characterized by the Western demand for “global health governance” – purportedly as a response to the spread of communicable diseases accelerated by globalization. Health has been redefined as a security concern; the developing world is portrayed as a teeming petri dish of SARS, AIDS, and tropical infections, spreading “disease and death” across the globe34 and requiring Western powers to establish centralized health systems designed to “overcome the constraints of state sovereignty.”35 Imperial interventions in the health field are justified in the same terms as recent “humanitarian” military interventions: “[N]ational interests now mandate that countries engage internationally as a responsibility to protect against imported health threats or to help stabilize conflicts abroad so that they do not disrupt global security or commerce.”36

Providing support for national healthcare operations is no longer on the agenda; to the contrary – in keeping with structural adjustment programs that have required ruinous disinvestment in public health throughout the developing world37 – health ministries are routinely bypassed or compromised via “public-private partnerships” and similar schemes. As national health systems are hollowed out, health spending by donor countries and private foundations has risen dramatically.38 Indeed, the US-based Council on Foreign Relations envisions a withering away of state-sponsored healthcare delivery, to be replaced by a supranational regime of “new legal frameworks, public-private partnerships, national programs, innovative financing mechanisms, and greater engagement by nongovernmental organizations, philanthropic foundations, and multinational corporations.”39

The exemplar of philanthropy in the era of global health governance is the Gates Foundation. Vastly endowed, essentially unaccountable, unencumbered by respect for democracy or national sovereignty, floating freely between the public and private spheres, it is ideally positioned to intervene swiftly and decisively on behalf of the interests it represents. As Bill Gates remarked, “I’m not gonna get voted out of office.”40 Close working relationships with UN, US and EU institutions, as well as powerful multinational corporations, give BMGF an extraordinary capability to harmonize complex overlapping agendas, ensuring that corporate and US ambitions are simultaneously advanced. To better understand how BMGF operates and in whose interests, it is worth looking closely at the Foundation’s global vaccine programs, where until recently the bulk of its money and muscle was brought to bear.



NEXT: III. Gates and Big Pharma


Notes:

21. The Gates Foundation’s occasional pretensions to selfless charity are belied by the policies of its Trust, which invests heavily in “companies that contribute to the human suffering in health, housing and social welfare that the foundation is trying to alleviate.” Andy Beckett, “Inside the Bill and Melinda Gates Foundation,” Guardian, July 12, 2010, http://www.theguardian.com/world/2010/jul/12/bill-and-melinda-gates-foundation. (back)

22. Bill Gates, Annual Letter 2011, http://www.gatesfoundation.org/Who-We-Are/Resources-and-Media/Annual-Letters-List/Annual-Letter-2011. (back)

23. Foundations and Public Policy: The Mask of Pluralism (SUNY Series in Radical Social and Political Theory 2003); see also “New Study on the Role of US Foundations,” Aspects of India's Economy No. 38, Dec., 2004, http://rupe-india.org/38/foundations.html. (back)

24. E.g. “[i]n Indonesia the Ford Foundation-sponsored knowledge networks worked to undermine the neutralist Sukarno government that challenged U.S. hegemony. At the same time, Ford trained economists (both at University of Indonesia and in U.S. universities) for a future regime supportive of capitalist imperialism.” Roelofs, “Foundations and American Power,” Counterpunch, April 20-22, 2012, http://www.counterpunch.org/2012/04/20/foundations-and-american-power/. (back)

25. Quoted in E. Richard Brown, “Public Health in Imperialism: Early Rockefeller Programs at Home and Abroad,” Am J Public Health, 1976 September; 66(9): 897–903, 897. (back)

26. From its earliest days Rockefeller’s philanthropy hid a domestic agenda as well. The Foundation was forced to retreat from sponsorship of research into labor relations after the 1916 Walsh Commission Report found it was “corrupt[ing] sources of public information” in an effort to whitewash predatory business practices and industrial violence. Jeffrey Brison, Rockefeller, Carnegie, and Canada, Montreal: McGill-Queen’s University Press, 2005, p. 35. (back)

27. E. Richard Brown, op. cit., p. 900. (back)

28. David Killingray, “Colonial Warfare in West Africa 1870-1914,” reprinted in J. A. de Moor & H.L. Wesseling, eds., Imperialism and War, Leiden : E.J. Brill : Universitaire pers Leiden, 1989, pp. 150-151. (back)

29. E. Richard Brown, op. cit., p. 900. (back)

30. Randall Packard, “Visions of Postwar Health and Development and Their Impact on Public Health Interventions in the Developing World,” reprinted in Frederick Cooper & Randall Packard, International Development and the Social Sciences, Berkeley: Univ. of California Press, 1997, p. 97. In a 1948 address to the Fourth International Congress of Tropical Diseases and Malaria, Marshall, a leading architect of US policy during the early years of the Cold War, outlined a grandiose vision of healthcare under ‘enlightened’ capitalism: “Little imagination is required to visualize the great increase in the production of food and raw materials, the stimulus to world trade, and above all the improvement in living conditions, with consequent cultural and social advantages, that would result from the conquest of tropical diseases.” Ibid., p. 97. (back)

31. Report of the Study for the Ford Foundation on Policy and Program, Detroit: Ford Foundation, November, 1949, p. 26, http://www.fordfoundation.org/pdfs/about/Gaither-Report.pdf. (back)

32. Quoted in Packard, op. cit., p. 99. (back)

33. Wilbur G. Downs, M.D., “The Rockefeller Foundation Virus Program 1951-1971 with Update to 1981,” Ann. Rev. Med. 1982 33:1-29, 8. (back)

34. Andrew F. Cooper and John J. Kirton, eds., Innovation in Global Health Governance: Critical Cases, Aldershot: Ashgate Publishing, 2009, ch. 1. (back)

35. Michael A. Stevenson & Andrew F. Cooper, “Overcoming Constraints of State Sovereignty: Global Health Governance in Asia,” Third World Quarterly, vol. 30, no. 7, 3009, pp. 1379-1394. (back)

36. Thomas E Novotny et al., “Global health diplomacy– a bridge to innovative collaborative action,” Global Forum Update on Research for Health, vol. 5, 2008, p. 41. (Emphasis added.) (back)

37. See Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action position paper, April 18, 2002, http://www.africafocus.org/docs02/sap0204b.php. (back)

38. Global Health Watch, pp. 210-11. (back)

39. David P. Fidler, The Challenges of Global Health Governance, CFR Working Paper, May, 2010, http://www.cfr.org/global-governance/challenges-global-health-governance/p22202. (back)

40. Interview with Bill Gates, NOW with Bill Moyers, May 9, 2003, transcript of television interview, http://www.pbs.org/now/transcript/transcript_gates.html. (back)

III. Gates and Big Pharma

“Guinea pigs for the drugmakers”
Despite annual revenues approaching $1 trillion, the global pharmaceutical industry has lately experienced a critical decline in the rate of profit, for which it lays most of the blame on regulatory requirements. A US think tank has estimated the cost of new drug development at $5.8 billion per drug, of which 90 per cent is incurred in Phase III clinical trials mandated by the US Food and Drug Administration and similar agencies in Europe.41 (These are tests administered to large groups of human subjects in order to confirm the effectiveness and monitor the side effects of new vaccines and other medicines.) The international business consulting firm McKinsey & Company called the situation “dramatic” and urged Big Pharma executives to “envision responses that go well beyond simply tinkering with the cost base” – primarily the relocation of clinical trials to emerging markets, where drug safety testing is seen as relatively cheap, speedy, and lax.42

It is in this specific context that BMGF’s intervention in the distribution of certain vaccines and contraceptives must be seen. Heavily invested in Big Pharma,43 the Foundation is well positioned to facilitate pharmaceutical R&D strategies tailored to the realities of the developing world, where “[t]o speed the translation of scientific discovery into implementable solutions, we seek better ways to evaluate and refine potential interventions—such as vaccine candidates—before they enter costly and time-consuming clinical trials.”44 In plain language, BMGF promises to assist Big Pharma in its efforts to circumvent Western regulatory regimes by sponsoring cut-rate drug trials in the periphery.

The instruments of this assistance are Gates-controlled institutions like the GAVI Alliance, the Global Health Innovative Technology Fund, and the Program for Appropriate Technology in Health (PATH) – public-private partnerships purportedly devoted to saving Third World lives. Notionally independent but so heavily funded by Gates as to function as virtual arms of the Foundation, these organizations began to conduct large-scale clinical trials in Africa and South Asia in the mid-2000s.45

Africa soon experienced an “unprecedented increase in health research involving humans” who were typically “poverty-stricken and poorly educated”46; the results were predictably lethal. In 2010 the Gates Foundation funded a Phase III trial of a malaria vaccine developed by GlaxoSmithKline (GSK), administering the experimental treatment to thousands of infants across seven African countries. Eager to secure the WHO approval necessary to license the vaccine for global distribution, GSK and BMGF declared the trials a smashing success, and the popular press uncritically reproduced the publicity.47 Few bothered to look closely at the study's fine print, which revealed that the trials resulted in 151 deaths and caused “serious adverse effects” (e.g., paralysis, seizures, febrile convulsions) in 1048 of 5949 children aged 5-17 months.48 Similar stories emerged in the wake of the Gates-funded MenAfriVac campaign in Chad, where unconfirmed reports alleged that 50 of 500 children forcibly vaccinated for meningitis later developed paralysis.49 Citing additional abuses, a South African newspaper declared: “We are guinea pigs for the drugmakers.”50

It was in India, however, that the implications of BMGF’s collaboration with Big Pharma first rose to widespread public attention. In 2010 seven adolescent tribal girls in Gujarat and Andhra Pradesh died after receiving injections of HPV (Human Papilloma Virus) vaccines as part of a large-scale “demonstrational study” funded by the Gates Foundation and administered by PATH.51 The vaccines, developed by GSK and Merck, were given to approximately 23,000 girls between 10 and 14 years of age, ostensibly to guard against cervical cancers they might develop in old age.

Extrapolating from trial data, Indian physicians later estimated that at least 1,200 girls experienced severe side effects or developed auto-immune disorders as a result of the injections.52 No follow-up examinations or medical care were offered to the victims. Further investigations revealed pervasive violations of ethical norms: vulnerable village girls were virtually press-ganged into the trials, their parents bullied into signing consent forms they could not read by PATH representatives who made false claims about the safety and efficacy of the drugs. In many cases signatures were simply forged.53

An Indian Parliamentary Committee determined that the Gates-funded vaccine campaign was in fact a large-scale clinical trial conducted on behalf of the pharmaceutical firms and disguised as an “observational study” in order to outflank statutory requirements.54 The Committee found that PATH had “violated all laws and regulations laid down for clinical trials by the government” in a “clear-cut violation of human rights and a case of child abuse.”55 The Gates Foundation did not trouble to respond to the findings but issued an annual letter calling for still more health-related R&D in poor countries and reaffirming its belief in “the value of every human life.”56

Making markets
By thrusting the HPV vaccine on India, The Gates Foundation was not merely facilitating low-cost clinical trials but was also assisting in the creation of new markets for a dubious and underperforming product. Merck’s version of the vaccine, called Gardasil, was introduced in 2006 in conjunction with a high-powered marketing campaign that generated $1.5 billion in annual sales57; the vaccine was named “brand of the year” by Pharmaceutical Executive for “building a market out of thin air.”58 Aided by enthusiastic endorsements from the medical establishment, Merck at first persuaded Americans that Gardasil could protect their daughters from cervical cancer. In fact the vaccine was of questionable efficacy:

The relationship between [HPV] infection at a young age and development of cancer 20 to 40 years later is not known. … The virus does not appear to be very harmful because almost all HPV infections are cleared by the immune system. [S]ome women may develop precancerous cervical lesions and eventually cervical cancer. It is currently impossible to predict in which women this will occur and why.59

The prestigious Journal of the American Medical Association in 2009 openly questioned whether the vaccine’s risks outweighed the potential benefits.60 As word of Gardasil's defects emerged, American and European women began to decline the vaccine, and by 2010 Fortune Magazine declared Gardasil a “marketplace dud” as year-over-year sales fell by 18 percent.61 GSK's copycat HPV vaccine, Cervarix, experienced a comparable sales trough.

Billions in profits and capitalization were at stake. At this stage the Gates Foundation stepped in. Its principal tool was the GAVI Alliance, launched by BMGF in 2000 with the “explicit goal to shape vaccine markets.”62 GAVI was charged with co-financing vaccine purchases with Third World public health ministries, meanwhile “finding the type of large-scale funding needed to sustain long-term immunisation programmes” and “laying the foundations that will allow governments to continue immunisation programmes long after GAVI support ends.63 In essence, BMGF would buy up stockpiled drugs that had failed to create sufficient demand in the West, press them on the periphery at a discount, and lock in long-term purchase agreements with Third World governments.

In 2011 GAVI held a highly publicized board meeting in Dhaka where, with the enthusiastic endorsement of UN Secretary General Ban ki-Moon, it announced a worldwide campaign to introduce HPV vaccines to developing countries: “If [developing] countries can demonstrate their ability to deliver the vaccines, up to two million women and girls in nine countries could be protected from cervical cancer by 2015.”64 GSK adopted a “Global Vaccine Availability Model” involving tiered pricing to permit “transition[ing] into poorer countries with the help of ‘partners’ such as UNICEF, the World Health Organization, and the Global Alliance for Vaccines and Immunization.”65 Meanwhile PATH was rushing to complete a large-scale, five-year long project “to generate and disseminate evidence for informed public sector introduction of HPV vaccines” in India, Uganda, Peru and Vietnam. An Indian Parliamentary report observed: “all these countries have state-funded national vaccine immunization programs, which if expanded to include Gardasil, would mean tremendous financial benefit to the … manufacturer.”66
By FYE 2012, Merck was able to report a 35 percent jump in worldwide Gardasil sales, reflecting inter alia “favorable performance in Japan and the emerging markets,” where “sales growth is being driven by vaccines.”67 Evidently, a drug rightly deemed suspect by Americans would be good enough for women in the developing world.

Other dangerous drugs that failed to gain a toehold in Western markets have received similar attention from the Gates Foundation. Norplant, a subcutaneous contraceptive implant that effectively sterilizes women for as long as five years, was pulled from the US market after 36,000 women filed suit over severe side effects undisclosed by the manufacturer, including excessive menstrual bleeding, headaches, nausea, dizziness and depression.68 Slightly modified and rebranded as Jadelle, the same drug is now being heavily promoted in Africa by USAID, the Gates Foundation, and its affiliates. A recent article on the Gates-sponsored website Impatient Optimists elides its dangers and disingenuously states that the drug “never gained traction” in the US because inserting and removing the device was “cumbersome.” With Gates Foundation support, however, Jadelle “has played a pivotal role in bringing implants to the developing world” and is soon to be complemented by a second Norplant clone, Merck’s Implanon.69

An equally risky contraceptive, Pfizer’s Depo-Provera, recently received the Gates Foundation imprimatur for distribution to poor women worldwide. In the US and India feminists fought against approval of the injectable drug for decades due to its alarming list of side effects, including “infertility, irregular bleeding, decreased libido, depression, high blood pressure, excessive weight gain, breast tenderness, vaginal infections, hair loss, stomach pains, blurred vision, joint pain, growth of facial hair, acne, cramps, diarrhea, skin rash, tiredness, and swelling of limbs”70 as well as potentially irreversible osteoporosis.71

After the US Food and Drug Administration succumbed to industry pressure and granted approval in 1992, studies found a marked racial disparity in Depo-Provera prescriptions between white and African American women, leading to charges that “this form of long-acting provider-controlled birth control is routinely given to women of color in order to deny them the ability to control their own reproduction.”72 White American and European women, by contrast, receive the drug only rarely and typically as a treatment for endometriosis, greatly limiting its commercial potential in the West.

Hence Pfizer stands to benefit enormously from a Gates-sponsored program, announced with much fanfare at the 2012 London Summit on Family Planning, to distribute the drug to millions of women in South Asia and sub-Saharan Africa by 2016:73
[Y]ou do the numbers: If 120 million new women users chose Depo-Provera, at an estimated average cost between $120-$300 per woman annually, that works out to $15 billion to $36 billion in new sales annually, a nice payoff from leveraging $4 billion in research money.74

Foundation publicity suggests that its aggressive backing of a discredited drug is merely a response to appeals from poor women. “Many [African] women want to use injectable contraceptives but simply cannot get access to them,” claimed PATH President and CEO Steve Davis.75 Reproductive rights activist Kwame Fasu disagrees: “No African woman would agree to being injected if she had full knowledge of the contraceptives’ dangerous side effects.”76



NEXT: IV. A Broader Agenda


Notes:

41. Avik S.A. Roy, Stifling New Cures: The True Cost of Lengthy Clinical Drug Trials, Manhattan Institute, April, 2012, http://www.manhattan-institute.org/html/fda_05.htm. (back)

42. Vivan Hunt et al., A Wake-Up Call for Big Pharma, McKinsey & Co, Dec. 2011, http://www.mckinsey.com/insights/health_systems_and_services/a_wake-up_call_for_big_pharma; Michael Edwards, R&D in Emerging Markets: A New Approach for a New Era, McKinsey & Co., Feb. 2012, http://www.mckinsey.com/insights/winning_in_emerging_markets/r_and_38d_in_emerging_markets_a_new_approach_for_a_new_era . (back)

43. In 2002 the Gates Foundation invested $205 million in pharmaceutical companies, including Merck & Co., Pfizer Inc., Johnson & Johnson, and GlaxoSmithKline. Ruben Rosenberg Colorni, “Bill Gates, Big Pharma, Bogus Philanthropy,” News Junkie Post, June 7, 2013, http://newsjunkiepost.com/2013/06/07/bill-gates-big-pharma-bogus-philanthropy/ . (back)

44. Discovery and Translational Sciences Strategy Overview, BMGF website, http://www.gatesfoundation.org/What-We-Do/Global-Health/Discovery-and-Translational-Sciences. (back)

45. Gates-funded public-private consortia typically subcontract with local Contract Research Organizations (CROs) to conduct trials in the field, allowing the Foundation to maintain arms-length distance from the realities of recruiting and injecting human subjects, which frequently involves deception and coercion. The global CRO industry is projected to reach over $32 billion by 2015. See WEMOS, The Clinical Trials Industry in South Africa: Ethics, Rules and Realities, July 2012, pp. 11-13, http://www.wemos.nl/files/Documenten%20Informatief/Bestanden%20voor%20'Medicijnen'/
Clinical_Trials_Industry_South_Africa_2013_v3.pdf. (back)

46. A. Nyika et al., “Composition, training needs and independence of ethics review committees across Africa: are the gate-keepers rising to the emerging challenges?,” J Med Ethics, 2009 March; 35(3): 189–193. (back)

47. E.g., “Malaria vaccine could save millions of children's lives,” Guardian, Oct. 18, 2011, http://www.theguardian.com/society/2011/oct/18/malaria-vaccine-save-millions-children. (back)

48. “First Results of Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Children ,” N Engl J Med 365;20, November 17, 2011. Though some of the deaths would have been expected due to high infant mortality rates in Africa, children who received the vaccine died at more than twice the rate of children in the control group. Ibid., p. 1869. (back)

49. “Minimum of 40 Children Paralyzed after New Meningitis Vaccine,” VacTruth.com, Jan. 6, 2013, http://vactruth.com/2013/01/06/paralyzed-after-meningitis-vaccine/. The report relied on the Chadian daily La Voix.(back)

50. Johannesburg Times, July 25, 2013, http://www.timeslive.co.za/news/2013/07/25/we-are-guinea-pigs-for-the-drugmakers. (back)

51. Sandhya Srinivasan, “A Vaccine for Every Ailment,” Infochange, April, 2010, http://infochangeindia.org/public-health/healthcare-markets-and-you/a-vaccine-for-every-ailment.html. PATH maintained that the dead girls had been bitten by snakes or fallen down wells. Ibid. (back)

52. Kalpana Mehta, Nalini Bhanot & V. Rukmini Rao, Supreme Court Pulls Up Government Of India Over Licensing And Trials With “Cervical Cancer” Vaccines, Countercurrents.org, Jan. 7, 2013, http://www.countercurrents.org/mehta070113.htm. (back)

53. Aarthi Dhar, “It’s a PATH of violations, all the way to vaccine trials: House panel,” The Hindu, Sept. 2, 2013, http://www.thehindu.com/news/national/its-a-path-of-violations-all-the-way-to-vaccine-trials-house-panel/article5083151.ece. (back)

54. Parliament of India, 72nd Report on Alleged Irregularities in the Conduct of Studies Using Human Papilloma Virus (HPV) Vaccine by PATH in India, Aug. 29, 2013, sec. II, http://www.elsevierbi.com/~/media/Supporting%20Documents/Pharmasia%20News/2013/
September/HPV%20Vaccines%20Parliameetnary%20Report%20%20Aug%2031%202013.pdf. (back)

55. Quoted in Aarthi Dhar, op. cit. (back)

56. Bill and Melinda Gates, 2014 Gates Annual Letter, Jan. 2014, http://annualletter.gatesfoundation.org/. (back)

57. Merck, 2007 Annual Report, http://www.merck.com/finance/annualreport/ar2007/vaccines.html. (back)

58. Zosia Chustecka, “HPV Vaccine: Debate Over Benefits, Marketing, and New Adverse Event Data,” Medscape, Aug. 18, 2009, http://www.medscape.com/viewarticle/707634. (back)

59. Charlotte Haug M.D., “The Risks and benefits of HPV Vaccination,” Journal of the American Medical Association, Aug. 19, 2009, p. 795, http://jama.jamanetwork.com/article.aspx?articleid=184404. (back)

60. Ibid. (back)

61. Shelley DuBois, “What Went Wrong With Gardasil,” Fortune, Sept. 7, 2012, http://money.cnn.com/2010/09/06/news/companies/merck_Gardasill_problems.fortune/ . (back)

62. GAVI Alliance, “Vaccine supply and procurement,” http://www.gavialliance.org/about/gavis-business-model/vaccine-supply-and-procurement/. As of July 2013, GAVI had received $1.5 billion in support from the Gates Foundation. Bill & Melinda Gates Foundation, Foundation Fact Sheet, 2013, http://www.gatesfoundation.org/who-we-are/general-information/foundation-factsheet. (back)

63. GAVI Alliance, “The Business Model,” http://www.gavialliance.org/about/gavis-business-model/the-business-model/. (back)

64. “GAVI takes first steps to introduce vaccines against cervical cancer and rubella,” GAVI press release, Nov. 17, 2011, http://www.gavialliance.org/library/news/press-releases/
2011/gavi-takes-first-steps-to-introduce-vaccines-against-cervical-cancer-and-rubella/#sthash.czf4Hmry.dpuf. (back)

65. Renee Twombly, “U.S. Girls To Receive HPV Vaccine but Picture Unclear on Potential Worldwide Use, Acceptance,” J Natl Cancer Inst, vol. 98, no. 15, Aug., 2006, pp. 1030-32. (back)

66. Parliament of India, 72nd Report, sec. 1.11. (back)

67. “Merck Announces Full-Year and Fourth-Quarter 2012 Financial Results,” Business Wire, Feb. 1, 2013, http://www.businesswire.com/news/home/20130201005282/en/Merck-Announces-Full-Year-Fourth-Quarter-2012-Financial-Results. (back)

68. Morrow, David J. “Maker of Norplant offers a settlement in suit over effects,” New York Times, Aug. 27, 1999, p. A1, http://www.nytimes.com/1999/08/27/us/maker-of-norplant-offers-a-settlement-in-suit-over-effects.html. (back)

69. Dorfliner et al., “The Evolution of Implants,” Impatient Optimists, Feb. 20, 2013, http://www.impatientoptimists.org/Posts/2013/02/The-Evolution-of-Implants. (back)

70. Amy Goodman, “The Case Against Depo Provera: Problems in the U.S.,” Multinational Monitor, Feb./March, 1985, http://multinationalmonitor.org/hyper/issues/1985/02/problems-us.html. See also N. B. Sarojini & Laxmi Murthy, “Why women’s groups oppose injectable contraceptives,” Indian Journal of Medical Ethics, vol. 2, no. 1, 2005, http://216.12.194.36/~ijmein/index.php/ijme/article/view/702/1715. (back)

71. US Food & Drug Administration, “Black Box Warning Added Concerning Long-Term Use of the Depo-Provera Contraceptive Injection,” FDA Talk Paper, Nov. 17, 2004, http://web.archive.org/web/20051221195621/http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html. (back)

72. Thomas W. Volscho, “Racism and Disparities in Women's Use of the Depo-Provera Injection in the Contemporary USA,” Crit Sociol 2011 37: 673, June 3, 2011, http://crs.sagepub.com/content/37/5/673.refs. (back)

73. Innovative Partnership to Deliver Convenient Contraceptives to up to Three Million Women,” BMGF press release, July 11, 2012, http://www.gatesfoundation.org/Media-Center/Press-Releases/2012/07/Innovative-Partnership-to-Deliver-Convenient-Contraceptives-to-up-to-Three-Million-Women. It is presumably a coincidence that the London Summit on Family Planning was timed to take place on the 100th anniversary of the First International Eugenics Congress. (back)

74. Paul B. Farrell, “Gates’ $4 Billion Foray in Global Family Planning,” MarketWatch, May 15, 2012, http://www.marketwatch.com/story/gatess-4-billion-foray-in-global-family-planning-2012-05-15. (back)

75. Ibid. (back)

76. Quoted in Lisa Correnti and Rebecca Oas, “Black Leaders, Rights Experts Denounce Gates’ New Contraceptive that May Increase HIV Risk,” Catholic Family and Human Rights Institute, Oct. 18, 2013, http://c-fam.org/en/issues/global-health/7574-black-leaders-rights-experts-denounce-gates-new-contraceptive-that-may-increase-hiv-risk. (back)

IV. A Broader Agenda

Behind BMGF’s coordinated interventions in pharmaceuticals, agriculture, population control, and other putatively philanthropic concerns lies a broader agenda. In a recent interview Bill Gates briefly strayed off-message to warn of “huge population growth in places where we don’t want it, like Yemen and Pakistan and parts of Africa.”77 His use of the majestic plural here is revealing: in spite of much rhetoric about “empowering poor people,” the Foundation is fundamentally concerned with reshaping societies in the context of ruling-class imperatives.

The central thrust of current imperialist strategy involves increasingly direct intervention in the developing countries/Third World, ranging from internal destabilization to regime change to outright military occupation. This is evidenced by recent wars of conquest in Iraq and Libya, multiple programs of destabilization and proxy warfare throughout the Middle East and North Africa, and the integration of African Union military forces into the framework of AFRICOM. Military aggression undergirds a redoubled effort to seize control of raw materials in developing countries, in particular oil and strategic mineral resources in the African continent. Big Philanthropy’s more aggressive interventions in the public health systems of the Third World reflect and complement this strategy.

Meanwhile, the capitalist core is pursuing an energetic program of what David Harvey has called “accumulation by dispossession,” leading to “a rapid and large movement of foreign capital taking control over huge tracts of land—mainly in Africa, Southeast Asia, and Latin America—by either outright purchase or by long-term leases and removal of peasant farmers from the land.”78 This process is facilitated in multiple ways by the activities of the Gates Foundation. What follows is an attempt to summarize the Gates agenda in a few broad strokes.
“Land mobility” not land reform
Hunger, claims the Gates Foundation website, is rooted in “population growth, rising incomes, dwindling natural resources, and a changing climate,” and is best addressed by enhancing agricultural productivity.79 Unmentioned is the fact that per capita food production has been trending upward for decades and remains at historic highs,80 meaning that hunger is an issue of unequal distribution rather than inadequate productivity. Extensive scholarship shows also that food insecurity has been greatly exacerbated over recent decades by massive dispossession of small farmers, depriving millions of their livelihoods.81 Contra Gates, the food crisis is not one of “rising incomes” but of vanishing incomes.

Although Foundation publicity pays lip service to the idea of sustainable smallholder agriculture, in fact its initiatives are uniformly directed toward high-tech, high-yield farming methods – much like the “Green Revolution” technologies that proved ultimately ruinous for rural peasantries beginning in the 1960s.82 Gates works closely with agribusiness giant Monsanto through organizations like the Alliance for a Green Revolution in Africa (AGRA), which steers billions in grant money primarily to biotech and GMO research.83 The Foundation has also thrown its weight behind a revival of Grameen-style microbanking schemes, which transpired during the 2000s to be a debt trap leading to dispossession of rural families.84

Far from empowering small farmers, BMGF’s efforts envision the exit of “inefficient” small farmers from their land – a process euphemistically termed “land mobility” – as revealed by an internal memo leaked to the press in 2008:

In order to transition agriculture from the current situation of low investment, low productivity and low returns to a market-oriented, highly-productive system, it is essential that supply (productivity) and demand (market access) expand together… [this] involves market-oriented farmers operating profitable farms that generate enough income to sustain their rise out of poverty. Over time, this will require some degree of land mobility and a lower percentage of total employment involved in direct agricultural production.85

The impact of these policies on small farmers and their families is disastrous. As Fred Magdoff recently explained, “the world capitalist economy is [no longer] able to provide productive employment for the huge numbers of people losing their lands. Thus the fate of those migrating to cities or other countries is commonly to live in slums and to exist precariously within the ‘informal’ economy.86

Indeed, the Foundation's agricultural policy strikingly resembles what Samir Amin describes as the logical outcome of subjecting agriculture to the same market principles as any other branch of production: 20 million industrial farmers producing the world's food supply in place of today’s three billion peasants.87 As Amin observes:

The conditions for the success of such an alternative would include: (1) the transfer of important pieces of good land to the new capitalist farmers (and these lands would have to be taken out of the hands of present peasant populations); (2) capital (to buy supplies and equipment); and (3) access to the consumer markets. Such farmers would indeed compete successfully with the billions of present peasants. But what would happen to those billions of people?88

Amin’s analysis chimes with the Gates Foundation memo quoted above, and there is reason to believe that BMGF is already contemplating strategies for coping with the “surplus” population that the processes of accumulation and dispossession are generating.

Population control not redistribution
In a 2012 Newsweek profile, Melinda Gates announced her intention to get “family planning” back on the global agenda and made the dubious claim that African women were literally clamoring for Depo-Provera as a way of hiding contraceptive use from “unsupportive husbands.”89 Boasting that a decision “likely to change lives all over the world” had been hers alone, she announced that the Foundation would invest $4 billion in an effort to supply injectable contraceptives to 120 million women – presumably women of color – by 2020. It was a program so ambitious that some critics warned of a return to the era of eugenics and coercive sterilization.90

Bill Gates, at one time an avowed Malthusian “at least in the developing countries”91 is now careful to repudiate Malthus in public. Yet it is striking that Foundation publicity justifies not only contraception, but every major initiative in the language of population control, from vaccination (“When children survive in greater numbers, parents decide to have smaller families”92) to primary education (“[G]irls who complete seven years of schooling will marry four years later and have 2.2 fewer children than girls who do not complete primary school.”)93

In a 2010 public lecture, Bill Gates attributed global warming to “overpopulation” and touted zero population growth as a solution achievable “[i]f we do a really great job on new vaccines, health care, and reproductive health services.”94 The argument is disingenuous: As Gates certainly knows, the poor people who are the targets of his campaigns are responsible for no more than a tiny percentage of the environmental damage that underlies climate change. The economist Utsa Patnaik has demonstrated that when population figures are adjusted to account for actual per capita demand on resources, e.g., fossil fuels and food, the greatest “real population pressure” emanates not from India or Africa, but from the advanced countries.95 The Gates Foundation is well aware of this imbalance and works not to redress it but to preserve it – by blaming poverty not on imperialism but on unrestrained sexual reproduction “in places where we don’t want it.”

From Malthus to the present day, the myth of overpopulation has supplied reliable ideological cover for the ruling class as it appropriates ever greater shares of the people's labor and the planet's wealth. As argued in Aspects No. 55, “Malthus’s heirs continue to wish us to believe that people are responsible for their own misery; that there is simply not enough to go around; and to ameliorate that state of wretchedness we must not attempt to alter the ownership of social wealth and redistribute the social product, but instead focus on reducing the number of people.”96 In recent years BMGF's publicity apparatus, exploiting Western alarm about “climate change,” has helped create a resurgence of the overpopulation hysteria last experienced during the 1970s in the wake of Paul Erlich’s bestseller The Population Bomb.97
Yet the sheer scale of BMGF's investment in “family planning”" suggests that its ambitions reach beyond mere propaganda. In addition to the multibillion dollar contraception distribution program discussed previously, BMGF provides research support for the development of new high-tech, long-lasting contraceptives (e.g., an ultrasound sterilization procedure for men as well as “non-surgical female sterilization”). Meanwhile the Foundation aggressively lobbies Third World governments to spend more on birth control and supporting infrastructure.98 while subsidizing steep cuts in the price of subcutaneous contraceptives.99

These initiatives lie squarely within the traditions of Big Philanthropy. The Rockefeller Foundation organized the Population Council in 1953, predicting a “Malthusian crisis” in the developing world and financing extensive experiments in population control. These interventions were enthusiastically embraced by US government policymakers, who agreed that “the demographic problems of the developing countries, especially in areas of non-Western culture, make these nations more vulnerable to Communism.”100 Foundation research culminated in an era of “unrestrained enthusiasm for government-sponsored family planning” by the 1970s.101 Less discussed but amply documented is the consistent support for eugenics research by US-based foundations, dating from the 1920s, when Rockefeller helped found the German eugenics program that undergirded Nazi racial theories,102 through the 1970s, when Ford Foundation research helped prepare the intellectual ground for a brutal forced sterilization campaign in India.103

Why have foundations invested so persistently in actual technologies and campaigns for population reduction? In the absence of a definitive explanation, two possibilities are worth pondering:

Gates and his billionaire associates may well share Dean Acheson's view – famously ridiculed by Mao Zedong – that population growth engenders revolutions by “creating unbearable pressure on the land.”104 A more recent expression of this idea, contained in the report of the US Vice President’s Task Force on Combatting Terrorism, is that “population pressures create a volatile mixture of youthful aspirations that when coupled with economic and political frustrations help form a large pool of potential terrorists.”105 Thus BMGF likely sees population control as a security imperative, in keeping with its fear of a “less stable” world and reflecting the philosophy of global health governance.106

Population control is, in another sense, one of the instruments of social control. It extends ruling-class jurisdiction more directly to the personal sphere, aiming at “full-spectrum dominance” of the developing world. Like laws regulating marriage and sexual behavior, such interventions in the reproduction of labor power are not essential to capitalists but remain desirable as a means of exercising ruling class hegemony over every aspect of the lives of the working people. Whereas the ideology of population control is intended to turn attention away from the existing distribution of wealth and income that causes widespread want, population control as such directly targets the bodies and dignity of poor people, conditioning them to believe that life’s most intimate decisions are outside of their competence and control.107
The relationship between bourgeois ideology and imperialist practice is dynamic and mutually supportive. As David Harvey has observed: “Whenever a theory of overpopulation seizes hold in a society dominated by an elite, then the non-elite invariably experience some form of political, economic, and social repression.”108 Seen in this light, BMGF's promotion of population control is doubly pernicious because it is cloaked in the language of environmentalism, popular empowerment, and feminism. Melinda Gates may evoke “choice” in support of her family planning initiatives, but in reality it is not poor women, but a handful of the world’s wealthiest people who have presumed to choose which methods of contraception will be delivered, and to whom.

Dependency not democracy
Speaking off the record, public health officials are scathing about the imperiousness of the Gates Foundation. It is said to be “domineering” and “controlling,” contemptuous of advice from experts, seeking to “divide and conquer” the institutions of global health via “stealth-like monopolisation of communications and advocacy.109 But the high-handedness of the Foundation goes far beyond office politics in Geneva. In general it “has not been interested in health systems strengthening and has rather competed with existing health services.”110 It routinely subverts the health ministries of sovereign nations, either coercing their cooperation or outmanoeuvring them via NGO-sponsored field operations that bypass existing infrastructure and personnel.

In particular, the Foundation’s emphasis on single-issue, vertically organized interventions tends to undermine community-based primary care, endorsed by the Alma Ata Declaration of 1978 as the model for Third World public health programs. Based implicitly on the “barefoot doctor” program that revolutionized public health in the People’s Republic of China, the philosophy of primary care proposed that the people “have a right and duty to participate individually and collectively in the planning and implementation of their health care.”111 In theory, the goal was not only improvement of health as such, but also popular empowerment and genuine democracy at the local level. People would be encouraged to believe that health care was not a gift from Western benefactors, but belonged to them as of right.

Although the Chinese model could never be properly implemented in non-socialist countries, Alma Ata inspired various community-based health initiatives in developing countries, achieving some success in lowering infant mortality and raising life expectancy.112 Today, however, primary care programs worldwide are on the decline due both to the imperatives of structural adjustment programs and to the meddling of US-based foundations.113 The Gates Foundation, for its part, invariably acts to steer resources away from community-based holistic doctoring and toward single-disease crash programs, controlled by Western NGOs in collaboration with health-related MNCs. Its approach to diarrhea, which kills upwards of one million infants annually, is a case in point.

The procedures necessary to control diarrhea are not mysterious: clean water and adequate sanitation are essential to prevention, while treatment consists of administering oral rehydration salts (ORS) and zinc supplements to afflicted infants. Chinese “barefoot doctors” achieved steep declines in diarrhea mortality from the 1950s through the 1980s by distributing ORS supplies at the village level and educating families on their importance and proper use.114 Yet while shepherding governments away from investing in the sanitation infrastructure and primary care that have been proven to save lives, BMGF funds and promotes vaccine research, marketing programs administered by NGOs, and “work[ing] with manufacturers and distributors to make ORS and zinc products more attractive to consumers—by improving flavors and repackaging products.”115
Perhaps Bill Gates, who became rich through the expert marketing of inferior software, really believes that poor mothers can’t be relied upon to take an interest in saving their children’s lives unless medicines are advertised like Coca-Cola. But BMGF’s overall stance toward diarrhea, as toward public health in general, reminds us that the attenuation of Third World democracy is far from unwelcome to the rulers. As the educational theorist Robert Arnove has observed, foundations are at bottom

a corrosive influence on a democratic society; they represent relatively unregulated and unaccountable concentrations of power and wealth which buy talent, promote causes, and in effect, establish an agenda of what merits society’s attention. They serve as ‘cooling-out’ agencies, delaying and preventing more radical, structural change. They help maintain an economic and political order, international in scope, which benefits the ruling-class interests of philanthropists.116

Charitable activities that undermine democracy and state sovereignty are immensely useful to the ruling class. Robust, effective social programs in developing countries are an impediment to the current imperial agenda of worldwide expropriation; healthy people, in control of their own destinies and invested in the social well-being of their communities, are better equipped to defend their claim to the wealth they possess and produce. Far better, from the point of view of the Good Club philanthrocapitalists, if the world’s poorest billions remain wholly dependent on a largesse that may be granted or withdrawn at pleasure.

A facelift for the rulers
In the wake of the 2007-08 financial crisis and the subsequent implementation of "austerity" programs worldwide, the super-rich experienced popular anger more directly than at any time since the Great Depression. The masses took to the streets worldwide; the avowedly anti-capitalist Occupy Wall Street movement received extensive and largely favorable press coverage; newspaper columnists openly wondered whether reforms might be needed to save capitalism from itself; Capital and The Communist Manifesto returned to bestseller lists. Particularly worrisome to the mega-rich was the extent to which they themselves, rather than vague complaints about “the system,” became the focus of discontent. Even relatively well-to-do Americans questioned the power and disproportionate wealth controlled by elites, now commonly identified as “the 1 per cent” or the “1 per cent of the 1 per cent.” Confronting widespread hostile scrutiny, the ruling class was in need of a facelift.

BMGF’s publicity operation was quick to respond. The Foundation exploited “multiple messaging avenues for influencing the public narrative” including the creation of “strategic media partners” – ostensibly independent news organizations whose cooperation was ensured via the distribution of $25 million in annual grant money.117 Bill Gates, said to be socially awkward and formerly shy of media attention, was suddenly ubiquitous in the mainstream press. In every interview Gates worked from the same talking points: he had resolved to dedicate “the rest of his life” to assisting the world’s poor; to that end he intended to give away his entire fortune; his uncompromising intelligence and business acumen made him uniquely qualified to wring “more bang for the buck” from philanthropic endeavors; he is nevertheless kindhearted and deeply moved by personal encounters with sick and impoverished children; etc. Invariably he told the suspiciously apposite story of his mother’s deathbed adjuration: “From those to whom much is given, much is expected.”118 At the same time BMGF expanded its online operations, using Twitter and Facebook to disseminate pseudoscientific aperçus and heartwarming images to millions of “followers” worldwide.119

Gates’ willingness to carry the torch for the world’s billionaires reflected an understanding that his Foundation plays an important ideological role within the global capitalist system. Apart from the promotion of specific corporate interests and imperialist strategic aims, BMGF’s expertly publicized activities have the effect of laundering the enormous concentration of wealth in the hands of a few supremely powerful oligarchs. Through stories of Gates’ philanthropy we are assured that our rulers are benevolent, compassionate, and eager to “give back” to the less fortunate; moreover, by leveraging their superior intelligence and technocratic expertise, they are able to transcend the bureaucratic fumblings of state institutions, finding “strategic, market-based solutions” to problems that confound mere democracies. This apotheosis of Western wealth and knowhow works hand-in-hand with an implicit contempt for the sovereignty and competence of poor nations, justifying ever more aggressive imperialist interventions. 120

Thus the Gates Foundation, like the MNCs it so closely resembles, seeks to manufacture consent for its activities through the manipulation of public opinion. Happily, not everyone is fooled: popular resistance to the designs of Big Philanthropy is mounting. The struggle is broad-based, ranging from the women activists who exposed the criminal activities of PATH in India, to the anti-sterilization activities of African-American groups like The Rebecca Project, to the anti-vaccine agitations in Pakistan following the revelation that the CIA had used immunization programs as cover for DNA collection.121 Surely a worldwide campaign to eradicate the toxic philanthropy and infectious propaganda of the Gates Foundation would be in the best traditions of public health.



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NEXT: The Gates Foundation in India: A Primer


Notes:

77. Ezra Klein, “Bill Gates: ‘Capitalism Did Not Eradicate Smallpox’,” Washington Post, Jan. 21, 2014, http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/21/bill-gates-capitalism-did-not-eradicate-smallpox/ (emphasis added). (back)

78. Fred Magdoff, “Twenty-First Century Land Grabs,” Monthly Review, vol. 65, no. 6, Nov., 2013, http://monthlyreview.org/2013/11/01/twenty-first-century-land-grabs. (back)

79. Agricultural Development Strategy Overview, BMGF website, http://www.gatesfoundation.org/What-We-Do/Global-Development/Agricultural-Development. (back)

80. Keith Fuglie and Alejandro Nin-Pratt, “A Changing Global Harvest,” 2012 Global Food Policy Report, International Food Policy Research Institute, http://www.ifpri.org/gfpr/2012/agricultural-productivity. (back)

81. See. e.g., Raj Patel et al., “Ending Africa's Hunger,” The Nation, Sept. 21, 2009, http://www.thenation.com/article/ending-africas-hunger; Utsa Patnaik, The Republic of Hunger and Other Essays, London: Merlin Press, 2007; Rahul Goswami, “From District to Town: The movement of food and food providers alike,” Macroscan, Jan. 8, 2013, http://www.macroscan.org/pol/jan13/pol08012013Rahul_Goswami.htm. (back)

82. See generally John H. Perkins, Geopolitics and the Green Revolution: Wheat, Genes, and the Cold War, Oxford University Press, 1997. See also Deborah Fahy Bryceson, “Sub-Saharan Africa’s Vanishing Peasantries and the Spectre of a Global Food Crisis,” Monthly Review, vol. 61, no. 3, July-Aug., 2009, http://monthlyreview.org/2009/07/01/sub-saharan-africas-vanishing-peasantries-and-the-specter-of-a-global-food-crisis. (back)

83. Raj Patel et al., op. cit. (back)

84. Aasha Khosa, “Grameen Bank Can’t Reduce Poverty: Economist,” Business Standard, April 2, 2007, http://www.business-standard.com/article/economy-policy/grameen-bank-can-t-reduce-poverty-economist-107040201126_1.html; Financial Services for the Poor Strategy Overview, BMGF website, http://www.gatesfoundation.org/What-We-Do/Global-Development/Financial-Services-for-the-Poor. (back)

85. Quoted in Community Alliance for Global Justice, “Footloose Farmers,” AGRA Watch, Aug. 19, 2011, https://agrawatch.wordpress.com/tag/land-mobility/ (emphasis added). (back)

86. Magdoff, op. cit. (back)

87. Samir Amin, “World Poverty, Pauperization, and Capital Accumulation,” Monthly Review vol. 55, no. 5, Oct. 2003, http://monthlyreview.org/2003/10/01/world-poverty-pauperization-capital-accumulation. (back)

88. Ibid. (back)

89. Michelle Goldberg, “Melinda Gates’ New Crusade: Investing Billions in Women's Health,” Newsweek, May 7, 2012, http://www.newsweek.com/melinda-gates-new-crusade-investing-billions-womens-health-64965. (back)

90. The Rebecca Project for Human Rights, Depo-Provera: Deadly Reproductive Violence Against Women, June 25, 2013, http://www.1037thebeat.com/wp-content/uploads/2013/06/DEPO-PROVERA-DEADLY-REPRODUCTIVE
-VIOLENCE-Rebecca-Project-for-Human-Rights-June-2013-2.pdf. (back)

91. Interview with Bill Gates, NOW with Bill Moyers, May 9, 2003, transcript of television interview, http://www.pbs.org/now/transcript/transcript_gates.html. In this interview Gates also discloses his admiration for the notorious Club of Rome report, Limits to Growth, a 1972 polemic that became central to a postwar revival of Malthusian thought. (back)

92. Bill and Melinda Gates, 2014 Gates Annual Letter. (back)

93. Dr. Denise Dunning, “Girls: The World’s Return on Greatest Investment,” Impatient Optimists website, http://m.impatientoptimists.org/?task=get&url=http%3A%2F%2Fwww.impatientoptimists.org%2FPosts%2F2014%2F02%2FThe-Worlds-Greatest-Return-on-Investment. (back)

94. Hendershott, op. cit. (back)

95. Patnaik, Republic of Hunger, pp. 10 et seq. (back)

96. Manali Chakrabarti, “Are There Just Too Many of Us?,” Aspects of India’s Economy no. 55, March, 2014, http://www.rupe-india.org/55/toomany.html. (back)

97. The tone and implications of Erlich’s influential tract, which has sold more than two million copies, can be judged from its set-piece opening describing a “stinking hot night in Delhi” experienced by the author and his companions: “The streets seemed alive with people. People eating, people washing, people sleeping. … People thrusting their hands through the taxi window, begging. People defecating and urinating. … People. People, people. … Would we ever get to our hotel?” Paul Erlich, The Population Bomb, Cutchogue, NY: Buccaneer Books, 1968, p. 1. (back)

98. Anne Hendershott, “The Ambitions of Bill and Melinda Gates: Controlling Population and Public Education,” Crisis, March 25, 2013, http://www.crisismagazine.com/2013/the-ambitions-of-bill-and-melinda-gates-controlling-population-and-public-education; Family Planning Strategy Overview, BMGF website, http://www.gatesfoundation.org/What-We-Do/Global-Development/Family-Planning.. (back)

99. “Innovative Partnership Reduces Cost of Bayer’s Long-Acting Reversible Contraceptive Implant By More Than 50 Percent,” BMGF press release, Feb. 27, 2013, http://www.gatesfoundation.org/Media-Center/Press-Releases/2013/02/Partnership-Reduces-Cost-Of-Bayers-Reversible-Contraceptive-Implant. (back)

100. Kingsley Davis, quoted in Donald T. Critchlow, ed., The Politics of Abortion and Birth Control in Historical Perspective, University Park, Penn.: Pennsylvania State University Press, 1995, p. 85. (back)

101. Ibid., p. 87. (back)

102. Edwin Black, “Eugenics: the California connection to Nazi policies,” San Francisco Chronicle, Nov. 10, 2003, http://www.sfgate.com/opinion/article/Eugenics-and-the-Nazis-the-California-2549771.php. See generally Allan Chase, The Legacy of Malthus, Champaign, Ill.: Univ. of Illinois Press, 1980. (back)

103. Mark Hemingway, “Ford Ahead: The Foundation Tightens Its Belt,” Wall Street Journal, June 26, 2009, http://online.wsj.com/news/articles/SB124598045813858017. (back)

104. Quoted in Mao Zedong, The Bankruptcy of the Idealist Conception of History, Sept. 16, 1949, http://www.marxists.org/reference/archive/mao/selected-works/volume-4/mswv4_70.htm. (back)

105. Public Report of the Vice President's Task Force on Combatting Terrorism, Feb. 1986, p. 1, http://www.population-security.org/bush_and_terror.pdf. (back)

106. Hence BMGF literature lays special emphasis on population control in urban sub-Saharan Africa and South Asia – putative hotbeds of “terrorism” and precisely areas to which peasants dispossessed via Gates-sponsored agricultural policies may be expected to relocate. (back)

107. Population control is also potentially a weapon of ruling class terror, as when India used coercive mass sterilization during the 1975-77 ‘Emergency’. In such a scenario, whether or not population control measures succeed in substantially reducing the numbers of people, they are effective in instilling and deepening among the common people a dread of the State and its power to intervene in their lives. (It is tempting to speculate that ultrasound and other high-tech sterilization methods funded by BMGF are appealing because they could facilitate coercive sterilization campaigns while avoiding the gory surgical botches that might draw unfavourable publicity.) (back)

108. David Harvey, “Population, Resources, and the Ideology of Science,” Economic Geography, vol. 50, no. 3, July 1974, p. 273. (back)

109. Global Health Watch, op. cit., p. 251. (back)

110. Ibid, p. 253. (back)

111. Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, September 6-12, 1978, http://www.who.int/publications/almaata_declaration_en.pdf?ua=1. (back)

112. Mala Rao & Eva Pilot, “The Missing Link: The Role of Primary Care in Global Health,” Global Health Action, Jan. 1, 2014, p. 2. (back)

113 .John Walley et al., “Primary Care: Making Alma-Ata a Reality,” Lancet 2008; 372: 1001-1007. (back)

114. Carl E. Taylor and Xu Zhao Yu, “Oral Rehydration in China,” Am J Public Health 1986; 76:187-189. (back)

115. BMGF, Enteric and Diarrheal Diseases Strategy Overview, Gates Foundation website, http://www.gatesfoundation.org/What-We-Do/Global-Health/Enteric-and-Diarrheal-Diseases. (back)

116. Robert Arnove, ed., Philanthropy and Cultural Imperialism, Boston: G.K. Hall, 1980, p. 1. (back)

117. Tom Paulson, “Behind the scenes with the Gates Foundation’s ‘strategic media partners’,” Humanosphere, Feb. 14, 2013, http://www.humanosphere.org/2013/02/a-personal-view-behind-the-scenes-with-the-gates-foundations-media-partners/. For example, NPR’s “Global Health Beat” and The Guardian’s Global Development page are underwritten by the Gates Foundation. Ibid. (back)

118. See, for example, Caroline Graham, “This Is Not The Way I’d Imagined Bill Gates,” Daily Mail, June 9, 2011, http://www.dailymail.co.uk/home/moslive/article-2001697/Microsofts-Bill-Gates-A-rare-remarkable-interview-worlds-second-richest-man.html. (back)

119. As of this writing Bill Gates’ Twitter account boasts 15.8 million followers. Social media is prized by corporate marketers as a low-cost, unmediated, seemingly “organic” method of distributing publicity. (back)

120. At the same time, the ideology promoted by BMGF fosters the involvement of the corporate sector within ‘philanthropic’ interventions, legitimizing the exploitation of public needs for private profit. This opens the door for private corporations to annex still more sectors of state activity, justifying the high cost of their services by invoking illusory "efficiencies.” BMGF's assistance to the ongoing privatization of US public education via the “charter schools movement” is a case in point. (back)

121. “Yes, Vaccinations Are a CIA Plot,” Economist, July 20, 2011, http://www.economist.com/blogs/democracyinamerica/2011/07/bin-laden-vaccine. (back)

The Gates Foundation in India: A Primer

— Sandhya Srinivasan*

“There is no better place to have an impact than India.” – Bill Gates1

How much money does the Bill and Melinda Gates Foundation (BMGF) spend in India?

BMGF has a substantial presence in India, directly funding projects totalling at least $1 billion from 2003, when it entered, to 2012.2 Apparently, this does not include funds given to international non-governmental organisations (NGOs) that run projects in India. (For example, BMGF has donated a total of almost $1 billion to a single international NGO, Program for Appropriate Technology in Health (PATH), to conduct and fund various projects; indeed PATH has been described as an agent of the foundation more than a grantee.3 PATH in turn runs projects in India.) In India, BMGF’s activities are largely in the fields of health and nutrition, where it co-funds government programmes, non-governmental organisations’ activities and pharmaceutical companies’ ventures here.

However, BMGF’s funds are small compared to India’s public health expenditure. The latter was $18.3 billion in 2010-11 alone.4 Thus BMGF’s funds as such cannot make a major contribution to meeting the health needs of India. Rather, if BMGF funds were withdrawn or declined, even a small (in percentage terms) increase in allocations by the Central and state governments would more than compensate for the loss.
What are BMGF’s objectives?

Key elements of the BMGF strategy5 – as described on the Foundation website – are as follows:
(i) using partnerships to leverage public and private resources to influence policy;
(ii) using State projects as ‘incubators of innovation’; and
(iii) underscoring the role of technology.

The BMGF strategy (as described on a website page that has since been changed but is available as an archived6 page) says:
“The foundation does not invest in delivering health or education services. Instead, we identify ways to leverage systems and innovate so these services achieve better outcomes for people.
All strategies leverage our partnerships to achieve impact...
All strategies underscore the role of technology.” (emphasis added)

In other words, BMGF’s objective is to influence Government policy. The foundation’s memorandum of understanding with the Bihar government (Bihar and Uttar Pradesh are the two states where the foundation’s work is concentrated, according to the foundation website) elaborates on this strategy: to use the foundation’s resources to “leverage public and private resources” for its objectives, and use “the state as an incubator of innovation” to influence national-level programmes and policy.

What are Product Development Partnerships (PDPs), and how does BMGF employ them to pursue its objectives?

The Gates Foundation has played a key role in promoting ‘Product Development Partnerships’ (PDP), a form of public-private partnership. PDPs bring industry and government together through what is described as a non-profit venture to develop technologies for health.

According to the website of the International AIDS Vaccine Initiative7 (a Gates grantee), the PDP is meant to “accelerate product development”, working in collaboration with “academia, large pharmaceutical companies, the biotechnology industry and governments in developing countries”. The products are vaccines, drugs, diagnostics, pesticides etc. For example, the PDP Innovative Vector Control Consortium (also a Gates grantee) is a “not for profit company and registered charity to overcome the barriers to innovation in the development of new insecticides for public health vector control … .”8
The last job of its chief executive officer was at Bayer CropScience.

The PDP’s job includes taking the product through clinical trials and regulatory approval – and getting country governments to introduce it into their programmes. While the proponents of PDPs justify them on the ground that they focus on disease areas without viable commercial markets, in fact an examination of PDPs indicates that one of its jobs is to identify the market. A study by the Boston Consulting Group9 commissioned by PATH’s Malaria Vaccine Initiative (with funding from USAID and BMGF) looks at the public and private markets for a malaria vaccine at various prices, what donors would fund, the US military as a market, and so on.PDPs are essentially ways for industry to influence the decision-making process and get entry into the large and relatively untapped markets of public health programmes in developing countries. A presentation10 by representatives of the Global Alliance for TB Drug Development and PATH’s Malaria Vaccine Initiative describes what it calls “country decision making”. Globally, PDPs work with multilateral agencies. Locally, “PDPs, WHO, pharma and other actors can assist in the generation of a public health case for and against adoption.” They may also need to assist in the “definition of disease burden; establishment of new decision-making bodies; support for local advocacy; and Phase IV studies.”
Not only does the product have to be developed and brought to market; the demand for this vaccine or drug needs to be created; organisations – including advocacy groups and the media – need to lobby for its inclusion in the country’s programmes. Phase IV studies, sometimes described as demonstration projects are conducted to establish the product can be introduced into a government programme. The PDP is also advised to assist in the establishment of “new decision-making bodies”. It is not clear what these new decision-making bodies could be, who they would represent, and how they would be established.

What role do contract research organisations (CROs) play in BMGF’s activities?

The Gates Foundation’s strategy of blurring of the distinction between public and private is also apparent in its support of private as well as ‘non-profit’ contract research organisations to carry out trials of the products developed by PDPs. Family Health International (FHI)11 describes itself as a “non-profit human development organization dedicated to improving lives in lasting ways by advancing integrated, locally driven solutions.”12 It provides “technical assistance”, partly through contract research, to corporate, governments and NGOs, and its donor base13 includes BMGF, USAID, Centers for Disease Control and Prevention (CDC, US), and Department for International Development (DFID, UK) – and Bayer Pharmaceuticals, GlaxoSmithKline (GSK) and Pfizer. In 2011, FHI,14 Quintiles,15 Pharmaceutical Product Development,16 and GVK Biosciences17 were named ‘preferred providers’ for contract research to a consortium of 14 ‘global health product development partnerships funded by BMGF, government agencies, private companies and “other sources”, that is expected to run 12818 clinical trials of vaccines and drugs in 2011-13. All four CROs run trials in India for pharmaceutical companies – in essence, they are commercial entities working (in this case) for what is described as a kind of non-profit sector.
To give another example, Aeras is a “global non-profit biotech” developing TB vaccines. The Aeras Global TB Vaccine Foundation is a PDP testing TB vaccines. Most of its board of directors19 were drawn from the pharmaceutical industry, and at least one is currently the president of a privately held biotech company. Its funding20 includes grants, “investments from industry partners”, and co-investments with other organisations, governments and institutions. The industry partners include Sanofi Pasteur, GSK and the biopharmaceutical companies, Okairos in Switzerland, and Crucell in the Netherlands.

In March 2011,21 Aeras and Crucell conducted a Phase 1 trial of a TB vaccine in Bangalore (it had already started Phase 2b trials in Kenya and South Africa) supported by the Research Council of Norway and the Indian government’s department of biotechnology. In 2012, the company announced plans to conduct, in India, the trial of another TB vaccine, being developed with GSK.22

What projects does BMGF fund in India?

In an Addendum we have compiled a partial list of BMGF-funded projects in India. From this list it can be seen that BMGF funding travels across a vast web of connections, including international institutions, Central and state governments, NGOs, educational and research institutions, public sector establishments, private corporate sector firms, and so on. This vast web provides it virtually unmatched reach, which can be translated into influence.

What are the implications of BMGF collaborations with the Government?

We can get an idea of BMGF’s method of operation, and its influence, through some examples. One example of BMGF’s influence with the government is Grand Challenges India launched in April 2013.23 This is a collaboration between BMGF, India’s Department of Biotechnology (DBT) and its Biotechnology Industry Research Assistance Council. According to a BMGF press release,
Under the Memorandum of Understanding that was signed last year, the DBT and the Gates Foundation have agreed to invest up to $25 Million each over 5 years in innovations in vaccines, drugs, agricultural products, and interventions related to malnutrition, family and child health.

Among the ‘grand challenges’ are: to create new vaccines and improve existing ones; to develop genetic and chemical strategies to control vector-borne diseases; and to improve nutrition by creating a “nutrient-rich staple plant species”.

A director at DBT is quoted24 as saying that the collaboration would ensure that India has access to the medicines developed from this funding. The very fact that a Government department has felt it appropriate to take funds from a private institution indicates the extent of influence BMGF wields. It is not that the Government needs $50 million to run a grant programme of this kind. Nor does the Government need such collaborations to get access to the patents to manufacture the medicines – it is legally entitled to issue compulsory licensing for the manufacture of essential drugs.
For BMGF, however, the Grand Challenges India collaboration, with foundation board members on the advisory board, is a way to gain access to decision making in public health research in India – to choose the subjects and focus of research.

Of course there is no reason to believe that any drugs and vaccines – and even ‘nutrient-rich’ staple plant species – developed through the Grand Challenges will improve people’s health.

Another instance of BMGF influence is its substantial funding25 with the government, of the Public Health Foundation of India (PHFI). BMGF’s funding includes $15 million to set up public health schools across the country. This gives Gates a say in the functioning and direction of these institutions – the type of research they conduct, and the academic programmes they run.
What is BMGF’s impact on India’s vaccination programme?

Gates assigns technology a central role in addressing questions of public health; vaccinations are a prime instance of such technology.

India’s public health priorities, including which diseases to focus on tackling, need to be determined independently of pressure from foreign and private interests. These priorities need to be addressed in a comprehensive way, with nutrition, sanitation, drinking water, and preventive measures and curative care. However, in fact the priorities are influenced to a large extent by international and private pressures, which also try to dictate the methods of tackling those priorities.

An important example of this is the polio eradication campaign, which has been heavily promoted by the Gates Foundation, Rotary International, the World Health Organisation, and others. In fact, Bill Gates treats it as a test case to prove the efficacy of interventions of this nature in public health.26 Under external pressure, the Government of India ignored the fact that polio eradication is not a public health priority for India. It gave polio, in effect, precedence over all other questions of public health, mobilising vast numbers of its employees (including 2.3 million vaccinators) to vaccinate 170 million children.27 In this it showed a zeal, urgency, and liberality of funding woefully lacking in its overall public health efforts, or indeed its efforts to improve the living conditions which breed disease. (Bill Gates mentions proudly how polio vaccinators “found children in the poorest areas of Uttar Pradesh and in the remote Kosi River area of Bihar—an area with no electricity that is often flooded and unreachable by roads.28) By focusing on one disease and ignoring all others – the polio vaccine is the only vaccine recognised by people all over India – as well as the conditions which breed disease, the polio campaign diverts human and material resources from other pressing needs, and in fact contributes to weakening even the existing universal immunisation programme. Further, the repeated doses of live attenuated vaccine are responsible for cases of vaccine-derived polio paralysis – something the campaign initially denied but finally admitted. This also raises questions of the harm it causes to children who contract polio in spite of vaccination – children who are forced into the programme and not even compensated for the harm caused to them.29
Finally, this focus on polio eradication ignores other water-borne infections which would be prevented if people had access to clean water and sanitation. One critic points out that India received a token donation of just $0.02 billion for its polio programme, but wound up spending $2.5 billion on it: “It is tempting to speculate what could have been achieved if the $2.5 billion spent on attempting to eradicate polio were spent on water and sanitation and routine immunisation. Perhaps control of polio, to the level of elimination, may well have been achieved as it has been in more developed countries.”30 The Gates view is that other infections will be addressed by other vaccines.

Thus, for example, BMGF has been pressurising the Government to introduce the hepatitis B vaccine and a pentavalent vaccine (against diptheria, pertussis, tetanus, hepatitis B, and haemophilus influenza b). It has funded trials of human papilloma virus (HPV) vaccines. And it is funding the development of, and actively promoting, a rotavirus vaccine. In all these efforts, BMGF has consistently disregarded serious concerns raised by senior public health professionals regarding these vaccines’ relevance, public health value, safety, and cost/affordability for India, as well as the ethics related to their trials.31 In none of these cases have BMGF and its partners been able to convincingly refute the criticisms made. Despite this, the Government seems to be moving along the lines indicated by BMGF.

What is the overall impact of BMGF in India? Are there no benefits?

No one would claim that everything BMGF funds is bad. Many things are unexceptionable. But these could as well be funded by the public sector. The fact is, BMGF’s funding of useful activities provides it credibility and influence to promote a broader agenda.

As we said at the outset, BMGF’s funds are not large in relation to India’s total public health expenditure. The real impact of BMGF is to further a major shift in health policy which has taken place during the last two decades. Earlier, there was at least formal adherence to a comprehensive approach to public health including nutrition, sanitation, drinking water, preventive health care, and an appropriate and universal system of curative care. Since the 1990s, this was progressively replaced with a World Bank-promoted model, which plays down the public sector and tries to involve the private sector in delivery of health care; imposes user fees for public services; and focusses on specific interventions rather than a comprehensive approach.

This approach has reached its zenith with the entry of Gates and his foundation. Their aim is to install a public health model driven by private corporations, and revolving around the use of privately-owned technological interventions, a ‘magic bullet’ for each disease. While such a model is incapable of delivering public health, it is geared to deliver a private profit.

[For a detailed discussion on BMGF’s role in influencing India’s vaccine policy, please see: Srinivasan S. Shift in directions of medical research. Social Development Report 2014. Forthcoming.]


Addendum: BMGF-funded projects in India – a partial list

The following partial list of Gates-funded projects in India gives a sense of BMGF’s reach and influence.

BMGF’s first directly funded work in India was Avahan, a massive $338 million project in HIV prevention. Avahan, which was launched in 2003,was to cover 5.3 million people in six states, through over 100 non-governmental organisations. BMGF later withdrew from the project, “to facilitate the transfer of control to the Indian government and other partners”. Interestingly, while the Avahan project has been criticised for the high salaries paid to consultants and project staff, and the problems that the government would face when taking it over, there seems to be relatively little analysis of the targeted intervention itself. There is, naturally, no comment on whether the project had any impact on people’s well-being.*****

Since the Avahan project, Gates funding has expanded to include research and projects on vaccines, maternal and child health and nutrition.32 One of the two Gates-sponsored state-level projects is in Uttar Pradesh, where it has given at least $75 million to at least five organisations and dozens of sub-contracted ones. While the project descriptions are vague, these projects seem to involve giving the poor, and especially mothers, health advice; offering community based health insurance as way to pay for their medical expenses; developing contraceptive programmes and systems for safe delivery practices.

The other state-level project is in Bihar, where Gates has funded projects totaling at least $84 million. Its collaboration with the state government, Ananya, is funded via the NGO CARE (CARE’s partners, incidentally, include Merck and Proctor & Gamble). Gates projects here are meant to promote various innovations in the fields of nutrition, contraception, and treatments for pneumonia, diarrhea, tuberculosis and leishmaniasis.

A collaboration between Gates, the Indian government, WHO, USAID, the World Bank and the private sector is to research TB diagnosis, treatment and research, and Imperial College, London for mathematical modelling and analysis tools to “catalyse” the establishment of in-country expertise for their use.

Gates’ contraceptive projects in India include: through the Urban Reproductive Health Initiative in Uttar Pradesh, with a focus on implants and injectables; Future Generations for contraceptives in Arunachal Pradesh; Management Sciences for Health and Deepam Education for Health for family planning programmes; Pathfinder International for awareness and service capacity; Family Planning Associaton of India to support the Small Family by Choice programme; and Jhpiego (an affiliate of Johns Hopkins University) to support government family planning divisions in UP, Bihar, Jharkhand, Rajasthan, MP and Chhattisgarh, and to “integrate” postpartum IUD devices into FP programmes.

Gates has funded CARE to develop ways of ‘scaling up coverage of essential family health interventions within the National Rural Health Mission; WHO to promote research on essential medicines for children, particularly for diarrhea and malaria; WHO and Yale to develop and evaluate the role of face-to-face social networks in the use of ‘skin care practices’ and the impact on neonatal mortality; University of Manitoba to increase the use of newborn and maternal interventions; Seattle Children’s hospital to improve maternal and child health and reduce under five mortality and the Baylor College of Medicine to study whether healthy women produce less of the amino acid arginine than pregnant Jamaican and American women to find interventions to reduce the number of low birth weight babies in India.

BMGF is promoting vaccines for cholera and rotavirus, among others. Through PATH, it has supported Serum Institute of India (SII) and Bharat Biotech to develop and conduct phase 3 trials of rotavirus vaccines on 10,000 infants (phase 1 and 2 trials were done on 200 children and adults at KEM Hospital, Pune), evaluated the rotavirus vaccine’s impact for its introduction and rollout; and conducted research for future enteric vaccine development. It funded the International Vaccine Institute to develop a cholera vaccine, got it licensed it to Shantha Biotech, and obtained WHO prequalification so that it can be included in health programes. It also funded research on the rotavirus vaccine through the Society for Applied Studies and has established a reference laboratory for the development of rotavirus vaccines at Christian Medical College (CMC), Vellore. It has funded CDC Foundation to produce a journal supplement on the rotavirus vaccine for India; and Imperial College, London, to improve immune response to oral poliovirus vaccine by treating enteric infections before vaccination.

BMGF has worked with the GAVI Alliance to implement the Advance Market Commitment for Pneumococcal Vaccines, and funded PATH and SII develop and introduce additional pneumococcal conjugate vaccines to the market; Johns Hopkins to support the development of a comprehensive approach to the disease burden of pneumonia and diarrhea in children and develop research to study the impact of the pneumococcal conjugate vaccine in India.

BMGF has also funded INCLEN for studies on burden, health, social and economic consequences, and development of innovations on pneumonia; King George Medical University to improve household decision-making for the management of pediatric pneumonia in Uttar Pradesh and Bihar; the Clinton Health Access Initiative for “developing and scaling effective product presentation and delivery models to rapidly and cost-efficiently increase coverage of oral rehydration salts (ORS) and zinc”; and PATH for a market research study to identify target product profiles for improved oral rehydration salts and zinc.

Gates supported a partnership between PATH, WHO, SII , and African governments to develop an affordable vaccine against meningitis A; International Vaccine Institute for a “policy makers’ meeting on the introduction of cholera vaccination using new-generation oral vaccines in India” and to identify how to accelerate introduction and uptake of cholera vaccines; Emory U on a knowledge, attitudes and practices (KAP) survey of vaccine providers to identify barriers to achieving high immunization rates; CMC Vellore, INCLEN and Child Health Foundation to organize courses in vaccinology and build an “expanded cadre of experts” in vaccines; WHO to “accelerate and sustain access to affordable vaccines of assured quality in China and India”; Centre for Research, Montreal, to “leverage” two literacy programmes by incorporating immunization messages; PHFI to improve the quality and coverage of the routine immunization program in India and by creating a vaccine delivery system; PATH to provide technical and managerial support to expand the adoption of live attenuated SA 14-14-2 Japanese Encephalitis (JE) vaccine and scale up the Expanded Program for Immunization in JE-endemic districts; INCLEN to understand the cold chain upgrade requirements for inclusion of new vaccines into the universal immunisation programme and develop the “analysis framework” to inform Government of India policy and programme decisions; SII to develop and license a quadrivalent HPV vaccine; PATH to develop a Phase 3 clinical trial training programme; and CDRF Global to identify populations for future TB vaccine trials (among the funders of this organization are the US department of defence, the national nuclear security agency and the department of homeland security).


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NEXT: Suniti Kumar Ghosh, 1918-2014
*Consulting editor, Indian Journal of Medical Ethics. (back)

Notes:

1. http://www.huffingtonpost.com/bill-gates/why-our-foundation-invest_b_1269014.html (back)

2. “...the Bill & Melinda Gates Foundation has invested more than $1 billion in programs to fight disease and poverty in India, I am pleased with the results of those investments, and we are going to continue to invest more in the future.” – Bill Gates, February 10, 2012. http://www.huffingtonpost.com/bill-gates/why-our-foundation-invest_b_1269014.html (back)

3. McCoy David, Kembhavi Gayatri, Patel Jignesh, Luintel Akish. The Bill & Melinda Gates Foundation’s grant-making programme for global health. Lancet 2009; 373: 1645–53 (back)

4. Choudhary M, Amar Nath HK. An Estimate of Public Expenditure on Health in India. National Institute of Public Finance and Policy (NIPFP), May 2012, http://www.nipfp.org.in/media/medialibrary/2013/08/health_estimates_report.pdf, puts public expenditure on health at Rs 83,348 crore in 2010-11. The average exchange rate in 2010-11 was Rs 45.58/US $. (back)

5. How we develop strategy https://docs.gatesfoundation.org/Documents/global-health-strategy-overview.pdf; the Ananya Partnership http://www.ananya.org.in/about-ananya/71-partnership-for-better-health (back)

6. http://archive-org.com/page/3175096/2013-11-17/http://www.gatesfoundation.org/How-We-Work/General-Information/How-We-Develop-Strategy (back)

7. http://www.iavi.org/Information-Center/Publications/Documents/IAVI_Innovative_Product_Development_Partnerships_2010_ENG.pdf (back)

8. http://www.ivcc.com/legacy/index-2.html (back)

9. http://www.malariavaccine.org/files/Market-Assessment-18Jan05-LB-BOS.pdf (back)

10. http://www.conceptfoundation.org/files/meeting/8.%20Wells%20-%20Country%20Dmaking%20PDP%20Mtg.pdf (back)

11. http://www.fhi360.org/countries/india (back)

12. http://www.fhi360.org/about-us (back)

13. http://2013annualreport.fhi360.org/downloads/Funders.pdf (back)

14. http://www.fhi360.org/fhi-selected-preferred-provider-consortium-product-development-partnerships-march-30-2011 (back)

15. http://www.telegraphindia.com/external/display.jsp?mode=details&id=26316 (back)

16. https://www.ppdi.com/Services/Industry-Expertise/Government-and-Public-Health/~/link.aspx?_id=9DBA28A91E004431AF173A6273636248&_z=z (back)

17. http://www.gvkbio.com/news-room/press-releases/2011/gvk-biosciences-is-the-preferred-provider-to-global-health-product-development-partners-consortium-to-focus-on-drugs-and-vaccines-for-neglected-infectious-diseases/ (back)

18. http://www.businesswire.com/news/home/20110325005376/en/Quintiles-Named-Preferred-Provider-Global-Health-Product#.UvT1yWKSzN0 (back)

19. http://www.aeras.org/pages/board-advisors (back)

20. http://www.aeras.org/pages/funders (back)

21. http://www.aeras.org/pressreleases/clinical-trial-of-tb-vaccine-candidate-starts-in-india#.Uvd5ImKSzN0 (back)

22. http://www.aeras.org/pressreleases/aeras-signs-agreement-with-gsk-to-jointly-advance-tb-vaccine (back)

23. http://www.gatesfoundation.org/Media-Center/Press-Releases/2013/04/Grand-Challenges-India-a-new-Partnership (back)

24. http://www.downtoearth.org.in/content/bill-gates-grand-challenges-and-indian-science-congress (back)

25. http://www.phfi.org/about-us/financial-information As of 2013, PHFI received Rs 219 crore. Of this, Rs 65 crore was from the government and Rs 69.22 crore from BMGF. (back)

26. Gates Bill. “What I learned in the fight against polio”, Wall Street Journal, November 10, 2013. http://online.wsj.com/news/articles/SB10001424052702303309504579181753580988412 (back)

27. http://ijme.in/~ijmein/index.php/ijme/article/view/1456/3177 (back)

28. Gates B, Wall Street Journal, 2013, op cit. . (back)

29. John T J. Ethics, human rights and polio eradication. Indian Journal of Medical Ethics 1999. http://ijme.in/~ijmein/index.php/ijme/article/view/1456/3178 (back)

30. Vashisht N, Puliyel J, Polio eradication: Let us declare victory and move on. Indian Journal of Medical Ethics, 2012 April-June 9(2): 114-7. http://ijme.in/~ijmein/index.php/ijme/issue/view/9 . (back)

31. See: Phadke A, Kale A. Epidemiology and ethics in the Hepatitis B vaccine. Indian Journal of Medical Ethics. 2000; 8(1): 8-9. http://ijme.in/~ijmein/index.php/ijme/article/view/1341/2968; Puliyel J AEFI and the pentavalent vaccine: Looking for a composite picture. Indian Journal of Medical Ethics 2013 July-September. 10(3): 142-6; Kumar S, Puliyel J. Minimal risk reduction makes $1 rotavirus vaccine uneconomical in India. http://jacob.puliyel.com/paper.php?id=318 (back)

32. http://www.huffingtonpost.com/bill-gates/why-our-foundation-invest_b_1269014.html (back)

But not to worry, Bill Gates really is thinking about 'the little people'...

https://pbs.twimg.com/media/CkhDlaaW0AAyZ3y.jpg

VNGiapaganda ‏@VNGiapaganda 19m19 minutes ago
Why I Would Revolt Against Capitalism

In fact, if I were in their shoes, that's what I'd do.

-Fuck Bill Gates-