By Clement Paule
Translation: Melissa Okabe
Passage au crible n°14
On January 29, 2010, during the Annual Meeting of the World Economic Forum in Davos, Bill and Melinda Gates announced that their foundation would finance the research, development and distribution of new vaccines in developing countries, at the level of 10 billion local dollars in 2020. According to the ex-CEO of Microsoft, this investment should allow for the considerable reduction of infant mortality tied to infectious diseases. So, the richest man of the world – Ranking Forbes 2009 – wishes to contribute to the amelioration of global public health by means of his foundation created in 1999. Indeed, the Bill and Melinda Gates Foundation, represents the first philanthropic organization in the world, with donation funds estimated at 34 billion dollars in September 2009. In the space of a decade, this private actor has imposed itself on the international scale as a major stakeholder in health policy. So much are its’ annual contributions in this domain – which already exceeded 1 billion dollars in 2007 – exceed henceforth the budget of the WHO and the bilateral financing of numerous States.
> Historical background
> Theoretical framework
> Analysis
> References
This type of philanthropic organization, associated with the patrimony of a captain of industry, has particularly developed in the United States for more than a century. Certain specificities of this country, such as the place occupied by the state, the non-profit sector or third sector, or better yet the Protestant work ethic, are not foreign here. In fact, the massive enrichment of a generation of American industrialists at the end of the 19th century allowed for the emergence of these of private actors. The big three embody this first philanthropic moment; this concerns the Carnegie, Rockefeller and Ford foundations established respectively in 1911, 1913, and 1936. These last foundations differentiate themselves from traditional charitable works by their will to rationalize the donation and by the amplitude of their endowments. Investing by means of their subsidies granted to education, to the preservation of peace or to medicine, they have quickly acquired world influence. At first suspected as a means of tax evasion, they have also been accused of diffusing American cultural imperialism. Case in point, researches conducted on the big three have particularly shown the weight of these members on United States foreign policy. Today, these foundations continue to endure and have even increased their donation funds; in 2008, for example, the Ford Foundation had more than 11 billion dollars.
However, if this first philanthropy knew to adapt to evolutions of the 20th century, it is at present exceeded by another generation of private foundations. This progression comes from a recently formed financial aristocracy, made up of entrepreneurs taking advantage of new technologies and economic deregulation: Bill Gates, the Walton family or Eli Broad, constitute the emblematic paragons. As for Warren Buffet, in 2006 he committed himself to give the largest part of his fortune to the Gates Foundation, amounting to about 30 billion dollars over several years. Such a true concentration of finances permitted the ex-CEO of Microsoft to massively invest in a health program directed toward developing countries. However, let’s recall that the implication of these philanthropic actors in this domain isn’t a novelty. Isn’t it in the Rockefeller foundation laboratories that Max Theiler – Nobel Prize laureate in medicine, 1951 – created the vaccination for yellow fever in 1937? However, Gates’ massive financing over the decade marks a considerable quantitative jump.
1. Philanthropic-capitalism (venture philanthropy). The new social entrepreneurs, including the Gates, rationalized the third sector by importing entrepreneurial techniques of capital risk firms. This doctrine opposes itself to traditional philanthropy, cancelling out the bureaucratic burden imposed on the traditional sector. In fact, this doctrine is insistent on flexibility, evaluation and social return on investment.
2. Diplomacy of a private actor. Since its creation, the Gates Foundation has found itself at the origin of major innovations in the health domain. If the international organizations and the states remain as principal actors in the sector, the financial contributions of the philanthropic giant allow it to pave the way for true diplomacy. It just so happens that this normative impact induces effects on the forms and contents of the international policies in matters of health.
The rise in power of the Gates Foundation cannot be explained without taking into consideration the repositioning of the WHO (World Health Organization) which has been in operation since the 1990’s. Confronted by budgetary difficulties and internal dissections, this international organization has therefore opted for a strategy open to private actors who would associate the grand philanthropic foundations with international institutions in the frame of public-private partnerships. However, this being the case, these new entities have determined the definition and the establishment of health programs at the global level, specifically in the fight against infectious disease. For its part, the Gates Foundation has shown itself to be omnipresent at the heart of these organisms, participating in global funds in the fight against AIDS, tuberculosis, and malaria. It has equally played a decisive role in the creation of GAVI (Global Alliance for Vaccines and Immunization), endowing it with 750 million dollars. However, the Gates’ investment does not reduce itself to financial involvement for its’ sitting experts to the committee of partnership directors. In addition, the Foundation supported the creation of new financial mechanisms – such as the IFFIm (International Finance Facility for Immunization) – specific for interesting the pharmaceutical industry in the research of new vaccinations.
The health strategy promoted by Bill Gates in fact resides in a generalized immunization to benefit developing countries, a solution judged to be profitable and efficient. In doing so, the ex-leader of Microsoft relaunches initiatives which have fallen short in the past, very reminiscent of the possible eradication of malaria in 2008. However, this angle has been qualified to be too narrow by specialists of public health and development, who reject a technological ideology. According to these specialists, this vertical vision neglects the political and socio-economic aspects of local realities. Moreover, certain key scientific figures are concerned about private actors, likely to use their weight to impose priorities. The head the WHO program against malaria complained in this manner of the 2007 pressures exerted by the Gates Foundation in favor of adopting the controversial program IPT (Intermittent Preventive Therapy). More generally, the intrusion of the philanthropic giant in the governance of global health risks wrecking havoc on the national health policies in developing countries. In this respect, such a gamble on the vaccination isn’t without consequence, as it can lead to imbalance in health offerings to the point of detriment, for example, less publicized obstetrics or nutritional care.
While the financial contributions of the Gates Foundation are welcomed by numerous observers, they also arouse certain reservations already appropriated to established organizations, at the time, by Rockefeller or Ford. Following this logic, the technological and entrepreneurial discourse of philanthropic-capitalism could conceal a redeployment of American soft power. Without presuming about the Gates and their intentions, it is strongly noted that their contribution has lead to encourage public-private partnerships and hybrid mechanisms of financing. Now, such a system constitutes a true re-legitimization of the market.
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Guilbaud Auriane, Le Paludisme. La lutte mondiale contre un parasite résistant, Paris, L’Harmattan, 2008. Coll. Chaos International.
Muraskin William, « The Global Alliance for Vaccines and Immunization: is it a New Model for Effective Public-Private cooperation in International Public Health? », American Journal of Public Health, 94 (11), Nov. 2004, pp. 1922-1925.
OCDE, Fondations Philanthropiques et Coopération pour le Développement, Tiré-à-part des Dossiers du CAD, 4 (3), 2003.
Piller Charles, Smith Doug, “Unintended Victims of Gates Foundation Generosity”, Los Angeles Times, Dec. 16th 2007, web: http://fairfoundation.org/news_letter/2008/01march/criticism_of_gates_foundation.pdf [Feb. 6th2010].
