Dangers of keeping the Gates wide open

Dinesh C Sharma
Journalist and author

Bill Gates, founder of Microsoft and head of international charity, Bill and Melinda Gates Foundation (BMGF), recently visited India and met a number of top government leaders, including the Prime Minister. In normal course, such a visit would be considered routine in government circles and for public figures like Gates. But it turns out that this was not a routine visit where mere courtesy calls were made and nice pictures tweeted. Prior to Gates’ visit and his meeting with the Prime Minister in November, Gates had hosted Modi in New York and bestowed upon him the ‘Global Goalkeeper Award’ for success of the Swachh Bharat Abhiyan on September 24. These two meetings — in New York and New Delhi — signal new bonhomie between Gates and the Indian government, virtually ending the unofficial embargo the Modi government had imposed on BMGF activities in the Indian health sector in 2017.

The controversy then related to allegations that the BMGF is meddling in key technical affairs of the country, particularly in the sensitive area of immunisation, through its partnerships with the Public Health Foundation of India (PHFI), which is supported by the Ministry of Health and Family Welfare. The Gates Foundation had funded an activity called ‘evidence to policy’ at the Immunisation Technical Support Unit (ITSU), which in turn acted as secretariat of another key body called the National Technical Advisory Group on Immunisation (NTAGI). This is a crucial panel that examines scientific evidence on the effectiveness of new vaccines and recommends their inclusion in the national vaccination programmes. Following the allegations, mainly led by Swadeshi Jagran Manch (SJM, an affiliate of the RSS), the Health Ministry decided to move the NTAGI secretariat to one of its research centres — the National Institute of Family Health and Welfare. The agreement with the  BMGF to run the ITSU was not renewed and the PHFI was put under the scanner of the Ministry of Home Affairs for its foreign-funded projects, including from the BMGF. 

That’s why when the PM decided to accept an award given by the BMGF, it raised the hackles of the SJM. Consistent with its stand against the foundation, its spokesperson Ashwini Mahajan tweeted on September 2 to “request the PM to reconsider this award, given the shady past of BMGF. BMGF is no philanthropist, they are doing business in the guise of philanthropy. They are also under severe allegations of conducting illegal and unethical medical trials to foster their business.” The tweet by Mahajan was in reply to one by Dr Jitendra Singh, Minister of State in the PMO, which had said, “another award, another moment of pride for every Indian, as PM Modi’s diligent and innovative initiatives bring laurels from across the world. Sh @narendramodi to receive award from Bill & Melinda Gates Foundation for Swachh Bharat Abhiyan during his visit to the US.” 

The stand taken by the SJM basically echoes the sentiments expressed by many in the global health community about the increasing influence of Gates on national immunisation policies in many countries, its inherent conflict of interest in promoting certain vaccine manufacturers and the power of capitalist philanthropy. These people welcomed the Indian government’s move to restrict the activities of the foundation, even though it was a token move because Gates continued to do business with some other government entities and state governments like Bihar. 

After the New York award to the PM, the foundation’s activities now extend beyond immunisation, and include a wider ambit of nutrition and agriculture. Gates, during his meeting with the PM in November in Delhi, is said to have “reinforced his foundation’s commitment to supporting the Government of India, in its efforts to meet the Sustainable Development Goals (SDG), with a particular focus on health, nutrition, sanitation and agriculture.” The PM too reciprocated by welcoming “data and evidence-based thoughtful interventions and support by development partners.”

In line with this widened agenda, Gates signed three key agreements with the government, including the one with the Ministry of Health and another with the Ministry of Women and Child Development. Under this, the BMGF will provide the Ministry of Health "technical, management and programme design support" to strengthen primary healthcare, including "improving nutrition services and increasing the immunisation reach." The Ministry of WCD handed over a "letter of intent" to the Director of BMGF's India country office, details of which have not been announced. The most problematic is the agreement Gates has signed with India’s top medical body — the Indian Council of Medical Research (ICMR) — for “collaborative research and training programme between India and the US, including enhancement of research capacity.” The collaboration will include fellowships for young scientists. Such allurements in the past have led to an impression that they allow international agencies to develop ‘soft power’ within government agencies. Already, a number of large public health research studies are sponsored or funded by the Gates Foundation. Findings from these studies are often used as evidence to formulate policies. 

It is precisely this kind of wide-ranging collaboration that public health advocates have been warning against, as they open the door for a non-state actor like Gates to exercise huge power and access into some of the highly technical, strategic and decision-making mechanisms within sovereign governments. The U-turn by the government on its ‘no foreign influence in health policy-making’ is intriguing. The agreements allow Gates to work through its ‘grantees and other partners’ in India. This opens doors for a number of players as virtually all major outfits are Gates grantees, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria; Global Vaccine Alliance; Primary Health Care Performance Initiative etc. 

Traditional philanthropy was never used to set any specific agenda or drive any. The work of Gates Foundation is all about being in the driving seat of global health. International corporate-led foundations are not answerable to people nor are they open to scrutiny of any kind. They wield too much power without accountability. That’s why the new partnerships with Gates raise more questions than they answer.