Subverting National Health Agendas: the new colonialism

India Today
March 2011,

Bill Gates with his wife Melinda.

The cacophony of public relations surrounding the visit of the three trustees of the Bill and Melinda Gates Foundation - Bill Gates, Melinda French Gates and Warren Buffet - has died down.

It is time now for a reality check. India is on the priority list for the world's largest private grant-making charity. A search for keyword 'India' on its website throws up 1336 results - of which 57 relate to grants and ongoing projects. In comparison, search for 'China' yields just 117 results.

The size of the projects in India ranges from about 50,000 dollars to 20 million dollars. A bulk of this mega funding is going for work related to new vaccines, technologies and approaches to disease control and prevention. All the funding is routed through a bunch of US-based organisations like the International AIDS Vaccine Initiative, Program for Appropriate Technology in Health (PATH), World Bank and a few universities (Columbia, John Hopkins, American). Gates' grants come attached with strings, making demands on sovereign governments to change their public policies.

Let's see how this is happening. The Foundation selects diseases as well partners to be funded. This selection process is not transparent and is handled not by epidemiologists (so it is not based on dominant disease patterns) but by people who were previously employed with management consultancies and drug companies.

By selecting a disease, a technology to tackle it (vaccine, drug, implant), commercial partner (drug and vaccine makers) and target group for the intervention, the Foundation is effectively making key policy decisions about a country's health programmes.

For instance, Gates wants India to use a vaccine for diarrhea and is rooting for newly developed vaccine product. Is it not for India's health ministry to decide whether it wants to tackle diarrhea through a technological fix - a vaccine - or through public health approach of providing clean water and sanitation? Not only that, Gates is using recipient countries like India to test new vaccines, drugs and approaches. Field trials on social acceptance of HPV vaccine is an example. He is also pushing a costly and controversial pentavlent vaccine, which multinational pharma companies have been lobbying for a long time.

He is even funding a market research study on assess 'willingness (of the poor) to pay' for oral rehydration salts (ORS)! It is amazing how Gates has surreptitiously become a part of India's formal public health policy making apparatus as well.

His nominees "advise the Minister of Health and Family Welfare and senior officials of the Ministry on strategies to achieve key objectives" of the UPA's flagship programme - the National Rural Health Mission (NRHM). They are member of a so-called International Advisory Panel which itself was born as a result of a grant of $661,244 Gates gave to Columbia University. One of the foundation's largest recipients is the Public Health Foundation of India (PHFI) - which is charged with developing public health capacity in the country. It has received grants totaling a whopping $33 million. And Gates got three seats on policy making body of PHFI. Now this number is reduced to two, as one of the Gates nominees Rajat Gupta had to resign from both PHFI and Gates Foundation following charges of insider trading in the US.

The Gates charity is by no means a benign giver, but is an ambitious attempt to create a global health governance system which promotes big pharma and which is accountable to none.