do billionaire philanthropists skew global health research?

The Bill Gates Problem: Reckoning with the Myth of the Good Billionaire Tim Schwab Metropolitan Books (2023)

Global wealth, power and privilege are increasingly concentrated in the hands of a few hyper-billionaires. Some, including Microsoft founder Bill Gates, come across as generous philanthropists. But, as investigative journalist Tim Schwab shows in his latest book, charitable foundations led by billionaires that direct vast amounts of money towards a narrow range of selective ‘solutions’ might aggravate global health and other societal issues as much as they might alleviate them.

In The Bill Gates Problem, Schwab explores this concern compellingly with a focus on Gates, who co-founded the technology giant Microsoft in 1975 and set up the William H. Gates Foundation (now the Bill & Melinda Gates Foundation) in 1994. The foundation spends billions of dollars each year (US$7 billion in 2022) on global projects aimed at a range of challenges, from improving health outcomes to reducing poverty — with pledges totalling almost $80 billion since its inception.

Schwab offers a counterpoint to the prevailing popular narrative, pointing out how much of the ostensible generosity of philanthropists is effectively underwritten by taxpayers. In the United States, for example, 100,000 private foundations together control close to $1 trillion in assets. Yet up to three-quarters of these funds are offset against tax. US laws also require only sparse scrutiny of how charities spend this money.

CRISPR-edited crops break new ground in Africa

Had that tax been retained, Schwab reasons, the government might have invested it in more diverse and accountable ways. Instead, the dispersal of these funds is being driven mainly by the personal interests of a handful of super-rich individuals. By entrenching particular pathways and sidelining others, philanthropy is restricting progress towards the global Sustainable Development Goals by limiting options (see also strings.org.uk).

Many Gates foundation programmes are shaped and evaluated using data from the US Institute for Health Metrics and Evaluation (IHME), which was founded — and is lavishly funded — by the foundation. Schwab suggests that such arrangements could be considered conflicts of interest, because in-house ‘evaluations’ often tend to justify current projects. In the case of malaria, for instance, the numbers of bed nets distributed in tropical countries — a metric tracked by the IHME — can become a proxy for lives saved. Such circularity risks exaggerating the efficiency of programmes that aim to tackle high-profile diseases, including HIV/AIDS, potentially at the expense of other treatable conditions for which solutions might remain unexplored (see also Philip Stevens’s 2008 book Fighting the Diseases of Poverty).

Limited scope

Similarly restricted views exist in other areas, too. In the energy sector, for instance, Gates flouts comparative performance trends to back exorbitantly expensive nuclear power instead of much more affordable, reliable and rapidly improving renewable sources and energy storage. In agriculture, grants tend to support corporate-controlled gene-modification programmes instead of promoting farmer-driven ecological farming, the use of open-source seeds or land reform. African expertise in many locally adapted staples is sidelined in favour of a few supposedly optimized transnational commodity crops.

Furthermore, the Gates foundation’s support for treatments that offer the best chances of accumulating returns on intellectual property risks eclipsing the development of preventive public-health solutions, Schwab notes. For example, the foundation promotes contraceptive implants that control women’s fertility, instead of methods that empower women to take control over their own bodies. Similarly, the foundation often backs for-profit, Internet-based education strategies rather than teacher-led initiatives that are guided by local communities.

Throughout its history, the Gates foundation’s emphasis on ‘accelerating’ innovations and ‘scaling up’ technologies, as noted on its website (gatesfoundation.org), obscures real-world uncertainties and complexities, and ignores the costs of lost opportunities. For example, Gates’s aim to eradicate polio is laudable. But pharma-based actions are slow — and can come at the expense of practical solutions for less ‘glamorous’ yet serious scourges, such as dirty water, air pollution or poor housing conditions.

Thus, by promoting interventions associated with the technological processes of extraction, concentration and accumulation that underpinned his own corporate success, Gates helps to tilt the playing field. His foundation tends to neglect strategies built on economic redistribution, institutional reform, cultural change or democratic renewal. Yet in areas such as public health, disaster resilience and education, respect for diverse strategies, multifaceted views, collective action and open accountability could be more effective than the type of technology-intensive, profit-oriented, competitive individualism that Gates favours.

Schwab traces the origins of this ‘Gates problem’ to the 1990s. At that time, he writes, Gates faced hearings in the US Congress that challenged anti-competitive practices at Microsoft and was lampooned as a “monopoly nerd” in the animated sitcom The Simpsons for his proclivity to buy out competitors. By setting up the Gates foundation, he pulled off a huge communications coup — rebranding himself from an archetypal acquisitive capitalist to an iconic planetary saviour by promoting stories of the foundation’s positive impact in the media.

Genetic modification can improve crop yields — but stop overselling it

Yet since then, Schwab shows, Gates has pursued a charitable monopoly similar to the one he built in the corporate world. He has shown that in philanthropy — just as in business — concentrated power can manufacture ‘success’ by skewing news coverage, absorbing peers and neutralizing oversight. For instance, Schwab documents how the voices of some non-governmental organizations, academia and news media have been muted because they depend on Gates’s money. While dismissing “unhinged conspiracy theories” about Gates, he describes a phenomenon that concerned activists and researchers call the “Bill chill”. By micromanaging research and dictating methods of analysis, the foundation effectively forces scientists to go down one path — towards the results and conclusions that the charity might prefer.

These issues are exacerbated by Gates applying the same energy that he used in business to coax huge sums from other celebrity donors, which further concentrates the kinds of innovation that benefit from such funding. But Schwab has found that transparency is scarce on whether or how Gates’s private investments or those of his contacts might benefit from his philanthropy. Questions arise over the presence of people with personal ties to Gates or the foundation on the board of start-up companies funded by the charity, for example.

Bigger picture

One minor gripe with the book is that although Schwab excels in forensically recounting the specific circumstances of Gates’s charitable empire, he is less clear on the wider political forces at work or the alternative directions for transformation that have been potentially overlooked. Schwab often implies that Gates’s altruism is insincere and rightly critiques the entrepreneur’s self-serving “colonial mindset” (see, for example, S. Arora and A. Stirling Environ. Innov. Soc. Transit. 48, 100733; 2023). But in this, Gates is a product of his circumstances. As Schwab writes, “the world needs Bill Gates’s money. But it doesn’t need Bill Gates”. Yet maybe the real problem lies less in the man than in the conditions that produced him. A similar ‘tech bro’ could easily replace Gates.

The challenges facing scientists in the elimination of malaria

Perhaps what is most at issue here is not the romanticized intentions of a particular individual, but the general lack of recognition for more distributed and collective political agency. And more than any single person’s overblown ego, perhaps it is the global forces of appropriation, extraction and accumulation that drive the current hyper-billionaire surge that must be curbed (see also A. Stirling Energy Res. Soc. Sci. 58, 101239; 2019).

Resolution of the Bill Gates problem might need a cultural transformation. Emphasis on equality, for instance, could be more enabling than billionaire-inspired idealizations of superiority. Respect for diversity might be preferable to philanthropic monopolies that dictate which options and values count. Precautionary humility can be more valuable than science-based technocratic hubris about ‘what works’. Flourishing could serve as a better guiding aim than corporate-shaped obsessions with growth. Caring actions towards fellow beings and Earth can be more progressive than urges to control. If so, Schwab’s excellent exposé of hyper-billionaire ‘myths’ could yet help to catalyse political murmurations towards these more collective ends.