Little wonder then that the charitable foundation he started along with his wife—the Bill and Melinda Gates Foundation (BMGF)—seeks to create massive impact in the shortest possible time. And with $47.9 billion in assets and about $5 billion annual spending across the developed and developing world, the Foundation’s ability to effect change is immense.
In India, where BMGF has focused the vast majority of its efforts on access to immunisation against preventable disease, its fingerprints are there for all to see. On one side, it has given grants to multiple vaccine makers, allowing them to lower their development costs and even pouring in tens of millions of dollars to fund clinical trials.
BMGF’s portfolio of grantees in India includes most vaccine makers, think tanks like Public Health Foundation of India, industry bodies like FICCI, large NGOs including CARE India and PATH, among several others. It also has another strategic investment fund that offers equity investment, debt and volume guarantees. All told, it has over 60 companies and not-for-profits combined in its strategic investment portfolio.
And even as it enables production, it works to ensure a market for these vaccines. Through Gavi (Global Alliance for Vaccines and Immunisation), BMGF helps the government fund vaccine purchases for its immunisation programme.
It builds supply on one side and ensures demand on the other. A self-sustaining system. One executive with an Indian vaccine maker spoke glowingly of the difference BMGF can make with its investment. “You get a tag of reputation, higher brand value and an image as a credible supplier in the market. In addition, there’s the high demand created by Gavi,” he says.
The system seems flawless. But BMGF is currently fighting against the odds to ensure it keeps chugging along once BMGF inevitably removes itself from the equation.
To do this, the Foundation has been on a charm offensive aimed at Indian Prime Minister Narendra Modi. Just last month, Modi was felicitated by BMGF, with the organisation giving him an award for his campaign to end open defecation in the country. Incidentally, the Foundation passed on giving Modi the same award two years ago, as per former BMGF executives, allegedly on account of his questionable human rights record.
This time around, though, the Foundation had no such qualms. Despite the protests of multiple groups. Stop Genocide, a project of the American human rights group Justice For All, sent a petition with more than 100,000 signatures to BMGF. Three Nobel laureates wrote an open letter to the organisation. A BMGF employee even resigned in protest, later writing in the New York Times about how the organisation’s decision went against its core values.
The reason is simple—as BMGF and Gavi look to withdraw from the Indian vaccine ecosystem, the Seattle-based foundation needs the Indian government to pick up the tab for the vaccine supply BMGF has enabled. But this won’t be so easy. The Indian government is notoriously miserly when it comes to health spends.
Further stacking the deck against BMGF are various question marks that loom over the organisation. There are concerns that the Foundation has hurt public sector vaccine makers. That its support for patenting medicines—thereby lowering access—contradicts its goals. And, in addition to all this, it has a fair few blemishes on its Indian record.
BMGF has been criticised by Jacob Puliyel, a former member of the National Technical Advisory Group on Immunisation (NTAGI). Puliyel says that the rotavirus vaccine the Foundation introduced in India has a high risk of potentially fatal side-effects. NTAGI is the body that advises the government on new vaccines.
A BMGF-funded trial was also criticised for various ethical lapses. In 2009, BMGF-funded NGO PATH along with the Indian Council for Medical Research conducted clinical trials for a vaccine against human papillomavirus (HPV). In all, seven girls in Andhra Pradesh and Gujarat died from complications arising from the GSK and MSD-made HPV vaccines being tested.
A panel appointed by the Indian health ministry in 2010 noted a number of shortcomings and alleged ethical lapses in the trial. Its report in 2011 noted that the trial on several occasions failed to obtain proper informed consent of participants. It also revealed that trial managers did not set up a mechanism for reporting any adverse effects.
BMGF, however, is hoping that by making an ally out of PM Modi, it can get past these hiccups. And it’s really making an effort. It has allegedly ceased funding one of its long-term partners in UP—Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP). The NGO has ties to the Indian National Congress, the political rival of Modi’s Bharatiya Janata Party.
Will charm get BMGF’s immunisation efforts across the finish line? Read today’s story to know more.