It can be difficult to fathom the extent of the Gates Foundation’s influence around the world, especially in global health and development. The pandemic provided a glimpse into how deeply embedded the foundation is in public health networks and research efforts that most people assume are the preserve of a few big, multilateral organisations like the WHO and the United Nations.
But because of the billions of dollars it has given away, the Gates Foundation often shows up alongside countries on lists of donors to these types of entities. In a 2018 study, the Brookings Institution found that the foundation was the seventeenth largest donor to 53 multilateral organisations. It was the only private actor; the rest were all countries.
The foundation’s annual budget alone is $8.3 billion, about the same as the annual gross domestic product of Monaco, or the 2023 net worth of Marc Benioff, the cofounder of technology giant Salesforce, philanthropist, and owner of Time magazine. That kind of money has given the foundation incredible heft and prominence, especially with the two co-chairs being such forceful and visible advocates of their work. Since the Buffett money started coming in, the foundation has given money to an ever-growing pool of nonprofits, universities, media entities, research centres, and start-ups and other for-profit entities whose work fits into its mission. It has given away more than $70 billion since its founding, which works out to $3.5 billion a year on average.
At the end of 2022, it had an endowment of $67 billion. There is no dearth of money to spend or trade-offs to make. This largesse has become increasingly troubling to critics because it allows the foundation to exert a level of influence that is often far larger than the money. Gates can easily get an audience with leaders of governments, businesses, and other organisations.
The multiple relationships the foundation has built through formal alliances and informal networks given the revolving door between the foundation, policy experts, and employees of multilateral organisations – one high-profile example is Dr Rajiv Shah who, before he became the president of the Rockefeller Foundation, was the USAID administrator appointed by President Obama, before which he held a number of government roles and played a crucial role in developing the vaccine industry for the Gates Foundation – allows for a tremendous amount of purchase that it can use to direct outcomes in line with its preferences. Together, the cash, the star power, and the leverage can and does skew the priorities of nonprofits, multilateral agencies like the WHO, research universities, and even governments, whether it’s about how best to deliver vaccines or which tools to use to increase crop yield.
One study published in 2008 found that as early as 2003, the National Institutes of Health, which is funded by tax dollars and focuses primarily on biomedical research to address the health problems of Americans, allocated $1 billion to fund global health priorities during a period when its budget grew little. The researchers attributed it to an initiative called the Grand Challenges in Global Health led by the Gates Foundation. By engaging the scientific community and drumming up positive coverage in the media, the foundation was able to direct the best researchers and funds to global health, one of its biggest priorities, the study concluded.
Bequests to universities are a big focus of grant-making. Since 2010, the Gates Foundation has given away at least $11.6 billion to 471 universities, according to one study, and the money was directed to fund research in three of its primary areas of interest: maternity and early childhood, agricultural research, and HIV/AIDS. Most of that money went to universities in the United States, but also the UK and Canada. In 2017, the foundation gave $279 million to the Institute for Health Metrics and Evaluation at the University of Washington, the largest private donation in the university’s history, on top of a $105 million grant it had given a decade earlier to help launch the institute.
The massive amount of money enabled the independent institute to conduct research and build databases on the state of global health, including Covid, tuberculosis, malaria, and other diseases, and become the preeminent source of data cited by media and other public health organisations. To build more databases in priority areas such as financial inclusion, the foundation has also provided funding to organisations like the World Bank.
Since 2011, the bank has published the Global Findex Database report every three years to track people’s access to digital financial services such as payments around the world. Directing resources to overlooked problems such as patchy data can be a good thing. At the same time, critics have long chafed that the foundation decides to fund whatever it deems important without inviting input from the broader scientific and research community. The criticisms can tend toward the polemical and the hyperbolic, but they are essentially arguments about unchecked power and accountability.
Academics, policymakers, and journalists, particularly leftists and progressives, as well as rival foundations, nonprofits, and disillusioned former workers have attacked multiple aspects of the foundation’s work and principles. Some take issue with the foundation’s reliance on a market-based, technocratic, fix-it attitude that entrenches long-standing power dynamics between rich and poor countries, and between donors and recipients. Others point to the pitfalls of relying on a narrow, top-down, data-based and expertise-driven approach that ignores local and cultural realities. Yet others say such untrammelled private power without public accountability is anti-democratic. A fourth group of critics says that the rigorous reporting the foundation demands from its grant recipients and its bureaucratic approach place unnecessary burdens on the staff of nonprofits that might not be set up to meet those requirements.
And although it is a low-level hum, the way the Gates Foundation casts its own work irks some critics. Often, the foundation will describe its work in terms of “lives saved” rather than “deaths prevented.” The latter term, which is drier and more technical, is often used by multilateral agencies. It might be a matter of semantics, but the Gates Foundation’s terminology plays into the notion that it has a superior mission, a loftier goal than others working in the field. When is a life saved, after all?
At the same time, defenders of the Gates Foundation point out that the data alone is evidence that its style of philanthropy works. The criticisms don’t carry much meaning for the people on the ground who have seen their incomes rising, their access to basic necessities like food, water, and medicine improving along with their health, or the yield from their crops increasing. If the critics are idealists who attack the foundation’s influence on normative grounds and question the underlying system that allows for one entity to have so much influence, the defenders are the beneficiaries and the realists who point to the fact that improving the quality of life for some within an unfair system is better than complete apathy.
Many observers and partners, however, take a nuanced view that acknowledges the successes on the ground while pointing out how the foundation sidesteps trickier questions about its size, influence, and lack of accountability. Manoj Mohanan, a public health expert who teaches at Duke University, said that the foundation could do a better job of disclosing how it makes decisions and assesses its success, inviting independent verification of the success or failure of a project they have undertaken. Mohanan, who has received grants from the foundation for his work, said that many other big grant-making bodies invite competitive proposals for grants and give out the funds. But with the Gates Foundation, academics and nonprofits searching for a grant often end up turning to their networks for introductions to foundation employees who might consider their project. Rather than making it about a bigger call for proposals, which would perhaps be more democratic, the foundation’s mandate comes from the two cochairs sitting at the very top.
The level of control is such that you might be sitting in a room discussing a grant and get an email from Gates asking for numbers about a specific disease. It suggests that the former couple want to keep the controls in their hands like it’s a small organisation, Mohanan surmised. “I hate to say it because I’m a beneficiary of the process, but networks become much more important in that setup than in a purely transparent process.”
The world was largely uncritical of the foundation in the first decade of its existence. If anything, much of the West was still on its free-market high at the beginning of the new millennium, and a business-focused approach to solving the problems of the world seemed to be a natural outgrowth of wealth creation. Two writers for The Economist even coined the term “philanthrocapitalism” to describe how individuals and corporations could apply market fundamentals for social returns. At the World Economic Forum in Davos in 2008, Gates gave a much-lauded speech on “creative capitalism,” arguing that businesses, nonprofits, and governments can collectively harness market forces so that people can work to reduce inequities without giving up profitability.
But talk of worsening inequality and rising billionaire influence in recent years has raised new questions about everything from political donations to philanthropy. One of the earliest and fiercest critics of the Gates Foundation is Linsey McGoey, a Canadian-born sociologist who teaches at the University of Sussex in the United Kingdom. In her book No Such Thing As a Free Gift, McGoey takes aim at philanthrocapitalism and, in particular, Gates, for his role in “shifting the global discourse on philanthropy in recent decades.” Through initiatives like the Giving Pledge, McGoey writes, Gates offers a “powerful antidote” to critics who point to the widening global wealth gap, because he and other billionaires can always say that they’re giving their money away.
Excerpted with permission from Billionaire, Nerd, Savior, King: Bill Gates and His Quest to Shape Our World, Anupreeta Das, Simon and Schuster.
