Besides its dizzying grants, the foundation is also becoming a magnet for talented staff and collaborators.
“We probably get more than our fair share of great external expertise and insight,” foundation chief executive Jeff Raikes says.
Foundation staff can have a certain self-assurance. When the history of global health is written, says Katherine Kreiss, who joined from the US Foreign Service in 2002 and now oversees the foundation’s nutrition projects, “the start of the Gates foundation will absolutely be a seminal moment.”
Some have reservations about this power and the use made of it. Mindful of the foundation’s ubiquity, few in the charity world are prepared to criticize it on the record. However, in May last year the Lancet published two authored articles on the foundation.
“Grant-making by the Gates foundation,” concluded one article, “seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review.”
The other article said that, “The research funding of the Foundation is heavily weighted towards the development of new vaccines and drugs, much of it high risk and even if successful likely to take at least the 20 years which Gates has targeted for halving child mortality.”
In a forthcoming article for the Journal of Law, Medicine & Ethics, Devi Sridhar, a global health specialist at Oxford University, describes as a “particularly serious problem” the “loss of health workers from the public sector to better funded [non-governmental organizations] offering better remuneration.”
She also suggests that the foundation, like other health organizations based in rich countries but, active in the poor southern hemisphere, “[has] tended to fund ... a large and costly global health bureaucracy and technocracy based in the north.”
“Much of our grant-making goes to large intermediary partners that in turn provide funding and support to those doing the work in the field, often to developing country institutions. We’re not able to provide a simple funding breakdown,” the Gates foundation responded.
The rise of the foundation has been part of a larger revival of interest in the West in the problems of poor countries. This phenomenon has encompassed increased government aid budgets, initiatives by the WHO and World Bank, celebrity-led events and campaigns such as Live8, image-conscious corporate schemes, and countless private ventures, from the sober and long-term to the reactive, adventure-seeking, self-styled “extreme humanitarianism” currently being practiced in Haiti by freelance US volunteers and breathlessly described in the July issue of Vanity Fair.
It is hard to see this explosion of activity as a wholly bad thing. Though it does have political implications.
“It’s kind of [creating] a post-UN world,” says someone close to the Gates foundation. “People have gotten interested in fast results.”