Nature: The ‘Bill Gates problem’: do billionaire philanthropists skew global health research?

13 February, 2024

Extracts from a book review and a comment from me below.


The ‘Bill Gates problem’: do billionaire philanthropists skew global health research?

Personal priorities are often trumping real needs and skewing where charitable funding goes.

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...

Schwab [points] 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.

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...

Nature 626, 477-479 (2024)



COMMENT (NPW): Dr Tikki Pang (WHO Geneva) was an early supporter of HIFA. In 2006 he co-authored a Lancet paper with global/public health experts Tim Evans and Muir Gray: 'A 15th grand challenge for global public health' (Lancet 2006; 367:284-286. ) which challenged the Gates Foundation 'to ensure that everyone in the world can have access to clean, clear, knowledge'. I have just read an email I sent to my co-directors at the time: "For me, this article raise the **hugely exciting** possibility of getting *major* funding from the Gates Foundation to enable us to pursue our goal of healthcare information for all". We put in a funding proposal to the Gates Foundation: no response. I checked with the authors: they had received no response either. Despite this call for 'clean, clear, knowledge', the Gates Foundation (and every other funder) appears to remain uncommitted to universal access to reliable healthcare information. Healthcare information initiatives (including HIFA) remain seriously underfunded.

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: