Philanthropic gifts for health: the stage is set

Abstract

Philanthropy, literally the love of man, is alive and well, at least as far as donating money to healthrelated projects is concerned. The week before last, the world's richest man, Bill Gates, founder and chairman of software company Microsoft, announced in Mozambique that the charity he formed with his wife, the Bill and Melinda Gates Foundation, would donate £100 million (US$168 million) to the worldwide fight against malaria. 1 million people in Africa die every year from malaria, 90% of the worldwide mortality, according to the Foundation, which estimates that malaria eats up 40% of all public-health spending there and costs $12 billion in loss to the gross domestic product. The Gates' gift will be split three ways. $28 million will go over 5 years to a programme called intermittent preventive treatment in infants, a WHO project with other groups. In this programme, children get an antimalarial three times in their first year when they receive immunisations. The Foundation says this strategy could reduce the incidence of malaria by 60% and halve the frequency of severe anaemia. The second tranche, again over 5 years, is $40 million to the Medicines for Malaria Venture, to develop new antimalarials—this private-public partnership has four promising candidate drugs. The remaining $100 million goes to the Malaria Vaccine Initiative— immunisation is a long-standing interest of the Foundation. The Initiative has 15 candidate vaccines. The new Gates' money will be a tremendous fillip to the fight against malaria. The Foundation says that current spending is about $200 million a year, with about $1·5—2·5 billion needed, and that proper funding of malaria-control programmes could halve the malaria death rate by 2010 and halve it again by 2015. The Gates Foundation, with assets of $25 billion, is the richest charity in the world. The Foundation has already given away over $3 billion on health-related projects. But with a personal fortune of $47 billion, Bill Gates is a natural target for the critics of philanthropic giving. Why is it, some charge, that one person can amass such a fortune, pointing out the near-monopoly of Microsoft's operating system, which has already led the company to fall foul of antitrust laws in the USA? And, they continue, donating millions buys a lot of useful public-relations. Others argue that health spending is the responsibility of government and that charitable provision helps governments shirk their health spend. More practical criticisms include the lack of transparency about when and how medical charities make awards, and that such giving can distort the international health agenda when priorities are set. For instance, just as Bill Gates was giving away his $168 million, Russia had to borrow $150 million from the World Bank (at 2% interest) to fight tuberculosis and AIDS. It can also seem that only fashionable diseases are funded—in the sense that they are newsworthy and have strong lobby groups. There may well be a Global Fund to Fight AIDS, Tuberculosis and Malaria, but there is not yet one to support mental health, or to fight diseases of ageing or diarrhoea (another deadly childhood scourge in poor countries, preventable if clean water is supplied, and cheap and easy to treat). Flying in and spreading largesse while ignoring the need for long-term health-care infrastructure and the strengthening of in-country research facilities can happen—although this is not a criticism that can be levelled at the Gates Foundation, which does collaborate with other organisations to improve services. All such disparagement ignores the point— without philanthropic donations for health, patients will continue to suffer, especially in poor countries. With no evidence to the contrary, Bill and Melinda Gates should be taken as sincere—undoubtedly they are generous—about their philanthropy. What they, and other philanthropists from the business world do (such as Ted Turner, George Soros, and David Geffen), is to set an example for all those who are rich. Several industries have a debt to pay when health is considered. Either they profit from ill-health (drug companies, for-profit medical publishers) or their activities add to ill-health (motor, power, and arms industries). Bill Gates and others lead the philanthropic field—now more need to dig deep into their profits.