The bill gates problem, p.32
The Bill Gates Problem, page 32
For years, the Gates Foundation has leaned on Copenhagen, which helps recruit experts and drums up facts and figures that seem to support Bill Gates’s worldview. In 2019, Gates wrote a long op-ed for the Wall Street Journal based on research from the center, which he described as “a think tank that uses sophisticated algorithms and the best available data to compare alternate poverty-fighting strategies.” As he reported, Copenhagen had determined that his foundation’s $10 billion in spending on vaccines, bed nets, and drugs had returned $200 billion in social and economic benefits. “What if we had invested $10 billion in energy projects in the developing world? In that case, the return would have been $150 billion. What about infrastructure? $170 billion. By investing in global health institutions, however, we exceeded all of those returns,” Gates wrote. He did not mention that his private foundation funds the Copenhagen Consensus Center; nor was he crystal clear that his foundation had directly worked with the center to develop these estimates.
This arrangement in many ways defines the foundation’s engagement with the scientific enterprise, an area where Gates has become one of most important private-sector funders in the world. The foundation has donated more than $12 billion to universities and helped underwrite more than thirty thousand scientific journal articles. This charitable giving allows the foundation to shape entire fields of research and to secure an astonishing level of epistemic power—influencing what we know about the foundation and how we think about it. “There is not a single organization working in global health that is not somehow related—most likely financially related—to the Gates Foundation,” said Adam Fejerskov of the Danish Institute for International Studies. “And, of course, that is a huge problem, because it makes us ask who is setting the agenda in terms of what is being researched and what is not being researched.”
According to the academic database Web of Science, the foundation, for example, is the second-largest private-sector funder of research appearing in the scientific journal Vaccine (after GlaxoSmithKline). Foundation employees also publish their own research extensively in the journal, having coauthored more than one hundred papers. Additionally, the head of the Gates Foundation’s pneumonia program, Keith Klugman, sits on the editorial board of the journal. (He also sits on the board of the Journal of Global Antimicrobial Resistance.)
We see a variety of similar relationships throughout academic publishing, where the Gates Foundation acts as a funder, author, journal editor, and adviser. It has also built a wide network of influence through financial ties to top academic researchers and journal editors. The foundation, for example, funds commissions and high-profile leadership programs, like the Postsecondary Value Commission and WomenLift Health, that invite the participation of high-profile researchers.
Eric Rubin, the editor of the New England Journal of Medicine, has coauthored nineteen scientific papers that disclose funding from the Gates Foundation. At the same time, during his tenure as editor, the journal has published dozens of studies funded or authored by the Gates Foundation. “No foundation or nonprofit organization has any influence on my publications, and no funder has any influence on articles that the Journal publishes,” Rubin told me by email.
Yet, a reasonable person could question this. At the beginning of the Covid-19 pandemic, Rubin’s journal published a long commentary by Bill Gates in which he prescribed how governments should respond. Given that Bill Gates has no medical training, why was he given real estate in one of the most prestigious medical journals to play expert on the most important public health crisis in decades? Should we be surprised that Gates’s commentary had many blind spots? He failed to mention Covid-19 testing or social distancing, for example—two early interventions that were essential to arresting transmission and preventing infections and death.
Gates, notably, also did not enumerate or detail his financial conflicts of interest for readers, as the journal requires authors to do. While the Gates Foundation had hundreds of millions of dollars invested in pharmaceutical companies, and while Bill Gates may also have personal investments in pharma, he did not provide the names or details of these financial ties, which would have alerted readers to the fact that he or his foundation was in a position to potentially benefit financially from the advice he was giving in the journal. Instead, Gates issued a vague, generalized disclosure that his financial conflicts were “numerous.”
“Given the well-known extent of Mr. Gates’s financial holdings, we felt comfortable characterizing them as ‘numerous,’” Rubin told me in an email. “Readers can reasonably assume that any potential conflict is indeed possible for him.” This sentiment seems to boil down to the all-too-common refrain: Bill Gates doesn’t have to play by the same rules as everyone else.
As the pandemic wore on, the Gates Foundation eventually became the target of extensive criticism for its aggressive campaigning in support of patents, which were widely seen as limiting the production and distribution of vaccines. As this criticism of Gates spilled into the news media in the spring of 2021, Melissa Barber, a doctoral candidate at Harvard University, recounted on Twitter her own experience working with the Gates Foundation, on a research project related to intellectual property.
Seattle micromanaged the methods so only a negative assessment was possible, even tho[ugh] the report would be published as independent/evidence based.
At first I thought the Gates folks were just bad at methods. My colleagues were great, and we pushed back and tried to implement a rigorous/fair methodology.
A funder has no business dictating the methods of an independent eval[uation], but we were told we had to do it their way.
If you’re wondering if maybe I just misunderstood what was happening, I got so frustrated one day I asked point blank if the entire point of the evaluation was to justify shutting down the initiative, and I guess they were so surprised they answered honestly and said yes.
I left that job soon after and have been afraid to tell this story publicly b[e]c[ause] it’s hard to find a job in health systems where Gates isn’t at least indirectly involved.
But this to say—even in the rare times Gates funds orgs pushing against the ip [intellectual property] status quo, be wary.
Barber’s story describes not only the Gates Foundation’s willingness to bend research to advance its agenda but also the complex avenues it has to do this. In science, the answer you get depends on the question you ask, the assumptions you make, and the data and methods you use. And this is where a researcher’s, or a funder’s, bias can change outcomes. As Barber explained it, the Gates Foundation “micromanaged” and “dictated” the methods, which forced the research down one path—toward the results and conclusion Gates wanted.
As reported earlier in this book, the head of the WHO’s malaria program in 2007 alleged that the Gates Foundation’s expansive funding of malaria research was hurting science by pushing the research community into “a cartel” where independent, critical viewpoints could not be raised. This too is an important dimension of Gates’s funding influence. By using its money to amplify the voices of scientists who agree with its agenda, it can marginalize other perspectives.
The Gates Foundation’s influence over research is well known, but many observers are reluctant to criticize the foundation publicly. As Melissa Barber noted, she had been afraid to tell her story publicly because so many jobs in the field of global health depended on Gates money. Simply put, many scientists are reluctant to bite the hand that feeds them, or that may one day feed them, a phenomenon that academic researchers call “the Bill chill.”
Scholars I interviewed—who asked for anonymity—offered consistent, independent accounts of Gates’s meddling in scientific research to make it line up with the foundation’s agenda. One researcher working for a Gates-funded organization said it was normal to show drafts of studies to the foundation, giving them an opportunity to shape the research, which they did. Another source told me that when they applied for a job at the foundation, the interviewers made a point of describing how much influence the foundation had over the research it funded—both in the design of studies and in how the results were presented.
Such behavior speaks to the ways that monied interests seek to quietly influence science the same way they seek to influence politics. Securing favorable research advances bottom lines, gains regulatory approval, pushes legislators to adopt industry-friendly “science-based” policies, and inspires friendly media coverage. When powerful funders are involved in scientific research, the findings and results routinely support the funder’s agenda. This well-documented bias, called the funding effect, appears across a wide range of research fields.
It’s tempting to imagine the Gates Foundation having no “bottom line”—and no bias—as a humanitarian charity. And this is what makes its influence so malign. We imagine the foundation’s role in science as an independent, neutral, check-writing charity, supporting science for the sake of advancing knowledge. In reality, the Gates Foundation, like Big Pharma and Big Tobacco, has deeply vested interests in the research it funds, which it calls on to deliver favorable results—whether it is tallying the millions of lives it is saving, studying the merits of its interventions, or publishing evaluations that support its ideological position on issues like intellectual property rights.
This doesn’t mean that all Gates-funded researchers are hacks or sellouts. Many of the sources I leaned on to write this book are funded by the Gates Foundation and feel deeply conflicted about it—but they don’t always feel there’s another option. Likewise, among the tens of thousands of scientific papers the Gates Foundation has helped fund, we should expect to find important and valuable studies. This chapter isn’t arguing that everything the foundation touches is always and at all times corrupted but, rather, it intends to show how the foundation’s money can distort science. The threat Gates poses is in the aggregate, in the power it wields as a major funder to manipulate science when it wants to.
There are, of course, limits to Gates’s influence. Researchers like Reetika Khera have said no to Bill Gates’s funding. Melissa Barber bravely blew the whistle. And an impressive cadre of researchers in the social sciences (anthropology, geography, sociology, etc.), which Gates does not generally fund, have published a robust body of scholarship critical of the foundation. From its first days of operation, accomplished, high-profile scientists and researchers have raised ques- tions about the aims and legitimacy of the Gates Foundation. So, it’s not that critical research doesn’t exist. It’s that it doesn’t have the same visibility in the scientific discourse, or the same influence in the public discourse, as the work Gates funds. To a very large extent, what we know about the Gates Foundation comes from the Gates Foundation itself.
* * *
CHRIS MURRAY IS a towering figure in the world of global health—and he enjoys a level of prestige and wealth like few others in academia. He’s one of the highest-paid workers on the State of Washington’s payroll, for example. In his position as director of the University of Washington’s Institute for Health Metrics and Evaluation (IHME), he makes almost as much as the university president—around $800,000 in 2021. He’s also one of the rare scientists about whom biographies are written while they are still alive.
In the 2015 book, Epic Measures: One Doctor. Seven Billion Patients, author Jeremy N. Smith describes Murray’s pioneering work with health estimates as an extension of his medical training. Instead of treating individual patients, he’s diagnosing the globe, using Big Data to solve a big problem: in a normal year on the planet, approximately sixty million people die, but most of them pass from this earth without an autopsy or medical records citing a cause.
Knowing why and where people are dying is crucial to improving global health, and this is what makes Murray’s work with “health metrics” so important and influential. His scientific studies are among the most cited published research anywhere in science. Yet, with Murray’s big ambitions also comes a massive ego, one that has made him a deeply polarizing figure in science. The field of global health is littered with war stories of researchers who have had run-ins and blowups with Murray, many of them beginning the same way: with a request that he show his work.
Colin Mathers, a private consultant, told me that, in his previous position managing health statistics at the World Health Organization, he served as a scientific adviser to the IHME, but he left because Murray would not share basic information about how he formulated his estimates. “We felt that without access to the data, we couldn’t put our names to the results,” Mathers said in an interview.
Sam Clark of Ohio State University said that when he asked the IHME to provide the source code for a tool it used in its published estimates, the institute engaged in years of “obfuscation and blatant noncooperation” and later published a scientific paper attacking his work.
Another academic researcher asked to speak with me anonymously, saying he wanted to avoid provoking Murray, who turns “professional disagreements into personal accusations.”
“Chris Murray has always had one of these kind of force-of-nature personalities,” Andrew Noymer, a demographer at the University of California, Irvine, told me. “He does what he wants, when he wants—accountable to no one.”
Smith’s Epic Measures, more a hagiography than a biography, describes Murray as believing that “scientific progress relies on picking fights.” The book recounts an incident in which Murray accused an academic researcher of inflating child mortality estimates 10 percent higher than his own. “He knows that deaths translate into money for child health programs. Deaths are money,” Murray is quoted as saying. “Who’s right? That’s the only question. All that matters is being right.”
Murray is not right, but he’s also not wrong. Billions of dollars in spending—from health ministries, foreign aid offices, and philanthropists—lie in the balance of the health metrics enterprise. Inflating or deflating the incidence or prevalence of different diseases can affect funding decisions. Likewise, when health metrics show that a given intervention works—when we see infection or mortality numbers dropping—public policy can change. Getting health metrics right is important, which is why transparency, accountability, and independence are so essential. It is for this reason that scholars so widely question why Chris Murray—and Bill Gates—are in charge of this vital effort.
Bill Gates was a longtime fan of Murray’s work leading up to the creation of the IHME, the foundation’s highest-profile research project. Years before Gates provided seed money—and eventually more than six hundred million dollars—he had read a World Bank study Murray coauthored on the “global burden of disease,” citing it as inspiring his decision to devote most of his philanthropic spending to fighting disease. “I saw … that 12 million children are dying every year,” Gates told Scientific American in 2014. “Wow! It was mind-blowing to me that these preventable diseases—pneumonia, diarrhea, malaria and some other infections that infants get—had such a huge impact. That was the first time it dawned on me that it’s not hundreds of different diseases causing most of the problem—it’s a pretty finite number.” Murray’s research made Gates understand not only where to prioritize his spending but also the importance of health metrics more generally. If he was going to spend billions of dollars, he needed to measure and evaluate the effects of his spending.
When the Gates Foundation first got up and running, the World Health Organization had a robust health metrics program in place. Chris Murray had actually helped run it at one point. In the early 2000s, a change in leadership at the WHO—and Murray’s brash managerial style—led to a falling-out, and Murray went on to become a vocal critic of the WHO, citing its “potential for manipulating the data.” Could the WHO really be an impartial assessor of global disease when it was subject to political pressure from its member nations? The WHO, Murray reported, was simply “ill suited for the role of global monitoring and evaluation of health … We believe that the only viable solution will be to create a new, independent, health monitoring organisation.”
What Murray did not clearly disclose was that he himself planned to run this new organization. He first secured a promise of $115 million from tech billionaire (and onetime Bill Gates adversary) Larry Ellison to start his new research institute at Harvard. For reasons that are not totally clear, Ellison abandoned the project before it got off the ground. The student newspaper at Harvard, the Crimson, citing an anonymous source, reported that “Ellison had expressed disenchantment with Murray in private meetings on his yacht.”
His ambitions undimmed, Murray sought out another benefactor from the pleasure-craft class of American aristocracy. This took him to Seattle, where, with Bill Gates’s money, he launched the IHME in 2007.
Gates undoubtedly liked Murray’s Big Data approach to global health, but he may also have seen in Murray a man cut from the same cloth: a hard-driving personality with an entrepreneurial, combative spirit, someone with the rare combination of technical know-how and business acumen—and a desire to dominate. “Chris is super-good, but he likes controversy—and he doesn’t back down,” Gates said in an interview in 2014. “For the job of administering the normative database, he’s not absolutely the perfect person.”
While Gates uses the term normative database, others use monopoly. “In a relatively short period of time, the IHME has exerted a certain kind of hegemony or dominance on global health metrics production,” Manjari Mahajan, a professor of international affairs at the New School, said in an interview. “It’s a kind of monopoly of knowledge production, of how to know global health trends in the world. And that produces a concentration of epistemic power that should make anybody uncomfortable.”
That hegemony meant overtaking the WHO as the leading purveyor of health metrics. One former official from the WHO, which Gates also heavily funds, told me, “We were told we had to work with IHME, and the people that IHME doesn’t like were sidelined.… We were instructed to replace our statistics with IHME statistics. Now WHO is publishing documents with IHME statistics that have not been vetted by [member] countries.” By controlling the data, or the estimates, that define the global burden of disease, Chris Murray and Bill Gates also have the power to control the narrative of the entire field of global health.
