The bill gates problem, p.37
The Bill Gates Problem, page 37
Bill Gates has a much less nuanced view. In an interview with the Wall Street Journal—titled “Bill Gates: GMOs Will End Starvation in Africa”—he said, “It’s pretty incredible because it reduces the amount of pesticides you need, raises productivity, can help with malnutrition by getting vitamin fortification—so, for Africa, I think this is going to make a huge difference, particularly as they face climate change.”
The “huge” benefits Gates promised for African farmers never arrived, yet Gates remains steadfastly committed to his high-tech agenda. And he has little patience for critics and naysayers. “If there’s some non-innovation solution, you know, like singing ‘Kumbaya,’ I’ll put money behind it,” he said in a 2022 interview. “But if you don’t have those seeds, the numbers just don’t work.… If somebody says we’re ignoring some solution, I don’t think they’re looking at what we’re doing.”
It would be much easier to take Gates seriously, or find his words less condescending, if he were actually rolling up his sleeves and doing the hard work to substantiate his grand promises. The foundation has been working on GMOs for close to two decades—what does it have to show for this, aside from all the interviews, marketing, promises, and PR?
Every fall, the Gates Foundation releases a big report called Goalkeepers, which claims to offer a broad survey of human progress, and Bill Gates’s focus in 2022 was on agriculture, a clear signal of his plans to elevate its importance in the foundation’s portfolio in the years ahead. Gates promoted the “magic seeds” his foundation was working on, and he stressed the need for other innovations, like using artificial intelligence and predictive modeling to create “a data-based vision of what farms will need to look like in the future.”
Bill Gates’s doubling down on agriculture in the face of growing calls to defund his agricultural projects speaks to the way this issue has become personal for him. Since the publication of his 2021 book, How to Avoid a Climate Disaster, he has aggressively sought to assert his expertise on climate change, a hard sell given that his private foundation has largely avoided the issue for the past twenty years. By expanding his work in agriculture, where he already has a foothold, Gates can claim leadership on climate change, focusing on technological solutions for our food system.
“I would also say that if temperature rise stopped today, you could say, ‘Hey, you know, just take the best seeds we have now and adopt it for Africa,’” Gates said. “But temperature rise is not stopping. We do need the leguminous crops that make their own fertilizer. We do need the photosynthetic improvement. Those things [GMO crops] are 10 to 15 years away, but we need those because the temperature isn’t leveling off.” And just like that, Gates had bought himself a fresh fifteen-year time line.
There is absolutely no reason to believe that his innovation agenda will deliver. But we should also not doubt how committed Bill Gates is to his image as a champion for African farmers, whether they want him or not: “So on behalf of Africa—not just so they don’t have malnutrition but so they develop their economies so they can fight climate change—getting their agricultural productivity up, for a ton of reasons, should be a top priority.”
14
India
When Bill Gates’s career as a philanthropist began in earnest, and he decided he wanted to focus on health, HIV/AIDS was an obvious place to begin. The high-profile disease had celebrity champions and even celebrity victims—from Magic Johnson to Freddie Mercury to Fela Kuti. But the real poster child for the disease was the continent of Africa, where large numbers of poor people were dying because they could not afford treatment. As the world turned its attention to the plight of Africa, so did Bill Gates. But he also directed his foundation to look to another corner of the globe, where there were growing worries about an approaching tsunami of infections—India.
India hadn’t received the same level of support from the foreign aid funding complex, even as the nation had a larger population than the entire African continent. Bill Gates saw the market void and inserted himself in a big way, announcing a one-hundred-million-dollar program in 2002 to intervene where the Indian government was failing. “The recognition we came to, and one I think the government is also coming to, is that more needs to be done,” he said.
Gates traveled to India personally to make the announcement. The visit ended up drawing controversy because, in tandem with his philanthropic donation, he also announced that Microsoft was making a four-hundred-million-dollar investment in India. The potential corporate benefits behind Gates’s charitable gift weren’t lost on journalists, who, in the early days of the foundation’s work, had the mettle to challenge Gates.
The New York Times reported that Gates “deflected any suggestions that philanthropy could be good for business.” The Lancet published a more pointed editorial, asking whether Bill Gates was a “philanthropist or commercial opportunist.”
Gates’s business-cum-philanthropy efforts in India came at a time when Microsoft was in an escalating conflict with the Indian government over whether that nation’s vast public bureaucracy would embrace Microsoft’s software or, instead, pursue free and open software alternatives, like Linux. By announcing a double whammy of investments from both Microsoft and his foundation, Bill Gates sent a clear signal to the Indian government about his value proposition. Using philanthropy to advance the corporate bottom line is a long-standing practice of Microsoft.
“We need to have great relationships with governments all over the world,” Bill Gates said in 2008, speaking about Microsoft:
And because we make a product whose marginal cost of production is very low—software—and because information empowerment is so directly what we’re about, it’s not a stretch in any way, the idea that we go into over one hundred countries and do these things where we donate massive amounts of software. We even give cash gifts, and we train teachers. And we make sure we get visibility for that and we make sure when we hire employees they know about that. When we’re competing for government contracts, we remind people we’re a good citizen in that country. I can’t do the math for you in some hyper-rational way. I suppose you could go overboard on it, but versus not doing that, Microsoft is absolutely way better off.
In this interview, Gates went on to highlight a new Microsoft lab in India designed to help poor farmers and teachers. He noted that the project might get spun into the Gates Foundation. “If you figure out how to make governments love you by helping the poor people in that country,” he said, “you get both the benefit of the government loving you and you get to say you helped the poor in that country.”
Arguably, India could be seen as the jewel in the crown of Microsoft’s software empire. In addition to the enormous market it offers for Microsoft products, it also boasts a workforce of highly trained programmers and engineers who have become an important part of Microsoft’s bottom line—working for half of what the company pays employees in the United States.
It does seem more than a coincidence that India later became a major focus of the Gates Foundation. India today is the largest recipient of Gates money outside the United States or Europe, of more than six hundred charitable grants totaling close to $1.5 billion. The foundation’s first-ever foreign office was in India, and its HIV/AIDS project, called Avahan, turned into a sprawling $300 million program, one of the foundation’s biggest interventions of its kind at that time. In the years ahead, the foundation dramatically expanded its portfolio of charitable interventions in India to include maternal health, vaccines, financial systems, and other topics.
But it was a slow learning process. Figuring out how to work in India, and the need to work cooperatively with the government, began with some hard lessons in its early HIV/AIDS project. Manjari Mahajan was a graduate student at the time Avahan was getting off the ground in the early 2000s, and she found that foundation staff in India were open to discussing their work—a level of transparency and engagement that seems unthinkable today. Mahajan, an associate professor in international affairs at the New School, went on to publish her findings about Avahan’s questionable legacy in academic journals. Forbes India reported a second, consistent account of the project.
According to these two reports, a defining feature of Avahan was its “go big or go home” ethos. Job interviews were held at some of the nation’s fanciest hotels, and the very high salaries on offer attracted corporate talent from consulting companies like McKinsey. The director of Avahan, Ashok Alexander, a former senior partner with McKinsey, became the highest-paid employee at the foundation in 2007, taking home nearly five hundred thousand dollars in total compensation.
Asked about the five-star hotels, business class flights, and high-grade salaries, the foundation noted at the time, “We need the best talent to deal with an urgent problem on a war footing. If we need to get this talent from the corporate sector, we have to make it attractive for them.” This meant hiring technical specialists at salaries three or four times higher than what government agencies were paying, setting the stage for a brain drain that attracted talented people who might otherwise have worked in the public sector. The foundation’s rich spending also prompted a wide array of NGOs to line up behind its agenda. Mahajan’s research profiles one group that changed its focus from adolescent health to follow Gates money—and priorities. By 2009, more than one hundred NGOs were working under the Gates Foundation’s growing HIV/AIDS project.
Outside Avahan, the Indian government already had a robust HIV/AIDS program that other donors were working through, so, in some respects, the Gates Foundation was pursuing a parallel, independent strategy. And Gates was eager to contrast its approach with the Indian government’s, trumpeting how its hard-nosed, business-minded strategy would move the needle. “If a NGO becomes a barrier between providing a service to society, then we will get another NGO. We will short circuit the power structure to get the service to the people. We focus on speed, on scale, and on sustainability,” the director of Avahan said. “Our benchmarks are of the private sector. In the first year, we established our presence in 550 towns, with doctors, peer workers, and nurses. If we were a business organization, we would have been very proud of such rapid growth. We follow a business model with segmentation of the problem. Where in the social sector do you find such execution focus? Where do you find such structures of monitoring and evaluation?”
As the project got bigger and bigger, however, the Gates Foundation began to realize internally how minuscule its resources were in a nation of more than a billion people. And it realized that its silver bullet approach of devising succinct technical interventions wasn’t as easy as the elegant flowcharts its army of consultants and MBAs had devised on paper.
“They go in and they think distributing condoms and information is going to bring about behavioral change in the high-risk groups, especially sex workers,” Mahajan told me in an interview. “They find that it doesn’t work. So, they go back and try some other intervention, and that doesn’t work. They are partnering with all these NGOs, and so, they start listening more carefully to what these NGOs are saying, which is, ‘What good is it for a sex worker to have a condom if she is going to be beaten up by a customer if she tries to use it?’ So, they realize they have to understand the broader social and cultural dynamic.”
Mahajan said the Gates Foundation deserves credit for demonstrating its capacity to learn and pivot. Yet the lesson went only so far. While the foundation’s leadership came to realize its targeted interventions were too narrow, it also realized it didn’t want to take on the difficult, messy work of public health—building up the infrastructure and capacity of the nation to deliver the full scope of interventions needed against disease. “This type of broad-ranging structural work is not what we set out to do,” the foundation acknowledged.
Gates began formulating an exit plan, imagining it would hand off Avahan to the Indian government. As part of this plan, it issued press releases and grants that fundamentally changed the program from one that worked outside government to one that was now working closely with it. Mahajan reports that when she asked about the changing strategy, the foundation insisted that its plan had always been to hand the project off to the government.
Bill Gates had his own version of events. “One of the first programs we worked on in India was called Avahan, an HIV prevention program that’s now reaching millions of the people most at-risk for contracting and spreading the virus. With many international partners, we helped launch the project, refining it and measuring its impact along the way. After the first 10 years, the government of India has decided to take it over,” Gates said in 2012. “This is a great example of what collaboration between funders and governments can achieve. Avahan is saving lives, and it would not exist if we hadn’t provided funding and technical assistance to test out a promising new idea. However, the Indian government is scaling and sustaining the effort over the long-term. This pattern has been repeated across the country over the past several decades, and aid has steadily become a smaller and smaller portion of the national economy.”
The reality was nothing like the success story Bill Gates described. The Indian government deemed Avahan to be hugely expensive in terms of the benefits it delivered—and totally unsustainable. “We told them you can’t create a huge number of assets and then just leave and expect the government to take over everything,” the head of the Indian government’s HIV response effort told the news media. “We can never offer a replicable model. And if we are unable to sustain the programme, all of their effort will be for naught.”
“Avahan’s approach is too resource-intensive,” another Indian official noted. “This is not a model that can be replicated or scaled up by the state.”
One HIV activist from that era whom I interviewed echoed these sentiments, recounting to me having conversations with midlevel government employees along the lines of, “How does BMGF think they can just hand over such a huge thing, and they think we will want to take it up and run it? Where do we have the capacity to run it? Where do we have the people?”
Forbes India was unsparing in its final analysis of Avahan, headlining its story, “How Bill Gates Blew $258 Million in India’s HIV Corridor.” For all the foundation’s chest-thumping about its private-sector dynamism and hard-nosed business approach, from a dollars-and-cents perspective, Gates’s project seemed better defined by its wasteful spending and weak outputs. Avahan simply had not achieved what it had set out to do.
And as with all Gates Foundation interventions, when Gates abruptly changes its mind and abandons a project, there is collateral damage. The foundation’s profligate spending on Avahan had created a significant cottage industry of grantees who were left scrambling to rejigger their missions and priorities to find new funding. Forbes India profiled a former sex worker who had found gainful employment as a “peer educator” under Avahan. Now that the Gates project was shutting down, the woman worried about whether she would have to return to sex work—at age forty-five.
The other question Forbes raised was, “In a country where a branded condom sells for just 10 cents, what did Avahan spend on? It’s difficult to say because Avahan’s finances are largely opaque.”
One public health professional I interviewed, who has spent much of his career working on Gates Foundation grants, insisted that Avahan was enormously successful, telling me that if Gates hadn’t done this early work, there would, indeed, have been a major HIV/AIDS crisis in the nation. Asked if there was any independent research or scholarship supporting this claim, the source said they did not know. The Gates Foundation, likewise, trumpets that its work prevented six hundred thousand HIV infections, a claim based on academic research the foundation itself funded, not an independent evaluation. It is true that the predicted “tsunami” of HIV/AIDS in India never came to pass, but this is widely considered to be due to faulty projections, not because of the Gates Foundation’s interventions.
One clear lesson the foundation learned from Avahan was the importance of partnering closely with governments on the front end and not simply creating projects and expecting governments to take them over. It’s a lesson that echoes throughout the foundation’s work today, a kind of axiom on which its entire charitable enterprise exists and a marketing dance that helps manage public opinion. By bringing government partners and taxpayer dollars into public-private partnerships, the foundation gets political buy-in, public-facing legitimacy, and huge sums of money that it wouldn’t otherwise have. And it allows the foundation to argue that it’s not some puppet master pulling strings but simply one of many collaborative partners.
When pressed about its influence, the Gates Foundation often points to the fact that its annual charitable funding pales in comparison to government spending, whether on U.S. education or public health abroad. Gates also likes to describe itself, when convenient, as merely playing a “catalytic” role—to innovate new interventions that, if they work, governments can take and scale up. The idea is that the foundation comes up with the big ideas, does the pilot projects, plows money into measurement and evaluation, and then calls on governments to do the tedious, difficult work of “scaling up”—trying to turn Gates’s big ideas into real change.
It’s a model the foundation continued in its second chapter of work in India, focused on the states of Uttar Pradesh and Bihar, where it has funded a small army of “technical support units” that engage in a far-ranging array of public health interventions. As the former head of the foundation’s India office, Nachiket Mor, described it in an interview in 2016:
