The New Evangelists: Bill and Melinda Gates Spread the Good News on Global Health Aid

People usually come to the capital to criticize to government, Bill Gates joked at the start of his speech on Tuesday in Washington, but “we’re here to say two words you don’t often hear about government programs: Thank you.” The Gateses’ mission wasn’t just about gratitude, but to sell the simple—and, some might argue, simplistic—message that US government investment in global health works. They weren’t asking for money for themselves (the Gates foundation already has so much money to spend each year that they discourage individual donations), but rather to lobby US policy makers and citizens to continue the increasing American investment in global health.

Americans only hear the horrible stories about disease and malnutrition in the developing world, the Gateses said. The idea behind their new public advocacy initiative, the Living Proof Project, is to tell the stories of people in the developing world who are alive today because of US interventions in global health.

The reduction in mortality for children under five, from 20 million deaths per year in 1960 to eight million per year in 2008 is, Bill Gates said, one of the biggest accomplishments in the last 100 years. This happened because of higher incomes and smart spending on global health, and Bill says the US is largely to thank for it.

The Gateses talked about success in decreasing prices and increasing access to anti-retroviral treatments for AIDS patients, and praised the “American tax dollars” that have enabled “slow but real progress” towards finding an AIDS vaccine.

Bill Gates also talked about making “substantial progress” against malaria for the first time since the 1970s, arguing that scaled up indoor spraying and bednet distribution since 2004 has led to large reductions in malaria cases. [We’ve written posts on the Gateses’ erroneous use of African malaria data three separate times, with spectacularly non-existent effect on the Gateses.]

Gates went on to address some arguments that “skeptics” (who could they possibly be?) might level against the optimistic approach to global health.

There have been problems with corruption, he acknowledged, “if you look back at the history of aid” and “some of it ended up in the pocket of the local dictator.” But today’s global health spending, he argued, is different because it is more measurable. With health interventions, “we can measure the impacts, we can make sure the vaccines are getting to the children,” he said, though he left unclear how you identify the corrupt link in the chain from funding to inputs to outputs involving many separate actors.

To those concerned that aid creates a culture of dependency, Gates again pointed at history, saying that nearly twice as many countries in the 1960s received aid compared to today. Countries like Egypt, Brazil and Thailand, he said, are “not net recipients of aid.”  He predicted that the world will see increasing numbers of countries currently on aid becoming self-sufficient. We hope that includes the many countries that have become steadily more aid-dependent for five decades.

There’s been little substantive commentary on the speech in the news or blogosphere so far. Judging from the tenor of the enthusiastic real-time comments from viewers during the speech (“What can we do? Who to call or write?” and “I love hearing about the positive progress we have is so rare that this fact is broadcasted,” for example), the Gateses were preaching to the choir.

This NPR interview,  though just seven minutes long, is actually meatier than the Gateses’ speech. In it, the interviewer gets Bill and Melinda Gates to talk honestly about why the Gates Foundation behaves differently than governments (“we can take risks where a government won’t or can’t”), and how their entrepreneurial approach to development problems allows them to acknowledge failures and change their approach midstream. Great!

Melinda Gates retells the story of delivering the rotavirus vaccine (but without the relentlessly optimistic spin from the speech). They worked with a scientist to develop a lifesaving vaccine, but failed with something much more mundane: producing the right packaging. They didn’t realize that they needed to put the doses in small containers so that it could be refrigerated all the way from the lab to remote locations in Nicaragua. She said: “You just learn from it and say okay, that’s a small mistake we made, and we’re not going to make that mistake again.” Kudos again! Would you mind if we called you “searchers”?

But all of this left us with one big unanswered question.  If the Gateses indeed have a much-improved aid model, then why this big campaign to defend US government aid agencies (including USAID), whom we and many others have documented do not change in response to – or even acknowledge – failures?