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Bill Gates Foundation’s funding policy criticised

R. Ramachandran

Efficacy of huge grants to vaccination programmes questioned

GAVI received a disproportionately large sum of $1.5 billion for “purchase of new vaccines”
Higher costs would be borne by poor nations when GAVI funding is withdrawn

New Delhi: The pattern of awarding grants by the Bill and Melinda Gates Foundation (BMGF) has come in for criticism again. A critique of the Foundation’s disproportionately large funding of vaccination programmes was published in the medical journal Lancet last month (see The Hindu, May 10). This time the Foundation has been targeted for the same reason by two Indian doctors, Gopal Dabade of Dharwad and Jacob Puliyel of St. Stephen’s Hospital, Delhi, through a letter published in the journal’s latest issue.

David McCoy and colleagues pointed out in their critique of May 9 that “at least half of all funding” by the Foundation was linked to vaccination. In particular, they had found that the Global Alliance for Vaccines and Immunisation (GAVI) had received a disproportionately large sum of $1.5 billion for “purchase of new vaccines” and “general operational support.” The authors had observed that this “technological bias” was fundamental to the Foundation’s approach that grew from Gates’ belief that early childhood mortality could be eliminated by “the invention of a handful of new vaccines and getting them into widespread usage.” This large funding to GAVI is clearly in line with that philosophy of the Foundation.

‘Advance marketing commitments’

Dabade and Puliyel in their correspondence have highlighted yet another instance of GAVI receiving major funding of $1.5 billion for its new vaccine initiative called “advance marketing commitments (AMC).”

Through AMC, a consortium of developed countries and BMGF will guarantee money to the manufacturers of the vaccine that would be delivered to the immunisation programmes of developing countries at subsidized prices.

In fact, on April 3, the World Bank had decided to provide a financial platform for the Alliance’s specific AMC initiative for a new pneumococcal vaccine “thus creating a potential for a future viable market.” To a pilot GAVI’s AMC against pneumococcal disease, the governments of Italy, the U.K., Canada, Norway and Russia have joined hands with BMGF and committed $1.5 billion.

‘Diversion of money’

By pointing out that the efficacy of this vaccine in preventing childhood pneumonia remains highly questionable, Dabade and Puliyel argue that the policy of funding AMC for this vaccine “allows GAVI to divert BMGF money to vaccine manufacturers without providing commensurate benefits to the children it is supposed to help.”

To point out the vaccine’s low efficacy Dabade and Puliyel cite data from a 2008 paper of S.A. Madhi and associates in the Bulletin of the World Health Organisation (WHO) which show that 1000 children have to be vaccinated to prevent approximately four cases of pneumonia. “Given that the vaccine costs $250 per child,” Dabade and Puliyel point out, “$250 000 will be spent to prevent these four cases of pneumonia [whereas]…treatment of four children with pneumonia with oral cotrimoxazole, in accordance with the WHO protocol, will cost [only] $1 in India.”

Vaccine prices actually went up after GAVI funding, according to a 2008 analysis by L. Kamara and others on the financial sustainability of immunisation programmes in 50 countries. Based on this analysis, Dabade and Puliye argue that the higher costs would be borne by poor nations when GAVI funding is withdrawn.

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