Global health and the Bill & Melinda Gates Foundation

Abstract

David McCoy and colleagues' analysis of the grant-making programme of the Bill & Melinda Gates Foundation1 raises many questions that can be addressed properly only by extended study and debate. However, as recipients of major Gates Foundation awards for malaria programmes, there are some conclusions in the article, and in the accompanying Comment by Robert Black and colleagues,2 with which we disagree. First, McCoy and colleagues' acknowledged under-representation of developing-country recipients and the failure to take into account subrecipients of awards is a serious flaw in their approach and undermines their conclusions. In fact, six of the Gates-funded malaria programmes with which we are associated, and for which European or American institutions are classified as the major recipients of the awards, are partnerships between southern and northern institutions focused entirely on the needs and priorities of disease-endemic developing countries. The greatest part of the funding in all cases goes to the developing countries. Second, McCoy and colleagues conclude that the awards are made through an informal system of personal networks and relationships, with no independent or technical peer review. This has certainly not been our experience. The relationships developed with the knowledgeable, experienced, and committed project officers (a system also operated by other major funders) have been very beneficial but in no way lessens the rigour of the review process or of the reporting procedures required.