[A2k] New York Times: Gates Foundation's Influence Criticized

[Thiru Balasubramaniam]

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http://www.nytimes.com/2008/02/16/science/16malaria.html?scp=3D1&sq=3Dkochi=
&st=3Dnyt

February 16, 2008
Gates Foundation=92s Influence Criticized
By DONALD G. McNEIL Jr.

The chief of malaria for the World Health Organization has complained
that the growing dominance of malaria research by the Bill and Melinda
Gates Foundation risks stifling a diversity of views among scientists
and wiping out the world health agency=92s policy-making function.

In a memorandum, the malaria chief, Dr. Arata Kochi, complained to his
boss, Dr. Margaret Chan, the director general of the W.H.O., that the
foundation=92s money, while crucial, could have =93far-reaching, largely
unintended consequences.=94

Many of the world=92s leading malaria scientists are now =93locked up in a
=91cartel=92 with their own research funding being linked to those of
others within the group,=94 Dr. Kochi wrote. Because =93each has a vested
interest to safeguard the work of the others,=94 he wrote, getting
independent reviews of research proposals =93is becoming increasingly
difficult.=94

Also, he argued, the foundation=92s determination to have its favored
research used to guide the health organization=92s recommendations
=93could have implicitly dangerous consequences on the policy-making
process in world health.=94

Dr. Tadataka Yamada, executive director of global health at the Gates
Foundation, disagreed with Dr. Kochi=92s conclusions, saying the
foundation did not second-guess or =93hold captive=94 scientists or
research partnerships that it backed. =93We encourage a lot of external
review,=94 he said.

The memo, which was obtained by The New York Times, was written late
last year but circulated this week to the heads of several health
agency departments, with a note asking whether they were having
similar struggles with the Gates Foundation.

A spokeswoman for the director general said Dr. Chan saw the memo last
year but did not respond to it. It is =93the view of one department, not
the W.H.O.=92s view,=94 said the spokeswoman, Christine McNab. The agency
has cordial relations with the foundation, and the agency=92s policies
are set by committees, which include others besides Gates-financed
scientists, she said.

The Gates Foundation has poured about $1.2 billion into malaria
research since 2000. In the late 1990s, as little as $84 million a
year was spent =97 largely by the United States military and health
institutes, along with European governments and foundations. Drug
makers had largely abandoned the field. (China was developing a drug,
artemisinin, that is now the cornerstone of treatment.)

The World Health Organization is a United Nations agency with a $4
billion budget. It gives advice on policies, evaluates treatments =97
especially for poor countries =97 maintains a network of laboratories
and sends teams to fight outbreaks of diseases, like avian flu or
Ebola. It finances little research; for diseases of the poor, the
Gates Foundation is the world=92s biggest donor.

Dr. Kochi, an openly undiplomatic official who won admiration for
reorganizing the world fight against tuberculosis but was ousted from
that job partly because he offended donors like the Rockefeller
Foundation, called the Gates Foundation=92s decision-making =93a closed
internal process, and as far as can be seen, accountable to none other
than itself.=94

Moreover, he added, the foundation =93even takes its vested interest to
seeing the data it helped generate taken to policy.=94

As an example, he cited an intervention called intermittent preventive
treatment for infants, known as IPTi.

Other experts said IPTi involved giving babies doses of an older anti-
malaria drug, Fansidar, when they got their shots at 2 months, 3
months and 9 months. In early studies, it was shown to decrease
malaria cases about 25 percent. But each dose gave protection for only
a month. Since it is not safe or practical to give Fansidar constantly
to babies because it is a sulfa drug that can cause rare but deadly
reactions and because Fansidar-resistant malaria is growing, World
Health Organization scientists had doubts about it.

Nonetheless, Dr. Kochi wrote, although it was =93less and less
straightforward=94 that the health agency should recommend it, the
agency=92s objections were met with =93intense and aggressive opposition=94
from Gates-backed scientists and the foundation. The W.H.O., he wrote,
needs to =93stand up to such pressures and ensure that the review of
evidence is rigorously independent of vested interests.=94

Amir Attaran, a health policy expert at the University of Ottawa who
has criticized many players in the war on malaria, said he thought Dr.
Kochi=92s memo was =93dead right.=94 His own experience with Gates-financed
policy groups, he said, was that they are cowed into =93stomach-churning
group think.=94 But Dr. Attaran said he believed that scientists were
not afraid of the foundation, but of its chief of malaria, Dr. Regina
Rabinovich, whom he described as =93autocratic.=94

Dr. Rabinovich, when told of Dr. Attaran=92s characterization, said she
did not want to respond. Dr. Yamada of the Gates Foundation called it
=93unfortunate and inaccurate.=94

=93I=92m not a grantee of hers,=94 he said, =93but she=92s an extremely
knowledgeable leader. And if she has an opinion, she=92s entitled to
it.=94 He said he did not know the details of the IPTi issue, but added
that researchers often differed about policy implications.

There have been hints in recent months that the World Health
Organization feels threatened by the growing power of the Gates
Foundation. Some scientists have said privately that it is =93creating
its own W.H.O.=94

One oft-cited example is its $105 million grant to create the
Institute for Health Metrics and Evaluation at the University of
Washington. Its mission is to judge, for example, which treatments
work or to rank countries=92 health systems.

These are core W.H.O. tasks, but the institute=92s new director, Dr.
Christopher J. L. Murray, formerly a health organization official,
said a new path was needed because the United Nations agency came
under pressure from member countries. His said his institute would be
independent of that.

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Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International (KEI)
thiru@keionline.org


Tel: +41 22 791 6727
Mobile: +41 76 508 0997