The Gates Foundation, Ebola, and Global Health Imperialism

• Date: 01 September 2015
• Published date: 01 September 2015
• DOI: http://doi.org/10.1111/ajes.12110

The Gates Foundation, Ebola, and Global

Health Imperialism

By JACOB LEVICH*

ABSTRACT. Powerful institutions of Western capital, notably the Bill

& Melinda Gates Foundation, viewed the African Ebola outbreak of

2014–2015 as an opportunity to advance an ambitious global agenda.

Building on recent public health literature proposing “global health

governance” (GHG) as the preferred model for international

healthcare, Bill Gates publicly called for the creation of a worldwide,

militarized, supranational authority capable of responding decisively to

outbreaks of infectious disease—an authority governed by Western

powers and targeting the underdeveloped world. This article examines

the media-generated panic surrounding Ebola alongside the response

and underlying motives of foundations, governments, and other

institutions. It describes the evolution and goals of GHG, in particular

its opposition to traditional notions of Westphalian sovereignty. It

proposes a different concept—“global health imperialism”—as a more

useful framework for understanding the current conditions and likely

future of international healthcare.

Introduction

On March 18, 2015, the world’s wealthiest man issued a public call for

an ambitious new project: the creation of a global, militarized, suprana-

tional authority capable of responding decisively to outbreaks of infec-

tious disease (Gates 2015a). Appearing in the pages of the prestigious

New England Journal of Medicine (NEJM), Bill Gates’s article “The Next

Epidemic — Lessons from Ebola” was a “global call to action” designed

for maximum impact. A New York Times op-ed by Gates (2015b), timed

to appear simultaneously with the NEJM piece, launched a flurry of

*Jacob Levich (jlevich@earthlink.net) is an independent scholar and an administra-

tor at Stony Brook University. Portions of this article draw on a paper by the author

in Aspects of India’s Economy (Levich 2014).

American Journal of Economics and Sociology, Vol. 74, No. 4 (September, 2015).

DOI: 10.1111/ajes.12110

V

C2015 American Journal of Economics and Sociology, Inc.

media coverage that uncritically reproduced the multi-billionaire’s

arguments.

As chieftain of the most powerful private foundation in history,

Microsoft founder Bill Gates was already accustomed to setting the

agenda for global healthcare. The Bill & Melinda Gates Foundation

(BMGF) had come to dominate the field, wielding an endowment

worth $43.5 billion and distributing nearly $4 billion annually to fund

initiatives aimed at fighting malaria, polio, tuberculosis, HIV, and other

diseases. (Guardian 2015). In the words of one NGO official: “You can’t

cough, scratch your head or sneeze in health without coming to the

Gates Foundation” (Global Health Watch 2008).

Gates’s NEJM article seemed to call for an unprecedented and far

more muscular style of health-care management. Building on the

worldwide panic inspired by the 2014 Ebola outbreak, Gates warned of

catastrophic future epidemics that could be contained only through the

intervention of a powerful “global warning and response system”

explicitly modeled on the North Atlantic Treaty Organization (NATO).

U.N. officials had deemed the international response to Ebola too slow

but ultimately effective and, in some cases, “spectacularly successful”

(WHO 2014e). But Gates called it a “global failure,” especially by com-

parison with “our preparations for another sort of global threat—war”

(Gates 2015a).

Gates conceded that an international epidemic response system

already exists under the auspices of the World Health Organization

(WHO), but described it as “severely understaffed and underfunded.”

Since BMGF is already WHO’s leading funder, it might be asked why

Gates, leader of a network of billionaire philanthropists worth at least

$125 billion, did not simply move to increase funding of programs now

in place (Harmer 2012; Harris 2009). On this question the NEJM article

is silent, but answers are implicit in the text. Gates (2015a) envisions an

organization empowered to:

Work closely with Western military forces, specifically NATO, in

operations targeting the developing world. (Planning “should

include military alliances such as NATO”; “in a severe epidemic,

the military forces of many or all middle- and high-income

countries might have to work together.”)

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Bypass national safety regulations in order to fast-track testing

and use of novel vaccines and other medications. (New Ebola

drugs “were not tested in patients with Ebola until after the epi-

demic had peaked—in part because there was no clear process

for approving a novel trial format or for providing indemnity

against legal liability.”)

Suspend constitutional guarantees in sovereign nations affected

by epidemics. (“Because democratic countries try to avoid

abridging individuals’ rights to travel and free assembly, they

might be too slow to restrict activities that help spread disease.”)

Create worldwide surveillance networks, presumably free of pri-

vacy protections, that would make information about people in

developing countries instantly available to the imperial core.

(“Access to satellite photography and cell-phone data” would

permit tracking “the movement of populations and individuals

in the affected region.”)

Gates is plainly skeptical of the ability of traditional international

institutions (particularly the United Nations) to create an authority so

extravagantly empowered. Rather, he anticipates implementing his pro-

posal via a consortium of public and private entities, including the

World Bank and the G7 countries, NATO, and “some combination of

foundations and technology companies.” The U.N. role in this under-

taking is left ambiguous. Gates calls for discussion “about which parts

of the process [WHO]should lead and which ones others (including the

World Bank and the G7 countries) should lead in close coordination.”

While the article contains perfunctory nods to U.N. authority, as well as

brief lip service to the idea of strengthening public health services in

poor countries, there can be little doubt that Gates is advocating a new

form of international institution, transcending the United Nations, tar-

geting the developing world, and effectively controlled by the wealthy

nations of the West.

The thinking behind Gates’s piece was widely hailed as original,

even oracular. But in the tradition of Microsoft, which rose to global

dominance in the software field by adapting and exploiting the ideas of

other firms, Gates was merely appropriating a concept that now per-

vades the field of public health: that of “global health governance”

The American Journal of Economics and Sociology706