Second, how to ensure the accountability of private donors. One of the benefits that Mr Gates has brought to global health is his celebrity and, as we have seen, quite a lot of criticism. More and better debate is to be welcomed. The Gates Foundation says it welcomes this debate and prides itself on its willingness to learn. Mr Gates has also tried to make his own thinking more transparent.
Just because Mr Gates does not agree with his critics does not mean that he is unaccountable and does not listen. (Indeed, one of the weaknesses of government donors is their tendency to spread the money too thinly across different programmes to satisfy different lobby groups in the name of accountability.) Yet the risk that the scale of his foundation’s funding is stifling debate needs to be taken seriously. The Gates Foundation needs to show that it is ready to participate in the debate with its critics and to demonstrate that it is not just funding yes-men. Given how fearful those who are receiving his money are to be perceived as biting the hand that feeds them, the Gates Foundation probably needs to go out of its way to encourage debate and discover what these folk really say about it in private, to people like us!
Still, this creates a high-leverage opportunity for another foundation to support that debate. To do so would be risky and controversial, which sounds like a good idea. If only Steve Jobs, before his untimely death, had opted to stop sneering at Mr Gates’ philanthropy and instead extended their business rivalry into a full-on competition in giving to public health. But hopefully some other billionaire will rise to the challenge.
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