AIDS Response

The massive boost to global health funding that the Bill & Melinda Gates Foundation has given since its inception in 1994 is astonishing. The Foundation's current expenditure of around US$3 billion annually has challenged the world to think big and to be more ambitious about what can be done to save lives in low-income settings.

The Gates Foundation has added renewed dynamism, credibility, and attractiveness to global health. In particular, the Foundation inaugurated an important new era of scientific commitment to global health predicaments. For example, other more well-established funding organisations— such as the US National Institutes of Health—now take their international health responsibilities far more seriously thanks to the Foundation's energetic advocacy. Perhaps even more important is the fresh and deep political commitment to health that the Foundation has fostered.

There are several big successes the Foundation can take credit for. The Global Alliance for Vaccines and Immunisation, which received an initial gift from the Foundation of $750 million in 1999, has been its single most important contribution to global health so far. To that we would add the Foundation's investment in the Seattle-based Institute for Health Metrics and Evaluation, which, in its short life, has made a critical impact on international policy and thinking, acting as a valuable independent scientific monitor of global programmes in health.

But apart from questions over its investments, the Gates Foundation has received little external scrutiny. Last year, Devi Sridhar and Rajaie Batniji reported that the Foundation gave most of its grants to organisations in high-income countries. There was a heavy bias in its funding towards malaria and HIV/AIDS, with relatively little investment into tuberculosis, maternal and child health, and nutrition—with chronic diseases being entirely absent from its spending portfolio.