The ‘Bill Gates problem’: do billionaire philanthropists skew global health research? Personal priorities are often trumping real needs and skewing where charitable funding goes.

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to two lines
Intro running on two lines normally, please don’t break
it, with a byline. By Bernard Wood
The Bill Gates Problem:
Reckoning with the Myth
of the Good Billionaire
Tim Schwab
Metropolitan Books
(2023)
Do billionaire philanthropists
skewglobal health research?
Personal priorities too often shape
where charitable funding goes. By Andy Stirling
billions of dollars each year (US$7billion in
2022) on global projects aimed at a range of
challenges, from improving health outcomes
to reducing poverty— with pledges totalling
almost $80billion since its inception.
Schwab offers a counterpoint to the prevail-
ing popular narrative, pointing out how much
of the ostensible generosity of philanthropists
is effectively underwritten by taxpayers. In the
United States, for example, 100,000private
foundations together control close to
$1trillion in assets. Yet up to three-quarters of
these funds are offset against tax. US laws also
require only sparse scrutiny of how charities
spend this money.
Had that tax been retained, Schwab rea-
sons, the government might have invested it
in more diverse and accountable ways. Instead,
the dispersal of these funds is being driven
mainly by the personal interests of a hand-
ful of super-rich individuals. By entrenching
particular pathways and side-lining others,
philanthropy is restricting progress towards
the global Sustainable Development Goals by
limiting options (see also strings.org.uk).
Many Gates foundation programmes are
G
lobal wealth, power and privilege
are increasingly concentrated in the
hands of a few hyper-billionaires.
Some, including Microsoft founder
Bill Gates, come across as generous
philanthropists. But, as investigative journalist
Tim Schwab shows in his latest book, charita-
ble foundations led by billionaires that direct
vast amounts of money towards a narrow
range of selective ‘solutions’ might aggravate
global health and other societal issues as much
as they might alleviate them.
In The Bill Gates Problem, Schwab explores
this concern compellingly with a focus on
Gates, who co-founded the technology giant
Microsoft in 1975 and set up the William H.
Gates Foundation (now the Bill & Melinda Gates
Foundation) in 1994. The foundation spends
Bill Gates and other wealthy individuals who spend vast sums on research may back some types of solutions over others .
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shaped and evaluated using data from the US
Institute for Health Metrics and Evaluation
(IHME), which was founded— and is lavishly
funded— by the foundation. Schwab suggests
that such arrangements could be considered
a conflict of interest, because in-house ‘eval-
uations’ often tend to justify current pro-
jects. In the case of malaria, for instance, the
numbers of bed nets distributed in tropical
countries— a metric tracked by the IHME—
can become a proxy for lives saved. Such cir
-
cularity risks exaggerating the efficiency of
programmes that aim to tackle high-profile
diseases, including HIV/AIDS, potentially at
the expense of other treatable conditions for
which solutions might remain unexplored
(see also Philip Steven’s 2008 book Fighting
the Diseases of Poverty).
Limited scope
Similarly restricted views exist in other areas,
too. In the energy sector, for instance, Gates
flouts comparative performance trends to
back exorbitantly expensive nuclear power
instead of much more affordable, reliable
and rapidly improving renewable sources and
energy storage. In agriculture, grants tend to
support corporate-controlled gene-modi-
fication programmes instead of promoting
farmer-driven ecological farming, the use of
open-source seeds or land reform. African
expertise in many locally adapted staples is
sidelined in favour of a few supposedly opti-
mized transnational commodity crops.
Furthermore, the Gates foundation’s sup-
port for treatments that offer the best chances
of accumulating returns on intellectual
property risks eclipsing the development of
preventive public-health solutions, Schwab
notes. For example, the foundation promotes
contraceptive implants that control women’s
fertility instead of methods that empower
women to take control over their own body.
Similarly, the foundation often backs for-
profit, Internet-based education strategies
rather than teacher-led initiatives that are
guided by local communities.
Throughout its history, the Gates founda-
tion’s emphasis on ‘accelerating’ innovations
and ‘scaling up’ technologies, as noted on
its website (gatesfoundation.org), obscures
real-world uncertainties and complexities,
and ignores the costs of lost opportunities. For
example, Gates’ aim to eradicate polio is laud-
able. But pharma-based actions are slow— and
can come at the expense of practical solutions
for less-glamorous yet serious scourges, such
as dirty water, air pollution or poor housing
conditions.
Thus, by promoting interventions associated
with the technological processes of extraction,
concentration and accumulation that under-
pinned his own corporate success, Gates helps
to tilt the playing field. His foundation tends to
neglect strategies built on economic redistri
-
bution, institutional reform, cultural change or
democratic renewal. Yet in areas such as pub-
lic health, disaster resilience and education,
respect for diverse strategies, multifaceted
views, collective action and open accounta-
bility could be more effective than the type of
technology-intensive profit-oriented, compet-
itive individualism that Gates favours.
Schwab traces the origins of this ‘Gates
problem’ to the 1990s. At that time, he writes,
Gates faced hearings in the US Congress that
challenged anti-competitive practices at
Microsoft and was lampooned as a “monopoly
nerd” in the animated sitcom The Simpsons
for his proclivity to buy out competitors. By
setting up the Gates foundation, he pulled off a
huge communications coup— rebranding him-
self from an archetypal acquisitive capitalist
to an iconic planetary saviour by promoting
stories of the foundation’s positive impact in
the media.
Yet since then, Schwab shows, Gates has pur-
sued a charitable monopoly similar to the one
he built in the corporate world. He has shown
that in philanthropy— just as in business— con-
centrated power can manufacture ‘success’ by
skewing news coverage, absorbing peers and
neutralizing oversight. For instance, Schwab
documents how the voices of some non-gov-
ernmental organizations, academia and news
media have been muted because they depend
on Gates’ money. While dismissing “unhinged
conspiracy theories” about Gates, he describes
a phenomenon that concerned activists and
researchers call the “Bill chill”. By microman-
aging research and dictating methods of analy-
sis, the foundation effectively forces scientists
to go down one path— towards the results and
“Resolution of the
BillGatesproblem
might need a cultural
transformation.”
Transparency is scarce on whether charitable investments in vaccine companies might beneit philanthropists or their contacts.
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Books & arts

Lost Cities of the Ancient World
Philip Matyszak Thames & Hudson (2023)
The earliest cities — dating from the eighth millennium bc — were
once regarded as defensive strongholds. But their accessible
locations beside major rivers suggest they were created “for the
purposes of government, religion, education and trade”, writes
historian Philip Matyszak. His readable, well-illustrated book covers
37 “lost” cities in Europe, the Middle East and Asia, including Troy,
Thebes and Persepolis. Inexplicably, it omits Indus Civilization cities
such as Harappa, lost until the 1920s. Andrew Robinson
Breaking Through
Katalin Karikó Crown (2023)
Biochemist Katalin Karikó, daughter of a butcher, was born in 1950s
Hungary in a cramped earth-brick house without running water.
In 2023, she shared the Nobel Prize in Physiology or Medicine for
discoveries that enabled the development of vaccines against
COVID-19. Her autobiography describes her vital, sometimes moving,
personal and scientiic struggle for success. As she writes of her
father’s surprising mathematical gifts, “A person may lack prestige or
a diploma but nevertheless have a swift mind.”
Over the Seawall
Stephen Robert Miller Island (2023)
Forest ires in the American West are today exacerbated by the US
Forest Service’s attempts to stamp out ires in 1930s — creating
tracts of unbroken forest unnaturally abundant in fuel. Academics
call such ixes “maladaptation”, writes science journalist Stephen
Robert Miller. He prefers “solutions that backire”. His book examines
three examples: a sea wall in Japan, location of the 2011 tsunami
disaster; tidal management in the Ganges River Delta in often-looded
Bangladesh; and artiicial watercourses in parched Arizona.
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There are 137 living species of sea mammal worldwide. The majority
are cetaceans: whales, dolphins and porpoises. The blue whale is
perhaps the largest animal that has ever lived, “rivaled only by a few
dinosaurs”, notes palaeontologist Annalisa Berta in her illustrated
survey of sea mammals based on a lifetime’s study. The reason is
its diet: shrimp-like crustaceans known as krill, tiny but abundant in
some oceans. To survive, it needs an enormous mouth, which can
swallow a gulp of water equivalent to its body mass.
Handwritten
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In 1833, a seasick Charles Darwin wrote from Peru that he looked
forward to the end of his 1831–36 global circumnavigation “with more
interest, than the whole of the voyage”. This astonishing note appears
in historian Lesley Smith’s compelling collection of handwritten
documents held at the Bodleian Library in Oxford, UK. Others include
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conclusions that the charity might prefer.
These issues are exacerbated by Gates
applying the same energy that he used in
business to coax huge sums from other celeb-
rity donors, which further concentrates the
kinds of innovation that benefit from such
funding. But Schwab has found that trans-
parency is scarce on whether or how Gates’
private investments or those of his contacts
might benefit from his philanthropy. Ques-
tions arise over the presence of people with
personal ties to Gates or the foundation on
the board of start-up companies funded by
the charity, for example.
Bigger picture
One minor gripe with the book is that although
Schwab excels in forensically recounting the
specific circumstances of Bill Gates’ charitable
empire, he is less clear on the wider political
forces at work or the alternative directions
for transformation that have been potentially
overlooked. Schwab often implies Gates’ altru-
ism is insincere and rightly critiques Gates’
self-serving “colonial mindset” (see, for exam-
ple, S. Arora and A. Stirling Environ. Innov. Soc.
Transit. 48, 100733; 2023). But in this, Gates
is a product of his circumstances. As Schwab
writes, “the world needs Bill Gates’s money.
But it doesn’t need Bill Gates”. Yet maybe the
real problem lies less in the man than in the
conditions that produced him. A similar ‘tech
bro’ could easily replace Gates.
Perhaps what is most at issue here is not the
romanticized intentions of a particular indi-
vidual, but the general lack of recognition
for more distributed and collective political
agency. And more than any single person’s
overblown ego, perhaps it is the global forces
of appropriation, extraction and accumulation
that drive the current hyper-billionaire surge
that must be curbed (see also A. Stirling Energy
Res. Soc. Sci. 58, 101239; 2019).
Resolution of the Bill Gates problem might
need a cultural transformation. Emphasis on
equality, for instance, could be more ena-
bling than billionaire-inspired idealizations
of superiority. Respect for diversity might be
preferable over philanthropic monopolies
that dictate which options and values count.
Precautionary humility can be more valuable
than science-based technocratic hubris about
‘what works’. Flourishing could serve as a bet-
ter guiding aim than corporate-shaped obses-
sions with growth. Caring actions towards
fellow beings and Earth can be more progres-
sive than urges to control. If so, Schwab’s excel-
lent exposé of hyper-billionaire ‘myths’ could
yet help to catalyse political murmurations
towards these more collective ends.
Andy Stirling is a professor of science and
technology policy at the Science Policy
Research Unit at the University of Sussex, UK.
e-mail: a.c.stirling@sussex.ac.uk
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