- Rich people from the wealthy North also don’t grasp problems of the Global South that seem so far away.
- There hasn’t been a TB vaccine for 100 years and the first Phase 3 trials, the last vital step, will be carried out in Africa by the Gates Foundation, Welcome Trust, governments and other partners.
The Bill and Melinda Gates Foundation last month announced its largest-ever annual budget, unveiling US$8.6 billion (Sh1.4 trillion) to support projects in areas including global health this year. The announcement was made by the CEO Mark Suzman. He welcomed more philanthropists who are committing their resources to tackle the greatest challenges the world faces today. The Star’s John Muchangi joined a select pool of African journalists for a conversation with Suzman. Here are the excerpts:
In your Annual Letter, you make the case eloquently for the benefits of philanthropy. But, as you say, many billionaires hold their wealth close and give very little of it away. If one of them were here on the call with us, Elon Musk, for example, who’s given away less than one per cent of his wealth, what would you say to him or her to persuade them to be more generous?
Mark Suzman: It’s a very important question. And I don’t want to call out particular individuals, but there are a number of reasons why very wealthy people are often hesitant to give. Sometimes it’s as simple as just not wanting to fail. Often, these are very successful people in their fields and giving smartly and effectively is actually quite difficult and challenging.
Warren Buffett, who gives very generously a lot of his resources to us to spend, is famous for telling us and instructing us and saying that he doesn’t want us to take his lessons from business because in business he feels very confident about his decisions and his investments. But the kind of issues that he wants us to tackle at the foundation - HIV, poverty, malaria - are incredibly difficult and have not had much traction in traditional resources.
And so, we need to take bigger risks. And he uses a baseball metaphor, saying we need to swing and miss, and many of these wealthy people are not very comfortable swinging and missing. And so, our message and the example of Bill and Melinda and Warren, is that actually giving now, giving at scale, giving to alter human inequity, can make a very big difference, can be hugely impactful. And we have a number of very concrete examples to demonstrate that, that the need is now greater. If you think you’re actually retaining your resources, because you might give later, I think given the current global trends, actually now is when the needs are critical.
Are issues such as numerous geopolitical conflicts and others having an impact on the decision to give?
Mark Suzman: It’s a very important question. The biggest impact of geopolitical instability has actually been on traditional governmental funding, rather than philanthropic funding at this stage. This especially effects European countries, or the United States. We see conflicts in the Middle East and Ukraine, domestic priority issues around migration, the issues we’ve seen net resources going into. The aid to Africa dropped eight per cent in 2022.
Then I think for philanthropists coming in, there is often a question in terms of giving global – philanthropists from wealthy countries, high income countries, often don’t have a very good understanding of what the challenges or opportunities are in the Global South.
That’s something which we, at the Gates Foundation and with other partners, have been working to help demystify, because they worry, are there ways to spend money effectively? Can you actually have impact? When countries are unstable, what kind of impact can you see?
And I think we’ve proven [success] over the last two decades. For example, through initiatives like the GAVI (the Global Vaccine Alliance), or the Global Polio Eradication Initiative, but also in agricultural development where we support AGRA (Alliance for a Green Revolution in Africa), across multiple African countries, we’ve shown you can actually have very high impact on varying political situations. In the end, kids need to be immunised, whether it’s an election year or not.
And we can help provide some of the tools and structures, and drive down the prices of vaccines, and find new technologies, and new tools. And those are the opportunities that we’ve been trying to demonstrate to other philanthropists. And many of them have responded.
For example, in polio, for which we are very significant funders, and it’s one of the areas where we’ve increased our budget. It’s down to just 11 cases last year of wild polio virus, which was just in Pakistan and Afghanistan. Africa is free of wild polio virus, but still has vaccine-derived polio virus.
Are you getting enough support from the governments you work with? How can philanthropy effectively collaborate with governments to achieve sustainable and equitable development goals?
Mark Suzman: In terms of how governments have been receptive and what is the role of philanthropy, vis-a-vis government, that’s very important. And it’s because we like to say that our agenda really is the world’s agenda. It is set by the Sustainable Development Goals, which were set by every country on the planet at the UN as commitments to their own citizens.
And they set out clear goals in areas like health or agricultural development, poverty reduction, financial inclusion, women’s empowerment and gender equality. And those are areas we expect and hope governments to prioritise and take the lead on.
And then our role is to come in and help support and show, here are methods by which you can do much more innovative primary healthcare or vaccine delivery, or here are new tools or treatments. An example of something we are starting to fund this year on the African continent are the first Phase 3 tuberculosis vaccine trials. Phase 3 are the last trials before something is proven and we hope to be successful. There hasn’t been a new tuberculosis vaccine in over 100 years. And it has actually taken [the lead] back over from Covid-19 in the last year with 1.6 million deaths a year.
And so, that’s the kind of initiative that philanthropy can take. We’ll take the risk, and we’re being supported by the Wellcome Trust and other philanthropic enterprises to do those trials. We’re working on new treatments in tuberculosis and malaria as well. But in the end, when those are developed, it has to be governments that take the lead, working with international organisations like the World Health Organization, or the Global Fund to Fight AIDS, TB and Malaria, to ensure the people who need get them.
That’s not something philanthropy can do at scale. We can prove models, we can test models, but to actually provide impact at scale, that has to be government in the lead, with often the private sector driving some of the innovation and productivity, for example, in recent investments we made in Kenya and Rwanda to create the first big syringe manufacturers in Africa.
It’s the kind of thing that you don’t normally think of as a need. That’s something that will now have its own self-sustaining market. It’s enough syringes to cover the continent for vaccines domestically manufactured. We were the catalytic funders but long-term sustainability comes from governmental and multilateral sources.
How do you ensure the projects proposed by such small organisations align with the needs and priorities of the communities they serve?
Mark Suzman: Taking a step back, it’s definitely true that, historically, many philanthropies, global philanthropies, including ours, did not pay enough attention to developing long-term local partners in the countries and communities where we work.
Often, we would work through big international organisations and NGOs. Many of them do excellent work but the truth is, it’s clear if you want sustainable, long-term impact at scale it has to be driven by the countries and communities themselves, both government-led priorities but also within the communities, if it’s a health initiative, an education initiative, whatever it might be.
And so, we really, along with other partners, have been making a major effort to invest in organisations on the African continent, South Asia and other parts of world where we work. And many of those might start smaller. This is where we talk about the smaller organisations because all organisations have to start somewhere and grow. But then we’re talking about investing in them over many years.
And so, we have partners that I mentioned. Agra is one we work closely with; Amref many of you may be familiar with. We’ve got a range of examples of where we’ve been working with partners for them to grow and become stronger across the continent. And that’s something we’ll continue to do. That’s critical. We’re going to be working on the continent of Africa for the lifetime of the foundation.
As I said in the letter, we do have a finite lifetime. Unlike other foundations, we will spend ourselves down. We will not exist within 20 years of the deaths of our founders, Bill and Melinda French Gates, because they believe very strongly that they want their resources to be used against today’s problems and today’s needs. And they hope and expect that future generations of philanthropists will tackle future problems. And so, that’s a very core principle behind the way we operate.
In terms of how we follow up and monitor and measure, that’s a careful balance where, again, because we focus on human outcomes, nearly all the grants we give will have clear outcome measures that we agree with the partners on the ground that we want to work towards.
If we’re working on developing drought-resistant seeds, or drought resilient poultry, to take a couple of concrete examples, we want to make sure they’re reaching a certain demographic of women farmers across the continent. And on poultry, we work in Nigeria, Kenya, Ethiopia, Zimbabwe, a range of those countries.
And so, we all want to measure. Did it reach them? Have those farmers increased their income? Are they able to expand? Do they have extra resources they can expand on their families, and support educational health needs? And so, it’s those metrics that we will carefully follow up.
And they’re customised around whatever the sector is. Are you meeting HIV treatments for HIV-positive people in South Africa or Southern Africa broadly? Are we having a reach of new extension services to support smallholder farmers working on areas, whether it’s Nigeria or Ethiopia? In each of those, you’ll have a clear set of metrics, which we look at. We’ll adjust, we’ll examine every year.
And I know there’s sometimes debate about, does that reporting mean you don’t fully trust or empower your partners? And we don’t think that’s true at all. These metrics are discussed closely with the partners. We agree the goals together. We monitor them together, we course-correct together. But it is definitely true at the Gates Foundation that we want to make sure, in the end, our success is measured not in how much money we spent, but in lives saved and opportunities provided for the poorest and most vulnerable. We do try to measure that.