The Gates Foundation, Ebola, and
Global Health Imperialism
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 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.” 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.”)