Did Gates and Buffett do more good as businessmen than as philanthropists?

Provocative case for "yes" in today's Wall Street Journal (gated link), by Kimberley Dennis,  President of Searle Freedom Trust:

Wealthy businessmen often feel obligated to 'give back.' Who says they've taken anything?

Full disclosure: DRI benefits from post-docs indirectly funded by the Searle Foundation.

Read More & Discuss

A warning from Tajikistan

The following post was written by Alanna Shaikh. Alanna is a global health professional who blogs at UN Dispatch and Blood and Milk. A polio outbreak is underway in Tajikistan. 12 people have died of the diseases since March. 32 cases of polio have been confirmed, and 171 cases of acute flaccid paralysis (a signal of possible polio) have been identified. That’s a full-fledged outbreak in a country with an 82% vaccination rate. Until this January, there hadn’t been a polio case in Tajikistan for 13 years; Tajikistan was certified polio-free in 2002.

Tajikistan should simply not be seeing a polio outbreak – an 82% vaccination rate is enough to achieve herd immunity and protect even the unvaccinated. And we know this is not one of the rare vaccine-caused outbreaks because the WHO has done genetic analysis on the polio strain – it is wild polio.

Something has gone wrong in the health sector in Tajikistan. There are several ways that the health system could fail on vaccination. Vaccine records could be inaccurate, causing unvaccinated children to be missed by the system. Or the cold chain is not being maintained and the vaccines are losing effectiveness – the oral polio vaccine is especially vulnerable to warm temperatures. Whatever happened, it’s a sign of health system weakness and the Ministry of Health of Tajikistan will need support to improve it.

This outbreak calls into question the disease eradication approach to public health. Tajikistan has shown genuine commitment to polio eradication and that commitment has not been enough. Without a health sector strong enough to ensure effective vaccination coverage, a single-disease focus just doesn’t work. That idea is slowly being accepted. Eradication proponent Bill Gates called the eradication approach into question in his annual letter, mentioning slow progress to date in Nigeria.

If disease eradication is not the key to promoting global health, what is? Successful immunization against dangerous childhood diseases requires the same basic health sector resources as fighting HIV, protecting maternal health, and preventing chronic illnesses: a sufficient number of trained staff, useful data and the ability to act of it, health infrastructure, and effective financing methods. Support for those resources therefore strengthens a nation’s health as a whole.

Moving to a health systems approach for supporting global health will maximize the impact of global health spending. Every dollar spent will battle more than one disease. A broad systems approach also directly supports the goals of disease eradication by making sure that health staff are available, and trained, to provide vaccinations, and that the logistical system is in place to keep vaccines cold.

A systems approach will also support the structures needed to maintain disease elimination. Even after polio has been eliminated from a region, vaccination for the disease needs to continue as long as it still exists in human patients anywhere. And surveillance is necessary to watch and prepare for new outbreaks of the disease, like the one we are seeing in Tajikistan.

Tajikistan’s polio outbreak is a warning sign. You can’t eliminate a disease without also building a health system that ensures the disease stays eliminated.

Read More & Discuss

The New Evangelists: Bill and Melinda Gates Spread the Good News on Global Health Aid

People usually come to the capital to criticize to government, Bill Gates joked at the start of his speech on Tuesday in Washington, but “we’re here to say two words you don’t often hear about government programs: Thank you.” The Gateses’ mission wasn’t just about gratitude, but to sell the simple—and, some might argue, simplistic—message that US government investment in global health works. They weren’t asking for money for themselves (the Gates foundation already has so much money to spend each year that they discourage individual donations), but rather to lobby US policy makers and citizens to continue the increasing American investment in global health.

Americans only hear the horrible stories about disease and malnutrition in the developing world, the Gateses said. The idea behind their new public advocacy initiative, the Living Proof Project, is to tell the stories of people in the developing world who are alive today because of US interventions in global health.

The reduction in mortality for children under five, from 20 million deaths per year in 1960 to eight million per year in 2008 is, Bill Gates said, one of the biggest accomplishments in the last 100 years. This happened because of higher incomes and smart spending on global health, and Bill says the US is largely to thank for it.

The Gateses talked about success in decreasing prices and increasing access to anti-retroviral treatments for AIDS patients, and praised the “American tax dollars” that have enabled “slow but real progress” towards finding an AIDS vaccine.

Bill Gates also talked about making “substantial progress” against malaria for the first time since the 1970s, arguing that scaled up indoor spraying and bednet distribution since 2004 has led to large reductions in malaria cases. [We’ve written posts on the Gateses’ erroneous use of African malaria data three separate times, with spectacularly non-existent effect on the Gateses.]

Gates went on to address some arguments that “skeptics” (who could they possibly be?) might level against the optimistic approach to global health.

There have been problems with corruption, he acknowledged, “if you look back at the history of aid” and “some of it ended up in the pocket of the local dictator.” But today’s global health spending, he argued, is different because it is more measurable. With health interventions, “we can measure the impacts, we can make sure the vaccines are getting to the children,” he said, though he left unclear how you identify the corrupt link in the chain from funding to inputs to outputs involving many separate actors.

To those concerned that aid creates a culture of dependency, Gates again pointed at history, saying that nearly twice as many countries in the 1960s received aid compared to today. Countries like Egypt, Brazil and Thailand, he said, are “not net recipients of aid.”  He predicted that the world will see increasing numbers of countries currently on aid becoming self-sufficient. We hope that includes the many countries that have become steadily more aid-dependent for five decades.

There’s been little substantive commentary on the speech in the news or blogosphere so far. Judging from the tenor of the enthusiastic real-time comments from viewers during the speech (“What can we do? Who to call or write?” and “I love hearing about the positive progress we have made...it is so rare that this fact is broadcasted,” for example), the Gateses were preaching to the choir.

This NPR interview,  though just seven minutes long, is actually meatier than the Gateses’ speech. In it, the interviewer gets Bill and Melinda Gates to talk honestly about why the Gates Foundation behaves differently than governments (“we can take risks where a government won’t or can’t”), and how their entrepreneurial approach to development problems allows them to acknowledge failures and change their approach midstream. Great!

Melinda Gates retells the story of delivering the rotavirus vaccine (but without the relentlessly optimistic spin from the speech). They worked with a scientist to develop a lifesaving vaccine, but failed with something much more mundane: producing the right packaging. They didn’t realize that they needed to put the doses in small containers so that it could be refrigerated all the way from the lab to remote locations in Nicaragua. She said: “You just learn from it and say okay, that’s a small mistake we made, and we’re not going to make that mistake again.” Kudos again! Would you mind if we called you “searchers”?

But all of this left us with one big unanswered question.  If the Gateses indeed have a much-improved aid model, then why this big campaign to defend US government aid agencies (including USAID), whom we and many others have documented do not change in response to – or even acknowledge – failures?

Read More & Discuss

Slavic Tennis Women and Aid Agency Specializations

A recent post talked about the advantages of specialization in general, and for aid agencies in particular. But what should you specialize in? Obviously, in your “comparative advantage,” which is economists’ laborious jargon for “what you’re good at.” But where does comparative advantage come from and how do you find your own? These thoughts were prompted by watching US Open tennis on TV, where anyone who can read their –ova’s and –ieva’s is struck by the amazing predominance of Eastern European women in pro tennis. To be precise, 48 of the 128 women in the singles draw were Slavic (there’s a few Slavic men in the US open too, but it’s far more pronounced with women). Where does Eastern Europe’s comparative advantage in female tennis come from?

(Marginal Revolution asks a related question about where all the pretty Russian women (fashion models, tennis, etc.) suddenly came from, but here at Aid Watch we NEVER use cheap, sexist promotional tactics like discussions or pictures of beautiful women.) maria-sharapova.gif

National stereotypes are NOT OK, but SOMETIMES they MAY reflect SOME little underlying comparative advantage (which is obviously cultural rather than racial). According to a really old and lame joke, which OTHER people have made, and I am repeating here under duress only for educational purposes:

Heaven is where the police are British, the cooks French, the mechanics German, the lovers Italian, and it is all organized and run by the Swiss. Hell is where the police are German, the cooks British, the mechanics French, the lovers Swiss, and it is all organized and run by the Italians.

The classic economist’s explanation of comparative advantage is that it reflects what you possess in abundance relative to what you lack, compared to others. So a fertile-land-abundant country like the US has a big comparative advantage in agriculture –DUH.

Another (not mutually exclusive) explanation is that you develop comparative advantage by “learning by doing,” which is economists’ laborious jargon for “practice.” In Malcolm Gladwell’s entertaining new book Outliers, the explanation for Bill Gates’ success is that, by some accidents of fate, he happened to be one of the few 8th graders in the nation with almost unlimited access to a powerful computer in 1968. When you’ve been writing software since the 8th grade (plus possessing IQ in abundance, even if you lack everything else) you have a comparative advantage when you launch a software company 8 years later.

So some hints for aid agencies or NGOs deciding what is their comparative advantage is (1) what do you have in abundance compared to the others, and (2) what have you been practicing at already for 8 years?

And now let's crowd-source the question: how did Slavic women get a comparative advantage in tennis?

Read More & Discuss

Can Starbucks Buy a “Saving Africa” Image for a Nickel?

Starbucks003.jpg I was curious about what the going rate is these days for attracting customers who want to save Africa. Five cents was a little lower than I expected.

How much money is flowing to Africa from this? Aid Watch’s exclusive investigation consisted of asking about seven Starbucks cashiers around Greenwich Village how often they processed the Starbucks Red card, with its payoff of five cents for Africa per use. All except one cashier said it was rare to see them, maybe 1 or 2 in an 8-hour day. The one exception said they saw them about 10 times a day. So we have a payoff for Africa of between 5 and 10 cents per day per Starbucks cashier, with one outlier of 50 cents a day. This sample is obviously ridiculously unscientific, but perhaps it can attain the status of an anecdote.

The only excuse for my pitiful attempt at estimating RED card revenues is that I think it is really up to Starbucks to disclose to its customers how much money is really flowing to the Global Fund for AIDS in Africa. We are in luck -- Starbucks has a cool (RED) web site that actually documents in real time how many people are buying with the (RED) card (11,115!), how many Starbucks products they are buying (87,257), and how many days of AIDS medicine that translates into (10,146!).

OOPS, sorry, I misunderstood it. This is just a record of how many people have signed up online worldwide (11,115) to join the Starbucks RED campaign, how many Starbucks products they have pledged to buy, and how much that translates into in days of medicine. There is no verification that anyone actually buys the card or keeps their pledge. Even if they did, this would translate into a rather underwhelming contribution of $4,362.85 to the Global Fund. It’s not Starbucks’ fault that their customers don’t show much interest in the RED card, but Starbucks benefits even so.

Bill Gates celebrated the RED campaign as an example of what he sees as world-systemic change towards “creative capitalism,” where companies will respond to “reputational” philanthropic incentives as well as conventional profit ones. Yet if companies can obtain the RED branding, the Saving Africa reputation, for virtually nothing, just how strong is the incentive to give?

Read More & Discuss

MADE-UP MALARIA DATA ROUND 2: Gates Foundation responds, WHO graciously offers not to respond

The modest aim of an initiative like Aid Watch is to be one more small voice holding aid agencies and foundations accountable for doing good things for poor people. The aim of more accountability is to induce improved behavior by those guys, so that aid will work better. The Aid Watch blog already has had its first small test on trying to induce accountability. This post took Bill and Melinda Gates to task for claiming in the Financial Times that foreign aid had big victories over malaria in countries like Rwanda and Ethiopia, because the WHO country data they based it on was made up and later contradicted by the WHO itself.

The Gates Foundation did respond to this criticism, to their great credit (not directly, but that’s OK, it was visible enough in a response to the Chronicle of Philanthropy’s coverage of this controversy.)

What was their response to criticism for using invalid country data? Oops, they offered more invalid country data. The Gates Foundation spokesman offered the country data on Rwanda and Ethiopia from this journal article as defense for the Gateses’ claims on those countries' victories over malaria.

What does the cited article actually say? “Districts and health facilities were not randomly selected, but constituted a (stratified) convenience sample, selecting those sites where intervention scale-up had been relatively rapid and successful … Therefore, estimated impacts cannot be extrapolated to the countries nation-wide.”

Still, the Gates Foundation was a tad more responsive than the WHO, whose malaria chief first led astray the Gateses and the New York Times with false reports of victories over malaria based on made up country data, then the WHO issued totally different data in its official 2008 Malaria report a few months later, without ever retracting the New York Times story.

When Aid Watch’s intrepid investigator Laura Freschi approached the WHO for comment, she got the following response from the WHO Project Leader for Information Management & Communications, Epidemic and Pandemic Alert and Response (EPR):

“Hello. I have received your emails and phone call. However, WHO does not participate in blog discussions.

Thank you.”

It may seem obsessive to insist on good data, but bad data costs lives. The sad thing is that there have been SOME victories against malaria, and that solid data on WHAT is working WHERE is vital to guide the campaign against this tragic disease. Would Americans put up with the CDC using made up data to respond to a salmonella outbreak?

I guess Aid Watch is going to have to work a LOT harder to do our part to get a bit more accountability.

Read More & Discuss

Did Bill and Melinda Gates Claim Malaria Victories Based on Phony Numbers?

Tuesday’s Financial Times printed a Martin Wolf interview with the Gateses from Davos, available as a video on the FT web site. A sample quote from the interview:

We’re trying to make sure that people understand this: aid is effective…So, for instance, malaria incidence is down in countries such as Zambia, Ethiopia, and Rwanda. It’s down in some countries by over 50 percent and some by 60 percent…[if we and other donors] come in and distribute mosquito nets – 60m to date – that is how we have achieved these declines. So we are able to say, “Look, aid is making a huge difference, we are literally saving people’s lives."

Real victories against malaria would be great, but false victories can mislead and distract critical malaria efforts. Alas, Mr. and Mrs. Gates are repeating numbers that have already been discredited. This story of irresponsible claims goes back to a big New York Times headline on February 1, 2008: “Nets and New Drug Make Inroads Against Malaria,” which quoted Dr. Arata Kochi, chief of malaria for the WHO, as reporting 50-60 percent reductions in deaths of children in Zambia, Ethiopia, and Rwanda, and so celebrated the victories of the anti-malaria campaign. Alas, Dr. Kochi had rushed to the press a dubious report. The report was never finalized by WHO, it promptly disappeared, and its specific claims were contradicted by WHO’s own September 2008 World Malaria Report, by which time Dr. Kochi was no longer WHO chief of malaria.

(There was never a retraction in the New York Times, so perhaps Mr. and Mrs. Gates can be forgiven for being confused – although with most of the world’s public health professionals on Mr. and Mrs. Gates’ payroll you would think their briefers would have access to the most accurate information.)

The September 2008 WHO Malaria Report keeps Rwanda as a success story (along with some other new success stories – not mentioned in the New York Times – like Sao Tome & Principe and Zanzibar), but Zambia and Ethiopia are gone: the effects of malaria control in Zambia were “less clear,” and in Ethiopia, “the expected effects” of malaria control are “not yet visible.”

Digging deeper into the WHO Malaria Report, the standards for data on malaria are set so low, it is even more striking how the Kochi numbers – those numbers that fueled a February 2008 New York Times story and a February 2009 Gates claim – failed to meet even these low standards. The WHO says (in a small print footnote): “in most countries of Africa, where 86% cases occur, reliable data on malaria are scarce. In these countries estimates were developed based on local climate conditions, which correlate with malaria risk, and the average rate at which people become ill with the disease in the area.” Another stab at explanation of their malaria numbers was: “From an empirical relationship between measures of malaria transmission risk and case incidence; this procedure was used for countries in the African Region where a convincing estimate from reported cases could not be made.” (Possible translation: we make the numbers up.)

The shakiness of the numbers is visible when you look at them by country in the WHO Malaria Report. For the “success story” of Rwanda, there is an estimate of 3.3 million malaria cases in 2006, with an upper bound of 4.1 million and a lower bound of 2.5 million. But wait – another way to estimate cases, which is the one used to estimate trends, shows 1.4 million cases in 2006 (and this was an increase over the 2001-2003 average). Estimates of child malaria deaths in Rwanda are similarly all over the place – they do show a drop from 2001 to 2006, but the change is dwarfed by the vast imprecision conveyed by the lower and upper bounds.

In another WHO success, Zanzibar (which, to be fair, Mrs. Gates also mentioned as a success by in the interview), there seems to be more consensus on success from a combination campaign featuring indoor spraying of homes, insecticide-treated bed nets, and treatment of malaria patients with advanced drugs. It seems to be easier to make inroads into malaria on small islands. The American Journal of Tropical Medical Hygeine has published two articles suggesting there was success of malaria control in Sao Tome (also an island) and a corridor in South Africa, Mozambique, and Swaziland, apparently using more rigorous data methods.

As far as the country claims by the WHO and Mr. and Mrs. Gates, however, there seems to be mass confusion, and data that ranges from phony to made-up to shaky, about what interventions are responsible for what trends where. The WHO Malaria Report offers this ringing conclusion in its “Key Points” summary on how to control malaria:

In general, however, the links between interventions and trends remain ambiguous, and more careful investigations of the effects of control are needed in most countries.

Maybe the Gates Foundation should be funding more rigorous data collection. With all this effort to fight the tragedy of malaria, it’s even more tragic that the malaria warriors can’t even get accurate reports of who is sick and dying when and where.

Read More & Discuss