The distinguished former Deputy Executive Director of UNICEF responds to Mukesh Kapila:
Count me as a fervent admirer of Bill Gates’ enlightened philanthropy, especially in global health.
Along with many others, I welcome Gates’ recent announcement to donate virtually all his wealth to philanthropic causes over the next 20 years—focusing largely on health, education, and agriculture in Africa.
This stands in stark contrast to Elon Musk, the world’s richest man, who—with his billionaire allies—helped engineer the dismantling of USAID and deep funding cuts to CDC, NIH, WHO, UNICEF, NGOs, and universities conducting vital health research and services, particularly for vulnerable women and children in developing countries.
Naturally, Gates and the Bill and Melinda Gates Foundation (BMGF) have their critics. Some harbor deep suspicion of wealthy capitalists, while others spin wild conspiracy theories—from using Africans as guinea pigs for experimental vaccines, to sterilizing non-white populations under the guise of philanthropy.
More serious, however, are thoughtful critics like Professor Mukesh Kapila, a global health and humanitarian expert, who recently penned a measured critique: “The philanthropy of Bill Gates must be approached with caution.”
Technocratic Prescriptions and Vertical Campaigns
Kapila warns against pouring vast sums into narrowly targeted, highly technocratic programs that might deliver short-term gains but prove unsustainable in the long term. His concern is that such “vertical” approaches could skew national priorities and budgets, sidelining broader development goals.
In principle, I agree with many of Kapila’s points. But in practice, my experience at UNICEF shows that well-focused, goal-driven interventions can catalyze political will and mobilize broader support for human development.
Kapila’s concerns remind me of similar criticisms James Grant faced in the 1980s and 1990s when he led UNICEF’s “Child Survival and Development Revolution” (CSDR). At a time when 15 million children died annually from preventable causes, Grant championed low-cost, high-impact interventions like immunization, oral rehydration therapy, breastfeeding, and growth monitoring—collectively dubbed GOBI-FFF.
Vindication of the ‘Mad American’
Initially mocked as a ‘Mad American’ with a missionary zeal, Grant faced opposition from WHO and other institutions that feared selective child-focused efforts would undermine the broader Primary Health Care (PHC) strategy endorsed at Alma Ata in 1978.
Yet, despite PHC’s noble aspirations, little had changed in the years following Alma Ata. Structural adjustment policies, the debt crisis, and emerging diseases like HIV/AIDS overwhelmed already fragile health systems. PHC remained more of a dream than a movement.
UNICEF’s CSDR injected new energy into PHC, mobilizing not just health ministries but heads of state, civic leaders, media, and celebrities. By reframing “Health for All” as “All for Health,” CSDR galvanized public and political support like never before.
Critics feared that CSDR’s focus on a few measurable interventions would neglect broader development goals. But Grant’s vision was never narrow—he advocated for gender equality, debt relief, restructured foreign aid, and “adjustment with a human face.” Over time, even institutions like the World Bank and IMF were compelled to adapt to this more humane approach.
Child Survival as a Trojan Horse for Human Development
UNICEF never saw child survival as an end in itself, but as a gateway to broader development. Empowering parents to save their children’s lives led to greater demand for services and political accountability. Weak health ministries gained visibility, and national leaders took ownership of programs previously relegated to technical bureaucracies.
Mass mobilization campaigns involving NGOs, faith leaders, and the media helped overcome government inertia. The result: immunization and health interventions gained unprecedented public support and political traction.
These efforts culminated in the 1990 World Summit for Children, which laid the groundwork for the Millennium Development Goals (MDGs) and later the Sustainable Development Goals (SDGs). Thanks to the momentum initiated by CSDR, child mortality fell, life expectancy rose, and immunization rates soared.
A Different Era, a Similar Opportunity
Today’s context is, of course, different from the 1980s or 90s. Gates is not Grant, and BMGF is not UNICEF. A private philanthropy does not have the same mandate or legitimacy as enjoyed by a respected UN agency. Yet, some lessons endure.
Kapila argues that “vertical” interventions, like those backed by Gates, cannot ensure long-term sustainability. He’s partly right. Immunization rates rose sharply in the 1980s but declined somewhat in the 1990s. However, without the early aggressive push, progress would have been slower and more limited. Even if some gains were not fully sustained, they still improved lives and saved millions.
Gates’ ability to apply business acumen and technological innovation—now including artificial intelligence—to global health offers transformative potential.
Kapila rightly notes that unlike governments, private philanthropists are not accountable to citizens. But it’s unfair to expect Gates to shoulder the responsibilities of government. So long as philanthropic efforts align with national and global priorities, their selective focus is not only acceptable—it’s prudent.
Indeed, highly respected economists from the “Copenhagen Consensus” support targeted investments that yield maximum impact. If Gates chooses to focus on these “Best Buys,” who are we to question his judgment?
Kapila suggests that the Gates Foundation “listen more, preach less.” While well-meaning, such advice may be unrealistic for a 70-year-old philanthropist with a limited time horizon and an urgent mission.
Undermining UN Agencies?
Kapila worries that philanthropists like Gates may unintentionally weaken core UN agencies by channeling funds through parallel structures. He has a point.
After James Grant’s passing, UNICEF’s advocacy for child survival lost some steam, even if funding remained strong. Around that time, Gates began exploring global health investment, influenced by thought leaders like Nick Kristof and Dr. Bill Foege. This led to the birth of The Vaccine Alliance, GAVI.
If agencies like UNICEF and WHO had demonstrated greater leadership and innovation, perhaps Gates would have worked through them. That he, and others, helped create new mechanisms like GAVI and the Global Fund reflects, to some extent, a lack of confidence in traditional channels.
To regain relevance, WHO and UNICEF must modernize governance, improve efficiency, and partner more meaningfully with private donors—showing they can match newer players in delivering results.
Celebrating a Legacy
Despite some flaws—business controversies, personal issues, or alleged arrogance—Gates’ contributions are undeniable.
He and his Foundation have committed over $100 billion to saving lives and alleviating poverty, with plans to invest $200 billion more. Along with other partners, GAVI has contributed to vaccinating over 1 billion children, preventing more than 17 million deaths. The Global Fund and polio eradication efforts have similarly benefited from his support.
He’s backed data-driven solutions through the Institute for Health Metrics and Evaluation, pioneered new funding models like advance market commitments, and launched The Giving Pledge with Warren Buffett to encourage other billionaires to donate most of their wealth to worthwhile philanthropies.
His future focus includes leveraging AI to improve health, education, agriculture, and women’s empowerment—especially in Africa.
A Nobel-Worthy Contribution
Throughout history, wealthy people have funded good causes. But few have pledged to give away their entire fortune to help the world’s poorest people. Gates is not perfect, but his commitment to equity, public health, and human development is unmatched among his peers.
Surely, such a visionary, who has helped save millions of lives and devoted his fortune to serving humanity, deserves the world’s highest honor: the Nobel Peace Prize.
And one can only hope that more ultra-rich individuals—and more governments—will follow his example.
Source: https://www.mukeshkapila.org/in-defence-of-bill-gates/