It’s a truism that foundations lack accountability – unlike (democratic) governments and companies, which are at least in theory accountable to voters and shareholders. The justification for this – in the eyes of the philanthropy world, and presumably the wider world – is the assumption that foundations probably do quite a lot of good, and almost certainly don’t do any harm.
Judging from many of the contributions to the Alliance special feature on ‘Living with the Gates Foundation’, the emergence of the Bill and Melinda Gates Foundation is beginning to undermine this assumption. It’s not that Gates isn’t doing good, or that it is doing harm; it’s more that the resources the foundation brings to bear are so huge and the scale of its ambitions so great that it clearly could do serious harm – by distorting the fields in which it works. Richard Horton talks of Bill Gates becoming ‘one of the most – if not the most – powerful voice in setting the research agenda’ for global health.
‘If the Gates Foundation influences governments, NGOs and the media on global health, who will be able to offer objective feedback on its goals, practices and impact?’ ask Laura Freschi and Alanna Shaikh. ‘If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will Gates be accountable for that failure?’
One positive contribution the Gates Foundation may make to the wider field is encouraging debate about the role of foundations. In Megan Tompkins’ view, it’s possible that the greatest impact the Gates Foundation will have is fostering a debate on ‘appropriate policy for foundations in a democratic society’. I hope this Alliance special feature will play its part in kickstarting this debate and adding urgency to efforts to answer, and not avoid, difficult questions.
The difficulty of getting objective feedback about Gates was reflected in the difficulty in finding contributors to this Alliance special feature. Many of those we approached expressed great interest in the topic but preferred not to comment publicly. I am enormously grateful to guest editor Timothy Ogden – who is not afraid to raise the difficult questions – for agreeing to take on a role that many would have regarded as an unacceptably hot potato.
Finally, I’d like to dedicate this special feature to someone else who always raised the difficult questions and was afraid of no one – Olga Alexeeva, sadly no longer with us to raise these questions herself.