Review of ‘Inside Fortress Bill’ on BBC Radio 4

The point about global governance is that it ain’t a government. It’s just a jumble of people, organisations and states doing things that constitute governance. This includes very rich people essentially providing global public goods like healthcare. The Gates Foundation is a great example of this – in the absence of sufficient WHO/UN spending on health provision, the foundation steps up, with vastly larger budgets. But what does this mean for the private-public divide? Who’s accountable to who? Should global health governance really be set by the whims of a very very wealthy couple?

This radio programme (available until 10 January) was billed as a documentary in which “Katie Derham takes a ‘warts and all’ look at the Bill and Melinda Gates Foundation and examines the immense political power and global influence that it now wields.”

Except she didn’t really. She gathered a few critiques (relying heavily on Laurie Garrett of the Council for Foreign Relations) and put some of them to senior staff at the foundation.

They responded as you’d expect: acknowledging that improvements could be made, yet not dealing with the real issue about private foundations – they’re unaccountable to the people.

As the description of the programme put it (which was far more interesting and cutting than the actual interviews): 

“[Gates’ philanthropy] is a sharp contrast with his former persona of ruthless businessman flaunting competition law, buying off rivals and pursuing his goals with a vengeance. Critics believe his market-led philosophies can distort the picture, allowing Governments to be let off the hook, causing a brain drain in countries where they are backing aid, and the way that funds are distributed seems to be at the whim of the co-chairs who are beyond any form of accountability.”

A few points of interest from the programme below.

On the foundation…

  • the money is, of course, staggering: Gates has given $26.1bn, Buffett $36bn. 
  • the foundation sees itself as a catalyst – leveraging its funds by partnering with governments, corporations (which led it to Monsanto, upsetting many)…
  • …and it leverages Bill, too. His media value brings attention to stories otherwise untold. 
  • it places a strong focus on innovation and entrepreneurship (as befits its $500m campus, which the presenter shrugged off as ‘Bill’s own money’ – except that the foundation is Bill’s own money too, so that distinction doesn’t make sense)
  • and it places a high focus on tech solutions, such as spending on vaccine research that wouldn’t come from big pharma (e.g. leprosy, TB)
  • as the CEO put it: “we believe in capitalism as an effective approach to allocating resources in a society”


  • Medecins Sans Frontieres choose not to accept funding from the foundation; a ‘strategic decision to keep some form of independence’ and they had ‘concerns about engagement of private sector and resulting conflicts of interest’ (MSF spokeswoman)
  • a majority of funding for global health programmes comes from the foundation, which leads to tremendous vulnerability for associated programmes and fields (Garrett)
  • what matters in global health is is increasingly decided by a small group of Americans in Seattle (Garrett). Ultimately the foundation answers to Bill and Melinda Gates and Bill Gates Snr.
  • “previously you trusted governments to do development, but now things have completely changed” (spokesman of a charity funded by GF) – has it?
  • ‘it shares very little substantive info on what it’s doing and how it’s work is going’ (GiveWell spokesman)


  • there is a ‘responsibility for all of us to hold them to account; for us to help them succeed and stop them doing crazy things that billionnaires sometimes do’ (Matthew Bishop of The Economist and author of Philanthrocapitalism)
  • at least Bill Gates is spending, but perhaps he needs competition from another foundation – perhaps a Larry Ellison or a Steve Jobs Foundation might have done things differently (Matthew Bishop)



Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s