The chief of malaria for the World Health Organization has complained that the growing dominance of malaria research by the Bill and Melinda Gates Foundation risks stifling a diversity of views among scientists and wiping out the world health agency’s policy-making function.
In a memorandum, the malaria chief, Dr. Arata Kochi, complained to his boss, Dr. Margaret Chan, the director general of the W.H.O., that the foundation’s money, while crucial, could have “far-reaching, largely unintended consequences.”
Many of the world’s leading malaria scientists are now “locked up in a ‘cartel’ with their own research funding being linked to those of others within the group,” Dr. Kochi wrote. Because “each has a vested interest to safeguard the work of the others,” he wrote, getting independent reviews of research proposals “is becoming increasingly difficult.”
Also, he argued, the foundation’s determination to have its favored research used to guide the health organization’s recommendations “could have implicitly dangerous consequences on the policy-making process in world health.”
Dr. Tadataka Yamada, executive director of global health at the Gates Foundation, disagreed with Dr. Kochi’s conclusions, saying the foundation did not second-guess or “hold captive” scientists or research partnerships that it backed. “We encourage a lot of external review,” he said.
The memo, which was obtained by The New York Times, was written late last year but circulated this week to the heads of several health agency departments, with a note asking whether they were having similar struggles with the Gates Foundation.
A spokeswoman for the director general said Dr. Chan saw the memo last year but did not respond to it. It is “the view of one department, not the W.H.O.’s view,” said the spokeswoman, Christine McNab. The agency has cordial relations with the foundation, and the agency’s policies are set by committees, which include others besides Gates-financed scientists, she said.
The Gates Foundation has poured about $1.2 billion into malaria research since 2000. In the late 1990s, as little as $84 million a year was spent largely by the United States military and health institutes, along with European governments and foundations. Drug makers had largely abandoned the field. (China was developing a drug, artemisinin, that is now the cornerstone of treatment.)
The World Health Organization is a United Nations agency with a $4 billion budget. It gives advice on policies, evaluates treatments especially for poor countries maintains a network of laboratories and sends teams to fight outbreaks of diseases, like avian flu or Ebola. It finances little research; for diseases of the poor, the Gates Foundation is the world’s biggest donor.
Dr. Kochi, an openly undiplomatic official who won admiration for reorganizing the world fight against tuberculosis but was ousted from that job partly because he offended donors like the Rockefeller Foundation, called the Gates Foundation’s decision-making “a closed internal process, and as far as can be seen, accountable to none other than itself.”
Moreover, he added, the foundation “even takes its vested interest to seeing the data it helped generate taken to policy.”
As an example, he cited an intervention called intermittent preventive treatment for infants, known as IPTi.
Other experts said IPTi involved giving babies doses of an older anti-malaria drug, Fansidar, when they got their shots at 2 months, 3 months and 9 months. In early studies, it was shown to decrease malaria cases about 25 percent. But each dose gave protection for only a month. Since it is not safe or practical to give Fansidar constantly to babies because it is a sulfa drug that can cause rare but deadly reactions and because Fansidar-resistant malaria is growing, World Health Organization scientists had doubts about it.
Nonetheless, Dr. Kochi wrote, although it was “less and less straightforward” that the health agency should recommend it, the agency’s objections were met with “intense and aggressive opposition” from Gates-backed scientists and the foundation. The W.H.O., he wrote, needs to “stand up to such pressures and ensure that the review of evidence is rigorously independent of vested interests.”
Amir Attaran, a health policy expert at the University of Ottawa who has criticized many players in the war on malaria, said he thought Dr. Kochi’s memo was “dead right.” His own experience with Gates-financed policy groups, he said, was that they are cowed into “stomach-churning group think.” But Dr. Attaran said he believed that scientists were not afraid of the foundation, but of its chief of malaria, Dr. Regina Rabinovich, whom he described as “autocratic.”
Dr. Rabinovich, when told of Dr. Attaran’s characterization, said she did not want to respond. Dr. Yamada of the Gates Foundation called it “unfortunate and inaccurate.”
“I’m not a grantee of hers,” he said, “but she’s an extremely knowledgeable leader. And if she has an opinion, she’s entitled to it.” He said he did not know the details of the IPTi issue, but added that researchers often differed about policy implications.
There have been hints in recent months that the World Health Organization feels threatened by the growing power of the Gates Foundation. Some scientists have said privately that it is “creating its own W.H.O.”
One oft-cited example is its $105 million grant to create the Institute for Health Metrics and Evaluation at the University of Washington. Its mission is to judge, for example, which treatments work or to rank countries’ health systems.
These are core W.H.O. tasks, but the institute’s new director, Dr. Christopher J. L. Murray, formerly a health organization official, said a new path was needed because the United Nations agency came under pressure from member countries. His said his institute would be independent of that.