Exit in sight, Gates Foundation hopes India will foot the vaccine bill

On 25 September, Indian Prime Minister Narendra Modi was felicitated with the Global Goalkeeper Award by the Bill and Melinda Gates Foundation (BMGF). On the surface, it was recognition for the PM’s Swacch Bharat Abhiyan scheme—a program that seeks to eliminate the practice of open defecation. But there was a lot more riding on this award. It was the culmination of a years-long effort to make an ally of a man seen as critical to BMGF’s continued success in the region.

GDP Spent On HealthCare

Instituted by BMGF in 2017, the Global Goals Awards are meant to recognize champions of the United Nations General Assembly’s sustainable development goals (SDGs). Enshrined in 2015, these serve as a blueprint for a sustainable future without poverty, hunger, and preventable child deaths. For Seattle-based BMGF, which has worked towards preventing child mortality since its inception in 2000, the SDGs are something of a north star.

This sort of focus made India a key proving ground for the Foundation. In fact, with the country accounting for just under 1 million child deaths a year—a fifth of the global child mortality burden—BMGF set up an office in India in 2003, just a few years after the charity’s conception.

Since entering India, BMGF has also learned of three situations unique to the country. First, unlike countries in, say, Africa, where the Foundation is particularly active, the Indian government can afford to provide a decent standard of public health but doesn’t. For a developing country with a growing GDP, India is one of the lowest per capita spenders on health—with only around 1% of GDP spent on healthcare compared to the global average of 6%.

Big spender

With $47.9 billion in assets, BMGF spends about $5 billion annually across the developed and developing the world. It is also the single largest donor to the World Health Organisation

Second, India’s massive population blunts the impact of direct grants. Although BMGF spent more on India—$282.5 million—in 2017 as compared to any other country, the per-person spending came to 21 cents (Rs 15). In Uganda, where it spent only $34.9 million, the per-person spending was closer to 85 cents (Rs 59).

Lastly, it has understood that it can’t just foster innovation, affordability, and access. It needs the Indian government to adopt whatever it sets in motion and take things forward.

All of this made it clear to the Foundation that there was only so far it could go without having the Indian government decidedly onside. So, for the first iteration of the Global Goals Awards, the leadership of BMGF was sold on the idea of Narendra Modi is one of its inaugural awardees. The idea, however, was scrapped after internal protests at the highest level, said a former senior BMGF executive on condition of anonymity. BMGF neither confirmed nor denied this.

This didn’t stop the Foundation from expressing its appreciation for Modi. Bill Gates publicly lauded Modi and his government for everything from the Swachh Bharat campaign to financial inclusion and the Ayushman Bharat healthcare scheme. In lieu of the 2017 award, these statements from the left-leaning Bill Gates himself were part of a conscious decision to gain the Indian government’s support, says another former BMGF executive.

But after the Modi-led BJP won the mandate of the people for a second time running in mid-2019, BMGF realized that it needed to go the extra mile. Modi was here to stay and BMGF had to be close to him. Thus, despite various groups protesting against Modi’s chequered history on human rights, as well as one BMGF employee resigning in protest, the Foundation bit the bullet. Narendra Modi was made part of its latest cohort of awardees. BMGF has also stopped funding one of its long-term partners—Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP), which has ties to the BJP’s arch-rival, the Indian National Congress.

Modi, BMGF is hoping, will help it execute the second part of its philanthropic strategy—the exit.