What Has Gates Learned About Development Since Last Year?

Bill Gates' 'Annual Letter' always makes depressing reading. That someone so single minded about making money and controlling as much as possible [good article in the English Guardian on this issue] should understand so little about development is not as surprising  as the fact that, for all his money, he doesn't appear to be able to find advisors who have the balls to stand up to him and get him to at least fake an understanding.

Yet again, to Gates and his cronies, 'innovation' in agriculture in developing countries means wresting the little control left to small farmers out of their hands and putting it in the hands of multinationals, who can squeeze whatever blood is left in the farmers that hasn't already been squeezed out by other means. Technology, as Gates knows, is the preserve of the rich; the rich benefit from it, the poor pay for it. Genetically modified organisms (GMO) and various other technologies that impress Gates so much, and I don't believe he is unaware of this, are not designed to benefit small farmers in developing countries, nor will they ever do so.

In health, also, Gates obsesses about technologies, such as vaccines, single, headline-grabbing diseases such as polio and HIV and issues such as family planning. Yet, over and over again, research shows that it is not just technologies that allow substantial reductions in transmission of common preventable diseases, it is also things like sanitation, water and living conditions. There is no mention in his speech of sanitation and the only mention of water is in relation to GMOs. Polio, which Gates hopes to get credit for 'eradicating', is an example of a disease that will not go away just because everyone is immunized; people need access to clean water and good sanitation. That will help eradicate a whole host of diseases, not just the fashionable ones.

Gates, like a large chunk of the development industry as a whole, thinks that reducing birth rates in developing countries will magically mean that everyone has enough money and enough food. But people need a decent standard of living, gainful employment and food sovereignty. His policies of flying in technologies, whether in health or agriculture, actually increase dependency, poverty and insecurity. If lower birth rates are to occur at all, they will occur as a result of better health, a better economy, better education and the like, not the other way around. And talking of education, Gates is silent on the matter, except for education in the US.

As for HIV, the connection between this disease and enormous profits for Big Pharma is pretty obvious, even to Gates. His foundation has been instrumental in setting up a parallel health infrastructure for this, instead of trying to comprehend how existing conditions in health facilities in high prevalence countries, which are appalling, may have a lot of influence on how the virus spreads. Much of the foundation's money has gone into facilitating the sale of drugs and other technologies and much of the money has never left the US, except to go to US institutions, purpose built in high prevalence countries. Sometimes, the foundation sticks some of the few well qualified health professionals to be found in African countries into a Gates funded institution, just to make the whole thing more African. (For a good example, check out AGRA, the Alliance for a Green Revolution in Africa).

Against the above technocentricity, it's difficult to see why the man should share the HIV industry's obsession with male circumcision. But Gates does mention things like PrePex and the Shang Ring, which will make fat profits for a couple of medical device companies. He seems to think that male circumcision reduces HIV transmission by 'up to 70%', but I think even the most rabid circumcision enthusiasts wouldn't claim that; most would even concede that the up to 60% figure  claimed by the HIV industry is from carefully controlled trial conditions with carefully massaged results (though they might not use the word 'massage').

In addition to advocating male circumcision in countries where conditions in health facilities are dreadful and where there are many far higher priorities, Gates goes on to advocate technologies such as injectible hormonal contraceptives, which have also been associated with increased HIV transmission (male circumcision has been associated with higher HIV transmission in as many countries as it has with lower). Unsurprisingly, genuine improvements in health facilities are not part of the Gates Final Solution. And just to demonstrate his fragile grasp on public health, on the subject of antiretroviral drugs to reduce HIV transmission, he says "In studies where the patients used the tool as they were supposed to, the results were quite good." If people don't 'use the tool as they are supposed to', maybe the problem is with the tool.

And the letter goes on and on, with Gates demonstrating his global imperialist ambitions in every sentence, as well as his ignorance of the lives of the people who will suffer as a result. It seems like every year that passes other institutions with imperialist ambitions, such as the UN, World Bank and WTO, also align themselves with this man. Don't expect too many changes over the next year.