An evening with Bill and Melinda Gates and the decade of vaccines: is this the future of aid?

October 21, 2010

     By Duncan Green     

lp-logo283x224On Monday night I joined the besuited masses of the UK development scene to sit at the feet (OK, in a crammed 400 seat lecture theatre) of Bill and Melinda Gates as they promoted the ONE campaign’s ‘Living Proof’ project on effective aid. It was great to hear an optimistic message on aid and development for once, especially when it was laid out brilliantly in front of an audience that included a good number of journos.

But it was also weird, not least because they took an hour to try and convince an audience made up largely of aid workers of the merits of 110mnunDebreworkZewdie02aid – not the toughest ask Bill has faced in his career. In fact it sometimes resembled a viva, as the Gateses strutted their stuff before their peers, ably supported by Dr. Debrework Zewdie (right), deputy director of the Global Fund. And they definitely passed, especially Melinda who managed to combine authority and passion, while stopping just short of cheesy.

The chief object of their praise was the British government – two days before the announcement of its Comprehensive Spending Review (aid implications here), this was a very public endorsement from some pretty big fish of the coalition government’s commitment to increasing aid to 0.7% of GNI by 2013, despite the mayhem taking place in other departments. Andrew Mitchell, Secretary of State for International Development, was in the audience, and the Gateses dropped in on David Cameron to drive home their message. As they stressed business thinking, ‘return on investment’ and the need to increase impact assessment, backed by a blizzard of stats, it became clear just how influential the Gates Foundation has become in terms of the aid discourse both here and in the US.

Their main call was for what they termed a ‘decade of vaccines’: get universal distribution of existing vaccines for polio, measles etc and develop new ones for diseases such as malaria. I was struck by both the can-do optimism and the seductive certainties of the vaccine business – so many vaccines distributed = so many millions of lives saved and made healthy and productive. Inspiring stuff, and free of the messiness, complexity, politics and power struggles that usually characterize development. Just technology riding to the rescue, driven by philanthropy’s cash and willpower. And a stark contrast with the gloom that surrounds other issues like the failure to tackle climate change, or the huge complexity of trying to understand (let alone influence) political change. I was tempted – maybe this is what Big Aid should limit itself to – delivering concrete benefits, keep people alive, and leave the rest to national politics?

And yet. And yet. Inside my policy wonk head a nervous tic of ‘yes buts’ stopped me being completely won over. Bill played fast and loose on correlation v causality – OK, aid undoubtedly helped in countries like South Korea, but did Asia as a whole really take off because of aid (maybe I misheard that bit….)? Where do the effective state systems needed to deliver all these vaccines come from, and are big players like the Global Fund strengthening them or weakening them by setting up parallel systems? Surely, aid should help generate good politics as well as immunize kids, for example by empowering citizens to demand accountability? OK, it’s hard to do and hard to measure and a lot less easy to explain than vaccines, but we need Big Aid to do politics if it is going to work. Bill seemed to imply that the messy stuff was what other donors like DFID should be doing, but the danger is that vaccine-style aid actually crowds out the harder-to-measure activities.

The event was in a fantastic location – the British Science Museum. As I left through the half-lit exhibition halls, I passed lifesize replicas (or the originals, for all I know) of the Lunar Lander, and Stephenson’s Rocket. Science and Progress resplendent –technology is all you need. If only it was that simple.

3 minute Living Proof video here, but if you have an hour and half to kill, you can watch the whole event below (but make a cup of tea while it downloads……)