Laura Freschi and Alanna Shaikh have an article out in Alliance Magazine on the potential pitfalls of the Gates Foundation's massive influence on the global health funding. This paragraph says it all:
It is not inconceivable that you might find yourself some day reading a story about a Gates-funded health project, written up in a newspaper that gets its health coverage underwritten by Gates, reported by a journalist who attended a Gates-funded journalism training programme, citing data collected and analysed by scientists with grants from Gates. What happens when we need to move beyond the success stories? If the Gates Foundation influences governments, NGOs and the media on global health, who will be able to offer objective feedback on its goals, practices and impact?What happens when we need to move beyond the success stories? If the Gates Foundation influences governments, NGOs and the media on global health, who will be able to offer objective feedback on its goals, practices and impact? If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will Gates be accountable for that failure? Currently the foundation is ultimately accountable for its success or failure only to the four decision-makers on its board.I'm equally concerned - I've also written at length before about why we shouldn't assume that the Foundation's objective function is well-attuned to that of the countries it aims to help, as big philanthropic foundations will always be biased towards record-breaking wins over slow progress.
However, I suspect that the Gates Foundation's influence will slip somewhat in the future - budgets everywhere are squeezed right now, forcing many more players to turn to the Foundation for funding. This will change when resources start flowing again (not that I see it happening any time soon...).