Tuesday, Dec 06, 2022

Interview with Gates Foundation CEO & India Country Office Director: ‘We don’t have an agenda… we work with the govt’

In conversation with The Indian Express, Foundation CEO Dr Sue Desmond-Hellmann and India Country Office Director Nachiket Mor talk about its core values and plans in India.

Bill and Melinda Gates Foundation, Nachiket Mor, Sue Desmond-Hellmann, foreign money, Gates Foundation, HIV AIDS initiative, HIV AID initiative avahan, polio, NTAGI, india news, indian express interview Dr Sue Desmond-Hellmann and Nachiket Mor.

The Bill and Melinda Gates Foundation is best known in India for its HIV/AIDS initiative Avahan, but it is involved in many other fields including maternal and child health, financial inclusion and partnering the government in augmenting human resources in healthcare. Excerpts:

What brings you to India?

Sue: India is of such great importance to the Gates Foundation that since I have been CEO, this is my third visit. The India country office is our largest regional office. No matter who’s been in office, the focus that India has had on health and development is complementary to our focus. The work we have done in Bihar and Uttar Pradesh can touch 300 million people. So I think there is a lot of compatibility between our focus and the needs and inequities that exist in India.

How is it working with a government that seems inherently distrustful of “foreign” money?

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Nachiket: I wouldn’t want to directly comment on that but I can speak in our context. We’ve been here 15 years now, we are engaged very closely with the government. We do not do anything unless there is an explicit government conversation. We are not a relief organisation, we engage with the government to see where our technical expertise, our background can be helpful in solving a specific issue. Polio, HIV/AIDS have been successful multi-year partnerships, as is our work in Bihar. We are doing nothing, the government is doing everything. We are offering global expertise. We work with multiple governments in the states and Centre. We have not had a problem. Bill and Melinda got the Padma Bhushan award as a mark of partnership between two outstanding individuals and this great country.

Recently there was a debate about your engagement with the technical advisory group on vaccines, with allegations of conflict of interest. How would you respond?

Nachiket: It’s a matter of how you frame that conversation. Our engagement with NTAGI (National Technical Advisory Group on Immunization) and overall vaccination work has consistently been to strengthen national capacity to make good decisions. We don’t have an agenda. You have to decide. We work with the government where they ask us to, where they think there is a gap and we can add value. Somebody can see something in the shadows, it’s hard for me to argue. We believe there is enough local capacity. I wish sometimes we had the kind of power that people think we do. This is a strong government with strong decision-makers. They are not going to listen to me just because I wore a better tie. I see us and the government continuing on the path of mutual trust

What are your priority areas in India?

Nachiket: The big focus has been maternal and child health. The work has evolved in Bihar. One of the big challenges is women delivering at home in settings that are not entirely safe. We spent a lot of time thinking how frontline workers coordinate better. Scale is a new challenge. In Uttar Pradesh we started in 100 blocks with similar ideas and programmatic interventions…We are starting to think about larger challenges, what about financing? We need surgeons — UP has C-section rates of 1 per cent, Kerala at 35 per cent is too high, but 1 per cent is too low. You need surgeons, we are starting to engage with that conversation, trying to understand the issue. Is it that we have surgeons, is it just about transferring them to the right location, or is it that we don’t have enough surgeons? Can MBBS doctors be reskilled? We are starting to engage with medicine supply chains, electronic health records, etc.


The Gates Foundation has a vision of eradicating sleeping sickness, we are two countries short of eradicating polio. Any other low-hanging fruits the world should target?

Sue: We are extremely focused on disease eradication. We were extremely inspired by small pox eradication – India was such a hero in that. Neglected tropical diseases are a big focus for us. Lymphatic filariasis in India is a good example of a disease we think is low-hanging fruit. We are also very committed to polio now. One of our ambitions is to look at making new tools that pertain to malaria, it could allow the world to look at malaria as a disease that could be eradicated by 2035. Some of our ambitions in tropical diseases can be very long-term

Nachiket: Soil transmitted helminths is another area we are looking at much more seriously.


A lot of funds coming into India for healthcare are for the proverbial poor man’s diseases like TB, rather than for things like cancer which many consider as the new frontier. Why?

Sue: I am a cancer doctor. Bill and Melinda and I talked about this when I joined as an oncologist but really I am a public health person at heart. One of the specialities at Gates Foundation is we think about how we can address what we call market failures. Market failure is TB – it remains an extremely important global problem, yet if you are a company that wants to make money you would not necessarily make a TB drug. You would make drugs for diseases that wealthier countries and wealthier people get and they will pay for them. So cancer, heart disease, diabetes and high blood pressure are NCDs (non-communicable disease) that increasingly are affecting people in Southeast Asia, sub-Saharan Africa and yet pharma and biotech are making great new remedies for those. We don’t consider those market failures. We don’t see that level of activity in HIV/AIDS, malaria, TB, polio, so we are quite happy to focus on those areas. Cancer is not a market failure.

Nachiket: Except when there is an interaction. For example, human papilloma virus (HPV) is a public health challenge that one could deal with. Either one screens and treats or one vaccinates.

Sue: Yes, that is one cancer we have got involved with. It is a vaccine preventable disease and cervical cancer is a disease that disproportionately affects the poor. That’s the outlier in the cancer world.

Of late we have been debating a lot on whether paternity leave is important for empowerment of women. How effective do you think is an increase in maternity leave without legal backing for paternity leave?


Sue: I am not an expert on this. We do work with a lot of women. I am extremely proud of our foundation, which has put in place a 52-week full-pay family leave — moms and dads — driven very much by the leadership of one of our co-chairs, Melinda Gates. We are strongly supportive of women and girls and families. Even when there is paternity leave, men don’t stay with the kid, so there is a lot of work to be done. The other part of this is care for the elderly also falls on the women. Globally that is an increasing issue with an ageing population

Nachiket: One of the issues that Melinda has been very keen on is recognising the work that women do. India doesn’t do very well there. You may say that we have given you maternity leave but you have saddled me with a whole lot of other work at home. We assume women are on leave because they are not working in the formal sector but actually they are doing much more work that is unrecognized and unpaid. Some of our data initiatives will try to make some of this much more visible. Gender aspects of some of these problems have to be made visible and decision-makers and policymakers will then have more data to work with.

First published on: 02-09-2016 at 03:38:52 am
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