Are Bill Gates’s Billions Distorting Public Health Data?

In the early days of the pandemic, the IHME projected a far less severe outbreak than other models, which drew the attention of Donald Trump, who was eager to downplay the danger. At a March 31 press briefing, the White House’s coronavirus response coordinator, Debbie Birx, with the president at her side, used IHME charts to show that the pandemic was rapidly winding down.

““Throughout April, millions of Americans were falsely led to believe that the epidemic would be over by June because of IHME’s projections,” the data scientist Youyang Gu noted in his review of the institute’s work. “I think that a lot of states reopened based on their modeling.”

The institute’s uncanny resilience, unconventional methods, and media savvy have long made it controversial in the global health community, where scholars have watched its meteoric rise over the past decade with a mix of awe and concern. Years before Covid, the IHME gained outsize influence by tracking hundreds of diseases across the planet and producing some of the most cited studies in all of science.

But it has also spawned a legion of detractors who call the IHME a monopoly and a juggernaut and charge the group has surrounded itself with a constellation of high-profile allies that have made it too big to peer review, the traditional method of self-regulation in science. Fueled by more than $600 million in funding from the Bill & Melinda Gates Foundation—a virtually unheard-of sum for an academic research institute—the IHME has outgrown and overwhelmed its peers, most notably the World Health Organization (WHO), which previously acted as the global authority for health estimates.

Today the IHME’s sprawling estimates have become the gold standard for understanding an increasingly broad array of topics related to health and development—particularly in the data-poor developing world, where record keeping is sparse. Its website offers interactive maps that allow users to drill down to virtually any village in sub-Saharan Africa, for example, to find out how many years of education people have; how malaria, HIV, and lower respiratory infections are changing over time; who has access to piped water; or how many men are circumcised. These estimates—educated guesses, really—help guide billions of dollars in aid spending and tell health ministers, charities, researchers, and journalists where things are getting better or worse.

“In a relatively short period of time, the IHME has exerted a certain kind of hegemony or dominance on global health metrics production,” says Manjari Mahajan, a professor of international studies at the New School. “It’s a kind of monopoly of knowledge production, of how to know global health trends in the world. And that produces a concentration of…power that should make anybody uncomfortable.”

Critics say this monopoly power can be seen in the ways the IHME appears to play by a different set of rules from the rest of the scientific community. Many describe its estimates as a black box.

“It’s quite impossible to criticize or indeed comment on their methods, since they are completely opaque,” says Max Parkin, from the International Network for Cancer Treatment and Research.

Despite such criticisms, the IHME’s dominion keeps expanding—thanks in large part to Richard Horton, the editor in chief of The Lancet, who has put the credibility of the famed medical journal behind it, publishing more of the institute’s studies than any other periodical. While most scholars are lucky to publish one research article in The Lancet during a decades-long career, the IHME’s Murray has published more than 100.

The relationship between The Lancet and the institute was further underscored last year when Murray nominated Horton to receive the $100,000 Roux Prize from the IHME. It was a striking conflict of interest that raised eyebrows among scholars but virtually no public criticism. Challenging Horton could mean foreclosing on future publishing opportunities in a leading journal.

Some experts are also reluctant to criticize the IHME for fear of upsetting the Gates Foundation, one of the most important funders in global health and academic research more generally. According to the Web of Science database, more than 20,000 academic papers cite funding from the Gates Foundation, which has poured over $8 billion into universities in the past two decades, according to The Nation’s analysis of its charitable giving. Scholars have even used the term “the Bill chill” to describe their reluctance to bite the hand that feeds them.

“We are receiving millions of dollars for our polio campaign in Afghanistan and Pakistan from the Gates Foundation. We cannot jeopardize that campaign. Publicly criticizing the work of the IHME could potentially alienate the Gates Foundation,” one UNICEF official, who asked for anonymity, admitted to Mahajan in a study she published in 2019.

“Who is making such criticism, and where has the criticism been published or stated publicly?” an IHME spokesperson responded when asked about the institute’s controversial reputation. After The Nation forwarded several scholarly reviews, the institute struck a different tone: “This criticism is not new…. Part of the process over the past 12 years of creating a leading source of global health data is reckoning with criticism. IHME welcomes it and other critiques as one aspect of improving the Institute’s work.”

The 2015 book Epic Measures: One Doctor. Seven Billion Patients, by Jeremy M. Smith, describes Murray’s approach to health estimates as an extension of his medical training. Instead of treating individual patients, he’s diagnosing the globe, using Big Data to show governments and aid groups which diseases need the most attention and money.

Based on Murray’s estimates, Gates saw an opportunity to make a big impact, and his foundation went on to donate almost $40 billion to global health and development, becoming one of the most powerful political actors in the field.

Note: The complete article was appeared on website of THE NATION on December 3, 2020 and author Tim  Schwab is a freelance journalist based in Washington, D.C., whose investigation into the Gates Foundation was part of a 2019 Alicia Patterson Foundation fellowship.