BMGF had also developed a strong rapport with the Congress-led Indian government. The foundation even gave a grant to Rajiv Gandhi Charitable Trust (RGCT), which functions primarily in Amethi—until recently a bastion for the Congress’ Gandhi family.
Public Health Foundation of India
When the BJP-led government came to power in 2014, however, BMGF no longer commanded the same support, according to the former executive with BMGF quoted above. Initially, the government recognized its importance. In 2015, the Modi-helmed government awarded Bill and Melinda Gates India’s third-highest civilian honor—the Padma Bhushan.
The government even included the Rubella, Japanese Encephalitis, Rotavirus, and Injectable Polio vaccine—all of which had either direct or indirect funding from BMGF—in the government’s immunization program in 2015.
But in the following years, this budding relationship has soured.
Shortly after the Modi government announced demonetization—where it declared 86% of the nation’s currency invalid—Gates addressed the government’s policy think tank, Niti Aayog. While he avoided the topic of demonetization, a press release claimed he’d endorsed the policy. Gates cleared the air by stating he had no opinion on demonetization the following day, a move that antagonized the government.
Shortly after, in March 2017, the government took control of funding for the Immunization Technical Support Unit (ITSU) from the BMGF-supported Public Health Foundation of India (PHFI). ITSU provides strategy and monitoring advice for the government’s immunization program. Just two months later, though, the government prohibited PHFI from receiving foreign funding altogether.
Side effects and ethics
BMGF has been criticized for ignoring the side effects of its vaccine against diarrhea. The vaccine introduced in India has a high risk of intussusception—a potentially fatal side-effect of rotavirus vaccines, in which the intestine folds into itself, causing abdominal cramps, bloody stools, nausea, and vomiting. In addition, a 2009 BMGF-funded clinical trial led to the deaths of seven Indian girls. A panel appointed by the Indian health ministry in 2010 noted a number of shortcomings and alleged ethical lapses in the trial.
According to reports, some of this was motivated by the Swadeshi Jagran Manch (SJM), an affiliate of the Rashtriya Swayamsevak Sangh (RSS), the BJP’s ideological mentor.
The news of friction from the government started coming from various programs over the last three years. People were taken aback and an internal debate began on how do we work with the government? The earlier model of being in the background was not working. In states like Uttar Pradesh and Bihar, people did not see BMGF, they saw PHFI or Care (both funded by BMGF). Our work model used to be in the background. Now, the question was how do we have a voice?” said the former executive with BMGF.
The award in September was one answer. BMGF also went out of its way to stop funding long-term partners in UP—Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP). The organization, which is associated with the Congress’ Gandhi family, stopped receiving funds earlier this year, said the former executive. Ken did not get to question BMGF on this as the organization backed out of a pre-arranged meeting the day before publishing.
The urgency comes as BMGF realizes it is racing against the clock.
While BMGF helped vaccine makers fix the supply side of things, on the demand side, it relied on Gavi (Global Alliance for Vaccines and Immunisation). It donated to Gavi, which, in turn, helped create demand in regions where governments cannot or do not want to pay the initial price of vaccines. Up until now, India has relied on Gavi to introduce the new vaccines to the immunization program.
2017, in fact, saw Gavi’s spending in India reach an all-time high even as the government’s finance was just 79%, the lowest in the last five years. Moving forward, the government expects the expenditure on vaccines to increase from Rs 8,764.36 crore ($1.2 billion) in 2018 to Rs 12,364.31 crore ($1.8 billion) in 2022 as it seeks to scale up both rotavirus vaccine and pneumococcal conjugate vaccine from 2018 onward. In the same period, the government’s share of the vaccine burden would have to go from 79% to 97% (see chart) as Gavi’s $500 million support to India is expected to run out by 2021.