Your Solution Is The Problem, Mr Gates

Bill Gates seems to write at least some of this own materials. His 'annual letter' reads as you'd expect it to read if written by someone who has little understanding, of and probably little interest in, development. His priorities are high profile issues and his 'solutions' are high technology and narrowly focused. But development issues and appropriate measures to improve conditions are not isolated phenomena, they also have a context.

Gates' grasp of public health is particularly weak. He seems to think that a handful of diseases can be eradicated, without any attempt being made to improve the conditions that result in those diseases remaining widespread, often after decades of work and billions of dollars spent. He wants to eradicate polio and prevent cholera, for example, without ensuring that people have access to clean water and sanitation.

An article in Science and Development Network picks up on Gates' comments about the 'slow pace of progress' in fighting AIDS. In the case of treatment and care for HIV positive people, he probably has a point, although he seems to think this area is doing well. Yet, in high prevalence countries, only a minority are receiving the care they need and most of them are lucky to receive drugs, which are of limited value on their own.

The pace of progress in HIV prevention is even more lamentable, but I don't really see Gates and his Foundation doing much about it. He seems to think that if drugs and a few other things rain down from the heavens, everything will be fine. He doesn't seem to see the need for health facilities, trained personnel, equipment, processes and other supplies.

This naivety might be touching in someone who is still growing into such a role as his. But given the extent to which he and his Foundation skew global health, development and spending priorities, treating his word as gospel is downright foolish.

The fact is, Mr Gates, most deaths among HIV positive people in developing countries are preventable and treatable. Most of the people who are dying should not be dying. They die because developing country health services can barely even dole out the antiretroviral drugs they are given in such huge quantities (sometimes), while they don't have the cheap drugs they need to stop people from dying from diseases the Gates Foundation doesn't consider worth bothering about.

But Gates still reverts to his obsession, drugs, in the form of vaginal microbicides and PrEP. We've tried forcing drugs down the throats of HIV positive people, lets now try to force them down the throats of HIV negative people as well. Oh, and he wants a vaccine as well. And male circumcision.

Money is not going into investigating how people are becoming infected with HIV. It's assumed that sex is the problem and drugs are the solution. Health systems just don't seem sexy enough to merit attention, nor do improved infrastructures, water and sanitation, basic education or anything else that might alleviate the conditions that allow HIV to spread rapidly.

Gates said "given all the lives that are at stake, I am willing to be viewed as a troublemaker by people who are happy with the status quo". Sorry, Mr Gates, but you are the status quo in development, Indeed, that's what makes you a troublemaker.