How Ray Suarez Really Caught the Global Health Bug

Editor’s Note: This article was originally published on the author’s personal blog in July. With a few updates, we are running it as the first in a two part series exploring the implications of the Bill and Melinda Gates Foundation’s increasingly large and complex web of media partnerships. This part deals with a partnership between the PBS NewsHour and the Gates Foundation formed in 2008. Part two, running tomorrow, will examine a partnership with the Guardian, a British newspaper, announced in September, and one with ABC News announced on Wednesday.

How did PBS NewsHour correspondent Ray Suarez catch the global health bug? Simple, he said in a recent talk answering that exact question. Suarez explained: “The executive producer of the NewsHour, Linda Winslow, came into my office and asked me if I was interested in covering global health for the program and I said ‘yes.’ ”

But the actual reason is, following that conversation, Suarez wrote a proposal for the Bill & Melinda Gates Foundation resulting in $3.6 million of funding for NewsHour programming on global health. The Gates Foundation also sponsored the event at which Suarez was speaking. The moderator came from the foundation too, posing questions and selecting others from the audience, the funder interviewing a journalist whose global health education it had financed.

Suarez has heard gripes about Gates Foundation funding before. He defended the arrangement as giving an under-reported subject increased coverage while preserving “complete editorial independence.” Continued Suarez: “The foundation doesn’t hold the purse strings, encouraging some stories and discouraging others. And we don’t get approval before we embark on projects.”

But could Suarez’s own internal process for selecting stories and storylines be susceptible to influence? Certainly there are no stories thus far that seem contrary to foundation views. On the other hand, hardly every Gates-funded story examines an issue high on its agenda—obesity in China, for example. Malaria eradication does sit near the top of the foundation agenda. But NewsHour coverage of Tanzania mostly spoke of malaria elimination which targets specific regions rather than worldwide eradication, which is more difficult and controversial.

Suarez went to considerable effort to avoid covering global health projects also funded by his funder. He described this as an accomplishment, given “the remarkable number of pies around the world that the foundation has its fingers in…” However, the ubiquity of the Gates Foundation in global health is itself important. The malaria vaccine trial Suarez covered on his trip to Tanzania, for example, would never have taken place absent Gates Foundation support. The vaccine was shepherded forward by the Gates-funded PATH Malaria Vaccine Initiative. Both the event and its coverage are products of Gates money.

Every story has more facets than can be examined. But Gates Foundation funding discourages or even forecloses examination of certain storylines. Suarez can’t credit the foundation for making gigantic contributions to global health, for example. At the same time, the elephant in the room—the Gates Foundation—remains out of frame even as it pays for the camera.

Does that matter if the main effect of Gates funding is to increase awareness of global health? As Suarez pointed out:

A few months ago in Washington, I watched Bill & Melinda themselves give a presentation on global health research to an auditorium packed with a who’s who of Congress, the executive branch, think tanks and the media, not demanding one policy approach or another or recommending one drug protocol or another as much as hammering home the idea that public knowledge creates support for [global health] efforts…

By funding the NewsHour as well as Public Radio International, the foundation heightens general awareness of and support for global health. However, while the Gateses might not have advocated for specific programs, they and their foundation do have distinct policy preferences and require strict compliance. Furthermore, the foundation’s policy-agnostic advocacy efforts link together with its policy-shaping efforts, again by influencing the media.

In October 2008, the same time it awarded the NewsHour funding, the Gates Foundation granted the Kaiser Family Foundation (KFF) $2 million with a remit to “inform policy making and program development and implementation” for U.S. global health policy. The Kaiser Family Foundation doesn’t specify precisely how it uses these funds and publishes no annual reports on its website. Concerning its spending and governance, the KFF website only alludes to the possibility of such funding:

With an endowment of over half a billion dollars, Kaiser has an operating budget of over $40 million per year. The Foundation operates almost exclusively with its own resources, though we do occasionally receive funds from grant-making foundations, primarily to expand our global programs.

(UPDATE: Asked recently if KFF’s grant had been renewed, a Gates Foundation spokesperson said: “Yes, the Kaiser Family Foundation is a close partner of ours and last year we gave them a five-year, $9.9 million grant to support the important work they are doing to provide independent analysis of US global health policies.”)

Prominent among these programs is KFF’s US Global Health Policy portal. The portal selects and summarizes global health news from more than 200 worldwide sources spanning mainstream media outlets to blogs. KFF sends a daily email news digest to policy makers, opinion leaders and journalists. Also, KFF offers its own original research and analysis, from cheat sheets for journalists to extensive reports on subjects such as the US global health architecture.

Gates Foundation financing of the enterprise is, arguably, hidden. KFF’s daily emails carry no boilerplate mention of Gates funding. The only disclosure on the KFF U.S. Global Health Policy site resides under the “About” link at the bottom right of page, which says only that KFF’s work on global health and the global health gateway receives “substantial support” from the Gates Foundation.

In other respects, however, the influence of the Gates Foundation is more apparent. Not only does KFF have the power to choose what constitutes global health news, but, in summarizing the stories it selects, it can give them a construction of its choosing. In key instances, the Kaiser Family Foundation’s global health news coverage suggests bias both in story selection and preferential treatment of the Gates Foundation.

In May 2009, the Lancet ran two papers and an accompanying editorial offering multiple sharp criticisms of the Gates Foundation. The KFF summary muted the few criticisms it repeated and dismissed the one paper it discussed as “marred by ideological assumptions.” The summary quoted the Gates Foundation as saying “We welcome the article and its findings…” although, as the Lancet editorial noted, the foundation had actually “declined our invitation to respond…” Unusually and perhaps uniquely, KFF did acknowledge in its daily e-mail that it “receives substantial support from the Bill & Melinda Gates Foundation for the Kaiser Daily Global Health Policy Report.”

In June, USA Today ran a largely positive story on the Gates Foundation. But the article also said:

…the Gates Foundation has been painted by critics and even admirers as sometimes too heavy-handed in saying how its money is used and too prone to listening to the recommendations of experts vs. grass-roots groups when setting its strategies to battle global poverty.

In Kaiser’s rendering, this became: “The article reports on different perspectives about the Gates Foundation’s influence and approach to global health and other work.” While not strictly false, such gentle treatment does appear to be reserved for the Gates Foundation.

A June 19 Lancet story entitled “WHO heads back to the drug development drawing board” became, in KFF’s version, “WHO Scraps Old Drug Development Group, Creates New One,” and featured quotations about “unclear methods, a lack of transparency and signs of industry interference” as well as “suspicions of impropriety.” Although the Lancet story quoted one source as saying “We think this is a landmark decision,” that more positive perspective was not included in the KFF summary.

BMJ recently alleged improper ties between WHO H1N1 advisors and the pharmaceutical industry. KFF quoted the editor-in-chief of BMJ saying “The WHO’s credibility ‘has been badly damaged.’ ” However, four days later, Nature News/Scientific American wrote:

To judge from media coverage last week, a major scandal had been exposed in the handling of the H1N1 flu pandemic by the World Health Organization (WHO). But nothing could be further from the truth.

However, after this debunking, KFF only reported that “the authors of the BMJ piece agreed the timeline they presented in the article was off.” (UPDATE: Last week, KFF included a sub-headline in their global health roundup “WHO Director-General Defends WHO’s Response To H1N1.”)

KFF lets hard knocks for some organizations through, but cushions blows for the Gates Foundation and sometimes ducks them entirely. The Los Angeles Times ran a series of stories in January 2007, beginning with “Dark cloud over good works of Gates Foundation.” The Times contended that the foundation’s endowment investments worked against its global health objectives:

The Gates Foundation has poured $218 million into polio and measles immunization and research worldwide, including in the Niger Delta. At the same time that the foundation is funding inoculations to protect health, The Times found, it has invested $423 million in Eni, Royal Dutch Shell, Exxon Mobil Corp., Chevron Corp. and Total of France — the companies responsible for most of the flares blanketing the delta with pollution, beyond anything permitted in the United States or Europe.

The Kaiser Daily Global Health Policy Report never mentioned the series.

KFF frequently mentions coverage of the Gates Foundation appearing in the Seattle Times. But the Times‘s recent, June 15 story, “Gates Foundation gets low marks in relations with non-profits” went ignored. The foundation actually surveyed not just non-profits but all 1,544 of its grantees from a recent one-year period. There was good news, according to the foundation: “strong ratings for our work in grantees’ fields,” and “a positive impact on knowledge, policy, and practice in our strategy areas.” However, the Gates Foundation received “lower than typical ratings on many other aspects of the grantee experience,” such as communication and clarity with respect to goals and strategy.

The foundation paid out roughly $3 billion to its grantees over the timeframe examined yet the obvious potential story about the effectiveness of foundation spending received neither mention nor exploration, an omission true of all media organizations, not just the Kaiser Family Foundation. Concerns about transparency, raised by KFF in different circumstances, here go dormant.

The lens of KFF’s portal gives particular shape to reader perception of the world’s coverage of global health. KFF is also studying global health journalism in a project led by former Boston Globe global health writer and Pulitzer Prize winner John Donnelly. Donnelly left the Globe in 2008 to join Burness Communications, a media consultancy, where he is vice president and senior editor. At the same time, Donnelly became a media fellow at Kaiser Family Foundation. (I was interviewed in June by a member of Donnelly’s project.)

“Newspapers,” Donnelly said in a telephone interview, “have very strict ethical standards that assure you’re unbiased.” He characterized his past work for the Globe as “independent,” his stories involving consultation only with editors. As budget cuts swept the newspaper industry, the Globe closed its foreign bureaus, about a year before Donnelly departed. “In global health,” said Donnelly, “there are really very few of those jobs left.”

Asked about the possible influence of Gates Foundation funding on journalism, Donnelly explained in an e-mail:

I’m rarely doing much pure journalism now, so I don’t know if I can answer the question of whether Gates’ underwriting of journalism creates a conflict for journalists. I would think that journalists working on global health issues at NewsHour and NPR would be in the best position.

Donnelly seemed to defend non-disclosure of Gates Foundation funding to certain media organizations. “Indirect funding is not really seen as independent journalism,” he said by phone. “It’s seen as advocacy-based journalism.”

Donnelly currently writes for Global Health, a magazine published by the Global Health Council. The council has a three-year, $10 million grant from the Gates Foundation to “to foster policies that accelerate scale-up of cost-effective, proven health approaches and diffusion of best practices and innovation that have policy significance.” The grant was awarded in October 2008, like those won by the NewsHour and KFF. Global Health, which began publication in the winter of 2009, does not disclose Gates funding, as of this writing.

Donnelly said he didn’t know if Gates funding supported Global Health. He recently blogged the Pacific Health Summit for that publication. The invitation-only summit paid most of his airfare with the balance coming from another non-profit receiving Gates Foundation support. “I don’t know who funds the summit,” said Donnelly, other than numerous different organizations. On the summit website, the National Bureau of Asian Research (NBAR) sits atop the marquis of the four organizations behind the event, including the Gates Foundation. However, the Gates Foundation paid part or all of NBAR’s share of the Summit, $700,000. Again, the event and its coverage originate from the foundation whose role is larger than it appears.

(UPDATE: Global Health magazine appears to have changed their disclosure practices to include funding sources. The previously referenced blog entries written by John Donnelly simply stated that he “is a free-lance writer based in Washington, D.C.” Now Donnelly’s most recent blog for Global Health says: “John Donnelly is a freelance writer. His trip to Nepal was supported by the Ministerial Leadership Initiative for Global Health and the World Health Organization.”)

Is this ubiquity simply a property of global health, a consequence of a generosity both welcome and immense? Should air have to disclose that it is 21 percent oxygen?

I used to write about the Gates Foundation for the Seattle-based Crosscut. I stopped in November of 2009 after Crosscut, following financial struggles and a switch to non-profit status, announced it had received a $100,000 grant from the Gates Foundation. Some weeks after learning about the Gates grant in Crosscut, I inquired of the editor, David Brewster: “Any thoughts about editorial policy with respect to coverage of the Gates Foundation under Crosscut’s new funding paradigm?” Brewster responded:

No change at all. You should get it out of your head that Gates is funding us, and they insist they would be embarrassed if their funding in any way altered our independent reporting on them.

(UPDATE: Crosscut has since received a $400,000 grant and expects two more.)

The episode is suggestive of the ubiquity of Gates funding in the media, from unknown Crosscut to the PBS NewsHour. The subject of Gates funding is uniformly uncomfortable to those receiving it—which should perhaps suggest that something is wrong. Finally, the effects of foundation funding are quite universal: journalists who need the money seem to believe they can remain objective about their coverage.

John Donnelly says his study of global health journalism examines “what’s going on, how things have changed,” and what the future might look like. Perhaps it will conclude that the objectives of global health might not be harmed by increased transparency of funding sources. Journalism and the processes of an open society, quite obviously, are harmed when money influences coverage invisibly.

Certainly, Ray Suarez should be asking questions of the Gates Foundation, not the other way around.

Robert Fortner is a contributor to CJR.