Explaining The Rockefeller and Gates Foundation's Influence in the Governance of Global Health

306 Pages·2014·2.79 MB·English

by  Michael Stevenson

Agency Through Adaptation: Explaining The Rockefeller and Gates
Foundation’s Influence in the Governance of Global Health and
Agricultural Development

by

Michael Stevenson

A thesis
presented to the University of Waterloo
in fulfillment of the
thesis requirement for the degree of
Doctor of Philosophy
in
Global Governance

Waterloo, Ontario, Canada, 2014

© Michael Stevenson 2014
AUTHOR'S DECLARATION

I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis,
including any required final revisions, as accepted by my examiners.
I understand that my thesis may be made electronically available to the public.

ii
Abstract

The central argument that I advance in this dissertation is that the influence of the
Rockefeller Foundation (RF) and the Bill and Melinda Gates Foundation (BMGF) in the
governance of global health and agricultural development has been derived from their ability
to advance knowledge structures crafted to accommodate the preferences of the dominant
states operating within the contexts where they have sought to catalyze change.
Consequently, this dissertation provides a new way of conceptualizing knowledge power
broadly conceived as well as private governance as it relates to the provision of public goods.

In the first half of the twentieth-century, RF funds drove scientific research that produced
tangible solutions, such as vaccines and high-yielding seed varieties, to longstanding
problems undermining the health and wealth of developing countries emerging from the
clutches of colonialism. At the country-level, the Foundation provided advanced training to
a generation of agricultural scientists and health practitioners, and RF expertise was also
pivotal to the creation of specialized International Organizations (IOs) for health (e.g. the
League of Nations Health Organization) and agriculture (e.g. the Consultative Group on
International Agricultural Research) as well as many informal international networks of
experts working to solve common problems. Finally in the neo-liberal era, RF effectively
demonstrated how the public-private partnership paradigm could provide public goods in
the face of externally imposed austerity constraining public sector capacity and the failure of
the free-market to meet the needs of populations with limited purchasing power.

Since its inception, the BMGF has demonstrated a similar commitment to underwriting
innovation through science oriented towards reducing global health disparities and
increasing agricultural productivity in poor countries, and has greatly expanded the
application of the Public-Private Partnership (PPP) approach in both health and agriculture.
Unlike its intellectual forebear, BMGF has been far more focused on end-points and silver
bullets than investing directly in the training of human resources. Moreover whereas RF has
for most of its history decentralized its staff, those of BMGF have been concentrated mainly
at its headquarters in Seattle. With no operational programs of its own, BMGF has instead
relied heavily on external consultants to inform its programs and remains dependent on
intermediary organizations to implement its grants.

Despite these and other differences, both RF and BMGF have exhibited a common capacity
to catalyse institutional innovation that has benefited historically marginalized populations in
the absence of structural changes to the dominant global power structure. A preference for
compromise over contestation, coupled with a capacity for enabling innovation in science
and governance, has resulted in broad acceptance for RF and BMGF knowledge structures
within both state and international policy arenas. This acceptance has translated into both
Foundations having direct influence over (i) how major challenges related to disease and
agriculture facing the global south are understood (i.e. the determinants and viable
solutions); (ii) what types of knowledge matters for solving said problems (i.e. who leads);
and (iii) how collective action focused on addressing these problems is structured (i.e. the
institutional frameworks).

iii
Acknowledgements

I would like to begin by thanking my supervisor Jennifer Clapp. Since assuming this role
over five years ago, Jennifer has shown tremendous patience, kindness, commitment, and
skill. She has provided me with a high degree of latitude so that I could explore new ideas
and take on additional projects, emotional support in times of self-doubt, and guidance in
the art of balancing work-family responsibilities and duel careers. I feel very privileged to
have had such a wonderful mentor. I would also like to thank the other members of my
committee, Andrew Cooper, Derek Hall, and Dan Gorman, whose expertise and editorial
prowess were instrumental to ensuring that I had a defencible end product.

At the University of Waterloo, I would like to thank April Wettig for the tremendous
administrative and moral support she provided me with over the six years that I was a
student in the Global Governance program. I would also like to thank Will Coleman for
facilitating access to a much-needed work space at McMaster University in the spring of
2011, and Nancy Johnson for her efforts in ensuring that space available for as long it was.

I would like to express my gratitude to my former colleagues at the Balsillie School of
International Affairs, and in particular to Jason Thistlethwaite, Stefano Pagliari, Laura Reidel,
and Michele-Lee Moore, whose great empathy and sense of humour made returning to
graduate school the pleasurable experience it ultimately proved to be. I would also like to
thank Michael Moran for helping maintain my interest in my research, and for making
academic collaboration from half way around the world a lot of fun.

Without a doubt my greatest debt is to my partner Lynne Serviss, whose commitment to me
has remained steadfast. Lynne has endured many challenges borne of this PhD. Through
them all she has maintained her optimism, wit, and compassion. I love her dearly for this, am
extremely fortunate for her daily presence, and look forward to sharing a long life with her.

Since initiating this project, Lynne and I have become the parents of two beautiful little boys
whose love and affection have ensured that any research-related setbacks were always kept in
proper perspective. Their curiosity, creativity, and physical energy are a constant source of
inspiration, and we are incredibly lucky to have them in our life.

I would like to express my deep gratitude to Tina Serviss for being such a wonderful Oma,
and to David Serviss, Christine White and family for ensuring that holidays are always
joyous. My mother Beverly Stevenson has been a bedrock of support and a wonderful Nana
to her grandchildren, and I am extremely grateful for this. I would also like to thank the
dedicated and caring staff at McMaster Children’s Centre, and our many wonderful Westdale
friends. A very special thanks to Allison Henderson and Danny Priljeva, James and Danielle
Warner, Andrea Soos, Chad and Heather Harvey, and the rest of the ‘book-club’ families.

Finally, my love of reading and interest in world affairs were instilled at a very early age and
nurtured by my parents. I am forever indebted to them for providing me with so many
wonderful learning opportunities. My father would have been especially fascinated by the
focus of my thesis research, and it is to his memory that this dissertation is dedicated.

iv
Table of Contents

AUTHOR’S DECLARATION……………………………………………………….. ii
Abstract………………………………………………………………………………………...iii
Acknowledgements.…………………………………………………………………………….iv
Table of Contents..………………………………………………………………………………v
List of Abbreviations.…………………………………………………………………………..vii
Preface....………………………………………………………………………………………...x

Chapter 1: Introduction………………………………………………………………………….1

1.1 Beginnings …………………………………………………………………………………...1
1.2 Contribution to the literature………………………………………………………………....5
1.3 The empirical evidence……………………………………………………………………...14
1.4 Methodology………………………………………………………………………………..17
1.5 Chapter synopses………………………………………………………………………….. 21

Chapter 2: Existing explanations for RF and BMGF agency in global governance……...22

2.0 Introduction……………………………………………………………………………….. 22
2.1 RF and BMGF as products of the American Polity………………………………………….24
2.2 -Mainstream IR’s longstanding neglect of RF and initial disinterest in BMGF ………………26
2.3 – RF historiography at a glance……………………………………………………………...28
2.4 The Small, But Growing Body of BMGF-focused Literature………………………………..37
2.5 Conclusion…………………………………………………………………………………..42

Chapter 3: The relevance of existing theory to explain the agency of RF and BMGF……45

3.0 Introduction………………………………………………………………………………….45
3.1 Private Governance and Power………………………………………………………………46
3.2 Private power through the provision of public goods………………………………………...49
3.3 Knowledge Construction and Power…………………………………………………………53
3.4 Conclusion…………………………………………………………………………………...62

Chapter 4: RF and The Progression To Global Health Governance……………………..66

4.0 Introduction………………………………………………………………………………….66
4.1 The Progressive/Immediate Post-Colonial Era……………………………………………....68
4.2 The Rise of Collective Consciousness………………………………………………………..84
4.3 The Neo-liberal World Order………………………………………………………………..95
4.4 Conclusion…………………………………………………………………………………109

Chapter 5: RF’s Global Influence over the Governance of Agricultural Development…111

5.0 Introduction………………………………………………………………………………..111
5.1 A Driver of state-backed agricultural modernization in the progressive era…………………113
5.2 Innovation in the IO era: The International Agricultural Research Centres…………………122
5.3 Adaptation in the Neo-Liberal Era: Innovating Around an Expanding Biotechnology Industry....130
5.4 Agency through adaptation in a neglected region: A focus on Sub-Saharan Africa …………140
5.5 Conclusion………………………………………………………………………………….146
v
Chapter 6: BMGF’s Influence over Global Health Governance………………………149

6.0 Introduction……………………………………………………………………………….149
6.1 The Perkin Years: Building on the PATH Approach…………………………………….....151
6.2 From General Contractor to Specialist Agency: Decision-making within BMGF…………..161
6.3 Three Criticisms of BMGF’s Influence in Global Health Governance……………………..169
6.4 The Future of BMGF’s Global Health Program……………………………………………184
6.5 Conclusion…………………………………………………………………………………186

Chapter 7: BMGF’s Global Influence over the Governance of Agricultural Development...191

7.0 Introduction………………………………………………………………………………..191
7.1 BMGF Turns Its Attention to Agriculture: 2004 – 2009……………………………………194
7.2. Beyond AGRA: Comparing RF and BMGF Agricultural Programs………………………..209
7.3 BMGF and Political Advocacy in the Governance of Agricultural Development…………...219
7.4 BMGF and the CGIAR…………………………………………………………………….228
7.5 BMGF and FAO…………………………………………………………………………...232
7.6 The limits of BMGF influence in the Governance of Agricultural Development…………...234
7.7 The Future of BMGF’s Agricultural Program………………………………………………238
7.8 Conclusion………………………………………………………………………………….240

Chapter 8: Conclusion………………………………………………………………….244

8.1 Summary of the Main Arguments…………………………………………………………...244
8.2 Three implications of states embrace of PPPs in health and agriculture……………………..255
8.3 Final thoughts………………………………………………………………………………270

BIBLIOGRAPHY……………………………………………………………………...274

vi
List of Abbreviations

AATF African Agricultural Technology Foundation
AGRA Alliance for a Green Revolution in Africa
AHBFI Africa Harvest Biotech Foundation International
AMC Advance Market Commitment
APED Action Program on Essential Drugs (WHO)
BMGF Bill and Melinda Gates Foundation
CEO Chief Executive Officer
CDC Centers for Disease Control and Prevention (United States)
CFC Chlorofluorocarbons
CGIAR Consultative Group on International Agricultural Research
CIAT International Centre for Tropical Agriculture
CIMMYT International Centre for the Improvement of Corn and Wheat
CMB China Medical Board
CSO Civil Society Organization
CVI Children’s Vaccine Initiative
DDT Dichlorodiphenyltrichloroethane
DFID Department for International Development (United Kingdom)
DSP Department of Public Health (Mexico)
FAO Food and Agricultural Organization of the United Nations
FDA Food and Drug Administration (United States)
FF Ford Foundation
GAFSP Global Agriculture and Food Security Program
GAVI Global Alliance for Vaccines and Immunization
GCGH Grand Challenges for Global Health
GE Genetic Engineering
GEB General Education Board
GHP Global Health Partnership
GSK GlaxoSmithKline
GURT Genetic Use Restriction Technologies
HYV High Yielding Varieties
IAASTD International Assessment of Agricultural Knowledge Science, and
Technology for Development
IANPHI International Association of Public Health Institutes
IARC International Agricultural Research Centre
IAP Indian Agricultural Program
IAVI International AIDS Vaccine Initiative
IFAD International Fund for Agricultural Development
IFPRI International Food Policy Research Institute
IGA Informal Global Alliance
IHC International Health Commission
IHD International Health Division
IHME Institute for Health Metrics and Evaluation
IITA Institute of Tropical Agriculture
INCLEN International Clinical Epidemiology Network
IP Intellectual Property
vii
IPR Intellectual Property
IPRB International Program on Rice Biotechnology
IO International Organization
IR International Relations
IRRI International Rice Research Institute
JDR John Davison Rockefeller Sr.
LN League of Nations
LNHO League of Nations Health Organization
MAP Mexican Agricultural Program
MDGs Millennium Development Goals
MDP Mectizan Donation Program (Merck)
MEP Malaria Eradication Program (WHO)
MMV Medicines for Malaria Venture
MNC Multinational Corporation
MVP Meningitis Vaccine Project
NDC Non-Communicable Disease
NGO Non-Governmental Organization
NIH National Institutes of Health (United States)
OIHP Office International D’hygiene Publique
ODA Overseas Development Aid
OECD Organization for Economic Co-operation and Development
OSS Office of Special Studies
P4P Purchase for Progress
PAHO Pan American Health Organization
PASB Pan American Sanitary Bureau
PATH Program for Appropriate Technologies in Health
PC Population Council
PDP Product Development Partnership
PEPFAR Presidents Emergency Plan for AIDS Relief (United States)
PHC Primary Health Care
PIACT Program for the Introduction and Adaptation of Contraceptive
Technology
PIPRA The Public Intellectual Property Resource for Agriculture
PPP Public-Private Partnership
rDNA Recombinant DNA
RF Rockefeller Foundation
RIMR Rockefeller Institute for Medical Research
RSC Rockefeller Sanitary Commission
SEI Science Enabled Innovation
TAC Technical Advisory Committee (CGIAR)
TB Tuberculosis
TFCS Task Force for Child Survival
TRIPS Agreement on Trade-Related Aspects of Intellectual Property Rights
UN United Nations
UNDP United Nations Development Program
UNICEF United Nations International Children’s Emergency Fund
US United States
USAID United States Agency for International Development
viii
WFC World Food Council
WFP World Food Programme
WHO World Health Organization
WTO World Trade Organization
WWII World War II

ix
Preface

Variations of the main argument of this dissertation and supporting empirical evidence have
been presented publicly via three conference presentations and one co-authored journal
article.

I presented a version of chapter five entitled “The Rockefeller Revolution: Establishing a
Template for Philanthropic Power in the Governance of Global Food Security” at both the
2011 ISA annual convention in Montreal, QC, and the 2011 Canadian Political Science
Association Annual Conference, Waterloo, ON.

I also presented the central argument of the dissertation supported by material taken from
chapters four and six at the 2013 ISA annual convention in San Francisco in a paper entitled
“Agency Through Adaptation: Explaining the Rockefeller and Gates Foundations’ Influence
in Global Governance via the Public-Private Partnership Paradigm.”

Finally, a paper co-authored with Michael Moran, (“Illumination and Innovation: What
Philanthropic Foundations Bring to Global Health Governance, Global Society, 27(2), 2013:
117-137) contained empirical evidence from chapters four and six, and variations of several
arguments made in the dissertation. The most notable of these are that critical perspectives
comprise the majority of historical studies on RF’s influence in world affairs, and that RF
and BMGF have been innovators in global governance through their creation of governance
mechanisms that have worked to fill public and private sector gaps.

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