Of Social Diseases and Technical Fixes: BMGF and Tuberculosis in India

• In Event: Show me the money! Science and Technology in the Age of Mega-Philanthropy

Abstract

Recent trends in international assistance and philanthropic funding are transforming global health agendas and governance, with reverberations felt by national health programmes around the world. This paper analyses engagements by the Bill and Melinda Gates Foundation (BMGF) into tuberculosis control in India as a case study to explore some of the avenues by which new philanthropies are informing priorities and shaping approaches to disease and development.
Tuberculosis has been a curable disease for well over half a century, and it is now largely absent from the developed world. Over 95% of tuberculosis today occurs in developing countries, with India alone accounting for over one-quarter of the global burden of disease. Despite being identified as a public health emergency by the WHO in 1993, tuberculosis has long been lamented as an underfunded and neglected area of global health. However, the “emergence” of Multi Drug-Resistant Tuberculosis (MDR-TB) as a health security threat over the last decade has fuelled a resurgence of both scientific interest and donor funding in tuberculosis.
This paper focuses on projects and interventions funded by the BMGF over the past decade to aid India’s national tuberculosis control programme, especially around the national policy objectives of promoting “early diagnosis” and “treatment completion.” Specifically, the paper analyses the foundation’s deployment of digital technologies, such as fingerprint sensors, to achieve better patient surveillance and MDR-TB detection in India. I argue that these technologies, increasingly invoked as indispensable for disease control, have tremendous implications for the environments of tuberculosis care and public health. They not only influence debates around appropriate technology and laboratory infrastructure, but also actively refocus the problematic of tuberculosis as a social disease. The privileging of digital technologies in BMGF backed health interventions thus offers its own narrative around the causes and determinants of tuberculosis, especially MDR-TB, as well as its patients in developing countries.
Long understood to be an ancient disease as well as a modern one, this paper draws attention to how philanthropic interests are rearticulating tuberculosis as an object of global health and a disease of our times.

Author

• Anita Buragohain, York University, Toronto