…Africa Destroyed in the process.
After spending $16 billion over 30 years to eradicate polio, international health bodies have ‘accidentally’ reintroduced the disease to in Pakistan, Afghanistan, and Iran, as the central Asia region was hit by a virulent strain of polio spawned by the corporate pharmaceutical vaccine distributed there. In 2019, the government of Ethiopia ordered the destruction of 57,000 vials of type 2 oral polio vaccine (mOPV2) following a similar outbreak of vaccine-induced polio. In Sudan, a polio-vaccine outbreak is spreading.
It’s important to note that the oral polio vaccine being pushed on to the African population by the Global Polio Eradication Initiative (GPEI), a consortium which is supported and funded by the Bill & Melinda Gates Foundation.
Recently, Bill Gates published a plea in the Wall Street Journal for more government funding of “global health groups.” He recounts that he’s spent some $10 billion on such efforts, focusing on ridding the planet of malaria. While these seems admirable, from a historian’s perspective, this is not only backwards but potentially disastrous.
Population and related demographics are generally value-neutral outside of a specific context. The two great historical population controlling factors, war and epidemic, tend to cause governments to encourage population growth as insurance against the inevitable vicissitudes of history. And once established, reasonably successful agrarian economies typically produce in direct relation to their labor supply. But population surges have a wide range of effects on a society and can catalyze anything from the establishment of an empire to the collapse of a civilization.
Population growth is neither inherently stabilizing nor destabilizing. We know that the ancient Greeks and Romans considered water-powered machines, but we also know that they didn’t really make or use them. Our best explanation is that they simply didn’t need water power because of their ample supply of human labor (many of whom were slaves). Conversely, after the black death eliminated 50% of the European population in the 14th century, the gears, cams and shafts that northern Europeans had been experimenting with over the previous few centuries became vital to their civilization, and we quickly see this machinery improved and deployed into increasingly complex and efficient water-powered machines. In this case, population retarded the development of some ancient technologies and unleashed these technologies in creating the modern world.
Nearly every historian of 18th century Chinese history comments on the ways in which Chinese population growth caused many of China’s problems. In the 18th century, Chinese population was growing at about 10% per decade, and the country wasn’t developing quickly enough to handle the additional supply of humans. Further, as ethnic Hans (mostly seeking new farmland) pushed southward through Hunan and adjacent provinces, instability vastly increased. Eventually, China’s instability led to the “century of humiliation” (as the Chinese call it), multiple civil wars and eventual collapse. In part, the Japanese invaded China to relieve its own population pressures (specifically exerted on food supplies).
Population pressures are the likely culprit of the collapse of the Cahokia, the largest north American pre-Columbia city situation just east of St. Louis. The Cahokia population began to grow around A.D. 1050 and grew at a compounded rate of about 13% for two centuries until, likely due to food supply and waste disposal challenges, it collapsed on about A.D. 1250 and disappeared about a century later.
The British experienced population growth from 1700 to 1900 of about 9% per decade. Britain did not suffer wholesale collapse like the Cahokia or massive instability like the Chinese. Of course, Britain survived in part because it could alleviate population surplus by sending people to some of the 25% of the earth that they controlled. And the British were experiencing massive economic expansion and had all basic infrastructure problems solved. Thus, social or political collapse did not occur. But it shouldn’t be overlooked that the British empire suffered great weakness during this period, including losing its prized possession in North America. Britain’s North America problem was a political problem caused by population; the British could never accede to the demands of the North American colonies: political representation in Parliament. The demand was impossible precisely because the colonial population was growing faster than the British population and by 1830 would be greater; this was quite evident by the 1760s. It can be argued that some of Britain’s instability in this period can be blamed on its dramatic population growth, despite having a robust economy and adequate infrastructure. After the empire collapsed, the British decadal growth decreased to less than half, settling in at about 4%.
The United States also experienced substantial growth, peaking in the mid-19th century at over 30% per decade. Of course, the United States was starting from a small population, had substantial territory, and had the infrastructure required to support the growth. Since then, U.S. population decadal growth has declined by over 70%.
From a historian’s perspective, it’s axiomatic that decadal population growth of around 10% or greater puts substantial strain on a nation. Such growth, if sustained over a generation, often leads to war or instability or the collapse of entire nations. And so, when Bill Gates praises a program the result of which is probable significant generational population growth, I become worried. Does Africa have some secret of governance that has eluded nations for millennia?
First, some population statistics. In the decades of the 1970s and 1980s, during which Westerners were inundated with stories of Ethiopian malnutrition and starvation, the population of Ethiopia grew by 67%. Maybe Ethiopian infant mortality was high, but the population replacement rate was astronomical. Ethiopian starvation may be been exasperated by drought and related agrarian issues, but it’s obvious that one major issue is that Ethiopia has too many Ethiopians. The average decadal population growth rate for Ethiopia has been around 30% since the 1950s.
The Gates Foundation targets malaria, in part, because it impairs and kills, and malaria is most strong in the Central west of Africa — so let’s look at those countries. Nigeria’s population growth per decade since the 1950s is about 30%. The Ivory Coast’s population growth per decade also has been about 30%, though in the 1970s and 1980s it spiked up to about 50%. The entire central west of Africa faces current population growth consistently above 20%. By contrast, most industrialized countries have population growth of less than 10%. Japan is actually shrinking. South Korea, Australia, Spain and Germany have population growth under 2% (Germany’s average since the 1950s has been about 3%). France and the U.K. are under 5%. The United States, still a young and growing country, comes it at around 6%. And so in Africa we have nations coming off of decades of population growth substantially over 20% and it appears we’re heading into more decades of population growth over 20%. While historical aberrations exist, it’s simply not historically reasonable to conclude that a collection of countries with that kind of population growth without concomitant growth in infrastructure and economy can be stable.
By “infrastructure,” it’s worth while to review a standard infrastructure list so to emphasize that we’re not focused on bridges and roads. The general development of nations looks something like this:
1. Community and Aspirations. Whether organic (bottom up) or inorganic (top down), a sense of community is a necessary first ingredient to enable humans to work together to achieve anything else on this list. Without a sense of community, things like laws are largely irrelevant. Of course, the community needs to be aspirational so that not only are a group of people capable of working together, but they are interested in working together to solve bigger problems.
2. Agriculture. You need to figure out how to feed everyone. Whether by domestic production or trade, the efforts to supply food must be less than the total possible labor of the community — that excess labor then contributes to the items down the list.
3. Institutions. Usually priest and/or palace, institutions begin to solidify the community and its aspirations and begin to create institutional knowledge.
4. Law. Usually an early product of the institutions, the community and its aspirations begin to develop rules, first from the general morals and aspirations of the community, and these rules drive the creation and furtherance of trade/commerce, banking/money, etc. From these rules are derived laws, standards, courts and eventually something resembling an economic system. The most basic conception of initial law often involves water rights: who can use the river for power? Who can use the river for waste disposal? Who can use the river for irrigation? Who can fish and where? The law, together with the nascent institutions, are typically leveraged for basic infrastructure.
5. Basic infrastructure. Institutions + law = tax collection. This enables basic infrastructure, which typically entails roads, bridges, larger irrigation projects, dams, security/law enforcement.
6. Basic Manufacturing. Using this entails first supporting the above efforts by manufacturing farm tools, military items for security/defense, building tools and related items for dams, civic buildings, etc. Once those items are built or, at least, maintained locally, then manufacturing turns to items for export. The most common initial manufacturing effort is in textiles because it’s no/low-skill and labor intensive, so an economy with a lot of low-wage workers can effectively develop a textile manufacturing export economy (cf industrial revolutions in the U.K., U.S., China and most places).
7. Basic Education. The initial wave of education generally addresses literacy (to understand and implement laws and read contracts, for example) and basic skills. Usually such basic education does not develop through a rigorous K-College system because such systems are resource-inefficient but rather through apprenticeships (most advanced societies first developed this way).
8. Increasingly advanced institutions, law, infrastructure, manufacturing, education.
9. Healthcare and other luxuries such as sports teams, fancy airports, high speed rail.
Importantly, this list is not prescriptive but rather descriptive; this is the way civilizations develop. One cannot have the state spend money without the economic infrastructure to support the spending (or else you get the French Revolution or the Greek bailout or Detroit in general). Africa began with item #1 in the 1950s and 1960s with African nationalism, though Rwanda and South Africa and Rhodesia all suggest that the answer is still forthcoming. Stable legal infrastructure is still wanting across most of Africa, and Africa is revisiting massive civil infrastructure problems now that the colonial infrastructure last built in the 1950s is substantially declining. Population growth transforms very difficult problems into impossible knots, and the result is Boko Haram (very reminiscent of the White Lotus rebellion of the 1790s, which generally marked the beginning of the end for imperial China).
Rwanda experienced about 17% decadal population growth since the 1950s; historically dangerous but perhaps not cataclysmic. However, the overall growth number concealed the danger; Rwandans typically did not live long but as the life expectancy of Rwandans increased, the population bulge worked its way up. And there’s little more dangerous to a civilization than a population bulge of 20-year-old males with nothing to do — no jobs, no education, no hope. Those are the people who destroy civilizations. And the population of neighboring Uganda, from which the rebels of the Rwandan war invaded, had grown by 84% in the two decades preceding the war. War often acts as some force of nature imposing population control, and by the end of the Rwandan war in 1995, the Rwandan population had declined by 22% in just five years. Such is history.
With that in mind, let’s explore that argument in Gates’ WSJ essay. The premise starts with this:
“Buying medical supplies and getting them where they’re needed may sound easy, even boring, but it isn’t. Saving lives in developing countries often means getting medicines to remote villages and war zones.”
Curious that he doesn’t see what appears to be a self-evident problem. Let’s increase the populations of remote villages and war zones … what could go wrong?
“Without more funding over the next 10 months, all three of these institutions will have to dramatically scale back their efforts to fight diseases and keep people healthy. This shouldn’t be allowed to happen.”
The calculus here is: these programs are very basic to these countries and they haven’t the ability to pay for them. Here we must distinguish between personal and public charity. On a personal level, giving something necessary to someone who can’t afford it may be good and charitable. On a national level, such an act is typically disastrous. This is where the distinction between external and internal debt is important. China and Japan built and support their modern infrastructure mostly on assets and internal debt (e.g. they borrowed from themselves). However, building such basics by borrowing from others typically results in economic colonization. The bigger picture is that, given the infrastructure list above, building the basics of a nation without first having the economy to pay for them suggests that the infrastructure isn’t in place and the order of operations is askew; civil instability is inevitable.
“Since Gavi was founded, the number of children under the age of 5 dying in low- and middle-income countries has dropped by 40%”
We’ll come back to this later, but one of the main experiments supporting Gates’ malaria work, Garki, decreased malaria by over 60% and the consensus view on Garki is that is was a failure. Seems curious then that “40%” is a success.
“When Melinda and I began investing in these funds back in 2000, our goal was to save lives and stop suffering, and by that measure these institutions have succeeded beyond our wildest dreams. But they’ve also been successful in the way that investments traditionally are: They’ve created a lot of wealth, because when people aren’t sick in bed, they can go to work or school. The Copenhagen Consensus Center is a think tank that uses…”
Now we’ve arrived at the evidence for all the assertions: The Copenhagen Consensus Center. First, the “Center” is a bit of an enigma. It seems to operate out of a private mail box in Massachusetts and an actual location is somewhat difficult to determine; odd for a “Center.” Further, something around one-third of all its funds are paid to a single person. Not exactly a set of facts that support credibility.
Second, as best I can determine, the “Center” doesn’t really “use” anything; it promotes reports written by others. Gates does not cite an actual report, but I reviewed what seems to be the most recent report related to malaria on the Center’s website. That report was written by the “Public Health Foundation of India.” That foundation is subsidized by the Gates Foundation. So, yes, Bill Gates cites a study subsidized by Bill Gates that affirms that the works of Bill Gates are good and great, all of which is filtered through a “Center” that operates out of a private mail box in Tewkesbury Massachusetts. For credibility.
The Public Health Foundation of India study doesn’t really establish the economic support for Gates’ assertions; rather, in the tradition of the social sciences, it cites other studies (e.g. Guerin 2002; Sachs and Malaney 2002). The tradition continues, as these studies spend most of their time noodling on the brilliance of previous studies, often written by the same people.
Eventually, after much wading through the fog of citations, one gets to some kind of seminal study, which contains the initial miracle on which the faith is built. That miracle requires both that causation between malaria and poverty is established and a number can be affixed to the cost of that causation. The structure of the study that performed this miracle seems to be:
Step 1: Find a degree of “sameness” in countries that otherwise don’t have much malaria;
Step 2: Goal-seek something that looks like evidence of how the low/no malaria countries have economically out-performed malaria countries;
Step 3: Transmute the Step 2 observations into a readily consumable and repeatable ‘no malaria multiplier’ to plant into billionaires’ brains so that said billionaire can affix an amount on malaria investment.
This alchemy is why the social sciences aren’t respected.
Of course, the ‘sameness’ criteria are objective selections about which historians agree, and myriad criteria and the vast number of examples that would negate the results were all rigorously vetted and justifiably jettisoned. And the term ‘consensus’ was never used to gild the complete lack of consensus. Then everyone got a free unicorn.
Back in reality, there are no unicorns. Instead, there are a few simple questions: have you saved the lives of these children only to doom them to horrible deaths later? Have you exorcised the demons of colonialism only to visit upon Africa greater tragedy? Do you know what’s far deadlier than malaria?
Ok, since you insist, I can keep going….
Which is responsible for more death? Malaria or the wars in Sudan?
Malaria or the wars in Rwanda?
Malaria or the wars in the Congo?
And I’m only referring to the recent wars, not all the wars that came before them. And for metrics, you can go back to the pre-White-Man’s-Burden malaria numbers and a war in the Congo will still outpace you day-for-day and corpse-for-corpse. Social instability is far more lethal than malaria.
The poverty = malaria equation is just slipping on a correlation banana. It happens to the best of us when billions of dollars are on the line. Of course, there’s no evidence that wars cause poverty or poverty causes war but there’s a fairly strong correlation between war/population surges and war/dead people. So if dead people are a concern, then hundreds of thousands of infants who don’t die from malaria may very well grow up to be soldiers.
All this makes me think of parking tickets. Specifically, a 2006 study on parking tickets. Here’s the paper’s summary:
Corruption is believed to be a major factor impeding economic development, but the importance of legal enforcement versus cultural norms in controlling corruption is poorly understood. To disentangle these two factors, we exploit a natural experiment, the stationing of thousands of diplomats from around the world in New York City. Diplomatic immunity means there was essentially zero legal enforcement of diplomatic parking violations, allowing us to examine the role of cultural norms alone. This generates a revealed preference measure of government officials’ corruption based on real-world behavior taking place in the same setting. We find strong persistence in corruption norms: diplomats from high corruption countries (based on existing survey-based indices) have significantly more parking violations, and these differences persist over time. In a second main result, officials from countries that survey evidence indicates have less favorable popular views of the United States commit significantly more parking violations, providing non-laboratory evidence on sentiment in economic decision-making. Taken together, factors other than legal enforcement appear to be important determinants of corruption.
Countries with a culture of corruption haven’t made it through Step 4 in the nine steps listed above. Here’s a map of the paper’s findings:
This map isn’t anyone’s interpretation of whether a country has ‘free trade’ and whether our definition of ‘free trade’ limits malaria; it’s unpaid parking tickets. And yes, it correlates uncomfortably with various disease maps, including malaria.
So correlation bananas aside, whether decreasing malaria will produce the results Bill Gates claims will be a matter of history. And history has not been kind to generational population surges, particularly to countries that don’t pay their parking tickets.
Good work, Bill.
The darkening clouds are ominous for many in this urban neighborhood, promising rushing rainwaters stinking of human waste from overflowing septic tanks. As Africa faces a population boom unmatched anywhere in the world, millions of people are moving to fast-growing cities while decades-old public facilities crumble under the pressure.
Sewage is a scourge for residents of this community on the outskirts of Uganda’s capital, Kampala. Mud tinged with feces washes into homes during heavy rains. The sanitation crisis echoes that of cities across the developing world.
 Yes, I’d argue that the industrial revolution began mostly in modern-day eastern France and western and southern Germany in the 14th century at the latest. By the 15th century, very complex machinery, usually water-powered, were being developed and widely deployed in this region.
 China population fun fact: Today, China accounts for about 19% of the global population, but in the 18th century, China accounted for about 30% of the global population. Chinese population as a proportion of global population is at a 300-year low.
Some detail on the social instability that the Chinese population surge caused in this NYT essay by noted China historian Stephen Platt: https://www.nytimes.com/2012/02/12/opinion/sunday/is-china-ripe-for-a-revolution.html
 Beijing is extremely aware of and sensitive to not repeating the century of humiliation, which in large part explains China’s previous one-child policy. The century of humiliation generally starts around 1830 but realistically China was collapsing by the 1790s.
 Rhodesia is a good example of the challenge of establishing national identity without creating other problems — how does a nation establish identity this is inclusive of those who know how to farm? This is, of course, a problem that Haiti never resolved.
The author here notes the problem of managing rates of changes (in the context of Venezuela) — https://www.bloombergquint.com/view/venezuela-is-a-failure-of-the-left-not-just-a-failed-state. If not handled carefully, the process of developing institutions — both order and rate — can lead to disastrous results.
 Yes, this is the quality of the essay. You know how — if your parents have adequate disposable income — you can spend a few weeks during spring or summer break in a third-world country and save the poor? Then, as is the custom of our people, one produces a White-Man’s-Burden college admission essay. Anyway, Gates’ WSJ essay reads like a rough draft of one of those essays. My wife says this is a mean observation, and that I should be nicer, so I won’t make it.
 It is noteworthy that China is very aware that their Belt and Road initiative is economic colonization; they would never have built their own infrastructure using the same model that they offer to others because they know how toxic it is due to its lack of economic viability — which, of course, tethers you to whims of the power that holds the debt.
The idea that external charity for such basics leads to disaster is fairly well known. There’s been substantial revolt from the Africa-charity urges of white people, particularly from Africans.
Malaria and related reports are here: https://www.copenhagenconsensus.com/research-topic/health
Malaria specifically is here: https://www.copenhagenconsensus.com/publication/post-2015-consensus-health-perspective-malaria-raykar-and-laxminarayan
How “real” is the Copenhagen Consensus Center? No idea and not a debate I’m getting into, but it does seem to be something of a debate: https://www.desmogblog.com/2015/04/26/copenhagen-consensus-center-real-charity-foreign-conduit
 Don’t tell the kids, but one of the pro-malaria correlations in the study was “socialism.” They didn’t explicitly conclude that socialism causes malaria, but I do suggest that someone perhaps send a note of caution to Sweden.
 “Consensus” is a term that is much more likely to mean “blind group-think” than “everyone agrees.” It’s such a weirdly totalitarian term with which people are uncomfortably comfortable. Post Enlightenment, “consensus” should be a dirty word.
 The entire causal relationship comes from a paper with two points: Garki and sickle cell. Garki was a late 1960s WHO project in Nigeria to test a method for eliminating malaria. It is widely viewed (among malarialists) as a failure. Garki sought to test the WHO’s main tactic: Indoor Residual Spraying and Rapid Diagnosis and Treatment with chloroquine. I’d suggest it wasn’t necessarily a failure; it reduced malaria among children from 80% to 30%. (Sure, 30% isn’t ‘elimination,’ but it’s a dramatic decrease.) And it’s noteworthy what Garki didn’t do: it didn’t try to eliminate malaria the way it had previously been eliminated — targeting the larvae vector (not to mention providing screens for windows). The point of Garki is that malaria is a ravenous untamable beast that dooms people to poverty. Well, except the people in societies that function at a basic level … they seem to be able to deal with malaria. The sickle cell argument, per the cited studies, is that malaria is so endemic that evolution provided a slightly less lethal solution. Sickle cell provides immunity from malaria but inheriting sickle cell from both parents is generally lethal. Such a lethal exchange means malaria must be lethaler than sickle cell … except, sickle cell in sub-Saharan Africa kills about 90,000 people yearly. Sure, that’s a non-trivial number, but sub-Saharan Africa has a population of over 1 billion, and diarrhea kills almost a million. Which reminds me, diarrhea in sub-Saharan Africa is more than twice as lethal as malaria according to WHO. Of course, the sickle cell argument suggests a purpose, and we all know evolution is so purpose-driven. Not to mention all the other sub-population genetic aberrations that exist that often seem to have no purpose and yet can be lethal. Woo! Unicorns for all.
 Entire paper is here: https://www.nber.org/papers/w12312. Raw data, etc: http://emiguel.econ.berkeley.edu/research/corruption-norms-and-legal-enforcement-evidence-from-diplomatic-parking-tickets
 It seems that the DRC having no unpaid tickets is a minor miracle. Alas, some of those countries (e.g. South Sudan, Congo) are actually low/no data or otherwise excluded due to wars and genocidal shenanigans. The U.S. was excluded because they are the home team.
About Nathan Allen
Formerly of Xio Research, an A.I. appliance company. Previously a strategy and development leader at IBM Watson Education. His views do not necessarily reflect anyone’s, including his own. (What.) Nathan’s academic training is in intellectual history; his next book, Weapon of Choice, examines the creation of American identity and modern Western power. Don’t get too excited, Weapon of Choice isn’t about wars but rather more about the seeming ex nihilo development of individual agency … which doesn’t really seem sexy until you consider that individual agency covers everything from voting rights to the cash in your wallet to the reason mass communication even makes sense….