Global health is currently facing a significant crisis. Substantial and abrupt funding cuts from both US and European donors threaten essential programs and organizations, particularly the World Health Organization. While private foundations like Gates Foundation and the Wellcome Trust have signaled their inability to fully bridge these financial gaps, cuts from sovereign donors allows these foundations to increase their share of global health funding – and their influence. This shift demands scrutiny.
Our recent research article examines the Gates Foundation’s strategic efforts to extend its political presence in Europe. We found that the Foundation has forged strong ties with governments entities, public administrations and many organizations involved in global health and development. This results in a concentration of power in the hands of a private foundation, raising pressing normative questions about foundations’ influence on public policy. This blog summarizes our findings and considers their broader implications.
Building an international bureaucratic infrastructure
The Gates Foundation, headquartered in Seattle, has established a substantial bureaucracy with over 2000 staff globally, including offices in London and in Berlin. Much like embassies, the Foundation’s regional offices aim to build relationships with governments, local partners, and provide policy intelligence “from the ground,” reporting to the Foundation’s global policy and advocacy division in Seattle.
Engaging with government officials
A key aspect of the Foundation's strategy is fostering consistent interactions with elected officials and state bureaucracies. Over the past decade, this has involved an average of ten meetings annually with UK ministers and secretary of states, and nearly 100 meetings with the European Commission. Bill Gates has met with every sitting French president over the past 25 years. Beyond these high-level meetings, Foundation staff frequently engage with bureaucrats on a regular basis, sometimes establishing Memoranda of Understanding to collaborate on shared interests.
Funding advocacy and influencing policy
The Gates Foundation extends its impact beyond direct government engagement by funding an extensive network of stakeholders involved in global health and development. From 2007 to 2024, it allocated over $400 million in “policy and advocacy grants” to a wide range of NGOs, media outlets, think tanks, and universities. These funds are aimed at developing policy proposals, shaping public opinion, and advocating for policies and initiatives aligned with the Gates Foundation’s priorities.
Several NGOs, like Save the Children (UK), DSW (Germany), and Focus 2030 (France), have emerged as preferred advocacy partners, working closely with other Gates-funded global advocacy organizations such as the One Campaign and Global Citizen.
The implications of network diplomacy
Our research shows that the Gates Foundation’s engagement in Europe represents a form of “network diplomacy”, where powerful actors utilize various nodes of their networks to achieve policy goals. By funding entire policy ecosystems, the Foundation wields unprecedented influence over the policy landscape.
This concentration of power in the hands of a private actor raises important normative questions. Should a private foreign actor cultivate close diplomatic ties with governments in other jurisdictions while concurrently working with other stakeholders to steer policy? Are existing regulations adequate for ensuring transparency and accountability in these interactions? Is there still space for alternative policy proposals if entire ecosystems are aligned with the “Gates approach” to solving the world’s problems? Moreover, if everyone becomes a partner of the Foundation, who remains to hold the Gates Foundation accountable?
Towards a philanthropy-led global health?
European countries slashing their ODA budgets is bad news for the Gates Foundation, which relies on leveraging these funds to advance its objectives. Ironically, these cuts may solidify alignment between the Foundation and European countries, potentially ensuring continued funding for the Foundation’s key initiatives like Gavi and the Global Fund, while sidelining support for programs aimed at structural and health systems interventions.
Philanthropic foundations, particularly the Gates Foundation, will likely play an increasingly crucial role in future global health efforts. The Gates Foundation announced the opening of a new regional office in Singapore “to access the science and to partner with the philanthropic community”. Furthermore, a consortium of philanthropic organizations just launched a new fund to combat maternal and newborn mortality in sub-Saharan countries, independent of sovereign donors. After the era of public-private partnerships dominating global health governance, we may be heading towards a philanthropy-led global health, which raises important issues regarding the role of private power over global public health.
Antoine de Bengy Puyvallée & Katerini Storeng (University of Oslo), based on an article co-authored with Simon Rushton (University of Sheffield)
This blog post was first published on the International Health Policies Network blog.
About the authors
Antoine de Bengy Puyvallée is a Postdoctoral researcher at the University of Oslo’s Centre for Global Sustainability. His research focuses on global health governance, pandemic preparedness and response, and new forms of public-private cooperation. His phd thesis explored how global health partnerships like Gavi, the Vaccine Alliance, have become powerful organizations, and what role they played during the covid-19 pandemic (especially through COVAX). He currently works on projects exploring Scandinavian countries' politics on pandemic vaccines and the role of private philanthropic foundations in global health and development. Antoine has been the coordinator the Independent Panel on Global Governance for Health since 2018 and contributed to the organization of its international conferences in 2018 (#UHCPolitics) and 2019 (#Tek4HealthEquity). He is co-ordinator for The Collective.
Professor Katerini T. Storeng is a medical anthropologist whose research focuses on the social and political dynamics of the global health, particularly the of global public-private partnerships for health. She leads the Global Health Politics research group at the Centre for Development and the Environment, University of Oslo. Katerini is Co-Director of The Collective for the Political Determinants of Health.
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