In the past two decades, global health governance has undergone a quiet revolution, shaped less by sovereign states and more by the growing influence of private capital. The World Health Organisation (WHO), once envisioned as the democratic engine of international public health, has increasingly come to rely on large-scale philanthropic foundations. This shift toward what is now commonly termed “philanthrocapitalism”—where billionaire-funded entities use business strategies and methods to tackle social and environmental challenges—has profound implications. It is not just a matter of money, but of power, accountability and legitimacy. Amid what many now describe as a global health financing emergency, the WHO’s growing dependence on a handful of wealthy private actors has exposed deep cracks in the system of multilateralism upon which it was founded. Thus, philanthrocapitalism is undermining democratic global health governance by concentrating power in the hands of the wealthy and eroding public accountability.
Philanthrocapitalism and WHO’s Financial Shift
When the WHO was established in 1948, its financing rested primarily on assessed contributions—mandatory payments from member states calculated by metrics such as GDP and population. These payments formed the backbone of its budget and enabled the organisation to pursue independent, needs-based global health priorities. But by the 1990s, austerity-driven reforms and dwindling political interest in global public goods led to a freeze—and in some cases, a rollback—of these core state contributions. Into this vacuum stepped philanthropic foundations, corporate-linked charities and other non-state actors, who began offering voluntary contributions. Today, these voluntary funds make up over 80% of WHO’s budget. The vast majority are earmarked—meaning that donors, not WHO, decide how and where the money is spent.
This is where the logic of philanthrocapitalism takes hold. According to the WHO’s Programme Budget Portal for 2024–2025, the Gates Foundation is currently the largest donor, providing over $763 million or 13.16% of voluntary contributions to the WHO. The second largest contributor is another private actor, the GAVI Alliance which contributed $645 million or 11.61%. Notably, over 90% of the Gates Foundation’s donations were earmarked for specific diseases or technical programs, rather than the WHO’s core functions. In May 2025, the Novo Nordisk Foundation pledged $57.76 million to the WHO. Through its holding company Novo Holdings, the Denmark based Novo Nordisk Foundation owns Novo Nordisk, which made $42 billion in sales in 2024 from drugs like Ozempic and Wegovy, using the profits to fund scientific, social and humanitarian grants.
To regulate these interactions, the WHO adopted the Framework of Engagement with Non-State Actors (FENSA) in 2016. It was designed to establish guardrails for interactions with philanthropic and corporate entities. But FENSA has proven largely toothless. The framework has been inadequate for managing the vast power asymmetries between sovereign governments and mega-donors like Gates or the Rockefeller Foundation. In effect, it treats all “non-state actors” equally, even though only a handful control the majority of voluntary financing.
Funding Gaps and the Distortion of Global Health Priorities
This structural imbalance now sits at the heart of the WHO’s growing crisis. The WHO revealed it is falling nearly $1.9 billion short of the planned $4.2 billion budget for 2026–27, with an additional $600 million deficit projected through the end of 2025. These resources are needed to support essential global health functions such as disease surveillance, regulatory coordination and health system strengthening. At the same time, its earmarked programmes—targeting diseases like polio, malaria and COVID-19—are flush with resources. The result is a misaligned institution, overfunded for technical verticals and underfunded for horizontal public health priorities. This distortion is not an accident—it is a direct outcome of the political economy of philanthrocapitalism.
Philanthropic foundations, under the guise of neutrality and technical problem-solving, increasingly undermine democracy by using their wealth to shape development agendas, weaken public institutions, depoliticize structural issues like poverty and bypass democratic accountability—all while benefiting from tax privileges and promoting a corporate-driven vision of global change.
Philanthropic foundations tend to favour technical, vertical programs with measurable results—such as eradicating polio or developing a vaccine for a specific disease—over systemic, long-term investments like public health workforce training or community-based care. The Gates Foundation’s focus on malaria, polio and tuberculosis exemplifies this. GAVI’s funding model follows suit, focusing heavily on vaccine procurement and delivery while underemphasising the broader ecosystem of primary healthcare infrastructure.
The Political Risks of Philanthrocapitalist Dependency
Moreover, the ideologies embedded within philanthrocapitalist giving emphasise efficiency metrics and public-private partnerships—concepts borrowed from business strategy rather than social justice. Thus, philanthrocapitalism is entrenching a neoliberal development agenda by enabling elites to dominate and direct global policy priorities. GAVI, largely created and funded by Gates, has promoted a model of vaccine distribution that relies on corporate manufacturers and intellectual property protections. During the COVID-19 pandemic, GAVI co-led COVAX, a global vaccine-sharing initiative intended to ensure equitable distribution. Yet COVAX was criticised for failing to deliver on its promises, as high-income countries hoarded early vaccine stocks and patent waivers were fiercely resisted.
Beyond the structural distortions, there are real political risks. The rise of philanthrocapitalism and impact investing reflects a broader shift in development financing, where public aid is increasingly privatised and aligned with financial sector interests, allowing elites to reshape global development agendas under the guise of innovation and efficiency. As more governments retreat from public financing, the WHO becomes even more dependent on philanthropic largesse. This can become a vicious cycle. Governments, seeing the WHO’s needs met through private donors, feel less obligated to contribute themselves. But when philanthropic funding priorities shift—as they inevitably do—the WHO is left vulnerable. Its ability to respond to emerging crises, strengthen health systems or tackle neglected areas like mental health and climate-related diseases is hobbled.
Conclusion
None of this is to say that philanthropic contributions are inherently harmful. The generosity of donors like Gates, Wellcome and Bloomberg has undeniably saved lives and accelerated innovation. But the political consequences of allowing billionaire-backed foundations to shape the priorities of a multilateral public institution must be confronted honestly. These actors operate with minimal transparency, are not subject to democratic oversight and often mirror corporate values that are ill-suited to addressing the structural inequalities at the heart of global health.
Ultimately, the WHO’s crisis is not merely financial—it is a crisis of governance, of legitimacy and of global solidarity. Philanthrocapitalism may provide resources, but it cannot replace the foundational idea that global health is a public good, to be protected and promoted through democratic multilateralism. The more the WHO becomes a vehicle for donor-defined agendas, the more it drifts from the universal mission upon which it was founded.
Vivek N.D. is an adjunct faculty at the School of Legal Studies and Governance, Vidyashilp University, Bangalore. He holds a PhD in Political Science from the University of Hyderabad. His research focuses on global health governance and international relations.
Disclaimer: This story is auto-aggregated by a computer program and has not been created or edited by budgetbuddy.
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