In February, the coronavirus outbreak began ravaging Italy. In a matter of days entire cities were quarantined in the north, and in those that weren’t the number of cases began to rise rapidly. Hospitals quickly became overwhelmed, and reports prepared people for the eventuality that doctors might run out of ventilators and be forced to decide which patients to try and save and which to let die.
People mobilized quickly to donate to hospitals, and as the emergency spread across the country, many crowdfunding campaigns cropped up, including on GoFundMe. The platform, which lets users raise and donate money for a range of causes, and which had an Italian presence prior to the emergency, now lists hundreds of campaigns related to the coronavirus—mostly aiming to raise at least tens of thousands of euros, and often much more.
Overwhelmingly, Italian campaigns aren’t launched to pay for medical expenses associated with the disease—Italy offers government-funded universal health coverage—but to support existing institutions fighting the epidemic. From Bergamo—the city worst-hit by the pandemic—to Milan, Rome, and the southern cities, where cases are still fewer than the north, people have started campaigns to buy more ventilators, protective gear, and other supplies for hospitals.
The most successful campaign so far was to raise money to open a new intensive care unit in Milan’s San Raffaele hospital. As of this writing, it has raised close to €4.5 million (almost $5 million), exceeding its goal and claiming a spot among the most highly-funded campaigns in the history of GoFundMe. No medical crowdfunding campaign has ever raised more in Italy.
The success of the San Raffaele campaign is an amazing feat of lightning-fast fundraising and evidence of social media’s ability to galvanize people in a crisis. At the same time, it is emblematic of many of the limitations and biases that inevitably determine the success of crowdfunding, and who benefits from it.
The San Raffaele campaign was launched on March 9, just as the situation in Italy began to show the traits of an unprecedented emergency. It was on that day that the Italian government announced a country-wide lockdown. The total number of deaths, still fewer than 500, was expected to rise (it is now close to 16,000), and people around the world looked on with shock as the first country went into complete lockdown.
Many people around the world saw what was happening in Italy as a sign of things to come and were inclined to help. And for many Italians, donating offered a sense of agency amid the lockdown. But that was just part of the equation. What truly made the campaign take off was something else: It was launched by world-renowned influencer Chiara Ferragni, and her husband Federico Lucia (aka Fedez), a successful Italian rapper. The couple, a social media powerhouse, started the campaign by donating the first €100,000 to it, and promoted it on their accounts, which have close to 40 million followers across various platforms.
Their ambitious goal of €4 million (about $4.3 million) was reached in a matter of days, and about a month after its launch, the campaign continues to trend and attract donations. More than 200,000 people have contributed sums ranging from €5 to €50,000, and the campaign has been shared on social media nearly 190,000 times.
The speed at which the funds started coming in helped make the effort effective for tackling the fast moving disease. Shortly after it was launched, San Raffaele hospital started building an additional emergency ICU. Ten days later, it was ready to be tested, and by March 23, only two weeks after the campaign had been launched, it was ready for patient intake (link in Italian). On March 30, a second additional ICU was opened, with 10 extra beds, still thanks to the donation.
Italian contractors and technicians worked nonstop to turn the indoor basketball court into an ICU, and beds, ventilators, and other supplies were also provided in record time as the numbers of cases in Milan continued to climb (as of April 5, more than 11,500 cases have been confirmed in the city). The feat was reminiscent of China’s own rapid construction efforts.
Milan’s San Raffaele is a research hospital associated with a prestigious university and home to a well-known staff of specialists. It is also private. (Patients who will need the San Raffaele ICU won’t need to worry about paying, as the cost of care will be covered by the government.1)
In an interview, Lucia said they chose a private hospital because its nimble structure allowed for work on a new ICU to start immediately, with more flexibility than public providers.
Public hospitals in Italy are free to receive donations in agreement with private donors for specific use, a spokesperson for the Ministry of Health told Quartz. Indeed, Lucia said that he and his wife had originally contacted the Sacco hospital, which is public, but were not able to get all the documents they required to launch the campaign right away.
But while private hospitals may be more nimble, their priorities may differ from those of the healthcare system at large. And the most important funding gaps are not always the ones that can be filled most quickly.
The campaign also shows how inequality replicates itself through crowdfunding: Without the celebrity support, other hospitals haven’t been able to raise quite as much. In Milan, the Humanitas Hospital group will benefit from more than €300,000 thanks to a campaign launched by former AC Milan player, Zlatan Ibrahimović, more than the public hospital that received the most donations so far: the Policlinico, which received €260,000.
Hospitals that don’t serve wealthy communities (Milan is the city with the highest per capita income in Italy) or operate in rural areas, are out of the sight of generous large companies and wealthier donors, and end up being left behind.
This is especially true in southern regions, where people tend to have less disposable income and local healthcare infrastructures are in more precarious condition. To face the emergency, Milan’s hospitals have been able to expand their capacity dramatically. Alongside the expanded San Raffaele ICU, the public hospital Policlinico added a whole new ICU, which with nearly 200 beds stands as Italy’s largest, and several other government hospitals expanded their ICU capacity thanks to private donations, mainly from large companies.
Although many campaigns have been launched to support the ICU of hospitals in the southern, poorer regions, only one—for Naples—is among the most funded on GoFundMe, having nearly reached its goal of €950,000. Conversely, several hospitals in many much smaller cities in the north (even in regions not as affected by the emergency yet), have been able to raise more significant donations, relative to the size of their population.
Two other issues come up frequently when it comes to crowdfunding campaigns: Transparency and accountability. To ensure funds are used appropriately, GoFundMe has a guarantee in place that will refund donations if they are found to be misused. People can report any campaign violations, and the organization will investigate, involving the authorities where needed.
The vastness of the offer makes it impossible to check all the campaigns, particularly once the funds have been transferred, which leaves the burden of signaling irregularities to the donors. According to GoFundMe, less than 0.1% of campaigns are actually found to be fraudulent.
A campaign like the one to fund San Raffaele reveals just how elusive accountability can be. People who donated to the San Raffaele campaign did so under the premise that “the funds raised will be directly donated to the hospital to strengthen intensive care.” More specifically, the campaign singles out the need to purchase “fans, non-invasive ventilation devices, hemodynamic monitoring devices, [and] monitors” for the hospital.
But it’s hard to track exactly how the hospital spends the money, and to check that, as promised to donors, it used the money to strengthen intensive care units, not to, say, pay salaries or purchase other supplies. The hospital isn’t required to provide a breakdown of how it used the funds or what it will do with any excess donations, should there be any.
Of course, in this case it’s hard to imagine donors would oppose any use of funds that can save lives. And donors probably largely trust both those who started the campaign and the institution that will get the donation.
But similar dynamics apply to campaigns with lower profiles, which might misrepresent or even take advantage of the situation. For example, a campaign that originated in the US to donate masks and other protective gear to San Raffaele includes a link to a video of the hospital’s new ICU—under construction to treat patients of Covid-19—as evidence that doctors there lack the equipment they need. In reality, the construction is evidence of the substantial funds it had just received. (Quartz contacted the author of the campaign, who said she sent the equipment to the hospital; as of publication San Raffaele had not confirmed receiving it.)
Finally, there is the problem of paying for the service. Donations to charity are typically free, and tax deductible in many countries (although, of course, charities have overhead costs). But GoFundMe, which hosts the campaign, is a private company, and its speed and efficiency come at a cost.
This campaign, like all other individual campaigns on the website, gives 100% of the funds raised to those who raised them, asking donors to leave a tip to help with the platform’s management.
While the tip is optional, the platform typically adds a default 10% at checkout, which donors can change or remove. In the context of this campaign, this eventually emerged as a violation of Italian regulations since the site advertises free donations, it cannot suggest a 10% tip. GoFundMe must now reduce the default to 0% for its Italian campaigns.
As of March 20, according to its CEO, GoFundMe has raised more than $40 million for 22,000 causes related to coronavirus. It is likely that by the end of the pandemic this number will be much higher. The company has also donated $1.5 million of its own money to causes addressing the coronavirus emergency. That’s a sign of how generous people are in a crisis, how lucrative the crowdfunding business can be, and how essential it’s become to healthcare worldwide.
(Chiara Ferragni and Federico Lucia didn’t reply to a request for comments for this story. San Raffaele hospital in Milan declined to comment.)