The WHO has a worrisome reliance on the Bill & Melinda Gates Foundation

People pose with syringe with needle in front of displayed World Health Organization (WHO) logo, in this illustration taken December 11, 2021. REUTERS/Dado Ruvic/Illustration
People pose with syringe with needle in front of displayed World Health Organization (WHO) logo, in this illustration taken December 11, 2021. REUTERS/Dado Ruvic/Illustration
Image: Reuters/Dado Ruvic
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The importance of the World Health Organization (WHO) has arguably never been so evident. But despite the essential role it continues to play in trying to promote and coordinate the global response to covid-19, the WHO continues to struggle to have reliable financial backing.

The organization, the UN agency dedicated to public health, is still struggling to get its194 member states to support an important change in its financing structure, economist Mariana Mazzuccato and global health professor Ilona Kickbush write in a recent article. The change, first proposed in 2016, would increase the regular fees states provide to the organization annually, as opposed to ad-hoc contributions that can change according to the country’s will.

Since it comes as fixed funding approved every two years, this money is consistent and easier to plan for, and increasing it would give the WHO the opportunity to plan better and spend less time trying to get individual projects off the ground. Regular funding, now 16% of the WHO’s, would increase to 50% of its budget.

But the change would also have another important effect: It would reduce the impact private philanthropies—notably, the Bill & Melinda Gates Foundation—on the overall budget. The Gates Foundation is the second-largest contributor to the WHO. As of September 2021, it had invested investing nearly $780 million in its programs this year. Germany, the biggest contributor, had contributed more than $1.2 billion, while the US donated $730 million.

The problem with private funding

Assessed contributions used to be the WHO’s main source of funding until the 1990s. Since then, the overall budget increased significantly, allowing the WHO to undertake more ambitious projects. But this increase was all based on voluntary donations, which became the predominant source of funding for the organization.

Regular fees have remained essentially unchanged in the past decades, so while the agency has had a larger budget it hasn’t been able to count on its stability. Donations can change by a lot, as it happened in 2020, when Donald Trump’s US administration cut its WHO budget, taking away more than$400 million.

The declining relevance of regular fees had another consequence, as it opened the way for private philanthropies to have an even larger impact.

For an intergovernmental organization such as the WHO to be so reliant on private philanthropy—especially one whose leaders have personal interests and investments in healthcare—is problematic. For one, it gives a non-government actor an outsized influence on the development and health priorities carried on by the international organization. While private foundations can be very generous, they also can be even faster than governments to change their mind about donations, or more dogged in demanding that their funding is used for specific priorities over others.

Private foundations’ resources tend to be more dependent on the stock market and other investments and could have financial interests that run contrary to their stated missions. This has been the case for the Gates Foundations, which was once a big investor in fossil fuels, and is true of some of Bill Gates’ personal investments, which include farmland that sells its produce to fast food chains.

But at its core, the financing system delegates to a private organization the governments’ responsibility of providing healthcare for their own citizens as well as globally, which was a central tenet (pdf) in the WHO’s creation.

On its part, the Gates Foundation acknowledges that its financial role in the WHO’s work is essential because the organization is underfunded. It has frequently said national governments should step up their contributions.

Increasing assessed contributions would help make the WHO less dependent of private donations, and overall closer to its original mandate. While the change wouldn’t necessarily assure countries would be contributing more overall, it would lock in a higher base of contributions that the organization could rely on, making it less vulnerable to any pressures exerted by donors—both countries and private ones.