On May 19 this year, U.S. President Donald Trump threatened to permanently cancel U.S. payments to the World Health Organization (WHO). One month earlier, Trump had already announced that the U.S. would not honour its biannual 500 million USD commitment. The next day, the Bill and Melinda Gates Foundation stated that they would donate an additional 150 million to the WHO, on top of a previous 100 million USD. The Gates’ largesse precedes COVID19. Since 2000, their foundation has granted almost four billion USD to the WHO to support a gigantic program against polio, and additional hundreds of millions for other programs on malaria, HIV, and maternal health, and the escalated use of technology in health. The Gates Foundation is a crucial contributor to the WHO, second only to the U.S.
Despite its pre-existing involvement with the WHO, the Gates Foundation’s statement surprised many. The public wondered how it could be possible for a private actor to replace the contribution of a state to an international organization. In reality, there is nothing to be surprised about. For at least a century, philanthropic foundations have funded international organizations involved in health issues, including fighting pandemics, or even conducted what we call today global health policy. Actually, the continuities are so fundamental that the foundations from the early twentieth and the early twenty-first century seem to choose to globally fund health policies for similar reasons. Because the arguments are similar, and the means they used comparable, the criticisms raised against philanthropic foundations generally and their health policies also remain remarkably stable. The similarities between the past and the present suggest that the criticisms are here to stay. Indeed, certain observers would venture that older and newer philanthropic foundations are built upon the same questionable bases: unequal income distribution and lack of transparency and accountability.