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.