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    HealthBill Gates' influence on global health decisions: this is how the WHO is financed

    Bill Gates’ influence on global health decisions: this is how the WHO is financed

    Tedros Adhanom Ghebreyesus has been the Director General of the WHO since 2017. At the helm of this body, decisions on global health pass through his hands. However, not all decisions are entirely his and his hands are sometimes ‘tied’.

    The World Health Organization (WHO) is a specialized agency of the United Nations that was born in 1948 (its Constitution enters into force that year, on April 7: the date on which World Health Day is commemorated) with the objective of to achieve for all peoples the maximum degree of health and physical, mental and social well-being -understood not only as the absence of conditions or diseases-.

    Head of the agency in recent years, Ghebreyesus aspires to lead a “strong” WHO with which to “face new health challenges” throughout the world.

    “We need a WHO in line with the 21st century, which belongs to everyone equally. We need a WHO managed effectively, with adequate resources and results-oriented, devoting special attention to transparency, responsibility and optimization of resources”, he states in his vision.

    How the WHO is financed: where they come from and how the resources are allocated

    Achieving those goals depends on how much money the agency has and what it can do with it. And on many occasions you cannot do what you want.

    This is influenced by the way in which the WHO is financed, through 2 main sources: Assessed contributions from Member States (i.e. the membership fees of countries, based on a percentage of GDP agreed by the General Assembly of the United Nations) and voluntary contributions from these States and from other partners (including other United Nations and intergovernmental organizations, philanthropic foundations, the private sector and other sources).

    The former represent less than 20% of the total budget, according to the WHO itself. The rest, more than 80%, comes through voluntary contributions.

    It hasn’t always been like this: in the 70s and 80s it was the other way aroundas Ghebreyesus recalls and laments in a 2020 video. In this he spoke of the development of a strategic plan with 2 objectives: “increase funding and improve the quality of financing”.

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    Although the WHO shows its appreciation to all donors, it also leaves signs that not all donations are created equal. Volunteers are further classified according to the degree of flexibility that WHO has in deciding how to spend these funds:

    • The flexible, or completely unconditional (WHO has full discretion on how these funds should be used to finance its work) represent 4.1% of all voluntary contributions. According to data from the organization for 2020-2021, the United Kingdom is the largest contributor in this regard, with some 135 million dollars (126 million euros, at current exchange rates), while Spain ranks 11th, with 4.5 million (4.2 million euros).
    • The money for commitments thematic and strategic (partially flexible) they offer “some degree of flexibility in their allocation” and provide “more effective and efficient earmarked funding.” They represent the 7.9% of all voluntary contributions (in 2020-2021).
    • voluntary contributions specific they find each other “strictly intended” to specific program areas or geographic locations; In addition, they must be spent within a certain period. They represent 88% of all voluntary contributions: 9 out of 10 euros in this section.

    The WHO states on its website that it is “extremely grateful to all donors”, but suggests which are their ‘favorites’: “In particular those that provide flexible financing and funding for thematic and strategic commitments, as this allows WHO to be agile and strategic in its efforts to achieve the goals.”

    “Thus, WHO calls for increased flexible funding arrangements. WHO Member States are currently engaged in an active discussion to find ways to improve WHO funding and ensure it is flexible, predictable and sustainable,” she adds.

    The influence of Bill Gates and other billionaire philanthropists in the WHO: “He who pays is in charge”

    What does all this have to do with Bill Gates? A lot. A good part of those voluntary contributions not as flexible as the WHO would like come through the philanthropic donations of billionaires like him.

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    Specific, the Bill and Melinda Gates Foundation — co-chaired by the Microsoft founder and recently divorced Melinda French — is second largest donor to WHO (They have already held that position in 2018-2019 and in 2020-2021).

    It alone is responsible for more than 88% of the total amount donated by philanthropic foundations to the global health agency, well ahead of others such as the Bloomberg Family Foundation (3.5%), the Wellcome Trust (1, 1%) and the Rockefeller Foundation (0.8%), points euronews.

    This is how Bill Gates decides where to invest his money

    “Currently, the WHO only controls a quarter of its budget”hence “cannot set the global health agenda and has had to do the bidding of wealthy donorsnot only from the rich nations of Europe and North America, but also from wealthy philanthropists like the Gates Foundation,” Lawrence Gostin, director of the WHO Collaborating Center on National and Global Health Law, warns this outlet.

    Gostin draws attention to the difference in size between the WHO budget (less than that of a large US teaching hospital and a quarter of the budget of the country’s Centers for Disease Control and Prevention, or CDC, he compares). and its objectives (to protect global health).

    For her part, Kelley Lee, professor of public health at Simon Fraser University (Canada) and author of a book on the WHO, points to “a chronic resource deficit” that “significantly worsened” when member states froze their contributions in the 1980s and 1990s, in statements collected by euronews.

    A situation that led the WHO to be cutting staff and activities on the eve of the COVID-19 pandemic, declared in March 2020 and after which it had to appeal to the world community to obtain the necessary resources to fight this . “It’s like building a fire station when a fire breaks out,” she compares.

    “The Gates Foundation has been enormously important in advancing global health in many areas” and its donations are “greatly appreciated,” but they compromise the independence of the WHO, Lee explains.

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    “There are also important questions to raise about good governance, such as accountability, representativeness and legitimacy of for a single foundation to be so influential. The current system is frankly undemocratic,” he countered.

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    The enormous funding of the Bill and Melinda Gates Foundation “dwarfs most governments and other donors, giving it a much stronger voice in many key global health circles, including the WHO,” notes Lee, who summarized with a saying: “He who pays, rules”.

    Gostin, from within the WHO, expresses himself along the same lines: he qualifies that of course he wants these funds to continue flowing, but he defends that the organization should be able to use them “at its own discretion in the matters that the director general considers most important in the world”, collects euronews.

    The Bill and Melinda Gates Foundation enters the debate: “It is not correct”

    This situation has led the Bill and Melinda Gates Foundation to receive criticism for its power and influence in the WHO and in the field of global health, reports Reuterswhich collects that the foundation will spend the highest annual budget in its history (8,300 million dollars, or more than 7,700 million euros) this year.

    This has been announced by its general director, Mark Suzman, in his annual letter on January 17, in which he responds to criticism.

    “It is not right for a private philanthropic organization to be a major funder of multinational global health efforts”accepts Suzman, who points out that countries should lead this effort: “I would love to see many more governments pass us on that list, because that would mean more lives saved.”

    “But make no mistake: when there is a solution that can improve livelihoods and save lives, we will fight for it with perseverance. We will not stop using our influence, along with our monetary commitments, to find solutions.”maintains the general director of the Melinda French and Bill Gates foundation, collects Reuters.


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