The Two Washington’s Dilemma

In recent years, funding for international health governance has gone up along with the number of private enterprises that are now devoted solely to the prevention and curing of the world’s most common deceases.However, as funding has gone up it has become clear that there are two powerhouses that have the most control and sway over where funding is going to go. The two Washington’s dilemma is a phenomenon in which the two largest providers of funds for both private and public health organizations are the Gates Foundation (Based in Seattle, Washington) and the US government (Based in Washington, DC). While global health governance funding is currently sitting at around $20bn, it has gone down in recent years (in particular because of the financial meltdown of 2008) from an all-time high of around $26bn. While the globe as a whole is contributing to the global health governance institutions (such as the WHO, etc.) the largest donor to the current global health governance architecture is the US (by anoverwhelmingly large amount). This possess a large problem, because as the US starts to reduce spending (not just on foreign aid but across the board) for the upcoming fiscal years, there is little to no preparation in place (from BRICK or EU countries) to offset the loss in funds from the US’s austerity measures. On the other hand, (in the private sector) the Gates foundation, while well guided and well meaning, has an extremely large influential and financial power over other private institutions. As Laurie Garrett points out in his review for the “Existential Challenges to Global Health” many institutions “that had traditionally played roles in global health withdrew or decreased their commitments, feeling the Gates Foundation was filling the space.” This meant that the Gates foundation had a larger stake and more influence on which issues would be tackled and as Garrett also points out, “creating a danger that certain issues will be left out of the fray.” While the Two Washington’s Dilemma can be tackled and dealt with, it must be said that it will take a lot of time and effort to create institutions and to push governments (especially those of China, India and the EU) to put more funds into global health governance. If we are able to successfully push the governments and create the institutions to offset the power currently controlled by the two Washington’s it would make sure that if one of these institutions were to fail it would not completely cripple the global health climate.


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