The modern World Health Organization (WHO) faces some immense challenges. Ebola may be what immediately comes to the mind, but response to emergencies and epidemics is by no means old work at this international organization. Rather, Laurie Garrett highlights for us five “existential challenges to global health.” Among these five, three are inextricably tied to financial and structural concern, a swift departure from the notion that Ebola, malaria, HIV/AIDS, and the like are the largest issues begging for WHO solutions. It is the opinion of this author that while it is quite productive to be critical of the implications of governance structure on the success of the organization’s mission, a large sum of the energy vested in that criticism could be better spent furthering the successes of the organization in question. In other words, fretting about the influence of a donor like the Bill and Melinda Gates Foundation on the WHO is not going to solve any of the organization’s immediate problems or even its existential challenges, especially when minimal alternatives have been provided.
To those like Garrett, the overwhelming size of contributions to the WHO on the part of the Bill and Melinda Gates Foundation (beginning at 1.2 billion in 1998), actually pose an existential threat to global health governance. In her words, “After its dramatic entrance, some that had traditionally played roles in global health withdrew or decreased their commitments, feeling the Gates Foundation was filling the space.” Now, it is not believed that proponents of an international institution often cite donors as not one, but two (the lack of sustainable finance in target countries as well as the excess of wealth in parties with less incentive to donate), causes of existential challenge to the institutions very existence, but that seems to be the case with Garrett and the WHO.
Her logic is not totally unsound, of course (her opinion is far more expert than mine). In a collective action problem like funding the WHO, where all parties benefit from its work, once a privileged provider is able to “take the lead,” many other actors face an incentive to not contribute in any meaningful way, thinking, “ah, x actor will take care of it.” We certainly have seen this happen with the U.S. throughout the duration of our coursework. However, Garrett fails to recognize that while the Bill and Melinda Gates Foundation has the substantial capacity of a privileged provider, the group lacks an overwhelming interest in funding the WHO. Even with all of the incentives one might be able to enumerate as to why the Foundation cares to invest so much in the organization, there is a noteworthy undercurrent of altruism to the situation.
Along the same lines: Does the size of the contributions give the Bill and Melinda Gates Foundation a great deal of influence at the WHO? Yes. That having been said, we must ask ourselves if it is their influence hindering further progress. Polio inches closer and closer to extinction under the WHO. Child death rates have plummeted. “More of humanity is living into its seventh and eight decades.” These are only a few of the incredible improvements in global health since the WHO’s inception. This is not to say that the organization is without its problems. Garrett is correct when she asserts that food distribution and global warming are actual threats to the success of the WHO. However, the idea that other, wealthier actors are justified in their negligence of WHO funding—just because the Bill and Melinda Gates Foundation and the United States seem to be, numerically at least, tackling the big problems—is unacceptable. It is the hope of this author that more and more people see it make little sense to begrudge the WHO for succeeding where many other international institutions have not—funding. And as WHO resources spread thinner and thinner to fight the aforementioned challenges, perhaps the incentive for all members to contribute even further will enter the minds of those actors with both overwhelming capacity and interest in consistent global health.
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I agree with the author’s point that too much effort may be spent on fretting about the increasing influence of major donors to the WHO. Too often, we may question their intentions while completely ignoring the positive effects they have brought about. However, I am concerned over attributing donor contribution as pure altruism and saying that donors have no vested interest in funding the WHO activities. The more the Bill and Melinda Gates Foundation increases funding to the WHO, the more dependent the organization becomes. As it increases its shares within the WHO, the foundation would be accountable to only itself and in effect we would have created a situation where there are high incentives to cheat. While not belittling the benefits the world has reaped from such favorable donations, caution should be maintained on what kind of institution is being created as a result.
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As Anthony points out in this post, the threat–for the most part–isn’t the Bill and Melinda Gates Foundation (BMGF). They are the second largest voluntary donor to the WHO, and with voluntary funding providing between seventy-five and eighty percent of the WHO budget, that is a necessary contribution. However, there is one concern that does come up regarding BMGF donation, as well as broader voluntary funding as a whole. Much of this funding comes attached to earmarks, which specify where the money can be used and what projects it must be spent on. Because the donations do not match up with the need, the system–and the WHO in particular–faces widespread allocative inefficiency, as the supply in various areas does not meet the demand.
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