However, from the Eighties onwards, things started to change. Until then, the organisation had relied on the contributions of its member states for its regular budget. In 1982, however, the World Health Assembly, the WHO’s decision-making body, voted to freeze its budget — under pressure from the Reagan administration, which saw the WHO as a socialist-leaning, unaccountable organisation working against American interests. This was followed by the 1985 decision by the United States to withhold its contribution, in part as a protest against its “Essential Drug Program”, which encouraged developing countries to develop their own capacities to produce essential medicines, rather than rely on Western drug companies — small wonder leading US-based pharmaceutical companies were averse.
As a result, the organisation was forced to rely increasingly on extrabudgetary funds provided by “stakeholders”: not only governments and bilateral and multilateral agencies (such as the World Bank), but private and corporate donors as well, includingpharmaceutical giants such as GlaxoSmithKline and Novartis. Over the years, among the private extrabudgetary donors, the Bill & Melinda Gates Foundation rose above the rest: by the 2010s, it had become the WHO’s second-largest donor, accounting for around 10% of all funds.
Since voluntary contributions are earmarked, the donors largely get to call the shots on the use of the funds they contribute, as Margaret Chan, the WHO’s former Director-General, complained a few years back. This has led to the proliferation of public-private programmes more or less independent of the rest of the WHO’s programmes and decision-making structure, such as the Children’s Vaccine Initiative…
The priorities of WHO have evolved accordingly, moving away from community-centred care to a more vertical, commodity-based approach”, writes David Bell, a public health physician and former WHO staffer specialising in epidemic policy. “This inevitably follows the interests and self-interests of these funders.” In place of the preventative and “holistic” approach to health initially championed by the WHO, which viewed health as the outcome of a wide range of economic, social and political factors, a new paradigm has slowly emerged: a commercialised approach to health, single-mindedly focused on high-tech, largely vaccine-based solutions, with a particular interest for genetically engineered biotechnologies — an emerging industry potentially worth billions of dollars.
A crucial role in this shift was played by Bill Gates. As the WHO’s second-largest funder, Gates exercises a massive influence over the organisation, as even admirers of the foundation admit. And he has used that influence to promote vaccine-driven responses to matters of global health — through the WHO as well as through related public-private partnerships such as GAVI (Vaccine Alliance) and CEPI, also funded by Gates. In 2011, Gates spoke at the WHO, and declared: “All 193 member states [must] make vaccines a central focus of their health systems”. The following year, the World Health Assembly adopted a “Global Vaccine Plan” that the Gates Foundation co-authored, and over half of the WHO’s total budget now goes to vaccines.
His obsession with vaccines really shouldn’t come as a surprise. The Gates Foundation is strongly connected to the pharmaceutical industry, and ever since its creation, it has owned stakes in several drug companies. The foundation’s website even candidly declares a mission to pursue “mutually beneficial opportunities” with vaccine manufacturers. This is the essence of what has been called philanthrocapitalism — “a capitalist, market-based, for-profit approach to solving the world’s biggest and most pressing issues”. This kind of corporate-driven approach exemplifies the conflicts of interest inherent in the WHO’s dependence on unaccountable private donors such as the Gates Foundation.