WHO’s priorities shaped by its reliance on grants from donor organizations, study suggests

The World Health Organization’s (WHO’s) priorities are being skewed by its increasing reliance on donations from organizations such as the Gates Foundation (previously known as the Bill and Melinda Gates Foundation), which must be spent on specific health challenges favored by the donors, suggests a study published in the journal BMJ Global Health.

Between 2000 and 2024, more than half of the US $5.5 billion donated by the Gates Foundation to WHO was directed toward vaccine-related projects and polio, while relatively little funding was spent on other issues considered to be important by WHO.

The Gates Foundation has become WHO’s second biggest source of funding in recent years, contributing 9.5% of WHO’s revenues between 2010 and 2023. Its largest funder was the United States, but earlier this year the US announced it would withdraw from WHO from January 2026. Germany and the UK were third and fourth largest WHO funders, respectively.

Although it is widely assumed that the Gates Foundation’s financial power allows it to exert influence over WHO’s work program, little research has been undertaken to track exactly how its grants are spent.

To address this, the authors extracted data from the Gates Foundation website on all its grants to WHO between 2000 and 2024 to determine the number and value of grants, and the diseases, health issues and activities they funded.

Between 2000 and 2024, the Gates Foundation made 640 grants worth US $5.5 billion to WHO. In total, 6.4% of all grants made by the Gates Foundation during this period went to WHO.

More than 80% of the Gates Foundation’s grants to WHO (US $4.5 billion) were targeted at infectious diseases and almost 60% (US $3.2 billion) were spent on polio. More than half of the Foundation’s money (US $2.9 billion) was used to fund vaccine programs and related projects.

Relatively little funding from the Gates Foundation was directed towards non-communicable diseases, strengthening health systems, and broader determinants of health, despite their importance to WHO strategy and global health more generally.

Just US $11.8 million (0.2%) was spent on water and sanitation and US $37.4 million (0.7%) on health systems strengthening. Less than 1% of the Foundation’s funding went towards non-communicable diseases, despite them being responsible for 74% of global deaths with 77% of these deaths occurring in low- and middle-income countries.

WHO’s budget comes from two sources—assessed contributions from member states, calculated according to a country’s wealth and population, plus voluntary contributions or extra-budgetary funding from member states and non-state organizations. Around nine-tenths of the income comes from voluntary or extra-budgetary funding, and almost all of this money is “earmarked,” i.e. given on the condition that it funds activities and projects defined by the donor.

The way WHO is funded limits its ability to fulfill its strategic goals, the authors say.

“Assessed contributions from member states are nowhere near the level needed to fund its strategic priorities, so WHO must rely on earmarked voluntary contributions from donors,” they say. “Consequently, activities and areas that donors favor receive more resources than are required, while those they are not interested in do not get enough.”

And the situation could worsen if the United States—WHO’s largest donor—carries through with its threat, announced in January 2025, to withdraw from WHO.

While it is easy to blame major donors like the Gates Foundation for undermining WHO’s independence by pursuing its agenda through WHO, the authors say, “We should not, however, lose sight of the fact that it is the member states’ failure to increase assessed contributions in line with WHO’s needs over the last four decades that has created a situation in which the organization is forced to rely on voluntary contributions from donors.”

They add, “WHO has asked for more flexible and sustainable funding, warning that without fundamental changes to the way it is financed, it will be unable to achieve its strategic aims. If the member states continue to ignore these exhortations, then WHO will remain vulnerable to the influence of external donors and will struggle to address the full spectrum of contemporary global health challenges.”