The Gates Foundation, global health and domination: a republican critique of transnational philanthropy

Abstract

The turn of the twenty-first century witnessed a revival of interest in the role of philanthropy in the international system, especially in the fields of global poverty and health. Yet, despite an emergent critical literature in development studies and international studies, philanthropy has barely featured in the debate on global distributive justice. This article uses the republican conception of domination as an analytical framework to precisely articulate concerns of justice raised by transnational philanthropy. Using the Bill and Melinda Gates Foundation and its role in global health as a test case, it argues that transnational philanthropy is characterized by an asymmetric distribution of power, which is sufficient to produce dependence, and that is uncontrolled insofar as its use either rests on the will of powerful agents or on terms of social cooperation beyond contestation. This arbitrary character is particularly relevant to philanthropy because of its use of epistemic power to produce and legitimize knowledge. In short, transnational philanthropy is dominating. If individuals have the right to exercise control over the social institutions that profoundly affect their basic interests, then philanthropy has a problem of justice that cannot be dismissed.

Decolonising global health research: Shifting power for transformative change

“…By virtue of their funding contributions, powerful states, their bilateral agencies, private foundations, and corporate actors, among others, shape the global health research agenda. Bilateral agencies tend to push foreign policy and other domestic interests [ 65 , 66 ], while corporate actors are driven by profit, and many private foundations by the creed that the private sector can more effectively tackle intractable global health problems [ 67 ]. Bilateral and multilateral agencies should be held accountable for what they fund with taxpayer contributions, while private funders—who are primarily accountable to their boards—must be appropriately regulated and prevented from having undue influence on the shaping of research priorities [ 68 , 69 ].…”

The biomedical securitization of global health

“…Contrary to what could be expected vis-à-vis a veritable global health challenge, the pandemic response has only in a limited manner enhanced non-medical, social-science-oriented health research, and rather marginalised or even weakened it [ 7 ]. Simultaneously, due to their sheer financial power, philanthropic foundations such as the Gates foundation have enormous influence on academic and research agendas, health care supply and public policies worldwide [ 74 ]. Their focus on output-based performance measures and innovation further drives the verticalization of biomedical approaches at the expense of integration, interdisciplinary cooperation and wider system approaches [ 75 , 76 ].…”

COVID-19 vaccine apartheid and the failure of global cooperation

“…Indeed, some analysts suggest that the prominent role of private actors is not new and comes from ‘the combination of governments gradual withdrawal from the realm of R&D and de-prioritization of immunisation, and pharmaceutical companies’ reluctance to innovate for populations of poor countries’ (Stevenson and Youde, 2021: 411; see also Youde, 2013). A ‘curious mixture of the private and the public’, philanthropic organisations are self-interested while being ‘shaped by public entities’ and acting for ‘their [own] conception of the public good’, which, combined with virtually unlimited funding, is problematic (Blunt, 2022: 2040; see also Harman, 2016). Private actors’ financial power and constant lobbying of state entities allows them to influence health policies, which results in a regulatory compromise that allows them to pursue both profits and public health goals (Harman, 2016; Montalban, 2011; Rivière, 2003).…”