A new paper argues the World Health Organization (WHO) has become too reliant on voluntary contributions from external groups and will be unable to achieve its strategic aims without changes to the way it's financed.
The report, published this week in BMJ Global Health, focuses on funding that the WHO has received from the Gates Foundation, which in recent years has become the WHO's second largest source of funding behind the US government, contributing 9.5% of the WHO's revenues from 2010 through 2023. Unlike funds that come from WHO member states, the money from the foundation must be used on activities and projects defined by the donor.
Using data obtained from the Gates Foundation website on more than 36,000 individual grants, researchers from Queen Mary University of London show that, from 2000 to 2024, the foundation made 640 grants worth $5.5 billion to the WHO, a total that represents more than 6% of the money disbursed by the foundation over the period. Of that amount, $4.5 billion was earmarked for infectious diseases, with polio and vaccine-related projects the primary recipients.
While the funding is critical for the WHO, especially with the United States planning to withdraw from the organization in 2026, the authors of the paper argue that the strings attached to the money undermine the WHO's independence and its ability to address other pressing global health challenges. And they say the problem ultimately stems from member states' inability to provide the type of sustainable funding WHO leadership has long been calling for.
"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," they wrote.
Reliance on earmarked voluntary contributions
One of the issues, according to the analysis, is that the amount of money available to the WHO—$6.8 billion for the 2024-25 budget cycle—is "simply inadequate" to achieve its three main priorities, which include "ensuring healthy lives and well-being for all at all ages," "achieving universal health coverage," and "addressing health emergencies and promoting healthier populations."
But the other problem is the way the organization is funded. The two primary budget sources for the WHO are assessed contributions from member states (calculated according to a country's wealth and population) and voluntary contributions or extra-budgetary funding from member states and non-state organizations. While assessed contributions from member states accounted for 75% of WHO revenues in the early 1970s, voluntary contributions became the main source of funding in the 1990s and now account for 90% of WHO revenues. And roughly 90% of these contributions are earmarked.
"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," the authors wrote. "Consequently, activities and areas that donors favour receive more resources than are required. while those they are not interested in do not get enough."
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.
For the Gates Foundation, which has issued more than $83 billion in grants since its founding in 2000, one of its favored activities has been polio eradication.
"Polio eradication is a top priority for our foundation," the foundation says on its website. "We have a unique ability to contribute to the fight against polio by taking big risks and making nontraditional investments."
According to the analysis, almost 60% of the money the Gates Foundation gave to the WHO from 2000 through 2024 ($3.2 billion) was spent on polio eradication projects and programs. In 2022 and 2023, the foundation accounted for 56.5% of WHO's funding for polio eradication efforts.
The study authors argue that although eradicating polio would be a remarkable achievement, there are several other infectious diseases that have a much larger effect on global health than polio, including malaria and HIV. While the Gates Foundation also gave the WHO money to address those issues over the study period ($296.9 million for mosquito-borne diseases [mostly malaria] and $240.2 million for sexually transmitted infections [mostly HIV]), those amounts are far less than what it gave for polio.
The analysis also found that a comparatively small amount of funding went to non-communicable diseases, with $58.5 million directed to grants focused on cervical cancer (concentrating primarily on HPV and the development of vaccines), $51.8 million spent on issues related to smoking, and $70.7 million focused on nutrition. Less than 1% of Gates Foundation grants to the WHO were aimed at strengthening healthcare systems.
The authors argue the Gates Foundation's approach to global health and WHO funding is too concentrated on addressing infectious diseases through vaccine development and delivery and not enough on programs to address non-communicable diseases, which account for 74% of global deaths.
"The foundation's emphasis on using vaccines to tackle infectious diseases means that it overlooks some major global health challenges that are of strategic importance to WHO," they wrote. "When other funders are willing to fund these—as with health systems strengthening—this is not a problem. But when neither BMGF nor other major voluntary donors give much money to an issue, it creates a 'pocket of poverty' in WHO's budget."
WHO lauds 'long-standing collaboration' with Gates Foundation
The funding issues faced by the WHO, and its reliance on external groups like the Gates Foundation, will undoubtedly be exacerbated by the US withdrawal, which was announced in an executive order on January 20. The 1-year withdrawal process is set to be completed on January 22, 2026.
Since the WHO's founding in 1948, the United States has been a principal funder of the organization and has had significant say in its agenda. According to KFF, US contributions to the WHO have ranged from $163 million to $816 million annually over the past decade. The US withdrawal likely played a significant role in the WHO's decision to cut its 2026-27 budget from $5.3 billion to $4.2 billion.
This collaboration to protect people from multiple threats to health, including polio, malaria and neglected tropical diseases, has saved millions of lives and is providing hope for generations of people across the world.
The WHO had been working to shore up its finances even before recent events. In 2022, members states agreed to gradually increase their assessed contributions to represent 50% of the organization's core budget by the 2030-31 budget cycle, up from 16% in the 2020-21 cycle. The organization is also looking to expand its donor base and launched its first investment round in 2024, with the aim of raising $7 billion to support operations through 2028.
In an email response to a query from CIDRAP News, the WHO said it's grateful for the support of all its partners and "greatly appreciates its long-standing collaboration with the Gates Foundation, which has helped protect and promote the health of people around the world, especially in many of the poorest nations on the planet."
"This collaboration to protect people from multiple threats to health, including polio, malaria and neglected tropical diseases, has saved millions of lives and is providing hope for generations of people across the world," the WHO said. "At the same time, the partnership between WHO and the Gates Foundation has also focused on the importance of strengthening health systems at large, recognizing the work done to boost capacities in one area of health can also be beneficial to others."
A Gates Foundation spokesperson said the foundation believes it's the primary responsibility of governments to fund and lead the WHO.
"Philanthropy can make an important but limited contribution, and we’re glad to do our part," the spokesperson said. "Our funding to WHO represents a small share of WHO’s overall funding, and we hope that, over time, our share becomes even smaller as governments fully fund and equip WHO to tackle pressing global health challenges."
Editor's note: This story was updated on October 30 at 1:35pm with a statement from the Gates Foundation.
