The World Health Organization’s (WHO) growing reliance on donor funding, particularly from the Gates Foundation, is influencing its priorities and shaping how its resources are allocated, according to a new study published in BMJ Global Health. The research found that much of the funding received must be used for specific health challenges favoured by donors, potentially limiting WHO’s ability to address a broader range of global health issues.
Between 2000 and 2024, the Gates Foundation donated approximately US$5.5 billion to WHO, with over half of this amount directed toward vaccines and polio eradication. Despite WHO’s emphasis on a wide spectrum of health concerns, relatively little of this funding went toward other critical areas, such as non-communicable diseases, health systems strengthening, and sanitation.
The Gates Foundation has emerged as WHO’s second-largest donor, contributing nearly 10% of its revenue from 2010 to 2023, following the United States, which recently announced plans to withdraw from WHO by 2026. Germany and the United Kingdom follow as major contributors. The study highlights that while the Gates Foundation’s influence over WHO’s agenda has long been assumed, detailed analysis of its funding patterns was limited until now.
Findings show that 80% of the Gates Foundation’s grants to WHO targeted infectious diseases, with 60% spent on polio and nearly 53% on vaccine-related programmes. In contrast, areas such as non-communicable diseases received less than 1% of total funding, even though they account for 74% of global deaths, predominantly in low- and middle-income countries. Only US$11.8 million was directed toward water and sanitation initiatives, and US$37.4 million toward strengthening health systems.
The study also underscores how WHO’s dependence on voluntary and earmarked contributions—making up nearly 90% of its budget—limits its independence and flexibility. Since these funds are tied to donor priorities, WHO struggles to allocate resources in line with its strategic goals. The authors argue that the failure of member states to increase assessed contributions over the past four decades has left the organization vulnerable to donor influence.
They conclude that without reforming WHO’s funding model to ensure more flexible and sustainable financing, the agency’s ability to meet its strategic objectives will remain constrained. As member states continue to rely on donor-driven funding, WHO’s independence and capacity to address the full range of global health challenges risk being further compromised.
