The Gates Foundation has a huge impact on global healthcare, but is it too influential for comfort?

It can be difficult to fathom the extent of the Gates Foundation’s influence around the world, especially in global health and development. The pandemic provided a glimpse into how deeply embedded the foundation is in public health networks and research efforts that most people assume are the preserve of a few big, multilateral organisations like the WHO and the United Nations.

But because of the billions of dollars it has given away, the Gates Foundation often shows up alongside countries on lists of donors to these types of entities. In a 2018 study, the Brookings Institution found that the foundation was the seventeenth largest donor to 53 multilateral organisations. It was the only private actor; the rest were all countries.

The foundation’s annual budget alone is $8.3 billion, about the same as the annual gross domestic product of Monaco, or the 2023 net worth of Marc Benioff, the cofounder of technology giant Salesforce, philanthropist, and owner of Time magazine. That kind of money has given the foundation incredible heft and prominence, especially with the two co-chairs being such forceful and visible advocates of their work. Since the Buffett money started coming in, the foundation has given money to an ever-growing pool of nonprofits, universities,...

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