The WHO's legitimacy is under siege as the opaque practices and potential conflicts of interest within the WHO Foundation risk compromising the organization's impartiality and autonomy amidst growing corporate influence.

The World Health Organization plays a vital role in shaping global health policies and coordinating responses to public health crises. However, the organization's reliance on voluntary donations, particularly from private sector entities and philanthropic organizations, has raised alarming concerns about undue influence and conflicts of interest. The establishment of the WHO Foundation in 2020, aimed at mobilizing additional resources to support the WHO's mission, has further exacerbated these concerns. As the Foundation's practices deviate from its stated governance model, the WHO's independence and credibility are at risk, jeopardizing the trust placed in this global health authority. The incorporation of the WHO Foundation in Switzerland, a country known for its robust privacy laws, further underscores the lack of transparency surrounding the Foundation's operations. Moreover, as non-democratically elected international governmental bodies, the WHO and the WHO Foundation have the power to preempt the sovereignty of individual nations and the constitutions that protect their citizens, raising serious questions about accountability and the potential for abuse of power.

The Rise of "Dark Money" in Global Health

The influx of private funding into the WHO Foundation has brought to light the troubling influence of "dark money" in global health policy. The Foundation's donor list includes controversial multinational companies and pharmaceutical giants, whose interests may not align with the WHO's mission of promoting public health.

• Multinational companies like Nestlé have made substantial donations to the WHO Foundation, despite their non-compliance with international health guidelines.
• Pharmaceutical giants, including Roche, Johnson & Johnson, Sanofi, and Merck, have contributed to the WHO, raising questions about potential conflicts of interest.
• Nearly 40% of the money raised by the WHO Foundation in its first two years came from anonymous sources, with $26 million out of $66 million total donations coming from undisclosed donors.

The growing influence of philanthropic foundations in global health policy is another cause for concern. While their contributions have undoubtedly supported important initiatives, their outsized influence may skew priorities and divert attention from addressing the root causes of health inequities.

• The Gates Foundation and Gavi, the Vaccine Alliance, are among the top funders of the WHO, with the Gates Foundation alone contributing over $2 billion since 2000.
• Critics argue that the Gates Foundation's emphasis on technological solutions may divert attention and resources away from addressing structural determinants of health.
• The bulk of the WHO's funding comes from voluntary donations from member states, UN bodies, and private philanthropic organizations, which are often short-term and earmarked for specific projects, potentially impeding strategic planning and leading to inflexibility.

Eroding Transparency and Accountability

The WHO Foundation's lack of transparency and accountability is a grave concern, as it undermines public trust in the WHO and its ability to make unbiased decisions in the interest of global health. The Foundation's deviations from its governance model and the absence of clear conflict of interest policies leave the door open for undue influence from private interests.

1. Deviations from the WHO Foundation's Governance Model

• The Foundation's due diligence and transparency practices have been altered, making it easier to engage with industries posing reputational risks to the WHO.
• Donor anonymity has been granted, contrasting claims that it would only be allowed in exceptional circumstances.
• The WHO Foundation is accepting donations in the apparent absence of an agreed conflict of interest policy or standard operating procedures regarding the suitability of donors.
• The WHO Foundation's Gift Acceptance Policy lacks transparency, hindering public scrutiny of donations.

2. The Risks of Earmarked Funding

• The WHO Foundation has been vague about how funds, including $20 million in anonymous donations, are being distributed.
• Over 50% of the Foundation's donations are earmarked by donors, potentially dictating the WHO's priorities and leading to the neglect of crucial health topics.
• Earmarked donations from corporate partners are welcomed, but it's unclear how conflicts of interest are assessed or how their impact is measured.

3. Self-Dealing and Conflicts of Interest

• Self-dealing rules generally prohibit transactions between foundations and their board members, foundation managers, and certain family members, regardless of fairness or advantage to the foundations.
• Thomas Zeltner, who was Chairman of the WHO Executive Board, is now the founder and Chairman of the Board of Directors of the WHO Foundation, raising concerns about self-dealing.
• Conflict-of-interest policies should cover situations where there is even an appearance of conflict to maintain objectivity, reputation, and avoid liability.

Depoliticizing Corporate Influence

The WHO Foundation's structure and operations raise concerns about the depoliticization of corporate influence in global health policy. By operating at an arm's length from the WHO, the Foundation can make decisions with less public scrutiny and political oversight, potentially allowing private interests to shape the global health agenda.

1. The Illusion of Independence

• The WHO Foundation's arms-length relationship with the WHO allows it to make decisions with less public scrutiny and political oversight.
• This setup is seen as potentially depoliticizing key WHO financing decisions, making them less visible to wider audiences.
• If the Foundation is successful in generating substantial funds, it could threaten the WHO's operational independence and create a form of regulatory chill.
• Despite emphasis on strengthening the WHO during health crises, funds often end up directed to other institutions, undermining the WHO's capacity.

2. Managing Expectations vs. Reality

• The Foundation strategically manages expectations of accountable governance to mitigate concerns, while its actual practices contradict the model used to justify its existence.
• The informal and secluded nature of the Foundation's practices allows it to drift from its governance model without facing the same public scrutiny associated with decision-making within the WHO.
• There is a lack of clarity about the applicability of the Framework of Engagement with Non-State Actors (FENSA) norms and practices to the WHO Foundation.
• The WHO Foundation's Gift Acceptance Policy does not explicitly exclude donations from controversial industries like alcohol, raising concerns about insufficient protections against industry interference.
• The promotion of public-private partnerships (PPPs) and whole-of-society approaches by the UN and unhealthy commodity industries could undermine real progress in NCD prevention by giving industry more influence over public health strategies.

The Path Forward: Strengthening the WHO's Independence

To restore public trust and ensure that the WHO can fulfill its mandate without undue influence, it is crucial to reform the WHO Foundation and strengthen the WHO's policies on accepting private sector donations. Transparency, accountability, and robust conflict of interest safeguards are essential to protect the integrity of global health decision-making.

1. Reforming the WHO Foundation

• The WHO Foundation should be scrapped, and the WHO should strengthen its policies on accepting private sector donations.
• Robust conflict of interest policies and safeguards are essential to prevent regulatory capture and ensure that the WHO's decision-making serves the global public interest.
• The WHO cannot afford to be seen sacrificing its independence or impartiality to commercial determinants of health in pursuit of funding, considering how many global health challenges are driven by powerful transnational companies.
• The WHO Foundation should publish full details of contributions from non-State actors to enhance transparency and protect against conflicting corporate interests.
• The WHO should reconsider the role given to stakeholders with significant conflicts of interest in policy deliberations and consultations to promote a greater role for civil society and people living with NCDs.

2. Sustainable and Flexible Funding

• If governments continue to provide the WHO with the sustainable, flexible funding it needs to carry out its mandate effectively, both the governments and the WHO should be fully transparent about where that money is going, and if it is truly serving the public's best interests.
• Relying on voluntary contributions from private donors leaves the organization vulnerable to undue influence and undermines its ability to respond to global health challenges in a timely and equitable manner.
• The WHO faces a funding shortfall of over $600 million for 2022-2023, with only 16% of its budget covered by member states' regular contributions.
• WHO member states failed to agree on increasing mandatory financial contributions in 2022, leading the organization to rely more on private funding sources.

3. Protecting National Sovereignty and Democratic Accountability

• The WHO and WHO Foundation, as unelected international bodies, must respect the sovereignty of individual nations and the rights of their citizens protected by national constitutions.
• Global health governance should be guided by democratic principles, ensuring that the voices of all nations, particularly low- and middle-income countries (LMICs), are heard and respected in decision-making processes.
• The power imbalance between high-income countries (HICs) and LMICs in global health governance must be addressed to prevent the prioritization of economic interests over public health.
• Global health initiatives should engage with and learn from successful public health practices implemented by LMICs, rather than imposing top-down approaches driven by HICs.

Conclusion: The influence of "dark money" on global health policy, exemplified by the WHO Foundation's conflicts of interest, poses a significant threat to the integrity and independence of the World Health Organization. As unelected global bodies with immense power, the WHO and WHO Foundation must prioritize transparency, accountability, and democratic principles to maintain public trust and protect the sovereignty of individual nations. Without clear safeguards against undue influence from private interests and a commitment to equitable global health governance, the WHO risks losing its legitimacy as a guardian of public health.

To learn more about how you can stand up for your health rights, visit Stand For Health Freedom.

References

1. Maani N, Van Schalkwyk MC, Petticrew M, Ralston R, Collin J. "The new WHO Foundation - global health deserves better," BMJ Global Health 6, no. 2 (2021), https://doi.org/10.1136/bmjgh-2021-004950. 

2. Zenone M, Hawkins B. "Powerful allies and weak consensus: towards a deeper understanding of how health-harming industries seek to influence global health governance: Comment on 'Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases,'" International Journal of Health Policy and Management 11, no. 7 (2022): 1222-1224, https://doi.org/10.34172/ijhpm.2021.136.

3. Maani N, Van Schalkwyk MC, Petticrew M, Ralston R, Collin J. "The new WHO Foundation - global health deserves better," BMJ Global Health 6, no. 2 (2021), https://doi.org/10.1136/bmjgh-2021-004950. 

4. Ralston R, Hil SE, da Silva Gomes F, Collin J. "Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool," International Journal of Health Policy and Management 10, no. 5 (2021): 255-265, https://doi.org/10.34172/ijhpm.2020.52. 

5. Lacy-Nichols J, Marten R. "Power and the commercial determinants of health: ideas for a research agenda," BMJ Global Health 6, no. 2 (2021), https://doi.org/10.1136/bmjgh-2020-003850. 

6. Collin J, Hill SE, Kandlik Eltanani M, Plotnikova E, Ralston R, Smith KE. "Can public health reconcile profits and pandemics? An analysis of attitudes to commercial sector engagement in health policy and research," PLoS One 12, no. 9 (2017), https://doi.org/10.1371/journal.pone.0182612. 

7. Grady, Christine E., and Alan E. Fuchs. "Conflicts of Interests at Foundations - Avoiding the Bad and Managing the Good." USA: Forum of Regional Associations of Grantmakers, and Council of Michigan Foundations, 2005. https://www.michiganfoundations.org/sites/default/files/resources/Conflicts_of_Interest_at_Foundations.pdf. 

8. Maani N, Van Schalkwyk MC, Petticrew M, Ralston R, Collin J. "The new WHO Foundation - global health deserves better," BMJ Global Health 6, no. 2 (2021), https://doi.org/10.1136/bmjgh-2021-004950. 

9. Grady, Christine E., and Alan E. Fuchs. "Conflicts of Interests at Foundations - Avoiding the Bad and Managing the Good." USA: Forum of Regional Associations of Grantmakers, and Council of Michigan Foundations, 2005. https://www.michiganfoundations.org/sites/default/files/resources/Conflicts_of_Interest_at_Foundations.pdf. 

10. Patnaik P. "Following the money II: After the WHO, the World Bank gets a bashing," Geneva Health Files, April 30, 2021, https://genevahealthfiles.substack.com/p/following-the-money-ii-after-the. 

11. Rinaldi C. "Public-private partnerships with unhealthy commodity industries: are they undermining real progress in non-communicable disease prevention?: Comment on 'Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases,'" International Journal of Health Policy and Management 11, no. 7 (2022): 1212-1214, https://doi.org/10.34172/ijhpm.2021.118. 

12. Ralston R, Hil SE, da Silva Gomes F, Collin J. "Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool," International Journal of Health Policy and Management 10, no. 5 (2021): 255-265, https://doi.org/10.34172/ijhpm.2020.52. 

13. Carriedo A, Lauber K, Miller MM, Ralston R. "Lacking clarity or strategic ambiguity? Comment on 'Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases,'" International Journal of Health Policy and Management 11, no. 7 (2022): 1215-1218, https://doi.org/10.34172/ijhpm.2021.113. 

14. Rinaldi C. "Public-private partnerships with unhealthy commodity industries: are they undermining real progress in non-communicable disease prevention?: Comment on 'Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases,'" International Journal of Health Policy and Management 11, no. 7 (2022): 1212-1214, https://doi.org/10.34172/ijhpm.2021.118. 

15. Maani N, Van Schalkwyk MC, Petticrew M, Ralston R, Collin J. "The new WHO Foundation - global health deserves better," BMJ Global Health 6, no. 2 (2021), https://doi.org/10.1136/bmjgh-2021-004950. 

16. Zenone M, Hawkins B. "Powerful allies and weak consensus: towards a deeper understanding of how health-harming industries seek to influence global health governance: Comment on 'Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases,'" International Journal of Health Policy and Management 11, no. 7 (2022): 1222-1224, https://doi.org/10.34172/ijhpm.2021.136.