News Flash 477: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 477

Weekly Snapshot of Public Health Challenges


Informal WHA75 pre-meeting for Member States, non-State actors in official relations and the Secretariat during 11 April to 6 May 2022

Health Policy and Planning: Call for abstracts: Rethinking External Assistance for Health

WHO: World Immunization Week 2022 – 24 to 30 April

European Immunization Week 2022: Statement by Executive Director Emer Cooke – Why vaccines contribute to a “Long Life for All”

Audio Interview: Communicating Covid-19 Science

The Dilemma of Vaccine ‘Charity’ vs Building Africa’s Production Capacity

MSF calls on Moderna to transfer mRNA vaccine technology without further delay

WHO recommends Pfizer’s COVID-19 pill, but poor nations may lack access

We’re about to make the same mistake with COVID treatments that we did with vaccines, WHO says

Transparency urged to raise COVID-19 vaccine uptake

COVID-19 testing sees massive decline, leaving countries vulnerable

G20 agrees to set up global pandemic preparedness fund

Democratic Republic of Congo declares new Ebola outbreak in Mbandaka

UNICEF and WHO warn of ‘perfect storm’ of conditions for measles outbreaks, affecting children

World Malaria Day Bulletin: A message from TDR Director

J&J Teams up with African Centre to Find New Drugs to Address Antimicrobial Resistance

Protecting noncommunicable disease prevention policy in trade and investment agreements

Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data

Facilitating global access to diabetes treatments for non-EU patients


How are war crimes prosecuted?

Q&A: Women locked in care cycle as COVID-19 diverts funds

PREPARE Survey Data Release: Monitoring the Impact of COVID-19 on Children’s Education

Vulnerable Ukrainian children at risk of illegal adoption

Two Months after the Start of the War, Food Insecurity Continues to Grow

Croatia racing to mitigate impact of Ukraine war on agrifood sector

Colonialism: why leading climate scientists have finally acknowledged its link with climate change

Three start-up ideas for a circular economy

Establishing the National Institute for Research in Environmental Health, India

Asia’s coastal cities ‘sinking faster than sea level-rise’

Record-breaking Heatwaves in India and Pakistan Affect Over Billion People

Landmark UN Report Issues Stark call for Sustainable Land Management to Save Human Health











News Flash 476: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 476

Weekly Snapshot of Public Health Challenges



COVID-19 – is the pandemic over in Africa?

The Age of Antivirals

WHO and MPP announce names of 15 manufactures to receive training from mRNA technology transfer hub

Latest Peer-Reviewed Study Underlines Benefits of Second COVID Booster for Older People

Preventing Airborne Spread of Covid-19 and Other Respiratory Diseases

US Will No Longer Enforce Masks for Travel While Mask-less European Airlines See Jump in Staff COVID Cases

Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study

Audio Interview: The Effects of Covid-19 on Children

A Quick Guide for Talking With Vaccine-Hesitant Parents

Audio Interview: Do the Tobacco Wars Offer Any Lessons for the Vaccine Wars?

Following USA – WHO Reports on Wave of Acute Childhood Hepatitis in the UK and Ireland

Malawi Counts Success of Polio Vaccination Drive after Detecting First Case in 30 Years

mRNA vaccines: facts, figures and the future

Can mRNA vaccine tech take on tuberculosis?

Recently developed drugs for the treatment of drug-resistant tuberculosis: a research and development case study

MSF responds to new simplified WHO treatment guidelines for cryptococcal meningitis, the number two killer of people living with HIV/AIDS

Vitamin D3 supplementation during pregnancy and lactation for women living with HIV in Tanzania: A randomized controlled trial

How to protect, and why to prioritize, coastal waters

Climate change: Key UN finding widely misinterpreted

‘Missing’ India Air Pollution Data Restored to WHO Air Quality Database

No public health without planetary health

Worsening drought in Horn of Africa puts up to 20 million at risk: WFP


Gender-based Violence and the evidence vacuum: why we need to look beyond the gold standard

World’s stockpile of ‘usable’ nuclear weapons is increasing, watchdog warns

Here’s what Ukrainians with disabilities face as we cope with war

As Ukraine War Intensifies, WHO Moves Supplies and Supports Efforts to Assist Rape Survivors

People’s Health Movement Annual Report 2021

Lies, Damned Lies and Aid Statistics

Aligning Two Paths to Health

Decolonizing Global Health: Respect Your Partners

High Cost of Debt is Crippling Developing Nations: How can we Bridge the Finance Divide?

Is It Time to Rationalize Tax Expenditures?










News Flash 475: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 475

Weekly Snapshot of Public Health Challenges


27 APRIL 2022 Launch Event: Global Health Watch 6

Just launched: Health Data Governance Principles

G2H2 Press Release 13 April 2022: Immunizing WHO Pandemic Treaty Negotiations Against Pandemic Profiteers. Civil society calls for equity, transparency, and accountability during public hearings

Civil Society Alliance for Human Rights in the Pandemic Treaty warns World Health Organization of risk of inadequate consultation

WHO recommendations for resilient health systems

Webinar “G7 Engagement Groups” 5 April 2022

Statement on the eleventh meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

An Update on COVID Vaccines

COVAX asks for additional funding in case new COVID variant emerges

Pfizer Refuses Cooperation with DNDi on Study of Paxlovid Treatment Adapted to  Low Income Countries

Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 4-7 April 2022

Population Immunity and Covid-19 Severity with Omicron Variant in South Africa

Tackling the Pandemic of Inequality in Asia and the Pacific

COVID-19 Has Driven Racism And Violence Against Asian Americans: Perspectives From 12 National Polls

Single Dose of HPV Vaccine is Enough to Protect Against Cervical Cancer

Another Year and Another Respiratory Infection: 2022 Prospects for Tuberculosis Control in the Shadow of COVID-19

‘All Malaria Is Local’

Protecting noncommunicable disease prevention policy in trade and investment agreements

Environmental sanitation and the evolution of water, sanitation and hygiene


Equitable Access to Innovative Pharmaceuticals by Thomas Pogge

With COVID Vaccine Supply Outstripping Vaccination Rates, Pharma Giants Question Pursuit of IP Waiver 

Proposed TRIPS waiver a hollow diplomatic compromise with little practical impact

Understanding Drugs Markets: An Analysis of Medicines, Regulations and Pharmaceutical Systems in the Global South 

Patients or customers? The impact of commercialised healthcare on the right to health in Kenya during the COVID-19 pandemic

Towards a Culturally Diverse Aged Care System by Nikolaus Rittinghausen

Sequencing 100,000 species to secure food supplies

Can the world’s forgotten food crises weather the war?

Chile announces unprecedented plan to ration water as drought enters 13th year

Impact of climate change on biodiversity, agriculture and health: a call for papers

EXCLUSIVE: WHO Deleted India’s Air Pollution Data from its New Air Quality Database – Why?

Climate Risk Insurance in Pacific Small Island Developing States: Possibilities, Challenges and Vulnerabilities

Climate policies must allow women to control their bodies and their fates







Equitable Access to Innovative Pharmaceuticals

Globalized in 1995 by the TRIPs Agreement, humanity’s dominant mechanism for encouraging innovations involves 20-year product patents, whose monopoly provisions enable innovators to reap large markups or royalties from early users. Reliance on monopoly rents in the pharmaceutical sector is problematic for two main reasons. First, it imposes great burdens on poor people who cannot buy patented treatments at monopoly prices and whose specific health problems are therefore neglected by pharmacological research. Second, it discourages pharmaceutical firms from suppressing diseases by fighting them at the population level. Both problems can be much alleviated by establishing a supplementary alternative reward mechanism that would invite innovators to trade their monopoly privileges on a patentable pharmaceutical for impact rewards based on the incremental health gains produced with it. Such an international Health Impact Fund (HIF) would create powerful new incentives to develop pharmaceuticals against diseases concentrated among the poor, rapidly to provide such remedies with ample care at very low prices, and to deploy them strategically to contain, suppress, and ideally to eradicate the target disease. By promoting innovations and their diffusion together, the HIF would greatly increase the cost-effectiveness of the pharmaceutical sector, benefiting the world’s poor especially

By Thomas Pogge

Leitner Professor of Philosophy and International Affairs

    Yale University, New Haven, USA

Equitable Access to Innovative Pharmaceuticals



Equitable access to health requires equitable access to health care. In our world, such equitable access does not exist because billions of human beings are denied a minimally adequate income and also because patented pharmaceuticals are absurdly overpriced.

According to the latest FAO Report, three billion human beings – 41.9% of humankind – were unable, in 2019, to afford a healthy diet at an average cost of USD 4.04 per person per day at purchasing power parity[1] – even while the global average income (also purchasing-power-adjusted) was about USD 50 per person per day.[2]  Being so desperately poor, large percentages of humankind also lack safe drinking water,[3] adequate sanitation,[4] adequate shelter,[5]  electricity[6]  and basic education.[7] These severe deprivations make the poor much more prone to disease which in turn further reinforces their poverty. The grave injustice of these deprivations is apparent from the fact that they would not exist if poor people merely had their fair per capita share from the human exploitation of natural resources: minerals extracted, and planetary commons depreciated by human pollution. As it is, this natural wealth of our planet is unilaterally used and overused by a minority of humankind without compensation to the rest, while the poor must work very hard for their insufficient incomes.

The Monopoly Patent Regime

This severe injustice is further aggravated by the existing international rules governing innovation which, originating in the most affluent states, were foisted upon the rest of the world through the 1995 TRIPs Agreement, part of the WTO founding treaty.[8] These rules entitle innovators to 20-year product patents whose exclusivity provisions enable patentees to collect monopoly rents from early users.[9] Monopoly markups encourage development of innovations, but at the cost of greatly impeding their diffusion. This cost again falls most heavily upon the poor, who are excluded from advanced medicines during their patent period.

Monopoly patents lead to exorbitant prices, especially in the pharmaceutical sector. A typical example is sofosbuvir, an effective cure for hepatitis C, which Gilead Sciences introduced in the United States in 2013 under the brand name Sovaldi at a price of USD 84,000 per course of treatment. This is about 3000 times the cost of manufacture, a markup of 300,000%.[10] In poorer countries, where the upper classes are less affluent and less well-insured, patented drugs are priced much lower – but still unaffordable on the also much lower ordinary incomes there. Even five years after sofosbuvir’s market introduction, only about 7% of the 71 million persons living with hepatitis C had been treated, while the remaining 66 million remained ill and potentially infectious to others.[11] Such disease proliferation benefits the patentee who, by deploying its new drug in a global population-level strategy of disease eradication, would be reducing its current earnings and undermining its future sales.

Prices for advanced pharmaceuticals are set at such exorbitant levels because this is the most lucrative choice. Because economic inequalities are very large, even intra-nationally,[12] it is profit-maximizing to aim an important product at the affluent and well-insured: a lower price would not gain enough in increased sales volume to compensate for the loss in reduced profit margin. Each year, hundreds of millions suffer, and millions die, from lack of access to medicines that generic firms could and would supply quite cheaply if patent enforcement did not prevent them from doing so.[13]

Making pharmaceutical firms reliant on monopoly rents hurts the world’s poor also through its influence on R&D decisions. Firms that derive their earnings from monopoly markups ignore diseases that are heavily concentrated among the poor, as is shown by the strong correlation between disease-specific R&D investments and the average income of the corresponding patient population.[14] As a result, while male pattern baldness and erectile dysfunction garner abundant research attention, humanity is woefully underequipped with pharmaceuticals against the 20 WHO-listed “neglected tropical diseases,” which “cause devastating health, social and economic consequences to more than one billion people,”[15] as well as the familiar great diseases of poverty – including tuberculosis, malaria, hepatitis, pneumonia, and diarrhea – which routinely kill some six million people every year.[16]

Systematic neglect of the poor in both R&D and distribution of pharmaceuticals allows them to be a breeding ground where new diseases, such as Ebola, swine flu, and COVID-19, can gain traction and old diseases can survive and evolve new, perhaps more virulent or drug-resistant disease strains – as has happened with tuberculosis in China and India, and with malaria in South East Asia and Ethiopia. In this regard, the interests of poor and rich are well-aligned: we all want to see diseases contained, suppressed, and eradicated from this planet. But the only way to achieve this is with a population-level strategy that includes the poor.

Humanity has eradicated only one human disease, smallpox, in a joint effort led by the Soviet Union at the height of the Cold War.[17] We certainly could have eradicated other infectious diseases too, including most of those mentioned two paragraphs back. But under the current innovation regime, disease eradications are unlikely.[18] Here is why. Pharmaceuticals can protect people against harm from infectious diseases in two distinct ways. At the individual level, they can protect their users. At the population level, they can be deployed to contain and suppress a disease toward eradication, thereby saving people from being endangered by it in the first place. Although we consumers much prefer being benefited in the latter way, this way is money-losing for pharmaceutical firms which profit only by benefiting people in the former way. It is not profitable for them to address the needs of poor patients; and it is financial suicide for such a firm to suppress a disease for which it is selling an exclusive remedy. Under the current monopoly patent regime, pharmaceutical firms have a vital financial interest in the continued flourishing of their target disease. Thanks to this interest, the poor – though unable to afford patented medicines – nonetheless make a crucial indirect contribution to innovator profits.

To summarize and generalize. By relying on temporary monopolies, our current regime for stimulating and rewarding innovation generates two interrelated and highly destructive problems. It fails to realize huge potential benefits for poor people by guiding innovators to ignore their specific needs and to price existing innovations out of their reach. Relatedly, it fails to reward and hence to induce vast third-party benefits that a technology’s buyers and users care little about. The pharmaceutical sector illustrates both problems to perfection.

A Supplementary Health Impact Fund

Earning trillions of dollars on their patents each year,[19] patentees are willing and able to defend their privileges ferociously. The chances of achieving meaningful revisions of the TRIPS regime are therefore slim or nil. Twenty-five years of attempts at the WHO have yielded next to nothing; and the latest episode – the proposed TRIPS waiver for COVID-related products – has similarly been mired in shameful stalling and delay with daily reductions in the good it might yet accomplish. It is high time to explore the politically more realistic approach of addressing the problems without revision of the TRIPS framework.

The most important objective here is to incentivize firms to fully include poor people in their business strategy. Such inclusion requires an effective new pharmaceutical to be cheap enough to be affordable to all while delivering it to even the poorest is profitable enough for firms to want to do so comprehensively and effectively. In our world of widespread poverty, these two requirements stand in tension. There is no sales price that is low enough to fulfill the former and high enough to fulfill the latter requirement. To resolve this tension, firms must receive a delivery premium in addition to the sales price.

This can be achieved by creating a sector-specific add-on to the current regime: an international Health Impact Fund (HIF) that invites innovators to permanently forgo monopoly markups on a new patentable pharmaceutical in exchange for impact rewards. The word “invites” is key: innovators would have a choice, in regard to each qualifying innovation, whether or not to register it with the HIF.

The prohibition on monopoly markups could be implemented through open licensing or, perhaps preferably, through a tender process that selects two or three reliable contract manufacturers to mass-produce the registered pharmaceutical on the registrant’s behalf to meet global demand. Such a tender process affords superior economies of scale, facilitates health impact measurement, and makes it easy for the registrant to sell the product below its price cap into impoverished regions when the expected additional health gains make it profitable to do so.[20]

The HIF would pay registrants of a new pharmaceutical an alternative reward based on the incremental health gains produced with it. Here “health gains” are defined to include externalities, such as the benefits that use of a HIF-registered product confers upon third parties in the form of reduced infection risk. A registered pharmaceutical would earn its maximum reward by eradicating its target disease – and this even if the innovator then had no more patients left to treat with it.

Under the current monopoly regime, new pharmaceuticals that are just slightly better than existing alternatives can earn as much as first-in-class innovations; and duplicative products that do not improve the state of the art at all can still capture a large market share, thereby garnering huge profits and reducing the rewards of a preceding break-through innovation. The HIF avoids such inefficiencies by rewarding only incremental health gains, gains that would not have occurred without the registered innovation. It thereby discourages socially wasteful efforts to field a duplicative product against a HIF-registered innovation: if HIF-registered, the duplicate would earn too little for lack of incremental impact; if unregistered, it would earn too little because of its uncompetitive price.

The HIF would pay its rewards through fixed annual disbursements, each split among registered pharmaceuticals according to incremental health gains achieved in the preceding year. This principle of division ensures fairness among innovators, who are rewarded in proportion to benefit provided, all at the same reward-to-benefit rate. Each innovation would participate in ten of these annual disbursements and be freely available thereafter through open licensing.

So designed, the HIF would evolve a stable competitive reward rate. When innovators find it unattractive, registrations slow and the reward rate rises as older innovations exit at the end of their reward period. When the rate is seen as generous, it soon declines through proliferating registrations. Such predictable adjustment reassures registrants and funders alike that the reward rate is fair, and will continue to be fair, between them. By design, innovations earn competitive rewards.

The size of the annual disbursements can be set, and possibly raised, to attain the desired level of participation. If the HIF had annual disbursements of €6 billion, each registered pharmaceutical would participate in €60 billion worth of disbursements over its ten-year reward period. A commercial innovator would register a product only if it expected to make a profit over and above recouping its R&D expenses. There is some controversy over what these fixed costs per innovation (inflated to account for the risk of failure) amount to. The number of products registered with the HIF would throw light on this question because of the Fund’s self-adjusting reward rate. Were it to attract, say, 30 products, with three entering and three exiting in a typical year, this would show that the prospect of €2 billion over ten years is seen as satisfactory – neither windfall nor hardship.

The HIF improves upon innovation prizes and other pull mechanisms, such as advance market commitments,[21] in five ways. It constitutes a structural reform, establishing stable and predictable long-term innovation incentives. It lets innovators, who know their own capabilities best, decide which innovations to pursue across the whole range of disease areas. It avoids having to specify a precise “finish line” – hard to get right in advance – and instead rewards each registered innovation according to the benefits produced with its deployments. It avoids having to specify a reward-for-benefit rate, which instead evolves endogenously through market forces. It gives innovators strong incentives also to promote (through information, training, technical assistance, discounts, etc.) the fast, wide, impactful diffusion of their participating innovations.

The HIF would quite easily offset its cost through lower prices on registered pharmaceuticals and through large reductions in the global burden of disease, entailing cost-savings in other health care costs as well as substantial gains in economic productivity and associated tax revenues. Nevertheless, these great potential benefits must be appreciated, and this appreciation be converted into reliable long-term funding commitments. Innovators considering a high-impact R&D project must have firm assurance that they will get paid during their product’s first ten years on the market. If HIF rewards are perceived as uncertain, innovators will discount them with the result that its reward rate will be higher than necessary.

At least initially, reliable long-term commitments will have to be underwritten by states, with optionality again important for political feasibility. The HIF can get started with a few states, even just one. It makes sense to design the HIF so that it lets participating innovators sell their registered pharmaceuticals at patent-protected high prices in non-contributing affluent countries. This exception would give affluent countries a further incentive to join the funding partnership. It would also reduce the opportunity cost of HIF-registration, thereby raising the number of products the HIF would attract at a given size of annual disbursements.

With state contributions based on gross national income, the HIF might expand over time – through economic growth in contributing states, accession of new states, or agreement to raise the contribution rate – and would then attract more registrations. Similar growth could occur if states decided to devote part of an international tax – on greenhouse gas emissions, perhaps, or on financial transactions – to the HIF. In any case, the HIF should also welcome donations from non-state actors (foundations, corporations, individuals, and bequests), perhaps using them to build an endowment that could support an increasing share of its annual budget.

Most of the HIF’s cost would be borne by more affluent countries and people. The same is true of monopoly rents extracted from early buyers. But there is this crucial difference: impact rewards avoid excluding the poor. Such exclusion is deeply immoral, as when millions die from lack of medicines that generic manufacturers would be glad to supply quite cheaply. Such exclusion also harms us all by exposing us to dangers from diseases that emerge or propagate among the poor, often evolving new variants – or drug resistance, emerging when patients cannot afford to take the full dosage or full treatment course of an expensive drug.

Organizing a wide competition across the entire pharmaceutical sector, the HIF would create a new kind of competitive market that helps innovations achieve their full potential. Removing the headwind of monopoly rents and adding a tailwind of impact rewards, such a market transforms innovator motivation. While monopoly rewards incite massive efforts to deter, detect and terminate patent infringements, the HIF would encourage participating innovators actively to promote – through local-language instructions, adherence support, discounts, training, technical assistance, diagnostics, etc. – the rapid, widespread, and effective deployment of their technology for optimal benefit. It would stimulate innovators to holistically organize their research, development, marketing, and delivery operations toward producing the most cost-effective incremental health gains. In this way, the HIF would induce the development of precisely those high-value innovations that the current regime leaves inadequately rewarded. Innovators would have financial incentives to supply these new HIF-registered pharmaceuticals at very low prices and to collaborate with their large customers – national health services and organizations like the Global Fund, GAVI, Médecins Sans Frontières, and Partners in Health – on the optimal strategic deployment of these products aimed at containment, suppression, and ultimately eradication of the target disease. Creation of the HIF would greatly improve the prospects of permanently freeing humanity from some of the most destructive infectious diseases and greatly enhance humanity’s capacities to tackle new infectious diseases and disease strains.

A Health Impact Fund Pilot

The example of the Global Fund suggests that creation of the HIF is entirely possible. To mobilize the needed political support, it would be extremely helpful to try out the HIF approach on a smaller scale. COVID-19 was a great opportunity to do so. Instead, this pandemic became a depressing showcase for the flaws of the current monopoly regime. Effective vaccines were developed in record time. But manufacturing was scaled up slowly as innovators sought to safeguard their proprietary technologies and know-how, to avoid wasteful excess capacity, and to maintain a favorable demand-supply imbalance conducive to high prices. And the distribution of vaccines was driven not by a strategic effort to suppress the disease but by a scramble to maximize monopoly rents: innovators prioritized buyers who offered to pay more and rejected those who, only marginally profitable, might erode the product price and seemed more useful spreading and prolonging the pandemic with potential emergence of new disease variants.

Fortunately, a suitable HIF pilot is always feasible. Featuring a single reward pool of ca. €100 million, such a pilot might invite innovators to submit proposals of how they might, with one of their existing pharmaceuticals, achieve additional health gains in some selected poor country or region. An expert committee would select the four best proposals based on, inter alia, anticipated incremental health gains, prospects for broad, equitable access especially by the poor, susceptibility to reliable, consistent, and inexpensive health impact assessment, and promise of additional social value. Selected proponents – which might include non-commercial innovators such as DNDi and the TB Alliance – might then have three years for implementation. Thereafter, achieved health gains would be assessed – according to pre-agreed criteria, by an agency like the IQWIG, DEval or IHME – and the reward pool be divided proportionately.[22] The pilot would show how innovators respond to the novel competitive impact rewards, would help refine impact assessment, and would indicate how well impact rewards work in generating health gains and supplementary health policy insights. The most important objective here is to incentivize firms to fully include poor people in their strategy right from the start. For this to happen, an effective new pharmaceutical must be cheap enough to be affordable to all while delivering it even to the poorest must be profitable enough for firms to be eager to do so comprehensively and effectively. In our world of widespread poverty, these two requirements stand in tension. There is no sales price that is low enough to fulfill the former and high enough to fulfill the latter requirement. To resolve this tension, firms must receive a delivery premium in addition to the sales price. Such a premium, tied to health gain achieved, is an essential component of the Health Impact Fund approach, which offers firms performance rewards based on the real health gains they achieve with any of their products, on condition that they sell this product without markup (, 2021).


By supporting establishment of the HIF, citizens and governments of contributing states could take a real step toward fulfilling their long-declared commitments to human rights, poverty eradication, the 2030 Agenda of Sustainable Development Goals, and an international spirit of planetary solidarity.

The current global innovation regime perpetuates staggering global health deficits.  Creation of the HIF is an extremely cost-effective reform that could avert most of this harm – potentially freeing millions of poor people from their debilitating ailments and greatly raising humanity’s preparedness against communicable diseases. In fact, the HIF’s true cost is likely to be negative insofar as savings on registered pharmaceuticals and other health-care costs as well as gains in economic productivity and associated tax revenues would benefit the contributing funders – also indirectly by reducing the cost of health insurance, national health systems, and foreign aid. Further economies would arise from the HIF largely avoiding the wasteful expenditures now typical of the pharmaceutical sector: expenses for multiple staggered patenting in many jurisdictions with associated gaming efforts (e.g., evergreening), costs of preventing monopoly infringements, costs of duplicative innovations with mutually-offsetting competitive promotion efforts, economic deadweight losses, and costs due to corrupt marketing practices and counterfeiting. Thanks to these enormous inefficiencies of monopoly incentives, a shift toward impact rewards could dramatically improve global health and the lives of the poor without cost to anyone. Pharmaceuticals firms, in particular, would gain wholly new opportunities to do well by doing good: to earn money by benefiting rather than harming poor populations. Aligning profits with human needs, the HIF would make the business of innovation much more equitable in terms of research priorities and access to its fruits.



[1] FAO, IFAD, UNICEF, WFP and WHO, The State of Food Security and Nutrition in the World 2021 (Rome: Food and Agriculture Organization of the United Nations, 2021),, Table 5, p. 27. Since 2019, the situation has become even much worse, as the crises of climate, COVID-19, and Ukraine have caused a unprecedented 68% surge in food prices, driving the FAO’s food price index from 95.1 in 2019 to 159.3 in March 2022 (


[3] 2.2 billion human beings lack safe drinking water,

[4] 2 billion people live without adequate sanitation,

[5] Well over 1 billion people lack adequate housing. UN Habitat, Fact Sheet 21: The Right to Adequate Housing, , p. 1.

[6] 940 million people have no electricity,

[7] Some 160 million children aged 5–17 do wage work outside their own household and hence do not go to school (–en/index.htm) and over 750 million adults are illiterate (

[8] John Braithwaite and Peter Drahos, Global Business Regulation (Cambridge: Cambridge University Press, 2000), esp. chapters 7, 10, 20, 21. Daniel Gervais, The TRIPS Agreement: Negotiating History, Fourth Edition (London: Sweet & Maxwell, 2012).

[9] TRIPS Agreement,, Articles 27, 28 and 33.

[10] Melissa J. Barber, Dzintars Gotham, Giten Khwairakpam, and Andrew Hill, “Price of a Hepatitis C cure: Cost of Production and Current Prices for Direct-Acting Antivirals in 50 Countries,” Journal of Virus Eradication 6, no. 3 (2020): 100001. Available at

[11] Clinton Health Access Initiative, “Hepatitis C Market Report, Issue 1” (2020), p. 10. Available at

[12] Sean Flynn, Aidan Hollis, and Mike Palmedo, “An Economic Justification for Open Access to Essential Medicine Patents in Developing Countries,” Journal of Law, Medicine and Ethics 37, no. 2 (2009), 184–208 at pp. 187–188.

[13] Arguably, cutting patients off from affordable access to life-saving drugs in this way constitutes a violation of their human rights. See Thomas Pogge, “The Health Impact Fund and Its Justification by Appeal to Human Rights.” Journal of Social Philosophy 40, no. 4 (2009), 542–569.

[14] Javad Moradpour and Aidan Hollis, “Patient Income and Health Innovation,” Health Economics Letter (2020). Available at

[15] See World Health Organization, “Neglected Tropical Diseases,”

[16] Our World in Data reports 2.56 million deaths from pneumonia in 2017 (, 1.53 million deaths from diarrheal diseases in 2019 (, 1.18 million deaths from tuberculosis in 2019 (, 627,000 deaths from malaria in 2020 ( and 79,000 deaths from hepatitis in 2019 (

[17] Frank Fenner, Donald Henderson, Isao Arita, Zdenek Jezek, and Ivan Danilovich Ladnyi. Smallpox and its Eradication‎ (Geneva: World Health Organization 1988).

[18] To be sure, non-commercial innovators occasionally obtain funds to work on such diseases, leading to successes like the recent malaria vaccine developed at Oxford University: But they rarely have enough money for a successful tripartite campaign of product development, large-scale product manufacture, and global product distribution.

[19] In the pharmaceutical sector alone, sales of brand name products amount to about $800 billion annually. See International Federation of Pharmaceutical Manufacturers and Associations, “The Pharmaceutical Industry and Global Health” (2017), p. 5,

[20] For more detailed discussion, see Thomas Pogge, “The Health Impact Fund: Enhancing Justice and Efficiency in Global Health,” in Journal of Human Development and Capabilities, 13, no. 4 (2012), 537–559 at pp. 550–552.

[21] See Michael Kremer and Rachel Glennerster. Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases (Princeton: Princeton University 2004); and Michael Kremer, Jonathan Levin, and Christopher M. Snyder. “Designing Advance Market Commitments for New Vaccines” (2020). Online at

[22] Sophisticated methods of health technology assessment exist and are widely used, especially by national and private insurers, so the HIF and its pilot could draw on these methods.

Towards a Culturally Diverse Aged Care System

Find out below an article by the Centre for Cultural Diversity in Ageing which is funded by the Australian Department of Health under the Partners in Culturally Appropriate Care (PICAC) program. The Centre provides expertise in culturally inclusive policy and practices for the aged services sector, while supporting aged care providers to address the needs of older people from culturally and linguistically diverse backgrounds

For more information visit

By Nikolaus Rittinghausen

Senior Advisor & Project Officer

The Centre for Cultural Diversity in Ageing

PICAC Victoria, Australia

Towards a Culturally Diverse Aged Care System

Providers Can Tap into a National Program


Republished from the Centre for Cultural Diversity in Ageing Media Hub under permission by the Author
People from culturally and linguistically diverse backgrounds make up approximately a third of our older population, however, they are not a homogenous group. Each person is characterised by a unique identity which is influenced by life experiences and social, cultural, educational, economic and health determinants.

Culture, religion and migration experiences naturally shape the way people think and act. For example, people who were forced to leave their home country due to political persecution, often lack trust in government institutions and governmentrelated services.

The Partners in Culturally Appropriate Care Alliance (PICAC Alliance) is a national program funded by the Australian Department of Health to support aged care providers to deliver culturally appropriate care. It welcomes the Federal Government’s aged care budget which proposes a roadmap to ensure safer and better quality care for older Australians. One of the directions of the budget is the compilation of a new Aged Care Act which places human rights principles at the centre of governance and service delivery.

The PICAC Alliance has spoken on a number of occasions about the importance of incorporating the cultural, linguistic, and spiritual needs and preferences of older people from culturally and linguistically diverse backgrounds into the new Aged Care Act and that the human rights principles of the Act, such as the fundamental right to speak in one’s first language, are translated into everyday practice within the delivery of age services.

The PICAC Alliance recommends embedding inclusive service models and delivery into the heart of the organisation and that responding to the needs of all older, diverse people is deemed essential in delivering quality and equitable care.

The PICAC Alliance acknowledges the Federal Government’s major investment into translating and interpreting services to help culturally and linguistically diverse older people to access and navigate the aged care system. The PICAC Alliance further applauds the proposed implementation of the Specialist Verification Program, which will certify providers who offer specific services directed at diverse consumers. This program is intended to make specialist providers more accessible to these consumers, their families, carers and advocates. With the profile and preferences of consumers becoming increasingly diverse, aged care services and programs will need to more appropriately reflect this consumer diversity.

It is key that organisations have access to targeted support and training in relation to culturally inclusive governance and service delivery.

The PICAC Alliance supports aged care providers across Australia to develop culturally inclusive care across all levels of their organisations. The Federal Government also supports this notion through its Aged Care Diversity Framework. Launched in 2017, the framework highlights the need to strategically support older people with diverse characteristics.

The Centre for Cultural Diversity in Ageing, the PICAC Victorian provider, complemented the government’s approach to diversity and inclusion through the creation of its Inclusive Service Standards, which provide a strategic framework for services to adapt and improve their services and organisational practices so they are welcoming, safe and accessible.

To complement this framework, more resources are needed to give providers the necessary support, and further work is required to ensure the delivery of inclusive care.

Inclusive care is a concept and practice that is well developed in Australia due to the commitment by successive governments to multiculturalism, the principles of access and equity, and our culturally diverse older population.

As a country, we have the unique opportunity to continue this journey towards a culturally inclusive world-class aged care system.

The PICAC Alliance organisations and their resources, training and tailored supports have been instrumental in paving the way for inclusive care practices across Australia and supporting aged care providers on that journey.

The PICAC Alliance looks forward to continuing to support aged care service providers, and the wider aged care sector to journey towards a more inclusive aged care system.



News Flash 474: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 474

Weekly Snapshot of Public Health Challenges


Covid, Conspiracy-Theories, and the Struggle for Health for All by Judith Richter 

G2H2 Annual Report 2021

WHO Watch for 75th World Health Assembly: Call for Watchers to participate to the World Health Assembly (May 2022 -physically)

WHO: Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience

WHO: Public hearings regarding a new international instrument on pandemic preparedness and response 12 – 13 April 2022

Wed, 23 Mar 2022 Seminar in Brussels: International shared responsibility and solidarity: COVID-19 as a beneficial epidemic?

MSF urges governments to reject the draft COVID-19 text at WTO that would set a negative precedent

Neither the waiver people need nor a solution fit for a pandemic: Four reasons why we’re asking governments to reject the leaked text on COVID-19 at the WTO

ECDC and EMA issue advice on fourth doses of mRNA COVID-19 vaccines

Suspension of supply of COVID-19 vaccine (COVAXIN®)


How President Biden Can Expand Global COVID-19 Test-To-Treat

Interview with Ani Herna Sari, tuberculosis activist od Indonesia, GFAN Speaker

Interview with Naomi Wanjiru, Community-activist, nurse in aids- and tuberculosis clinic in Kenya

Bed net that ‘grounds’ mosquitoes cuts malaria cases

Hunting the ‘perfect protein’ for malaria mRNA vaccine

WWF report says online wildlife trade on rise in Myanmar

The Global Implications of the War in Ukraine on Military and Other Spending


The road to equality: How do EU Member States address inequalities through international cooperation?

Bulletin #22: Health as a bargaining chip People’s Health Dispatch Apr 2, 2022

Cadbury’s chocolate is made with cacao farmed by suppliers using child labour, I met the victims in Ghana

Public Food Procurement as a strategic tool to improve sustainability and trigger the transformation of food systems

Food is at the centre of Planetary Health – and the medical community needs to act upon it

Oxfam, others: West Africa facing worst food crisis in a decade

Why is the most harmful product the least regulated?

Meeting registration: Healthy Climate Prescription: What next? Apr 12, 2022 03:00 PM in Zurich

Heatwave Burns Through India Earlier Than Usual as Climate Crisis Deepens

Climate Mitigation Report Says 43% Reduction Needed in Carbon Emissions by 2030

WHO urges accelerated action to protect human health and combat the climate crisis at a time of heightened conflict and fragility

Green Deal: Modernising EU industrial emissions rules to steer large industry in long-term green transition

Green Deal: Phasing down fluorinated greenhouse gases and ozone depleting substances










Covid, Conspiracy-Theories, and the Struggle for Health for All

The reflections below stem from the concern that - as a result of people demonstrating against face-masks, anti-Covid vaccination, or some broader lock-down pandemic policies – too much media attention seems to have focused on how people can be attracted to what are portrayed as unreasonable ‘conspiracy theories.’

Such focus may add to the ongoing sidelining of existing broad contextual analyses of what may have gone wrong in global public health policy making and needs to be urgently corrected if the aim remains to achieve Health for All

Image Credit: Centers for Disease Control and Prevention (CDC)

Covid, Conspiracy-Theories, and the Struggle for Health for All


By Judith Richter

Researcher, Author, Social Activist [i]

If you feel overwhelmed and confused by the global predicament, you are on the right track. Global processes have become too complicated for any single person to understand. How then can you know the truth about the world, and avoid falling victim to propaganda and misinformation?”

Truth, in 21 Lessons for the 21st Century, Yuval Noah Harari, 2018[ii]


Health for All, Covid, and the risks of an overemphasis on conspiracy theories

Health for All emerged as a concept and a powerful rallying call in the late 1970s. This Call was clearly linked to a United Nation’s mandate to work towards a New International Economic Order (NIEO). It came about at a time when newly independent former colonies, as well as Latin American countries, were calling for a radical restructuring of what was perceived as an unjust world order. In the name of redistributive justice, they called for a halt to the continued exploitation of their resources and undue influences in their political environment.

Today, in social media, the term ‘World Order’ is circulating again. However, it is often linked to a narrative claiming that the Covid-19 virus was deliberately created by Bill Gates, conspiring with big pharmaceutical companies to establish a New World Order (NWO) that they would dominate so as to make even more profit on the backs of powerless citizens. It is understandable that such conspiracy narratives received media attention as they were often linked to incorrect reports that Covid-19 was not more harmful than a normal flu, and public health measures to stem the spread of the Covid-19 pandemic were therefore portrayed as an illegitimate exercise of state power.

My main concern in this article is not to discuss the various Covid-related narratives circulating in social media. On the contrary. I fear that an exaggerated media focus on the so-called conspiracy theories, will end up sidelining long-standing, contextual analyses about undue influence in the global health arena. I also fear it may not help to persuade those who believe in the above and similar narratives to look elsewhere to gain a clearer picture of how best to address the Covid-19 pandemic individually and as members of society.

These are personal reflections based on the work I have been doing since the mid-1980s when I started out as a volunteer pharmacist with an activist consumer protection group in Thailand. I have been privileged in my career as a sociologist with an interdisciplinary background to research and write analyses for UN bodies such as UNICEF and WHO, governments and critical civil society organisations and networks. Over the years, I have been particularly interested in trying to provide analyses that might help public institutions and civil society organisations to prevent harm caused by socially irresponsible practices of transnational corporations (TNCs), for example by holding mega-companies accountable through legally-binding international regulation or, at the very least, through exposure of corporate wrongdoers through naming-and-shaming.

Over the years, my research shifted to exploring whether public-interest actors were taking due care to protect their decision-making processes from undue influences of corporations and hyper-rich venture philanthropists or whether they contributed, unwittingly or knowingly, to increasing them, for example by embracing the stakeholder-partnership paradigm or by disregarding conflicts of interests.

In the course of this work I have met many people in civil society movements, public-interest organisations and academia who have voiced concerns about the direction health policies have taken since neoliberal ideology and policies have gained a dominant position. I am worried that their voices, which I tried faithfully to present in my work, will be drowned out by both, the citizens who are taking angrily to the streets as well as by the media reactions to their demonstrations.

Considering the complex, ever-shifting situation, considering the exchange of varying – often contradictory – scientific opinions in the media, considering public knowledge that pharmaceutical companies are profit-driven, considering the economic and psychological impact of lock-down measures, it is understandable that people react with confusion, anxiety or anger. Questions about the appropriateness of various measures to address the pandemic, the usefulness of masks depending on the circumstances, the efficacy and safety of various anti-Covid-19 vaccines, a perceived lack of attention to issues such as nutrition, and psychological and economic aspects of the measures are all legitimate issues for public debate.

But how does one achieve truly informed, serene, public debates in the current emotionally and politically charged atmosphere? How to sort out potential misunderstandings and problematic resistance to life-saving measures without to risk playing into the hands of politicians and groups from the Extreme Right who instrumentalise the pandemic for their own aims? [iii]

I do not know. But it does seem to me that less focus on ‘conspiracy theories’ would better ensure that thorough analyses of problems in health policy making are being heard. It could also help refocus attention on how to most adequately respond to new surges of this virus or to any future pandemic.

Bill Gates – a victim of conspiracy theories?

One example of the problems resulting from the prevailing focus on conspiracy theories is a Guardian article: Why people believe conspiracy theories: Could folklore hold the answer?[iv] The researchers claim to have found a new way to map the web of connections underpinning coronavirus conspiracy theories thus opening a new way of understanding and challenging them.

Basing their research on a folklore model, they drew parallels between people hunting down witches and people accusing computer-magnate Bill Gates of evil intentions such as creating and using the pandemic to achieve world domination. This, they claim, helps to explain how Bill Gates had become the “great villain” in many of the ‘conspiracy’ theories about the origin and handling of the pandemic.

The Guardian’s folklore article contained an important sentence: “There are non-conspiratorial criticisms of his [Bill Gate’s] position as the most powerful decision-maker in global health, affecting the lives and healthcare of millions of the world’s poorest people.”

Why then did this Guardian article focus on, and implicitly defend, Mr. Gates as a victim of current-day witch-hunters? Why did it create an emotional association between the fate of Mr. Gates and that of powerless human beings who died under horrific circumstances?

Acknowledging grains of truth in Covid ‘conspiracy’ narratives

In my view, an earlier Guardian article provided a better example of how to create more clarity starting from a sea of rumours. It explored how the story of the Covid-19 pandemic as a “plandemic” – a planned conspiracy between the pharmaceutical industry, Bill Gates and the World Health Organization – had started. This article helped me to answer some questions asked by friends who had received the viral video presenting the particular account of Dr. Judy Mikovits.[v]

This article did not immediately label people as irrational fanatics when they think something may be problematic. It quoted Professor Eric Oliver, author of a book about conspiracy theories, who pointed out that adhering to a conspiracy theory is not necessarily irrational, in other words, to not discard conspiracy theories per se. As one reason for peoples’ lack of trust in drug regulatory authorities, he referred to well known facts about overly close relations between pharmaceutical firms and the US FDA leading to the opioid crisis. And he wondered whether opposition to polio immunization in Pakistan might have something to do with the CIA using the cover of an immunization team to hunt down Osama Bin Laden.[vi]

Acknowledging grains of truths in problematic accounts may help create greater understanding between health policy makers and professionals on the one hand and people who question proposed health measures, on the other hand. We also need to acknowledge that it is reasonable for people to try to establish a narrative – a coherent story – to better understand the pandemic-related public health measures that have deeply affected their lives.

This might help cultivate a more serene atmosphere for constructive debates about which pandemic measures are appropriate, at which particular moment, or the benefits versus potential adverse effects of specific vaccines. At least this is what I hope – it is not a given.

Media often focus on those pandemic policy critics who seem to believe in simplistic scenarios of a few evil conspirators acting under a veil of secrecy and elaborating a plan to harm innocent human beings[vii]. But many citizens who criticize Covid-policies may simply feel that they are only getting part of the truth or may have lost trust in science or politics. These critics may be open to learning how to better analyze the impact of influential actors in the health arena if they are not lumped together with those who spread totally unfounded scenarios.[viii]

A first step would be to acknowledge for example, that in the case of the actors most cited in Covid-conspiracy narratives – namely venture philanthropists, pharmaceutical companies, and the World Economic Forum (WEF) – while many of their activities are conducted openly, others are hidden from the public view. All three actors have enormous resources to hire professional lobbyists and public-relations specialists, and to make donations in cash, kind, or ‘seconded’ personnel.

Since I am concerned about the level of aggressiveness and attribution of evil intentions which frequently characterize discussions about Covid-related issues, I would like, however, to point at a statement by Professor Jonathan Marks, based on his analyses of institutional erosion and integrity in public health: one does not have to “demonize” an actor to point at a problem he may have created[ix]. 

Concerning analyses of actions of transnational corporations, for example, it may be useful to remind readers that corporations are not persons. They are artificial legal entities and as such can hold neither benevolent, nor evil, intentions in the way human beings do. But, as sociologist Colin Crouch points out in his book The Strange Non-Death of Neoliberalism, these transnational “giant corporations”, as he calls them, are actors with so much power and economic resources that they threaten to destroy the market as well as democracy.

Pharmaceutical companies, for example, have undoubtedly provided us with many helpful medicines. But, of course, they need also to be analyzed as actors driven by the imperative to make profit in an ever more competitive world. This is why health justice and corporate accountability movements have long called for their commercial and political activities to be made more transparent and held in check. This is why they continue calling for rational drug policies which ensure that the medicines these companies are producing are the right ones, to be delivered at the right time, at a fair price. This is why they call for public policies that would prevent pharmaceutical giants from producing problematic products, delivered with skewed information, at the highest price the market can bear – thus depriving a large part of the world’s population of the fruits of medical research.

In relation to Bill Gates, on the other hand, it may be useful to point out that, as one of the richest men in the world, analyses of his role as venture philanthropist based on the assumption that his actions are driven by profit-motives – or by a charitable heart – are not necessarily helpful. We cannot see into Mr. Gates’s mind or heart. This focus might divert debates into unnecessary discussions about character.

As the 4th richest man on earth, with an estimated fortune of 132 billion dollars, Mr. Gates does not need to earn more money.[x] On the other hand, lauding Mr. Gates for his generosity seems unfair when compared to the money donated by millions of citizens who try to alleviate the fate of more unfortunate human beings, or the efforts people ‘invest’ in struggles for a more just world.

Given Bill Gates’s enormous influence as sponsor, and as shaper of mega public-private initiatives and public agendas, there is certainly an urgent need to provide the public with a better picture of his role in public health. And this can be done through thorough contextual political economy analyses of Bill Gates’s statements, the policies of the Bill and Melinda Gates Foundation (BMGF), and the impact of its funding.

All in all, there is a need to give a clearer picture about whether, when and how transnational corporations, their fora such as the WEF, Bill Gates (and other venture-philanthropists and their foundations) contribute to, or undermine, WHO’s mandate to “work for the attainment by all peoples of the highest possible level of health.”

And to point out that a system based on the putative generosity on the part of the ‘winners’ of global neoliberal restructuring towards its ‘losers’ undermines struggles for a more just world.  In the words of Sociology Professor Linsey McGoey:

“Private philanthropy in general can be a threat to democratic accountability and a just society. Reverence for big donors implies that billions of underpaid and exploited people should be satisfied with philanthropic crumbs from a self-appointed aristocracy rather than entitled to economic justice. What’s really needed for a fairer, more equal society is not charity but justice…”[xi]

More than grains of truth: influence of TNCs, venture-philanthropists and the World Economic Forum on the road towards Health for All

It seems to me that in relation to Covid-19, there has been far more coverage of ‘conspiracy theories’ as well as articles lauding the foresight and benevolence of Bill Gates or publishing his ‘expert’ opinion on the matter, than attempts to shed light on the web of connections between WHO (and other UN-agencies), pharmaceutical and other health related companies, Bill Gates, Ted Turner (and their venture philanthropy foundations), the World Economic Forum, academics, and some public-interest NGOs, as well as engineered, public-private/multi-stakeholder partnerships,- alliances and -‘movements’.

What is the impact of these webs of influence on public policy making at this important time? Given that the Covid-19 virus seems to have become endemic, we need better public knowledge about public-private webs of connections. Only this will allow concerned policy makers and citizens to recognize and prevent undue influence on the evaluation of the policies to date and the formulation of future pandemic policies by for-profit actors or hyper-rich funders.

In the following part, I shall therefore try to draw as a backdrop a very rough chronology of some key events in the international health – and other – arenas which have had an impact on international health policy-making today.

The chronology starts in the 1970s, at the time of struggle for a New International Economic Order. It ends with what is often presented today – in a positive light – as an emerging new world order: a world administered through a system of global, polycentric, ‘multi-stakeholder governance.’

1974, when the UN General Assembly approved the Declaration on the Establishment of a New International Economic Order, seems far away today. As part of this, UN agencies received the mandate to find ways to rein in corporate power which had just been involved in the military putsch in Chile which ended in the overthrow and death of the democratically elected President Allende.[xii]

Four years later, the Declaration of Alma Ata called for “Health for All by the year 2000.” This Declaration reaffirmed WHO’s constitutional mandate to focus on health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”, as a “fundamental human right”. It declared “that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.” Peoples’ participation was a key word of the time.[xiii]

The call for Health for All was firmly connected to the New International Economic Order. WHO’s then Director-General, Dr Halfdan Mahler, and much of the WHO staff, worked in this spirit. Health for All strategies were focused on prevention: They were based on a view of health that challenged the simple mechanistic model of our bodies where one just needs to find a ‘pill for every ill’ – or a vaccine for that matter.

This holistic[xiv] view of health also drew attention to economic, social, political and cultural origins of ill-health. The New International Economic Order, through ‘redistributive justice’, was meant to help eradicate ‘diseases of poverty’. The seventies were also a time when Western medicine started paying more attention to psychosomatic origins of ill-health.

The WHO, moreover, wanted to address commercial causes of ill-health. The organization started work on international codes to regulate health-related transnational corporations. These were meant to ensure that corporate practices contribute to peoples’ health rather than creating ill-health, for example through misleading information and marketing of infant food or pharmaceuticals, a lack of life-saving medicines through overpricing, or the dumping of proven harmful or inefficient medicines on developing countries.

However, even before the adoption of the WHO-UNICEF International Code of Marketing of Breastmilk Substitutes in 1981, transnational corporations started resorting to professional public relations advisers to help them elaborate strategies to prevent further transnational regulation of their practices. These strategies included spying on, silencing and splitting what transnational corporations perceived as opposition, as well as the plan to gain greater influence at WHO by pressuring for recognition of business associations as non-governmental organizations (NGOs) ‘in Official Relations.’ [xv]

The United States, in the name of freedom of commercial speech, often helped transnational corporations in the prevention of transnational regulation by threatening to withhold, or actually withholding, its contributions to WHO. Work towards a comprehensive international code for pharmaceutical companies was the 1980s after the election of the neoliberal key leaders Ronald Reagan in the US and Margaret Thatcher in the UK. [xvi]

With the fall of the iron curtain in 1989, history took a very unexpected turn. I still remember the talk of how people all over the world would now profit from the “peace dividend.” An end to the arms race and ‘wealth for all’ through the spread of the capitalist neoliberal economic model.

Soon after, a new policy paradigm arose in UN fora: that of the great ‘partnership’ between the public and the private sectors.  Transnational corporations successfully lobbied at the 1992 UN Conference on Environment and Development to be seen as ‘partners’ in solving the world’s most pressing problems – rather than contributors to the causes of these problems. People were being told that they could rely on TNC’s ‘corporate social responsibility’ and that, moreover, TNCs should be seen as benevolent ‘corporate citizens’, as legitimate ‘stakeholders’ in public affairs. In the environmental arena, business was henceforth recognized as one of the “Major Groups” to discuss the shape of sustainable development.

WHO’s Member States did, nevertheless, use their international regulatory power one more time in 2003, when they adopted the WHO Framework Convention on Tobacco Control. What helped was that tobacco companies had been convicted in the US for their deceptive practices and that a WHO-commissioned study had revealed a whole gamut of covert tobacco company strategies designed to continue harmful marketing and prevent regulation, including the use of academics and plans to use the influence of their associated food companies at UN fora.  What also helped was that the then Director-General, Dr Gro Harlem Brundlandt, stood firmly behind the regulation. However, she introduced a problem for future regulatory attempts. Dr. Brundlandt stressed that tobacco companies were being regulated because they marketed a product that clearly harmed health and insisted that food should not be seen that way.

In 2004, just after the adoption of the above mentioned ‘Tobacco Convention’, there was discussion about dealing in a similar manner with the marketing practices of the big snack and soft-drink companies. However, the United States insisted at the World Health Assembly in 2004 that the so-called non-communicable diseases – many of which were related to obesity – needed to be dealt with in a multi-stakeholder fashion and asked for insertion of related wording into the policy document[xvii]. Corporations have been part of the policy processes ever since.

The appearance of Bill Gates as a very rich venture philanthropy funder at the turn of the millennium created a whole gamut of different problems, not only in the international public health arena.

It coincided with a change in the direction of policy at the WHO headquarters: In 2001, Dr. Brundlandt commissioned a Report on Macroeconomic and Health: Investing in Health for Economic Development. WHO started to champion policies that were no longer based on Health for All approaches.[xviii] So-called global public-private partnerships for health were lauded as innovative, cost-effective, solutions to solving the health problems of the poor. The key-model was GAVI – the Global Alliance for Vaccines and Immunization – which had been launched by Bill Gates and UNICEF’s then Executive-Director Carol Bellamy at the World Economic Forum in January 2000.

Already at the very beginning, there were warnings that reliance on private funding for development purposes and a proliferation of GAVI-type PPPs which had corporations on their decision-making boards, might have far reaching negative systemic impacts.[xix] Meanwhile, there are historical-contextual analyses of the impact of Bill Gates’ funding on international public health which confirm that his preference for market-based solutions to public health problems, his long-term focus on vaccines, and his specific type of global public-private partnerships, have contributed to eroding broad public health policy approaches and the capacity of WHO to fulfill its constitutional mandate. [xx]

There is evidence that Mr. Gates hampered, rather than promoted, equitable access to vaccines because of his long-term promotion of strong patents and influence on vaccine pricing – even during the Covid pandemic.[xxi] One could furthermore argue that Mr. Gates has contributed to an overall increase in the economic and political power of transnational corporations worldwide, for example through his company’s lobbying against cartel laws in the 1990s, the Bill and Melinda Gates Foundation’s funding of a project which ended up distorting the very concept of conflict of interest, and the funding of an evaluation report of the public-private SUN – Scaling Up Nutrition – ‘movement’ which called for coopting or sidelining of IBFAN, the corporate accountability network which had tirelessly worked towards strengthening the regulation of infant food companies.[xxii]

And there are questions whether his influence on pandemic planning contributed to neglect of non-high-tech measures, in particular masks, in the early phase of the pandemic; and to what degree a Gates Funded statistic institute contributed to underestimating the seriousness of first Covid-outbreaks and over-early proclamation of an end of the Covid-19 pandemic.[xxiii]

But Mr. Gates is not the only venture philanthropist who has influence in the health arena. During WHO’s last ‘reform’ under Director-General Margaret Chan, Member States called for greater transparency on staff secondments. It was then revealed that a high post was occupied by a person provided by Ted Turner’s UN Foundation. To my knowledge it is not known what advice was given by this person concerning the direction of WHO’s reform.

Since the appointment of the new Director General, Dr. Tedros Adhanom Ghebreyesus in 2017, the UN Foundation was given a visible role in reshaping the civil society arena so that the civil society organisations would be working in ‘partnership’ with business actors towards what is now called Universal Health Care (UCH) – a plan which many civil society actors fear may end up in commercialization of health care and increased influence of actors who favour, and profit from, privatization of health care, in particular big health insurance companies. This is why critical academics suggest not using the term UHC in relation to the struggle for better health care systems.[xxiv] The Peoples Health Movement accused WHO also of using the celebrations of 40 Years after the Alma-Ata Declaration in 2018, to turn the original intent of the Declaration on its head – increasing business influence while decreasing the influence of civil society actors and Member States who remain supportive of the original spirit of Health for All.[xxv]

Concerning the third actor often named in peoples’ conspiracy narratives, the World Economic Forum (WEF), civil society actors and academics have long tried to draw attention to the fact that we are already far along the road towards reshaping our health-, and other global, arenas along plans that were elaborated by the WEF under its Global Redesign Initiative (GRI), now renamed Global Reset. The aim is called a system of global, polycentric, ‘multi-stakeholder governance’.  In fact, it is a road towards a fragmented system of public-private governance, where so-called “alliances of the willing and the able” are meant to take over the tasks of UN agencies wherever these are presented as unfit to fulfil their mandate.[xxvi]

At the same time, UN agencies continue to be cajoled, pressured, or willingly agree to becoming part of this public-private hybrid governance system. WHO’s current Global Programme of Work, for example, is based on the idea that WHO will become part of what was presented as a developing “ecosystem” of multi-stakeholder governance.[xxvii] 

Neoliberal narratives and restructuring

I can understand that it is not always easy for media to give a better analytical picture. There has been a bias in research towards what fits the neoliberal ideology since it took flight the world over.

I have witnessed, and at times experienced, the increasing tendency to disregard, sideline and silence those voices and analyses which do not support what I consider to be a non-sensical, yet by now hegemonic, narrative of the 21st century: that, in the name of ‘inclusiveness’, all ‘stakeholders’ need to work together in a spirit of ‘trust’ in public-private/multistakeholder ‘partnerships’ and ‘movements’; and that the best world order is a global system of ‘multi-stakeholder governance’. Such a system might be better called a system of plutocratic governance – a system where money rules. It is a system with totalitarian features.[xxviii]

A particular problem is that the great ‘partnership paradigm’ (or multi-stakeholderism as others call it), and the call to form even more new ‘multi-stakeholder partnership’ initiatives, has been cemented under the ‘overarching’ Sustainable Development Goal (SDG) Number 17. Why critical voices in the sustainable environment arena have not prevented this remains for me a yet unresolved question.

In my view, the public-private/multi-stakeholder ‘partnership’ narrative is a most powerful, indeed a hegemonic, sub-narrative of that legitimizing neoliberal ideology. The neoliberal narrative promised that ‘free’, unregulated, markets would take best care of our economic as well as political concerns. By now it is undeniable that all over the world, markets have been deregulated and reregulated in the interests of big, including financial, corporations.[xxix] The spread of ‘free’ – in the sense of ‘unfettered’, ‘predatory’ – market economies has created hitherto unknown wealth for some multi-billionaires and mega-companies, while the great majority of humankind has seen their livelihoods dwindle.

Given that neoliberal restructuring has involved cutting national tax bases, given that Member States’ contributions to UN agencies have been frozen since the 1980s, given that assessed Member State contributions constitute only about 20% of WHO’s funding, calls on WHO to accept funding from ever wealthier venture philanthropists or transnational corporations have become incredibly hard to resist. [xxx]

When Dr. Chan headed WHO, she could have reversed this situation. She could have pointed out that it created unacceptable institutional conflicts of interest for the agency. It is, as if our ministries of health were funded only to a fifth by taxes, and the remaining funding would come from actors who decide how their money should be spent. One does not have to be an expert on conflicts of interest to understand that such a situation threatens the integrity, independence, and trustworthiness of the world’s highest authority of public health.

Dr. Chan, and other high WHO officials, could have used the calls of some Member States for guidance on conflicts of interest in interactions with business actors, and civil society support for lifting of the freeze, to ask for full funding through assessed Member State contributions. At the time, the budget of WHO was lower than the budget of many major hospitals in the United States.[xxxi]

Instead, the WHO Secretariat supported a redefinition of the conflict of interest concept during the development of WHO’s Framework of Engagement with Non-State-actors (FENSA). It ignored expert warnings that this could actually increase conflicts of interest.[xxxii] This Framework further contributed to legitimizing the participation of business and philanthropic actors in public affairs, by making it easier for them to gain Official Relations status with WHO. Poorer WHO Member States had wanted a barrier against undue influences. Instead, FENSA was soon promoted as an “enabling framework” for multi-stakeholder partnerships.

Immediate priorities for media coverage

In sum, much attention has been paid to narrow conspiracy theories and their impact on peoples’ acceptance of pandemic policies, in particular to vaccination and the wearing of masks. This has resulted, among other things, in portrayals in the media of Mr Gates as a victim of unreasonable witch-hunters.

This focus, in addition to that on Mr Gates as a most generous donor and even prophet of the current pandemic and expert on the matter, risks undermining a much-needed, better-informed public discussion on his role in public health policy making. A similar risk also applies to sidelining critical questions about the role of transnational corporations and the World Economic Forum.

Existing analyses of the influence of Bill Gates surely justify more questioning of what influence he and his Foundation had in the way the pandemic was handled. How can we ensure that health policies, research on and distribution of vaccines are discussed freely and without undue influence? It would be an extremely helpful first step if media stopped presenting Mr. Gates as an expert on vaccines, pandemics, and public health.

Instead, media should urgently turn to broader analyses of health politics. The World Health Assembly in May 2022 may be decisive in shaping future global health policies and the global health ‘governance’ system.[xxxiii]

Discussions have begun about post-pandemic health-, as well as economic policies (which, in Europe, are now joined by a new war-economy). An overarching question is: who will decide how much public funding will be available for social aspects, nationally and globally and how will it be distributed?[xxxiv]

Following the added-pandemic strain on our health care systems, we risk increasing pressure for privatization of our health care systems as the way forward. Will we instead have a thorough review of which health care systems best serve peoples’ needs, taking the experiences of the pandemic into account? Will we have debates about how to adequately pay for health care professionals and -personnel and deal with the continuous brain drain from poor to rich areas of this world?[xxxv]

Given that obesity has also emerged as an important risk factor for the development of serious Covid-19 infections, we need to push and enable WHO and its Member States to finally start addressing commercial factors of ill-health via legally-binding, international regulation of the marketing of obesogenic products.

Most urgent attention has to be paid to the increased risk of hunger and starvation which may result from the economic consequences of the pandemic policies (and also, directly and indirectly, from the war in the Ukraine).

Concerning the vaccine-debate at a global level, the question of why there has been such an unequal access to vaccines should reopen debates about so-called rational drug policies, about appropriate regulation of the practices of pharmaceutical giants, about ways to support and undertake research that is based on serving the public-interest on a global scale.

And of course, there is a need to reframe transnational public health issues with the guiding star of achieving Health for All. It is a struggle linked to protecting and promoting peoples’ individual as well as social, political, economic and cultural human rights. It is also linked to continuing struggles to achieve international, legally-binding regulation of business along human rights principles. It is linked to discussions and struggles aiming to achieve a world order that is not based on the predatory neoliberal ideology and system.

Standing in the way of progress is the lack of transparency and overly close relationships of our public institutions and important personalities with transnational corporations, venture philanthropies, and the World Economic Forum. These relationships need to be exposed and urgently disentangled.[xxxvi]

 Afterthought: Media in the neoliberal world

Neoliberal restructuring of the media-scene, including ownership of media by billionaires or heads of states, has unfortunately diminished the capacity for critical reporting of reputable media. This has led to much disenchantment of the readers from the critical left.

In more recent times, reputable media have been discredited by Russia and by former president Trump as “fake news”, and by the New Right in Germany as the “lying press” (Lügenpresse). How to prevent that their calls to stop reading any newspaper, or tuning into public TV channels, are being followed? Moreover, many people are today primarily reading whatever news are selected by their mobile-phones instead of paying for, or subscribing to, print or e-media.

Political scientist Timothy Snyder advocates as an essential way to fight totalitarian systems or dictatorships subscribing to a journal that does the essential investigative work.[xxxvii] This concurs with the advice by Yuval Noah Harari to people who have the tendency to classify most news-items as either “post-truth” or ‘fake news’:

“It would … be totally wrong to conclude… that any attempt to discover the truth is doomed to failure, and that there is no difference whatsoever between serious journalism and propaganda… Don’t expect perfection. One of the greatest fictions of all is to deny the complexity of the world and think in terms of pristine purity versus satanic evil…. No newspaper is free of biases and mistakes, but some newspapers make an honest effort to find out the truth whereas others are brainwashing machines… if you want reliable information, pay good money for it.”[xxxviii]

I follow this advice[xxxix]. However, I remain alarmed to learn that important media outlets such as the New York Times, the BBC, the Guardian as well as the German weekly Die Zeit have been accepting funding from the Bill and Melinda Gates Foundation.[xl] As investigative journalist Tim Schwab noted in his thorough analysis about the multiple links of the foundation with a variety of journalistic institutions:

“Gates’s generosity appears to have helped foster an increasingly friendly media environment for the world’s most visible charity. Twenty years ago, journalists scrutinized Bill Gates’s initial foray into philanthropy as a vehicle to enrich his software company, or a PR exercise to salvage his battered reputation following Microsoft’s bruising antitrust battle with the Department of Justice. Today, the foundation is most often the subject of soft profiles and glowing editorials describing its good works.”

I therefore wonder: Has there been adequate debate about the impact Gates funding might have had on media reporting? Why do we still find so little of it in the mainstream media? According to Tim Schwab:

“Insofar as journalists are supposed to scrutinize wealth and power, Gates should probably be one of the most investigated people on earth—not the most admired.” [xli]

Only if the media pay attention to more sophisticated analyses of corporate and venture philanthropists’ influence in the public health arena – analyses made by civil society groups and movements, critical academics, and investigative journalists – can they fulfil their mandate to contribute to an informed public opinion through open debates.

Second afterthought: Situated knowledge

While writing this piece, I have once more been reminded of the fact that knowledge is situated – how much it depends on the researcher’s situation in space and time.[xlii] I can see how much these reflections were influenced by my life experiences, my work, and what I read. I was reminded of it also through reactions of some of the first readers of this piece. The word Covid-related ‘conspiracy theories’ often evoked thoughts about the North American situation.

However, this was not the standpoint from which I was writing these reflections. I was born in Western Germany, not so long after the Second World War. When I grew up, this part of Germany still had a social market system. From the age of nineteen, I have spent much of my life outside of Germany. I have been part of, and been interacting with, several international citizen organisations and networks. I also exchange ideas with friends and colleagues in academia and UN agencies. Since 2015 I live in the Czech Republic – a neighbouring country of the now reunited Germany – where many citizens still remember their time behind the ‘iron curtain’. It is from there that I have been observing some of the reactions to the Covid-pandemic (and more recently to the war in the Ukraine). [xliii]

Via social media, I have often received information pieces which worried me as a health professional. This included messages spreading the analogy of mouth-nose-covering with “muzzles” (Maulkörbe) – negatively labelling masks as an infringement to ‘freedom of speech.’ This emotionally loaded analogy made it often difficult for me to have a reasoned discussion about the usefulness of masks as barrier method against transmission of microorganisms. I have also received social media-calls to reject vaccines and masks – often linked to the idea that it would be enough to build up natural immunity (and also often connected to problematic advice on ‘alternative’ medicines and nutrition – such as eating only warm food).

It is from media that I learned that the great majority of German citizens have been doing their best to protect others, and themselves, by following the prescribed pandemic policies[xliv] – while challenging some of them in courts (a possibility which is only available in a democratic country).

It is from media that I learned that in today’s reunited Germany, journalists, as well as scientists and politicians, are braving intimidation and death threats. I also learned that a young man, only twenty years old, was shot because he asked a customer of a gas station to wear the prescribed mask. Journalists have shown how the Extreme Right purposefully increased confusion and resistance to anti-Covid vaccination in the hope to create a civil war mood which would help them overthrow “those up there.” They have helped to expose plans of the Extreme Right to feed popular rage, and to instrumentalise Covid-demonstrations to stage a “popular uprising” against an alleged “Corona-Dictatorship”. They uncovered, just in time, a plot of a fanatic group to murder Saxony’s prime minister, Michael Kretschmer in December last year. Journalists and camera(wo)men continue risking physical assault at anti-Covid policy demonstrations.[xlv]

Today, I therefore also subscribe to media to honour those journalists’ who brave such adversity to work for a democratic and peaceful society. I also wish to express my gratitude to the journalists who must be exhausted from translating for the public the rapidly changing Covid-related information and public health measures over the past two years.

On the other hand, I am more than ever aware of the need to support truly independent, investigative journalism, as well as science in the public interest.[xlvi] I do hope that, in a small way, my meandering reflections may contribute to efforts towards a world in which information is not distorted by commercial, or political, biases – nor by unfounded social media messages.


[i] Judith Richter, PhD Social Sciences, MA Development Studies, MSc Pharm.Sc., Dipl. Trop.Med.Biol.

Author of the books Holding Corporations Accountable: corporate conduct, international codes, and citizen action; and of Public-private partnerships and international health policy making: How can public interests be safeguarded? – as well as numerous other publications and think-pieces.

Declaration of interests: This paper is self-funded. My work as researcher was never funded by companies nor venture philanthropies.

Acknowledgments: I thank Alison Katz and Robert Peck for English-language editing. I also thank them, and other reviewers, for their comments. Any shortcomings of this paper, however, are my responsibility.

[ii] Part IV, Truth, p. 213

[iii] Also, how wise is it to lump together the most diverse types of personalities under the labels such as ‘conspiracy’ believers or ‘anti-vaxxers’? For example, in Germany, opposition to vaccines and face-mouth covering reach from the Extreme Right, over people from the traditional left, to (primarily) women who believe firmly in the benefits of homeopathy and what they call ‘alternative’ medicine (see

Some persons of the latter community have long believed – and spread – the rumour that vaccines create autism.  The German Federal Institute for political education mis-classified vaccine resistance based on this belief as a conspiracy theory. See Bundeszentrale für politische Bildung (bpb), 2022, Lexikon einfach: POLITIK, accessed 22.01.2022.

If one does not classify them as conspiracy believers, then one may find new ways of addressing their doubts about modern medicine. An editorial in a Czech medical journal suggested to initiate a discussion within the medical community about the fact that belief in homeopathy can have negative health consequences.

I am aware that those who declare their belief in ‘alternative’ health are a heterogenous group. Not all reject vaccination, some may use homeopathic globuli after vaccination, others may be specifically against the anti-Covid-19 mRNA vaccines. In addition, there are persons who are more in favour of a ‘holistic’ approach to health – an approach to modern medicine that also considers psychological, nutritional, social, economic, and political factors of health. These groups overlap, but many in the holistic groups do not believe in homeopathic medicine and would not reject vaccination per se.

More complex, still, is the case of heads of states or health professionals who have promoted the use of unproven Covid-therapies which may have potentially harmful consequences such as the antimalarial drug Hydroxychloroquin or of Ivermectin. It seems difficult to challenge their claims since this is often portrayed as unjust persecution in social media. For info on these medicines, see e.g. chapter “not recommended medicines/Nicht-empfohlene Medikamente”, in Klemperer, David with Joseph Kuhn and Bernt-Peter Robra (2022) “Corona Verstehen – evidenz-basiert”, Living E-book, Version of 23 March, pp. 164-167  Cf. also FDA website. Why You Should Not Use Ivermectin to Treat or Prevent COVID-19.

[iv] Leach, Anna and Miles Probyn (2021) “Why people believe conspiracy theories: Could folklore hold the answer,” The Guardian, 26. October

[v] Her claims in the first half of 2020 included: that mask-wearing was dangerous because it “literally activates your own virus”; and the warning: “If they were successful in mandating it (a COVID-19 vaccine) for everyone, at least 50 million Americans would die, probably from the first dose”, see e.g.;;

[vi] McGreal, Chris (2020) “A disgraced scientist and a viral video: how a Covid conspiracy theory started”, The Guardian,14 May. I would like to add to this a potential explanation behind resistance to vaccination, one that may lie behind rumors of sterilizing vaccines being given to unsuspecting victims: They might be based on the fact that immunological contraceptives were being developed under the problematic label ‘antifertility-vaccines’. It is possible that the fundamentalist US evangelical and Islamic groups who heard about this new technology at the 1993 UN Conference on Population and Development continue to spread rumors about their existence and that this contributes to resistance to vaccines against harmful viral diseases. However, work on this technology-line was stopped by an international campaign in the 1990s, a.o. because of concern over their potential for abuse. Richter, J. with Sarah Sexton (1996) Vaccination” against pregnancy: The politics of contraceptive research. The Ecologist, Vol. 26, No. 2, March/April, pp. 53-60

Finally, those who wonder why people might draw connections between Bill Gates and implantable chips, just search under “Gates contraception and chips” and you will find that his foundation did fund, for example, the development of contraceptive chips.

[vii] This is how “conspiracies” are most often defined – as “a secret plan made by two or more people to do something bad, illegal, or against someone’s wishes” (Cambridge Academic Content Dictionary); or “a secret agreement made between two or more people or groups to do something bad or illegal that will harm someone else.” (Cambridge Wörterbuch Business-Englisch).

[viii] This concurs with the opinion of media specialist Professor Bernhard Pörksen who advised against the use of wholesale labels such as ‘paranoïd’ or ‘hysterical’ for participants in the German “Queerdenker” protests. See Government, media and public analyses, in Wikipedia (2022), Protests over COVID-19 policies in Germany,, accessed 21.03.2022

[ix] Marks, Jonathan H. (2019) The perils of partnership: Industry influence, institutional integrity, and public health. New York, Oxford University Press, pp. 142-143. This book gives excellent advice how to restore integrity in public institutions. He stresses: “We need not demonize industry to protect public health. But we need not— and should not— insist on common ground with industry to promote public health. On the contrary, we imperil public health, as well as the integrity of public health agencies, when we confound the common good and common ground.”

[x] BloombergsBillionairesIndex (2022), accessed 23.03.2022. Fortune after the divorce settlement in 2020. I do not know whether this index takes into consideration Gates’s landholdings in the US.

[xi] McGoey, Linsey (2021) The People v. Bill Gates, London Review of Books-LRB blog, 4 May,

[xii] Resolution adopted by the General Assembly, 1st May, Doc. A/RES/S-6/3201

For a short account of the context, see Richter, J. (2001) Holding corporations accountable: corporate conduct, international codes, and citizen action. London & New York: Zed Books, pp 8-9


[xiv] Or what public health expert Professor David Klemperer prefers to call bio-psycho-social view of health.

[xv] Richter, Judith (1998) Engineering of consent: uncovering corporate PR. The CornerHouse, Briefing Paper No. 6, March,

For a shift towards using ‘dialogues’ as issues-management strategy, see

Richter, J (2002) “Codes in context: TNC regulation in an era of dialogues and partnerships.” The Corner House, Briefing Paper No. 26, February (which is also a summary of my book Holding Corporations Accountable)

[xvi] Richter, Judith (2001) Holding Corporations Accountable, op. cit., p.92-94

[xvii] WHO (2004) Global strategy on diet, physical activity and health,; personal observation at the World Health Assembly.

[xviii] For one snapshot of the time, cf. Richter, J. (2004), Public-private partnerships and international health policy making: How can public interests be safeguarded? Elements for Discussion Series, Ministry for Foreign Affairs Finland, Helsinki, September, pp. 76-81 (and more broadly: 68-83)

[xix] Richter, J. (2003) We the peoples’ or ‘we the corporations’? Critical reflections on UN-business partnerships. Geneva, IBFAN/GIFA.

Ollila, Eeva (2003). Global-health related public-private partnerships and the United Nations, Policy Brief No.2, Helsinki: Globalism and Social Policy Programme (GASPP).

[xx] McGoey, Linsey (2021) The People v. Bill Gates, op. cit.

Birn, A.-E. & J. Richter (2018) U.S. Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present. Health Care under the Knife:  Moving Beyond Capitalism for Our Health. eds. Howard Waitzkin and the Working Group for Health Beyond Capitalism, Monthly Review Press (advance chapter, May 2017, see)

McGoey, Linsey (2016) No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy, London, Verso Books.

[xxi] Álvaro Morcillo Laiz (2020) New Viruses, Old Foundations. COVID-19, Global Health, and the Bill and Melinda Gates Foundation, WZB Blog Orders Beyond Borders Understanding the globalized world, posted May 28

[xxii] E.g. Richter, J (2014) Conflicts of interest and global health and nutrition governance – The illusion of robust principles,  BMJ 2014;349:g5457, 25.Sept.;  for a history of the social engineering of a multi-stakeholder ‘movement’, its problematic ‘principles of engagement’ and redefinition of conflicts of interest, see FIAN/IBFAN/SID (2019) When the SUN casts a shadow: The human rights risks of multi-stakeholder partnerships: the case of Scaling up Nutrition (SUN)

[xxiii] Richter, J. (2021) Corona-policy-chaos and Health for All, 20 May, online-publication PEAH – Policies for Equitable Access to Health,

Zaitchik, Alexander (2021) How Bill Gates impeded Global Access to Covid Vaccines, The New Republican, 12 April

Schwab, Tim (2020) Are Bill Gates’s Billions distorting public health data? The Nation, 3 December

[xxiv] Birn, Anne-Emanuelle and Nervi, Laura (2019). “What Matters in Health (Care) Universes: Delusions, Dilutions, and Ways towards Universal Health Justice,” Globalization and Health 15 supplement, pp. 1-12. doi:10.1186/s12992-019-0521-7

[xxv] See, for example, analyses by the People’s Health Movement (PHM); in particular in PHM et al. eds. (2022) Global Health Watch 6: In the Shadow of The Pandemic. Bloomsbury Academic, forthcoming June, chapters on UHC and PHC (B1, pp 83-104) and on privatisation (B3, pp 129-146)

[xxvi] See in particular the work of Harris Gleckmann on the WEF-GRI and multi-stakeholderism, including his recent chapter on COVAX; and the website of the Transnational Institute (TNI), e.g.; and TNI-chapter The World Economic Forum’s Great Reset: Corporate Ambitions and the Future of Multilateralism in and beyond Global Health, in PHM et al. eds. (2022) Global Health Watch 6, op. cit., forthcoming June; as well as the website of G2H2 at this year’s World Health Executive Board Meeting in January 2022.

Richter, J (2014) “Time to turn the tide: WHO’s engagement with non-State actors & the politics of stakeholder-governance and conflicts of interest.” 12 May, RR & letter to the BMJ

[xxvii] And Richter, J. (2017) Comments on Draft Concept Note towards WHO’s 13th General Programme of Work, 14 November ,

It also suggested concentrating on “impact” rather than on making the best possible policy plans. Such an approach may well contribute to side-lining broad public health policy making and assessments. Narrow assessments, e.g. on how many childrens’ lives were saved by a vaccine donation can declare success when a broad based assessment might show a negative impact on the health care system. To use a German proverb, it might contribute to a situation of “operation successful – patient dead.” For further problematic quotes, see

Richter, J. in cooperation with Alessia Bigi, (2017) “Comment on WHO’s draft 13th General Programme of Work”, IBFAN-GIFA Briefing Paper, 28 November,  These are analyses during the development of the WHO Global Work Plan, not of the final GWP

[xxviii] Richter, J. (2021) Defending and reclaiming WHO’s capacity to fulfil its mandate, op. cit.

[xxix] George, Susan (2015) Shadow sovereigns: How global corporations are seizing power, Cambridge, Polity Press

[xxx] Left out of the ‘free’ market narrative is, furthermore, that health is not something that follows market rules. We cannot e.g. lower the price of anti-cancer drugs by simply saying to a TNC “your medicine is too expensive, I shall have another product from your competitor.” As for vaccines in times of pandemics, we depend utterly on the integrity and trustworthiness of public systems and public officials to choose for us the most appropriate vaccine and negotiate the best possible price.

[xxxi] As pointed out by Gostin, Lawrence O. (2015) The Future of the World Health Organization: Lessons Learned from Ebola, Milbank Quarterly, published online, September 8,

E.g. CSOs (2016) Civil Society Statement on the World Health Organization’s Proposed Framework of Engagement with Non-­State Actors (FENSA), accessed 27.03.2022

[xxxii] Rodwin, Marc A. (2020) WHO’s Attempt to Navigate Commercial Influence and Conflicts of Interest in Nutrition Programs While Engaging With Non-State Actors: Reflections on WHO Guidance for Nation States; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”, IJHPM,

[xxxiii] At the World Health Organization’s  Executive Board Meeting in January this year, civil society organisations and movements were raising alarm about propositions to expand privatization of health care services by using ‘multi-stakeholder’ approaches to work for ‘Universal Health Care’, that efforts to address commercial origins of ill-health were being further weakened, and that civil society voices – in particular of those who have long called for the prevention of undue influence of transnational corporations and multibillionaire-sponsors in international public health and nutrition policy making – were being further sidelined.

[xxxiv] E.g. Labonté, Ronald (2022) Analysis The World We Want:  A post-covid economy for health: from the great reset to build back differently, BMJ 2022; 376 doi: (Published 25 January)

[xxxv] For an analysis, see eg PHM et al. eds. (2022) Global Health Watch 6, op. cit., forthcoming June

[xxxvi] One step in regaining a separation of spheres and arms-length distance would consist in a true revision of, followed by repairing major flaws in, WHO’s Framework for Engagement with non-State Actors (FENSA). Until its wrong conflict of interest concept is corrected at WHO-level, public servants, health professionals and citizens may want to direct their attention to preventing that the FENSA (or SUN’s) false conceptualization of conflicts of interest are undermining existing conflict of interest regulation in their countries

[xxxvii] Snyder, Timothy (2017) On Tyranny: Twenty lessons from the twentieth century, Penguin Random House, UK, London

[xxxviii] Harari, Yuval Noah, 2018, op. cit., pp. 242-243

[xxxix] Journals may need to reflect how to make this possible for citizens who may not have a regular, or high enough, income to pay for a subscription. For example, the Guardian makes it possible for people to pay what they can afford.

[xl] See Transparenzhinweis behind the article by Simmank, Jakob (2020) Bill Gates, die Weltverschwörung und ich, Die Zeit, 8 Juni. It contains no information about the amount received from the BMGF.

[xli] Both quotes, see Schwab, Tim (2020) “Journalism’s Gates keepers”, Columbia Journalism Review CJR, 21 August,, accessed 11.03.2022

For Tim Schwab’s series of articles on the matter. E.g.  Of particular interest for German analysts may be his BMJ article (2021) Covid-19, trust, and Wellcome: how charity’s pharma investments overlap with its research efforts, 3 March since the same actors are active in advice about international health policies at German government level (for a German translation of this and other article, see Pharma-Brief, the newsletter of the BUKO Pharma-Kampagne)

[xlii] As in Sandra Harding’s Standpoint theory

[xliii] From that standpoint, I hope, I am forgiven for not being able to sufficiently cover another aspect of the Covid-pandemic: the fight for access to anti-Covid vaccines. In Germany the term “vaccine apartheid” has an entirely different connotation than in poorer parts of our world; see e.g. Ivanova, Alena (2021) Vaccine apartheid is prolonging COVID – not vaccine hesitancy, openDemocracy, 2 December

[xliv] Which, according to Prof. Klemperer, may base much of their analyses on the COSMO-Studie

[xlv] Fuchs, Christian (2022) «Rechtsextremismus: Ein inszenierter Aufstand,» die Zeit, updated 13 January

[xlvi] In Germany, critical, independent information on the pandemic can be found in: Klemperer, David et al., Corona-verstehen, a living e-book which is updated continuously, Critical analyses on pharmaceuticals and international health politics are provided by the newsletter and other publications of the BUKO Pharma-Kampagne.