Short Abstract:

Philanthropy is a significant power in global development and debates rise toward 'philanthrocapitalism', which questions its unaccountability, neoliberal ideology, techno-evangelism, etc. However, few research explored how such power asymmetry is formulated which leads to ethical risks. This research focuses on global health and explores how the Bill Melinda Gates Foundation influence the agenda.

Long Abstract:

Introduction

Philanthrocapitalism was initially defined by Matthew Bishop and Michael Green [1] as a form of philanthropy conducted through a capitalist business model by entrepreneurs. It was further interpreted as the practice that integrates market motifs, motives and methods with philanthropy, especially by high net-worth individuals (HNWIs) and their institutions [2]. The main concern for philanthrocapitalism is that it becomes a mode of governance—a means of agenda setting and policy creation by the ultra-rich for global development [2]. Researchers have long been questioning such power because of the lack of accountability and legitimacy of the HNWIs to impose their neoliberal ideologies through a top-down (i.e. rich-to-poor) process, such as selective funding [3] and issue framing on beneficiaries. By framing development challenges as scientific problems; beneficiaries as productive entrepreneurs rather than victims; and philanthropy as a social investment rather than a donation, the market values and practices were further embedded and extended within society [2]. However, it was still unclear how such power dynamics have taken effects through philanthropic activities.

Global health is a major field for international philanthropies and faces typical controversies in the dominance of major private foundations. The Rockefeller Foundation was active in the diffusion of Western medicine and health technologies to the Global South (and particularly China) from the 1920s onwards, but also in establishing the international health architecture, including the WHO’s predecessor, the League of Nations Health Organization (P56) [3]. Since the 21st century, the Gates Foundation has gradually taken up the place of the Rockefeller Foundation and become a major player in shaping the global health agenda that supplies 10% of the World Health Organization’s (WHO’s) funding [4]. In the meantime, neoliberalism imposed by philanthrocapitalism is claimed to “structure debates and shrink ‘policy space’ in global health policy, imposing constraints and limiting what is ‘sayable’, ‘doable’—and even what is ‘thinkable’—in global health governance” [5]; concerns for the tech evangelism and technological bias are raised toward the Rockefeller and the Gates Foundation [6]. By determining what questions researchers bond to ask, big philanthropies envisage scholarship as a product and academia is thought of as a marketplace [7].

There have been few empirical studies about philanthrocapitalism. Roosa and Rebecca [8] conducted an initial exploration of beneficiaries’ views on BGMF’s projects in Tanzania and found complaints about coercion and a lack of engagement. Interviews with stakeholders. Interviews with actors in the Global Alliance of Vaccine and Immunization (GAVI) also revealed how Bill Gates has advocated for vertical, disease-centred, measurable, and technology-focused solutions, and the opposite side who supported whole health system strengthening was gradually marginalized in GAVI’s missions [9]. To date, most literature is still theoretical arguments about the inherent justice concerns of philanthropic activities [10]. There has been a call for more emphasis on local knowledge and qualitative exploration to decolonize global health [11]. Therefore, this research aims to form a more detailed view of how the power of BMGF has been unfolded and how that influences the global health agenda at multiple levels.

Framework

Though an institution can leave certain bilateral relations, it cannot leave the broader social institution’s understanding of what constitutes legitimate knowledge and research priorities [12], because power is not just about the shaping of choices but also about the shaping of identities and knowledge [13]. Philanthropic power can be described through three types of “power” in global health: ‘compulsive’ power is easily seen, such as bilateral donors tying health aid to trade. Less visible ones include structural power, which means that relations between institutions enlarge the capacities of some while reducing those of others. The third is ‘productive’ power, such as how issues are deliberately framed and presented to shape the thinking and behaviours of others [14]. This is particularly relevant to global health, as academic funding is the critical information to reveal the power relations established around BMGF, not only because of the foundation’s emphasis on ‘scientific philanthropy’ and explicit support for academic projects [6] but also because of the knowledge-intensive and value-laden nature of global health practices. The funding system for global health research is criticized as dominated by the global north [15]. The power framework was later developed into a more detailed research guide, which was constructed into three empirical sites of power research in health policy: actor relationships & networks, sources of power, and broader societal flows & expressions of power [16].

This research will be based on the above power structures and explore how BGMF exercises its power through each channel, including direct financial/technique flows, the relations formed among BGMF and relevant influencers, and its influence in the scientific and health narratives, and how these 3 channels interact with each other and reinforce themselves:

1. How BMGF exercises its power through compulsory channels, whether the projects.

2. What are the relations formed around BMGF and beneficiaries.

3. What are the BMGF’s influences in the scientific and health narratives

4. How these 3 channels interact with each other and reinforce themselves

Methods and data sources

This research will adopt a mixed-method approach. To understand the compulsory powers through donation, direct funding data will be collected and analyzed, including the flow of money, conditions, involved agencies, goals, and results. Data may come from project databases and online sources including press profiles, news releases, data, and official websites.

To understand how BMGF influence knowledge generation, data will primarily come from the Web of Science. All literature that states funding from BMGF will be retrieved, and their contents, word frequency, and network analysis will be applied to both institutional affiliation and co-funding agencies.

A discourse analysis of reports/news/papers will be conducted with a focus on how BGMF and beneficiaries frame priorities, problems, and solutions. For example, what is framed as global/universal values/standards and what is framed as local [17].

A snowball sampling strategy will be adopted to identify and interview relevant stakeholders, especially on who was involved in specific projects and how. Semi-structured interviews will be developed, which could include whether BMGF’s power to give or withhold mission-critical funds impacts grantees