Governance in crisis

Abstract

Over the two decades prior to the COVID-19 pandemic, a powerful class of large private foundations emerged as influential actors in global governance. Their presence is more prominent in global health than any other issue area: foundations now account for 20 percent of all development assistance for health, and the Bill and Melinda Gates Foundation (BMGF) became the World Health Organization's second largest donor behind the United States government. This dissertation examines the core question: Under what conditions do private foundations influence policies and institutions governing health crises at the global and state levels? I argue private foundations influence global policy outcomes primarily through strategic engagement in public-private partnerships (PPPs)-through which they gain voting power typically reserved for states in global governance-alongside institutional embeddedness achieved through repeated interactions with other global health actors. This runs counter to prior findings suggesting donation amount and policy windows created by crises may facilitate foundation policy influence. Findings furthermore suggest private foundations may circumvent regulations against lobbying domestic or foreign governments via PPP engagement, to influence domestic policy outcomes in low-and-middle-income countries. While a body of global health research examines similar issues, foundations as non-state actors in global governance are largely under-theorized in international relations (IR). This project seeks to bridge global health scholarship with IR theory, integrating both philanthropy as an actor and global health as an issue area with broader IR theoretical approaches. The first article presents a novel data set to analyze trends and mechanisms by which foundations engage in global outbreak response between 2002 and 2019. The second draws on these data, utilizing a mixed-method approach to argue foundation policy influence occurs primarily through PPP engagement and repeated interactions with other governance actors. Building on these findings and engaging with a case study from the COVID-19 response, the third article presents a theory of large private foundation engagement in global health governance, to be tested in future research both in the context of other issue areas, using new data from the COVID-19 pandemic.--Author's abstract