The power of private foundations: Rockefeller and Gates in the struggle against malaria

Abstract

This article investigates the rationale that informs the global engagement of private foundations and addresses the question of to what extent and in what way they have the power to (autonomously) shape global social and health policy in line with their convictions even when others disagree or could be expected to disagree. Following a conceptual discussion of power and taking malaria policy as the basis of a historical comparison between the Rockefeller Foundation and the Gates Foundation, the article shows that private foundations are impressively successful in promoting their vision of social and health problems while downplaying potential conflicts and passing over alternatives to their policy prescriptions. Moreover, the foundations can draw on their status as private actors in order to assert autonomy for their own actions even though their ultimate goal is to affect the policies of others – those of the public sector in particular. While the foundations’ power is originally based on their monetary resources that often serve as leverage for the mobilization of external resources, their funding of research and interventions helps them in the long run to even develop authority in their field of engagement. With a view to malaria policy it is noteworthy that both foundations analysed were successful in shaping policy in line with their convictions but limited their take on the malaria problem to ‘safe issues’ and marginalized other perspectives. In particular, they promoted a biomedical rather than a social understanding of health problems, they preferred time-limited investments over sustained spending, and they favoured solutions that promised readily recognizable results. Both foundations brought this biomedical-managerial frame to its logical end when they developed a preoccupation with malaria eradication and shaped global policies accordingly while others pointed at the less obvious dangers and problems of this seemingly persuasive approach.