Starved of public financing, the WHO has had to rely upon voluntary contributions from donor countries, private philanthropies, companies, and NGOs. Unlike funds from assessed dues, individual donors can earmark “extrabudgetary” monies for whatever specific purpose they like, thus circumventing WHO control. In 1970, these private contributions constituted a quarter of the agency’s budget. By 2008, they constituted nearly 80 percent. Thus it is now the private donors, not the WHO, who can call the shots in Geneva, and thereby shape the global health agenda.
Their influence is clear. The WHO allocates its regular budget to the diseases that account for the most mortality around the world. Extrabudgetary funds, in contrast, support different interests. According to an analysis of the agency’s 2004-05 budget, 91 percent of the WHO’s extrabudgetary funds were earmarked for diseases that account for just 8 percent of global mortality. Given the dominance of extrabudgetary funds in the WHO’s overall expenditures, the WHO ended up spending 60 percent of its funds on illnesses that account for just 11 percent of global mortality.