The transparency of donations to the World Health Organization (WHO) Foundation—an independent body that seeks funds from across industry, civil society and governments, and awards grants to the WHO — has plummeted over its first 3 years of operations, a new analysis has found.

The analysis found that the majority of donors are not publicly disclosed, including some unnamed gifts as big as $11 million, which raises concerns about the potential “level of outside influence and role of commercial interests in setting WHO priorities,” the researchers wrote.

In 2020, the foundation was set up to solicit funds from a wider range of donors than the WHO can directly accept, including wealthy individuals and corporations. The WHO–a United Nations agency that supports global public health, and has a small program to address the negative influences of industry on public health–mostly relies on financing from member states and a few large donors including the Bill and Melinda Gates Foundation. 

Parul Pandey, a spokesperson for the WHO Foundation wrote in a statement to US Right to Know, that the foundation knows all its donors, including those who request public anonymity, and that all are subject to the same “strict due diligence and governance reviews” to ensure no conflict of interest.

Requests for donor anonymity are subject to additional internal review and the foundation has a gift acceptance committee that reviews any flagged donations, Pandey wrote.

In addition, the foundation publishes biannual transparency reports. And every contribution goes through a “risk appetite framework and matrix” before entering into a grant agreement to ensure high standards of governance and visibility, Pandey wrote. 

Proponents of the WHO Foundation argue that the agency needs more donors to achieve its goals. Its finances are on shaky grounds and it now faces further constraints after United States President Donald Trump pulled US funding from the WHO. 

In a media interview, Anil Soni, the chief executive officer of the WHO Foundation, said the foundation will keep the WHO at arms reach from corporate influence. Previously, Soni was head of global infectious diseases at Viatris, a pharmaceutical company. The foundation has accepted donations from companies such as Meta. But Soni said it will not accept donations from some industries, including firearms and tobacco. It’s unclear if it will accept donations from other health-harming industries such as fossil fuel, alcohol and soda companies, the analysis notes.

Nonetheless, some academics and civil society organizations are concerned that accepting donations from industry, such as businesses selling alcohol and infant formula, poses a conflict of interest. Evidence suggests that some companies use donations “as opportunities to distract or reframe product harms.., and assist wider lobbying efforts against public health regulation,” wrote the authors of the new analysis published in the journal BMJ Global Health.

The authors of the analysis, including Nason Maani, who works on inequalities and global health policy at the University of Edinburgh, Scotland, UK, dug through funding disclosures from donors on the WHO Foundation website. 

Since its launch, the foundation has disclosed donations over $82 million, of which more than 62 per cent were anonymous, the analysis found. Most of these were donations over $100,000. And the proportion of anonymous donations rose over time. In 2023, the foundation did not disclose the source of nearly 80% of contributions, up from nearly 40% in its first two years.

Using a scale to judge transparency in donations developed by Open Democracy, an independent international media platform, the researchers gave the WHO Foundation a D grade. This grade is for organizations that only name a minority of funders and not in a systematic way, putting it on par with some ‘dark money’ think tanks, the researchers wrote. The foundation’s grade fell from a B in its first years of operating when it disclosed at least 85% of funders who gave $100,000 or more. 

The researchers also found large inequalities in the initiatives that donors direct their funds towards. Donors preferred specific initiatives such as vaccinations or helping Ukraine. But donor priorities don’t always match national needs, plans and priorities, the researchers wrote. 

Where disclosures were made public, such as by Meta, the donations suggest some strategic alignment with their own priorities, rather than giving for charitable means, the authors wrote. For example, Meta gave funding for the WHO department of communication and digital health. In both of these areas “large social media companies have faced public scrutiny due to their potential role in facilitating misinformation…, and ongoing debates regarding their role in child and adolescent mental health”, the researchers wrote.  

The analysis concluded that it is difficult to assess where conflict of interests may occur given the proportion of anonymous donations to the WHO Foundation. The WHO’s funding model poses “potentially significant legitimacy implications for the organisation and for global health,” the researchers wrote. They call for the urgent development of more effective mechanisms for transparency and accountability. 

The WHO Foundation is not the only body raising funds for public health from private sources to be criticised for a lack of transparency. In 2018, lawmakers in the U.S. House of Representatives chided the Centers for Disease Control Foundation and the Foundation for the National Institutes of Health for accepting anonymous gifts. In a separate investigation, the CDC Foundation was found to have accepted funds from the Coca-Cola Company. 

Rachel Bonnifield, director of global health policy, at the Center for Global Development, an independent research institution, says she is “somewhat surprised by the lack of transparency” found in the analysis. However, she says the publicly anonymous donations are only a minor source of funding for the WHO–about 1% of its budget request, and she doesn’t think they will impinge on the WHO’s independence.

But, she adds, it is “unwise to create poor optics of this kind”. 

Lisa Bero, professor of medicine and public health at the University of Colorado Anschutz Medical Campus, who specializes in bioethics and conflict of interest, says the WHO depends on external funding because it is unable to function solely based on contributions from the member states. But the donations and what they are used for should be transparent, she says.  

“I recognize that some funders prefer to remain anonymous, but given that corporate capture of public health is a concern, transparency is critical for health organizations,” she says.