The funding crisis puts global health system under enormous pressure

Worldwide, 4.5 billion people lack access to essential health services. Around a quarter of the world’s population also lacks access to essential medicines - in the poorest regions of Africa and Asia, this figure rises to as many as half the population. At the same time, the global health system itself is in the throes of a deep crisis: Public funding is being slashed, geopolitical tensions are hampering international cooperation and the system is becoming increasingly fragmented.

Governments and international organisations are therefore increasingly turning to private actors such as companies and philanthropic foundations to find alternative sources of funding. Through so-called blended finance, public funds are to be used to attract private investment for development goals. At the same time, more and more public-private partnerships are emerging and healthcare services are increasingly being privatised.

At first glance, this appears to be a practical solution: Private funds are intended to bridge financing gaps and promote innovation. Yet there is a fundamental problem underlying this: A large proportion of pharmaceutical research and many health programmes are already publicly funded today. Nevertheless, pharmaceutical companies secure control over the prices and availability of medicines through patents and licensing rights. The high profits then flow back to the companies, further strengthening their economic and political power. This creates a cycle in which public funds enable private profits.

Private actors gain influence, yet critical debate is lacking 

What is often missing from many debates, however, is a critical examination of the growing power of private companies, their lobby groups and philanthropic foundations, and the consequences for global health equity. This is also evident in current debates on reforming the global health architecture ahead of the 79th World Health Assembly, which takes place in Geneva from 18 to 23 May 2026. While governments are discussing how to close funding gaps and improve coordination, the growing influence of private actors and its consequences are missing from the agenda.

Two questions lie at the heart of the official reform process: How can the increasing fragmentation of the system be overcome, given the multitude of different actors and interests? And how can funding gaps be closed? Many proposals rely on greater involvement of private actors.

One example of how uncritically many governments and international organisations approach such partnerships is the new collaboration between the food company Nestlé and the United Nations University (UNU). Through this partnership, Nestlé will be involved in the UNU’s education and training programmes in the field of nutrition. 

Many civil society organisations see this as a problematic conflict of interest. They criticise the fact that Nestlé has for years been deliberately using training and sponsorship to influence scientific debates, dietary recommendations and political decisions. This is particularly problematic because Nestlé has repeatedly been criticised for selling unhealthy products and its aggressive advertising, especially of infant formula.

More power, fewer players: three far-reaching consequences for global health

The increasing power and growing influence of private actors has three far-reaching consequences, based on our paper on the growing influence of private actors in global health:

1. Profit motives determine access to medicines

Patents and market power often determine which medicines are available and how expensive they are. This was particularly evident during the COVID-19 pandemic: Although vaccines were developed and funded with substantial public money, access was very unevenly distributed worldwide. At the same time, research into diseases that primarily affect poor people is often neglected. These include, for example, cholera or so-called neglected tropical diseases, because they are less profitable for companies. Privatised healthcare systems also exacerbate social inequalities, as access to medical care depends more on income and ability to pay than on actual need.

2. Those who pay have a say: private actors are increasingly influencing political decisions

Private companies are increasingly influencing political decisions in the health sector. Through lobbying and their participation in multi-stakeholder partnerships, they play a role in the allocation of public funds and in setting political priorities. At the same time, the voices of civil society and affected communities are often heard less. 

Philanthropic foundations, too, are increasingly shaping which issues take centre stage through their funding. They frequently support market-based, technical and short-term measurable solutions. Long-term measures, such as building stable health systems or tackling the social causes of disease, often receive less attention.

3. Competing actors and self-interest complicate coordination within the global health system

According to its mandate, the World Health Organisation (WHO) is the central coordinator of global health policy. Yet the reality is different. An increasing number of actors, including global multi-stakeholder initiatives such as the Global Alliance for Vaccines and Immunisation (GAVI) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, are now competing alongside the WHO for scarce public funds, political influence and control over global health priorities.

This often leads to duplication of structures and additional reporting obligations for countries in the Global South. The focus is primarily on programmes targeting individual diseases, as well as technical and market-oriented solutions to global health problems. Added to this are voluntary commitments by companies and organisations. Binding legal measures, prevention and tackling the root causes of disease are often pushed into the background. The result: economic and political power is concentrated in the hands of a few actors, often without sufficient democratic oversight. This further exacerbates existing inequalities.

Germany, too, is increasingly relying on private actors

Germany plays an important role in this development. The German government, too, is increasingly relying on cooperation with private actors, for example through the action plan ‘Strong Partnerships for a Successful Global Economy’ by the Federal Ministry for Economic Cooperation and Development (BMZ). It aims to promote more public-private partnerships and new financing models aimed at increasingly involving private capital in global health policy.

At the same time, Germany is home to an influential pharmaceutical industry and wields considerable influence over international institutions such as the World Health Organisation. However, this also places a particular responsibility on the German government to advocate for clear rules, greater transparency and a fairer global health architecture. To do so, it should take the following six actions:

• Strengthening the WHO financially through higher mandatory and untied government contributions and securing its role as the central international health organisation, rather than outsourcing international health governance tasks to multi-stakeholder partnerships.
• Limiting the influence of lobbying and establishing rules and minimum standards, including transparency and accountability requirements for cooperation with private actors and multi-stakeholder partnerships, particularly regarding the use of public funds and conflicts of interest
• Ensuring access to medicines by linking publicly funded research to clear access and transparency conditions, limiting monopolies and driving forward reforms of the global patent system – for example, through an expanded TRIPS waiver during global health crises.
• Using public-private partnerships, blended finance and other market-oriented financing models only in justified exceptional cases, and instead enabling greater government investment in health, for example through debt relief, combating tax evasion and profit shifting, and taxes on products hlf armful to health
• Strengthening prevention and public health systems, and addressing the structural causes of disease, rather than merely promoting short-term individual programmes
• Involving civil society organisations and affected communities more closely in health policy decisions and strengtheningha their capacity 

A global health system out of balance

Publicly funded healthcare systems are increasingly influenced by private interests. Profits and political influence are concentrated among a few major players, further exacerbating existing inequalities. Without political countermeasures, there is a risk of growing global inequalities and further restricted access to healthcare, particularly for disadvantaged groups.

If the role of private actors in the current reform process is critically scrutinised and re-regulated, this offers the chance for a fairer global health system. A system driven not by profit, but by the common good, and which places the right to health for all people at its centre.

Read the briefing: Global health in crisis: Six theses on the role of private actors