How the Gates Foundation Sustains European Donors’ Political Support for Global Health Initiatives

The Gates Foundation is widely recognized as the most powerful single actor in the field of global health. Beyond its immense financial contributions, the Foundation’s influence has relied on its ability to mobilize sustained support from sovereign donors for its preferred global health initiatives, notably Gavi, the Vaccine Alliance and the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. Yet the mechanisms through which the Gates Foundation practices such “catalytic philanthropy” remain poorly understood. Building on our recently published research on the Gates Foundation’s network diplomacy and policy and its advocacy grants in its European focus countries (the UK, Germany and France), this paper examines how the Gates Foundation has constructed a political advocacy apparatus to support the replenishment of the global health initiatives it has co-founded and backed over the past 25 years. We argue that the Foundation has successfully built advocacy coalitions which, through targeted campaigns, have elevated global health initiatives from the technocratic to the political arena in European donor countries and secured successful replenishments, even amid significant cuts to overseas development assistance. Empirically, the paper presents an in-depth case study of Gavi’s 2025 replenishment campaign in Norway, a co-founder and consistent funder of Gave and the Global Fund. We analyze the Gates Foundation’s “network diplomacy” with the state apparatus alongside its support for civil society and knowledge institutions to amplify political backing. The analysis draws on 25 in-depth key informant interviews, a systematic analysis of the Gates Foundation’s grants database, media analysis, policy and communication documents from organizations involved in the advocacy coalition, and correspondence between the Gates Foundation to the Norwegian government obtained through a freedom of information request. We find that the Gates Foundation significantly intensified its direct contact with government officials to make the case for Gavi, including by mobilizing Bill Gates’s personal relationships with the Norwegian Prime Minister and Minister of Finance, both of whom were involved with him in the creation of Gavi in 2000. The Foundation also funded numerous civil society actors that undertook extensive advocacy efforts in support of Gavi’s replenishment. An expert report commissioned by these and other civil society organizations and think tanks called for strengthening Norway’s leadership in global health and provided scientific legitimacy for continued funding of Gavi. The report was referenced repeatedly during Gavi’s replenishment campaign, including by Bill Gates himself. Overall, we demonstrate that the Gates Foundation’s policy and advocacy strategies play a central role in sustaining political and financial support for specific global health initiatives, fostering alignment between donor governments’ global health budgets and the Foundation’s own priorities. This raises important questions about the political influence of a foreign private foundation – controlled by one of the world’s wealthiest individuals – on European democratic decision-making.