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22 Global Governance 349 (2016)
The Bill and Melinda Gates Foundation and Legitimacy in Global Health Governance

handle is hein.journals/glogo22 and id is 357 raw text is: Global Governance 22 (2016), 349-368 The Bill and Melinda Gates Foundation and Legitimacy in Global Health Governance Sophie Harman The Bill and Melinda Gates Foundation brings to light the legitimacy prob- lem with global philanthropy. The legitimacy problem here is twofold: first, with regard to the criteria used to assess the presence or absence of legitimacy in global governance; and, second, how analysis of legitimacy does not fully account for how we understand the legitimate basis of rule drawn from private wealth. This article begins to address this lacuna by an- alyzing the legitimacy of an actor that wields considerable authority in the field of global health politics and has growing prominence in contempo- rary global governance, the Bill and Melinda Gates Foundation. Key- words: Bill and Melinda Gates Foundation, legitimacy, philanthropy, global health, Beetham. PHILANTHROPY IS NOTHING NEW TO GLOBAL GOVERNANCE. IT HAS A LONG history of establishing international organizations, developing some of the first international welfare programs, and acting as a tool of US hegemony in the world.1 The Bill and Melinda Gates Foundation (BMGF) is an extension of the legacies left by US philanthropists such as John D. Rockefeller and An- drew Carnegie. However, the BMGF exists in a postglobalization world that encompasses global-policy-making goals, public-private partnerships, global information exchanges, prominent nonstate for-profit and not-for-profit actors, the cult of celebrity, and a myriad of new and old international institutions. This postglobalization world is best typified by global health governance, the central domain in which the BMGF positions its international affairs. Global health governance is an ever expanding field of governance that refers to trans-border agreements or initiatives between states and/or non-state actors to the control of public health and infectious disease and the protection of people from health risks or threats.2 It involves specialized public-private partner- ships, multilateral and bilateral institutions, epistemic communities, private companies, celebrities, ex-politicians, and a variety of civil society organiza- tions, and is underpinned by questions of equality, rights, and the efficacy of development assistance. Since the launch of the foundation in 2000, Bill and Melinda Gates have shaken up interest in global health by capturing the atten- tion of policyrnakers and the general public through the foundation's Global 349

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