Philanthrocapitalism, past and present: The Rockefeller Foundation, the Gates Foundation, and the setting(s) of the international/global health agenda

In recent years the Bill and Melinda Gates Foundation has emerged as this era's most renowned, and argu- ably its most influential, global health player. A century ago, the Rockefeller Foundation—likewise founded by the richest, most ruthless and innovative capitalist of his day—was an even more powerful international health actor. This article reflects critically on the roots, exigencies, and reach of global health philanthropy, comparing the goals, para- digms, principles, modus operandi, and agenda-setting roles of the Rockefeller and Gates Foundations in their historical contexts. It proposes that the Rockefeller Foundation's early 20th century initia- tives had a greater bearing on interna- tional health when the field was wide open—in a world order characterized by forceful European and ascendant U.S. imperialism—than do the Gates Foundation's current global health efforts amidst neoliberal globalization and fad- ing U.S. hegemony. It concludes that the Gates Foundation's pervasive influence is nonetheless of grave concern both to democratic global health governance and to scientific independence—and urges scientists to play a role in contest- ing and identifying alternatives to global health philanthrocapitalism. INTRODUCTION International health philanthropy, American-style, is back. Almost exactly a century after the Rockefeller Foundation began to use John D. Rockefeller's colossal oil profits to stake a preeminent role in shaping the institutions, ideologies, and practices of international health (as well as medi- cine, education, social sciences, agri- culture, and science), the Bill and Melinda Gates Foundation has emerged as the current era's most influential global health (and education, develop- ment, and agriculture) agenda-setter. The high profile of its eponymous soft - ware magnate founder and his wife, cou- pled with the Foundation's big-stakes ap- proach to grant-making and partnering, has made it a de facto leader in the global health field. Each of these two uber-powerful foun- dations emerged at a critical juncture in the history of international/global health. Each was started by the richest, most ruthless and innovative capitalist of his day