{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:02:05Z","timestamp":1789970525806,"version":"4.0.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>International philanthropic foundations have become prominent actors in global health, influencing funding priorities, institutional partnerships, and governance practices at a scale that increasingly rivals many state actors. While their role in multilateral organisations and low- and middle-income countries (LMICs) has been widely debated, less is known about how these actors operate within high-income donor countries themselves. Over the past two decades, Germany has emerged as a key contributor to global health initiatives and has developed close working relationships with international foundations, particularly the Gates Foundation and the Wellcome Trust. This study examines how global health stakeholders in Germany perceive the evolving role and influence of international philanthropic foundations within the country\u2019s domestic global health landscape and explores the implications for global health governance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across political, academic, civil society, private sector, and philanthropic stakeholders, four principles roles were attributed to international philanthropic foundations: strategic funding, thematic prioritisation, knowledge brokerage, and convening. Foundations were widely perceived as simultaneously enabling and constraining, providing resources, political momentum and continuity in global health engagement, particularly during periods of political uncertainty, while also concentrating agenda-setting power and shaping the boundaries of legitimate intervention. Five principal domains of perceived impact were identified: priority- and agenda-setting, governance fragmentation, organisational dependency, stabilisation of global health, and legitimacy debates. Influence was perceived to operate not only through financial resources but also through networks, expertise, and symbolic credibility, with growing dependency on private foundations described as deepening structural asymmetries within the field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The German case illustrates how international philanthropic foundations interact with public development institutions within a major donor state, simultaneously strengthening and reshaping national engagement in global health. The dynamics identified, including strategic alignment, thematic narrowing and organisational dependency, are not confined to LMIC contexts but are structurally embedded within the broader architecture of global health governance, reinforcing critique of the donor\/recipient binary that often frames this field of inquiry. As public financing contracts and philanthropic actors assume a more prominent role in filling resulting gaps, greater transparency, safeguards for pluralism, and governance frameworks that preserve accountability and equity in global health become increasingly important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1960171","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:35:23Z","timestamp":1789968923000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Private capital in a public field: a qualitative study of philanthropic influence in Germany\u2019s global health governance"],"prefix":"10.3389","volume":"14","author":[{"given":"Henrike","family":"Gerdkamp","sequence":"first","affiliation":[{"name":"School of Public Health, Bielefeld University","place":["Bielefeld, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Luetke Lanfer","sequence":"additional","affiliation":[{"name":"School of Public Health, Bielefeld University","place":["Bielefeld, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Saint","sequence":"additional","affiliation":[{"name":"School of Public Health, Bielefeld University","place":["Bielefeld, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1056\/NEJMra1109339","article-title":"Governance challenges in global health","volume":"368","author":"Frenk","year":"2013","journal-title":"N Engl J Med"},{"key":"ref2","volume-title":"Gestiftete Entwicklung?: Die Kooperation zwischen der deutschen Entwicklungspolitik und privaten Stiftungen","author":"Martens","year":"2017"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1080\/00076791.2024.2351085","article-title":"The evolution of the Wellcome Trust and market-based philanthropy in the UK","volume":"67","author":"Brooks","year":"2025","journal-title":"Bus Hist"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"sqae073","DOI":"10.1093\/isq\/sqae073","article-title":"Positioning among international organizations: shifting centers of gravity in global health governance","volume":"68","author":"Holzscheiter","year":"2024","journal-title":"Int Stud Q"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1987502","DOI":"10.1080\/17441692.2021.1987502","article-title":"COVAX and the rise of the 'super public private partnership' for global health","volume":"18","author":"Storeng","year":"2023","journal-title":"Glob Public Health"},{"key":"ref6","volume-title":"Power and Distribution in Global Health Governance: On the Failure of COVAX and the limits of market-based mechanisms. VerfBlog, 2024\/3\/28. Berlin, Germany: Verfassungsblog (legally: Max Steinbeis Verfassungsblog GmbH)","author":"Achenbach","year":"2024"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1136\/ARCHDISCHILD-2013-305693","article-title":"World Health Organization perspectives on the contribution of the global Alliance for vaccines and immunization on reducing child mortality","volume":"100","author":"Bustreo","year":"2015","journal-title":"Arch Dis Child"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1177\/107937391703900403","article-title":"Questioning stakeholder legitimacy: a philanthropic accountability model","volume":"39","author":"Kraeger","year":"2017","journal-title":"J Health Hum Serv Adm"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12992-021-00713-4","article-title":"An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries","volume":"17","author":"Jailobaeva","year":"2021","journal-title":"Glob Health"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/978-3-658-06177-7_3","volume-title":"Forschung zu Zivilgesellschaft, NPOs und Engagement","author":"Sandberg","year":"2014"},{"key":"ref11","doi-asserted-by":"crossref","DOI":"10.1093\/law\/9780197687710.001.0001","volume-title":"Global Health Law & Policy","author":"Gostin","year":"2023"},{"key":"ref12","volume-title":"Transnational Governance and Democratic Legitimacy: The case of Global Health","author":"Schaik","year":"2014"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"315","DOI":"10.15171\/ijhpm.2015.51","article-title":"Power in global health agenda-setting: the role of private funding comment on \"knowledge, moral claims and the exercise of power in global health\"","volume":"4","author":"Levine","year":"2015","journal-title":"Int J Health Policy Manag"},{"key":"ref14","volume-title":"Private Foundations and their Global Health Grant-Making Patterns: A Rapid Analysis of the Rockefeller Foundation, Wellcome Trust, and Bill and Melinda Gates Foundation","author":"Breen","year":"2023"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.37941\/RR\/2024\/2","volume-title":"Global Health Governance and the Challenge of Holding Power to Account","author":"McCoy","year":"2024"},{"key":"ref16","volume-title":"Policy Briefs","year":"2025"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e690","DOI":"10.1016\/S2214-109X(26)00008-2","article-title":"Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis","volume":"14","author":"da Silva","year":"2026","journal-title":"Lancet Glob Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1080\/09692290.2023.2237041","article-title":"Knowledge politics in global governance: philanthropists\u2019 knowledge-making practices in global health","volume":"31","author":"Littoz-Monnet","year":"2024","journal-title":"Rev Int Polit Econ"},{"key":"ref19","volume-title":"Philanthropic power and Development: Who Shapes the Agenda?","author":"Martens","year":"2015"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1093\/heapol\/czac109","article-title":"Global financing for health policy and systems research: a review of funding opportunities","volume":"38","author":"Kentikelenis","year":"2023","journal-title":"Health Policy Plan"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12992-025-01112-9","article-title":"The gates foundation's network diplomacy in European donor countries","volume":"21","author":"de Bengy Puyvall\u00e9e","year":"2025","journal-title":"Glob Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1016\/S0140-6736(17)31460-5","article-title":"Germany's expanding role in global health","volume":"390","author":"Kickbusch","year":"2017","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/S0140-6736(24)00936-X","article-title":"Germany's role in global health at a critical juncture","volume":"404","author":"Franz","year":"2024","journal-title":"Lancet"},{"key":"ref24","volume-title":"Germany: Partner in global health. Geneva, Switzerland: World Health Organization (WHO). Available online at:","year":"2025"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"h1210","DOI":"10.1136\/bmj.h1210","article-title":"Germany, the G7, and global health","volume":"350","author":"Yamey","year":"2015","journal-title":"BMJ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1186\/s12889-019-7114-5","article-title":"Soft power and global health: the sustainable development goals (SDGs) era health agendas of the G7, G20 and BRICS","volume":"19","author":"McBride","year":"2019","journal-title":"BMC Public Health"},{"key":"ref27","volume-title":"Germany Makes \u20ac500 million Pledge to WHO \u2013 Plug for \u201cmajor Funding gap\u201d left by United States. Geneva, Switzerland: Health Policy Watch (a project of the Global Policy Reporting Association, GPR \u2014 a Swiss non-profit)","author":"Fletcher","year":"2020"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/S0140-6736(23)01891-3","article-title":"Funding for global health research in Germany","volume":"402","author":"Saint","year":"2023","journal-title":"Lancet"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/S0140-6736(19)30479-9","article-title":"Germany's Global Health hub","volume":"393","author":"Green","year":"2019","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2200385","DOI":"10.2807\/1560-7917.ES.2022.27.20.2200385","article-title":"The WHO hub for pandemic and epidemic intelligence; supporting better preparedness for future health emergencies","volume":"27","author":"Morgan","year":"2022","journal-title":"Euro Surveill"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1038\/s41562-025-02321-3","article-title":"Power and representation at the world health summit","volume":"10","author":"Gelen","year":"2026","journal-title":"Nat Hum Behav"},{"key":"ref32","volume-title":"Seattle: Gates Foundation.","year":"2026"},{"key":"ref33","volume-title":"Funding Portfolio: Funded People and Projects","year":"2026"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"421","DOI":"10.54820\/entrenova-2022-0035","article-title":"Industrial and organizational mutations in the medical and pharmaceutical sectors impulsed by open innovation during the pandemic","volume":"8","author":"Adatto","year":"2022","journal-title":"entrenova"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3390\/healthcare10030540","article-title":"Global health governance and health equity in the context of COVID-19: a scoping review","volume":"10","author":"Kheir-Mataria","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e333","DOI":"10.1016\/S2468-2667(25)00033-7","article-title":"Public health in Germany: structures, dynamics, and ways forward","volume":"10","author":"Zeeb","year":"2025","journal-title":"Lancet Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual Health Res"},{"key":"ref38","volume-title":"Qualitative Inhaltsanalyse: Methoden, Praxis, Computerunterst\u00fctzung","author":"Kuckartz","year":"2012"},{"key":"ref39","first-page":"416","volume-title":"Global Health: Ethical Challenges","author":"Wilson","year":"2021"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1146\/annurev-lawsocsci-120220-074323","article-title":"Philanthrocapitalism and the separation of powers","volume":"17","author":"McGoey","year":"2021","journal-title":"Annu Rev Law Soc Sci"},{"key":"ref41","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198813057.001.0001","volume-title":"Global Health Governance in International Society","author":"Youde","year":"2018"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1111\/ijmr.12247","article-title":"Elite philanthropy in the United States and United Kingdom in the new age of inequalities","volume":"23","author":"Maclean","year":"2021","journal-title":"Int J Manag Rev"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1080\/14754835.2022.2104119","article-title":"The governance authority of non-state actors in the business and human rights regime","volume":"21","author":"Mende","year":"2022","journal-title":"Aust J Hum Rights"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/polsoc\/puae003","article-title":"Actors, alterations, and authorities: three observations of global policy and its transnational administration","volume":"43","author":"Moloney","year":"2024","journal-title":"Polic Soc"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1353\/sor.2013.0012","article-title":"Philanthrocapitalism: solving public problems through private means","volume":"80","author":"Bishop","year":"2013","journal-title":"Soc Res"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"108472","DOI":"10.1016\/j.ijid.2026.108472","article-title":"\"things fall apart\": the unravelling of Global Health governance and the imperative for action preserving infectious disease prevention and control","volume":"165","author":"Petersen","year":"2026","journal-title":"Int J Infect Dis"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1960171\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:35:28Z","timestamp":1789968928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1960171\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1960171"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1960171","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"1960171"}}