A deep dive into how Gates, Wellcome and Novo Nordisk spend their millions

With their new $300 million global health programme announced 6 May, the Gates, Wellcome and Novo Nordisk foundations bring together three very different funding networks. A Science|Business analysis shows how they operate, and who benefits.

Our review of their 2023 awards shows three universities were their top academic grant recipients: for Gates, the University of California San Francisco (UCSF); for Wellcome, University College London and for Novo Nordisk the University of Copenhagen. The foundations are, collectively, the world’s biggest source of charitable health funding, spending about $10 billion a year on everything from malaria to malnutrition, plus studies on sustainability and societal problems that affect health.

But how the money gets spent is more complicated than a simple ranking. While the universities – along with non-profits, companies and other recipients – get many grants for their own research and programmes, they also have dedicated networks of health researchers and providers across the Global South. As a result much of the money cascades down from the foundations, through the main grant recipients, and from there to a wide range of individual communities and projects around the globe.

“As a large foundation, we often make grants to large global intermediary organisations, who then subgrant the bulk of the funds to other partners that are located closer to the communities we aim to serve,” said a spokeswoman for the Gates Foundation

To understand the system, Science|Business took a deep dive into just one year, 2023, of the new grant awards that each foundation announced – mostly in the field of health research and delivery, and focused solely on universities.

The Gates grants

For the Global Health programme of the Bill & Melinda Gates Foundation, the single biggest university awards, totaling $39.8 million, went to UCSF. Second came Virginia Commonwealth University with $21.5 million, and third and fourth were the University of Cape Town with $20.2 million and a special health centre of the University of Witwatersrand with $19.2 million.

According to the Gates spokeswoman, much of the UC-San Francisco money is the latest contribution to a long-running international effort to reduce child mortality by testing a strategy of mass distribution of the antibiotic azithromycin. In 2023, $38 million was awarded for that project’s work in Niger – and much of that money will in turn be passed on to others involved locally in the work. Consequently, she said, it can be difficult for the foundation itself to keep track of all the ultimate beneficiaries.

Another example: all of the $21.5 million that Gates Global Health awarded last year to Virginia Commonwealth University is part of a big global search for cheaper ways to manufacture and distribute generic medicines.

The Gates foundation was created in 2000 with a mandate to improve health care across the globe, especially in the developing world. It has a massive endowment, totaling $75.2 billion last 31 December, from Microsoft co-founder Bill Gates, his ex-wife Melinda, billionaire investor Warren Buffett and others. Last year it awarded $7.7 billion for biomedical research, sustainability, agriculture, social and other fields affecting global health. It also uses the cascading-funds strategy with other types of grantees besides universities: its biggest awardees overall in 2023 were Seattle-based non-profit PATH, which has a mission to ensure universal healthcare, and the World Health Organisation.

The Wellcome grants

The top ten university grant awardees of the Wellcome Trust for its 2023 fiscal year ended 30 September were all UK institutions, each receiving multiple awards. Many were conventional grants for individual researchers at the universities; but many were also big, Gates-like projects with layers of beneficiaries.

University College London topped the Wellcome list with $99.8 million. Of that, $81.6 million was for a multi-year funding renewal for UCL’s collaboration with the Africa Health Research Institute in South Africa. That institute works with UCL researchers and students on a wide range of health projects, and itself has a network of local health researchers and providers.

Cambridge University ranked second with $59.9 million, and Oxford University was a close third with $56 million. The Wellcome Trust began in 1936, under the will of American pharmaceutical entrepreneur Henry Wellcome. Its fortunes were transformed in 1995 when the company was sold to Glaxo plc for £9.1 billion, and the trust now has assets of £36.8 billion. Last year, it made £1.2 billion in grant awards, mostly for health research and delivery.

The Novo Nordisk grants

The third funder, the Novo Nordisk Foundation in Denmark, also makes big awards to its local institutions - with a massive $470.7 million committed in 2023 to the University of Copenhagen and its Faculty of Health and Medical Sciences. Of that, $198.7 million is an eight-year promise of funding for a new global vaccine research centre at the university, announced last December. 

The relationship between the university and the foundation goes back a century, to when Copenhagen scientists licensed the first successful insulin-production method from University of Toronto researchers and started the foundation and what is now pharma company Novo Nordisk AS. Today, the company is riding a wave of profits from its new weight-loss drugs Ozempic and Wegovy – and the foundation, which owns a controlling stake in the company, saw its grant awards surge to $901.5 million last year. Of the three foundations, Novo Nordisk is the only one that still has controlling shares in its related company.

The second-ranking university on the foundation’s 2023 awards list was Aarhus University with $88.6 million. Third was the Technical University of Denmark with $35.3 million.  It also funded other universities, mostly in the Nordic region, such as Uppsala University and Karolinska Institutet in Sweden.