Global health. The current scenario and future perspectives

33 Partnership, and others. Many of these entities receive significant contributions from the Bill & Melinda Gates Foundation (BMGF), which is a central actor in this new configuration who entered the stage in the early 21st century, while active efforts to seek innovative financing models were launched. Other philanthropic foundations, such as the Clinton and Bloomberg Foundations, also participate. These new partnerships are comprised of a mix of donor state manufacturers or are headquarters of major producers of vaccines, supplies and medicines, like Great Britain, France, Norway and India; some aid recipient states, UN agencies or other multilaterals like the European Union; international non-governmental organizations (NGOs) like Oxfam, CARE and Médecins Sans Frontières, who are traditional partners of the system and representatives of specific communities of people living with certain diseases or vulnerable populations. Simultaneously, all these organizations participate in the World Health Assembly, but as observers. The possibility of a conflict of interest between non-governmental entities, profit or non- profit, and the WHO led to the formulation in 2016 of a framework known as FENSA (Framework of Engagement with Non-State Actors) (PAHO/WHO, 2016). Against the backdrop of globalization, which has brought about advantages and disadvantages for different countries, the evidence of growing inequalities between countries and within countries makes the goal agreed upon almost 50 years ago in Alma Ata increasingly distant. Additionally, the geopolitical transformations of the world, transitioning from the post-World War II bipolar Cold War era to a unipolar dominance and finally to the multipolarity of the 21st century with the rise of China and the increasing fragmentation of the European Union, directly impacts in the realm of global health. The serious controversy sparked by accusations regarding the origin of the SARS-CoV-2 virus and the handling of the WHO’s relationship with China by the Trump administration, which resulted in the withdrawal of the US from the WHO (later reversed by the Biden administration), can be largely explained by the reaction of this and other states to their own ineffectiveness in managing the pandemic, fueled by nationalist and populist responses. This, however, does not minimize the damage to the credibility of the WHO. In addition, the agency has faced regular accusations of representing the interests of major powers or blocks rather than the common good, of responding to political pressures rather than technical ones, or simply lacking the capacity to react to serious situations such as the Ebola crisis in Africa (which also led to years of debate and proposals to adapt the mandate to this new vision).