Gatekeeping Global Health Partnerships

Global governance is undergoing significant transformation. Scholars have long acknowledged a shift from hierarchical modes of global governance – such as international law negotiated under traditional international organizations – toward more flexible modes, like voluntary partnerships, networks, and market-based interventions. However, the reality is more complex than a simple transition from "old" to "new" governance modalities. Sometimes, public-private cooperation flourishes; other times, states retain exclusive control over global decision making. This raises a fundamental question: Why do public and private actors collaborate to address some global challenges but not others? Gatekeeping Global Health Partnerships engages with this question, investigating why public-private partnerships (PPPs) emerge to address only certain global health issues. It argues that civil society organizations (CSOs) play a crucial role in shaping these outcomes by influencing whether other types of actors – international organizations, states, and private actors – consider partnerships legitimate and desirable. This book develops a theory of multistakeholder interactions, showing that PPPs are more likely to arise when CSOs advocate for the provision of specific goods, such as medicines, rather than for regulatory measures. Drawing on an original dataset of 124 partnerships, it combines network visualization, qualitative text analysis, and comparative case studies of HIV/AIDS, neglected tropical diseases, nutrition, and non-communicable diseases. Through a mixed-method approach, it demonstrates how CSOs can both facilitate and block PPP formation. This book's argument and findings offer new insights into the politics of global health governance and provide a refined understanding of why public and private actors work together to address some global challenges but not others.