How Novo Nordisk’s profits are reshaping global health funding

The Novo Nordisk Foundation is throwing its weight around. The world’s wealthiest philanthropic foundation, NNF, holds the controlling interest in the pharmaceutical company, Novo Nordisk A/S, which has built a fortune on diabetes and weight-loss drugs. That allowed the Denmark-based foundation to increase its grantmaking from almost 3.9 billion Danish krone in 2018 to nearly DKK10.1 billion in 2024. And the foundation started 2026 with its largest donation so far, committing up to $860 million to the BioInnovation Institute in Denmark to support European innovation and job creation. The timing of NNF’s rise matters. Global health financing is tightening, bilateral aid is shrinking, and the Gates Foundation — long the dominant philanthropic player that NNF is eager to emulate — has announced plans to sunset its operations by 2045. Observers say NNF is positioning itself to play a much larger international role with a focus on the kind of discrete, technology-driven solutions that Gates also favors. “They are internationalizing rapidly, but part of this internationalization is the realization that if you want to have an impact, you need to bring things to scale,” Adam Moe Fejerskov, an expert on sustainable development and governance at the Danish Institute for International Studies, said. “It comes with a wider scope where you’re engaged and have a close eye on strategic collaboration.” A different kind of foundation NNF is not structured like most philanthropic giants. It has an explicit interest in improving the business fortunes of the companies it controls. That is why the foundation’s investments often dovetail with those of commercial arms, including preparing new markets for the companies’ products. “It can be difficult to know where the foundation starts and ends,” Fejerskov said. The foundation is unique, and the model is not widespread, limited largely to a handful of European nations, which means while NNF may carve out a prominent role in global health moving forward, it is unlikely to herald the emergence of new donors operating with a similar approach. But the size of its potential donations means NNF, alone, has the potential to catalyze a shift in global health priorities. NNF, which marked its 100th anniversary in 2024, has maintained both commercial and foundation arms since it was initially launched to produce and sell insulin. The profit-making side now includes the pharmaceutical behemoth Novo Nordisk A/S and Novonesis, a biomedical company. NNF holds a controlling interest in them through Novo Holdings, which also has investments in hundreds of other companies, including life science firms. It was the development of semaglutide, which began in the early 2000s, that changed Novo Nordisk’s fortunes. The medication, marketed as Ozempic and Wegovy, revolutionized obesity and diabetes treatment. By the end of 2024, Novo Holdings was managing assets worth DKK 1.06 trillion. Under the enterprise foundation model, when business is good, so is philanthropic giving. And business has been very good at Novo Nordisk. “That’s the genius of the enterprise foundations,” Steen Thomsen, Novo Nordisk Foundation Professor of Enterprise Foundations at Copenhagen Business School, told Devex. “The social donations will also grow by pretty much the same rate as the revenue.” Expanding global influence For decades, NNF’s activities were largely concentrated in Denmark. That has changed with Novo Nordisk’s economic fortunes. “We’ve embarked much more systematically on an international approach,” Rikke Johannessen, NNF’s director of global development, told Devex during a January briefing. “This is, of course, because global issues demand global solutions.” Health is among the foundation’s three strategic areas, along with sustainability and life science ecosystem. The expanded global health support has taken the form of funding for education, including the Partnership for Education of Health Professionals, to prepare health workers in India and East Africa to prevent and treat noncommunicable diseases. Infrastructure is also a priority, including a DKK 950 million grant to build a laboratory in Denmark to develop cell therapies for testing in humans. And Johannessen said there is an emphasis on research to accelerate access in low- and middle-income countries, particularly around efforts to prevent and treat noncommunicable diseases. “We support not only medical research, but health systems strengthening, continuity of care, with a particular emphasis on projects that address inequities and improve access,” she said. With the increased funding, NNF has also gotten more proactive, Fejerskov said, “not just reactively deciding on a proposal, but they will collaborate with you on what your program should look like.” At the same time, Johannessen said NNF has the capacity to react to emergencies by releasing grant funds within 24 hours of the declaration of a humanitarian crisis to partners who have already gone through the foundation’s vetting process. And as it steps on the global stage, NNF is looking to leverage its grantmaking. That includes joining two other major global health players — the Gates Foundation and Wellcome — in pledging $100 million each in 2024 to an initiative to tackle global health challenges, from the impacts of climate change to antimicrobial resistance, that particularly affect the most vulnerable. Fejerskov predicted these were steps toward even bigger partnerships in the future as NNF looks to increase its impact. Philanthropy meets market strategy Even as NNF has aspirations of wielding the influence of the Gates Foundation, its focus remains firmly tied to its corporate interests. Investments such as training ultimately help improve diagnoses of conditions that Novo Nordisk products treat, while research facilities might help introduce new products to the company’s portfolio. “The primary ambition of these foundations is to solidify, expand market access to increase the revenue and the operating environment within which the companies they own operate,” Fejerskov said. Some observers said this can create tensions between Novo Nordisk’s commercial interests and NNF’s philanthropic goals. Despite NNF’s emphasis on reducing inequality in health, T1 International, which advocates for people living with Type 1 diabetes, has accused Novo Nordisk of blocking affordable access to insulin. As one of the three major manufacturers of insulin, along with Eli Lilly and Sanofi, T1 says Novo Nordisk has pursued pricing strategies, product discontinuations, and an overall lack of transparency that have made it difficult for people who need it to access insulin. “If they’re invested so much in the global health space and really want to ramp up their philanthropic side, they have ample opportunity to do that by lowering list prices for insulin,” Chris Toavs, T1’s global advocacy manager, told Devex. T1 has also called on the World Health Organization to reject funding from pharmaceutical companies, including up to nearly $60 million that NNF has pledged to the agency between 2025 and 2028. An NNF spokesperson did not respond to a request for comment. Observers said this kind of scrutiny of how NNF navigates its business interest and philanthropic goals will only increase for a foundation determined to be a major international player. And NNF looks set to remain a force, despite some challenges on the business front in recent years. Novo Nordisk’s forecasting of the global demand for Wegovy was off, leading to struggles to meet orders, even as more affordable alternatives are starting to become available. Those issues seem to have driven NNF to take greater control of the company. In an effort to restore “competitive leadership,” the foundation pushed out the board chairperson along with several independent members in October 2025. NNF’s chair, Lars Rebien Sørensen, then took over as board chair of the company. With the fate of the company and the foundation now bound even more closely together, Fejerskov said he does not expect NNF to retreat. “I don’t see it wobbling or any doubt about where it’s going,” he said. At the same time, Thomsen said NNF’s rise has been an outlier and that global health is not likely to see more enterprise foundations emerging at a similar level. In part, that’s because there are not so many discoveries as lucrative as semaglutide, and in part because the number of enterprise foundations is limited. “It’s not the case that all enterprise foundations are Novo Nordisk,” he said.