Isn't the Gates Foundation effectively a trust in itself? I'm no economist, I don't know the exact definitions but the projects they do aren't overnight or one-off donations, they need long term (financial) support and guidance; vaccination development takes years, vaccination programs with the intent to eradicate diseases like polio take generations - e.g. the vaccine was developed in the 50's, it took ~70 years to mostly eradicate the virus in humans (only 30 known new cases in 3 countries in 2022).