 This conclusion will strike many in public health as unduly narrow, however. Private non-profit actors, especially charitable foundations and other non-governmental organizations (NGOs), frequently undertake measures that would be hard to characterize as anything other than public health interventions in their character and in the outcomes they  secure.[3]  For instance, vaccine research and development is often supported by NGOs, and vaccines are often delivered in epidemic contexts by NGOs. Similarly, NGOs often mount health promotion campaigns and provide resources to communities to improve local public health infrastructure. It seems contrived, at best, to conclude that because NGOs operate in the private sector, their activities do not constitute efforts to advance public health. Perhaps a more natural description is that NGOs as private entities undertake interventions to directly improve public health without themselves being governmental public health entities (Coggon 2012). Of course, one could argue that NGOs lack the standing to engage in public health activities because they are not accountable to citizens and do not act in their name. This is a legitimacy-based concern that has been levied against the development interventions of large-scale philanthropies generally. (Reich 2018) The core of the concern is that these large scale NGOs have the power to set agendas and priorities in ways that sidestep or usurp what should otherwise be the prerogative of functional nation-states to determine. In other contexts, this concern may have little purchase, however. Consider, for example, when global NGOs undertake activities with the robust cooperation of or at the invitation of the state, or in failed or otherwise problematic national contexts that lack the resources or the will to protect the health of all or some of the populations that live within their borders. Also, global, pan-national organizations, most notably the World Health Organization, play a critical role in advancing public health. It would be bizarre to conclude that policies and guidance of the WHO, or interventions that WHO leads, are not public health policies or interventions because the WHO is not a state actor and does not have the enforcement or police powers of a state.