The Bill and Melinda Gates Foundation (BMGF) is the world's wealthiest philanthropic organisation and a major player in global health governance. While its emergence may be dramatic, BMGF's role in global health mirrors the experience of the Rockefeller Foundation's International Health Division nearly 100 years earlier. Both organisations provoked fear and consternation, but their supporters argued that both offered innovative techniques and filled niches governments could not or would not address. This article examines the parallels in arguments for and against the global health activities between the Bill and Melinda Gates Foundation and the Rockefeller Foundation. It also calls into question larger questions about the role of private actors in global governance and whether their activities in recent years are really all that unprecedented.