Amid renewed scrutiny of the Clinton Foundation's foreign ties this week, Hillary Clinton pointed to the success of its low-cost contracts with pharmaceutical firms in a rare acknowledgement of her family's controversial nonprofit network.

The Democratic nominee, who has not held a press conference in 242 days and is selective about the media interviews she grants, seldom encounters questions about the Clinton Foundation despite the outsize role its past dealings have played on the campaign trail.

When will we see stories from CNN on Clinton Foundation corruption and Hillary's pay-for-play at State Department? — Donald J. Trump (@realDonaldTrump) August 1, 2016



Clinton denied on Sunday that she participated in any foundation activities while she served as secretary of state, employing a new defense of its operations by highlighting the negotiated healthcare deals.

But under her leadership, at least a handful of the State Department's global health efforts relied on drug companies that were also major Clinton Foundation donors in arrangements that raise questions about the distance Clinton kept from her family's philanthropy.

The Clinton Foundation has become a magnet for criticism from Republicans who have painted it as the embodiment of everything they see wrong with the Democratic nominee: her insularity, political longevity and willingness to skirt the rules when it suits her.

Clinton faced questions Sunday about alleged overlap between the work of her family's foundation and her official State Department duties.

"I'm really proud of the Clinton Foundation. I am proud of the work that it does. Thanks to the Clinton Foundation, nine million more people in our world have access to HIV/AIDS drugs because they negotiated contracts that made them affordable," Clinton said during an appearance on "Fox News Sunday," her first in five years.

"And there is absolutely no connection between anything that I did as secretary of state and the Clinton Foundation," she added.

However, the same pharmaceutical firms that donated to the Clinton Foundation and sought the foundation-funded contracts Clinton described were also lobbying the State Department at the same time as some pursued taxpayer-funded contracts to do similar work. Executives at those companies have also contributed heavily to Clinton's presidential campaign, complicating her attempts to attack the pharmaceutical industry as a political " enemy" akin to Republicans.

The Clinton Foundation boasts of the four million patients who gained access to HIV drugs through its work negotiating pharmaceutical contracts. A separate nonprofit, the Clinton Health Access Initiative, claims to have helped 11.5 million patients obtain the treatments. Neither of those figures matches the nine million patients Clinton cited during her interview.

The Clinton Health Access is just one of several charities operating within the sprawling philanthropic network known as the Clinton Foundation. Others include the Clinton Global Initiative, the Clinton Giustra Enterprise Partnership and the Clinton Family Foundation. In some cases, the distinctions between which nonprofits are separate entities and which are offshoots of the Bill, Hillary & Chelsea Clinton Foundation are unclear.

For example, the Clinton Global Initiative was peeled off from the larger Clinton Foundation in 2009 and operated as an individual charity until Clinton left the State Department in 2013, at which point it was rolled back into the main organization.

The confusing structure can make tracing the precise destination of donations to the foundation a difficult task. However, donor records show major pharmaceutical firms — including Pfizer, Merck & Co., and Sanofi — have written generous checks to the Clinton Foundation.

In its 2008 annual report, for instance, the Clinton Global Initiative touted a partnership with Merck to provide rotavirus vaccines to infants in Nicaragua. Shortly before that, the drug corporation was rocked by Brazil's decision to strip Merck of a patent on HIV drugs in order to open its markets to cheaper generic versions of the medication.

During Clinton's first year at the agency, Merck lobbied the State Department to ease regulations restricting the distribution of its drugs "in certain Latin American markets," according to lobbying disclosure forms from 2009. That placed the drug company's international interests squarely on Clinton's desk.

Clinton sat down with Merck CEO Kenneth Frazier privately in March 2012 in a meeting that was closed to the press, according to her official schedule from that day. Immediately afterward, she walked into a staff meeting about "global health strategy."

By June of that year, her staff was collecting press clips on a $75 million partnership with Merck, funded by the State Department, to reduce childbirth-related deaths in Africa. The Norwegian government had pledged a matching $75 million to the initiative, which was spearheaded by Clinton.

The government of Norway has also donated heavily to the Clinton Foundation, giving up to $25 million to the nonprofit. In fact, Clinton's emails suggest she even asked members of her State Department staff to facilitate a Norwegian donation to a foundation project that was hosted by the United Nations, the Global Alliance for Clean Cookstoves.

The clean cookstoves project served as a clear example of the blurred lines between Clinton's foundation and State Department work. In 2010, the secretary of state herself took the stage at the glitzy annual meeting of the Clinton Global Initiative and announced the State Department's commitment to the clean cookstoves alliance, which sought to reduce dependence on cookstoves for heating and cooking in developing countries.

Led by Clinton, the Obama administration poured $105 million into the clean cookstoves project.

As a senator, Clinton had reportedly written a letter urging the Department of Health and Human Services to approve Merck's human papillomavirus vaccine in 2005.

By 2011, under her purview at the State Department, the U.S. government had teamed up with Merck to provide that same HPV vaccine to women in Latin America and sub-Saharan Africa. The initiative was set to cost $75 million.

A spokesperson for Merck did not immediately return a request for comment.

In Aug. 2009, the Clinton Health Access Initiative announced it had negotiated a deal with Pfizer to provide HIV medications across the developing world at a price that was marked down by 60 percent. That same year, Pfizer was also lobbying Clinton's State Department in its interests, as it did every year of her tenure, according to the Center for Responsive Politics.

Pfizer gave up to $5 million to the Clinton Foundation, donor records show.

The pharmaceutical giant wrote a large check to the State Department to sponsor the U.S. pavilion at the 2010 World's Fair in Shanghai. The expo was a priority early in Clinton's term for political reasons, and the former secretary of state tapped her vast donor network to foot the entire $60 million bill during her first year at the State Department.

In 2012, Pfizer teamed up with the U.S. Agency for International Development, an arm of the State Department, for a major purchase of contraceptive drugs that were to be distributed to three million women.

Executives from Pfizer have also donated heavily to Clinton's presidential campaign.

"Our donations and partnerships with any given entity are determined by that entity's ability to expand access to healthcare and medicines, as well as work towards preserving and furthering innovation," Sharon Castillo, spokeswoman for Pfizer, said in a statement provided to the Washington Examiner.

A spokesperson for the Clinton Foundation referred inquiries to the Clinton Health Access Initiative, which did not return a request for comment.

The well-connected charity has weathered controversy for the pattern of preferential treatment that seemed to flow from the State Department to the most generous of foundation contributors, be they pharmaceutical giants or oil conglomerates, since Clinton launched her bid for the White House last year.

Many of those same donors line Clinton's campaign coffers today.

But the Democratic nominee continues to downplay criticism of her family's philanthropy on the increasingly limited occasions she is asked about it.

Earlier this week, a report detailing financial entanglements among Hillary Clinton's State Department, Russia and 17 companies that had either donated to the Clinton Foundation or paid former President Bill Clinton for a speech reignited the political perlustration of foundation activities that has come to define the nonprofit's public profile.