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How Bill Gates Impeded Global Access to Covid Vaccines
15/04/21
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April 12, 2021
Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine.
On February 11, 2020, public health and infectious disease experts gathered by the hundreds at the World Health Organization’s Geneva mothership. The official pronouncement of a pandemic was still a month out, but the agency’s international brain trust knew enough to be worried. Burdened by a sense of borrowed time, they spent two days furiously sketching an “R&D Blueprint” in preparation for a world upended by the virus then known as 2019-nCoV.
The resulting document summarized the state of coronavirus research and proposed ways to accelerate the development of diagnostics, treatments, and vaccines. The underlying premise was that the world would unite against the virus. The global research community would maintain broad and open channels of communication, since collaboration and information-sharing minimize duplication and accelerate discovery. The group also drew up plans for global comparative trials overseen by the WHO, to assess the merits of treatments and vaccines.
One issue not mentioned in the paper: intellectual property. If the worst came to pass, the experts and researchers assumed cooperation would define the global response, with the WHO playing a central role. That pharmaceutical companies and their allied governments would allow intellectual property concerns to slow things down—from research and development to manufacturing scale-up—does not seem to have occurred to them.
They were wrong, but they weren’t alone. Battle-scarred veterans of the medicines-access and open-science movements hoped the immensity of the pandemic would override a global drug system based on proprietary science and market monopolies. By March, strange but welcome melodies could be heard from unexpected quarters. Anxious governments spoke of shared interests and global public goods; drug companies pledged “precompetitive” and “no-profit” approaches to development and pricing. The early days featured tantalizing glimpses of an open-science, cooperative pandemic response. In January and February 2020, a consortium led by the National Institutes of Health and the National Institute of Allergy and Infectious Diseases collaborated to produce atomic-level maps of the key viral proteins in record time. “Work that would normally have taken months—or possibly even years—has been completed in weeks,” noted the editors of Nature.
When the Financial Times editorialized on March 27 that “the world has an overwhelming interest in ensuring [Covid-19 drugs and vaccines] will be universally and cheaply available,” the paper expressed what felt like a hardening conventional wisdom. This sense of possibility emboldened forces working to extend the cooperative model. Grounding their efforts was a plan, started in early March, to create a voluntary intellectual property pool inside the WHO. Instead of putting up proprietary walls around research and organizing it as a “race,” public and private actors would collect research and associated intellectual property in a global knowledge fund for the duration of the pandemic. The idea became real in late May with the launch of the WHO Covid-19 Technology Access Pool, or C-TAP.
By then, however, the optimism and sense of possibility that defined the early days were long gone. Advocates for pooling and open science, who seemed ascendant and even unstoppable that winter, confronted the possibility they’d been outmatched and outmaneuvered by the most powerful man in global public health.
In April, Bill Gates launched a bold bid to manage the world’s scientific response to the pandemic. Gates’s Covid-19 ACT-Accelerator expressed a status quo vision for organizing the research, development, manufacture, and distribution of treatments and vaccines. Like other Gates-funded institutions in the public health arena, the Accelerator was a public-private partnership based on charity and industry enticements. Crucially, and in contrast to the C-TAP, the Accelerator enshrined Gates’s long-standing commitment to respecting exclusive intellectual property claims. Its implicit arguments—that intellectual property rights won’t present problems for meeting global demand or ensuring equitable access, and that they must be protected, even during a pandemic—carried the enormous weight of Gates’s reputation as a wise, beneficent, and prophetic leader.
How he’s developed and wielded this influence over two decades is one of the more consequential and underappreciated shapers of the failed global response to the Covid-19 pandemic. Entering year two, this response has been defined by a zero-sum vaccination battle that has left much of the world on the losing side.
Gates’s marquee Covid-19 initiative started relatively small. Two days before the WHO declared a pandemic on March 11, 2020, the Bill & Melinda Gates Foundation announced something called the Therapeutics Accelerator, a joint initiative with Mastercard and the charity group the Wellcome Trust to identify and develop potential treatments for the novel coronavirus. Doubling as a social branding exercise for a giant of global finance, the Accelerator reflected Gates’s familiar formula of corporate philanthropy, which he has applied to everything from malaria to malnutrition. In retrospect, it was a strong indicator that Gates’s dedication to monopoly medicine would survive the pandemic, even before he and his foundation’s officers began to say so publicly.
[Advocates for pooling and open science, who seemed ascendant and even unstoppable early in the crisis, have been outmatched and outmaneuvered by the most powerful man in global public health.]
This was confirmed when a bigger version of the Accelerator was unveiled the following month at the WHO. The Access to Covid-19 Tools Accelerator, or ACT-Accelerator, was Gates’s bid to organize the development and distribution of everything from therapeutics to testing. The biggest and most consequential arm, COVAX, proposed to subsidize vaccine deals with poor countries through donations by, and sales to, richer ones. The goal was always limited: It aimed to provide vaccines for up to 20 percent of the population in low-to-middle-income countries. After that, governments would largely have to compete on the global market like everyone else. It was a partial demand-side solution to what the movement coalescing around a call for a “people’s vaccine” warned would be a dual crisis of supply and access, with intellectual property at the center of both.
Gates not only dismissed these warnings but actively sought to undermine all challenges to his authority and the Accelerator’s intellectual property–based charity agenda.
“Early on, there was space for Gates to have a major impact in favor of open models,” says Manuel Martin, a policy adviser to the Médecins Sans Frontières Access Campaign. “But senior people in the Gates organization very clearly sent out the message: Pooling was unnecessary and counterproductive. They dampened early enthusiasm by saying that I.P. is not an access barrier in vaccines. That’s just demonstratively false.”
Few have observed Bill Gates’s devotion to monopoly medicine more closely than James Love, founder and director of Knowledge Ecology International, a Washington, D.C.–based group that studies the broad nexus of federal policy, the pharmaceutical industry, and intellectual property. Love entered the world of global public health policy around the same time Gates did, and for two decades has watched him scale its heights while reinforcing the system responsible for the very problems he claims to be trying to solve. The through-line for Gates has been his unwavering commitment to drug companies’ right to exclusive control over medical science and the markets for its products.
“Things could have gone either way,” says Love, “but Gates wanted exclusive rights maintained. He acted fast to stop the push for sharing the knowledge needed to make the products—the know-how, the data, the cell lines, the tech transfer, the transparency that is critically important in a dozen ways. The pooling approach represented by C-TAP included all of that. Instead of backing those early discussions, he raced ahead and signaled support for business-as-usual on intellectual property by announcing the ACT-Accelerator in March.”
One year later, the ACT-Accelerator has failed to meet its goal of providing discounted vaccines to the “priority fifth” of low-income populations. The drug companies and rich nations that had so much praise for the initiative a year ago have retreated into bilateral deals that leave little for anybody else. “The low- and middle-income countries are pretty much on their own, and there’s just not much out there,” said Peter Hotez, dean of the National School of Tropical Medicine in Houston. “Despite their best efforts, the Gates model and its institutions are still industry-dependent.”
As of this writing in early April, fewer than 600 million vaccine doses have been administered around the world; three-quarters of those in just 10 mostly high-income countries. Close to 130 countries containing 2.5 billion people have yet to administer a single dose. The timeline for supplying poor and middle-income countries with enough vaccines to achieve herd immunity, meanwhile, has been pushed into 2024. These numbers represent more than the “catastrophic moral failure” the director general of the WHO warned about this January. It is a stark reminder than any policy that obstructs or inhibits vaccine production risks being self-defeating for the rich countries defending exclusive rights and gobbling up the lion’s share of available vaccine supplies. The truth repeated so often throughout the pandemic—no one is safe until everyone is safe—remains in force.
This easily anticipated market failure—together with the C-TAP’s failure to launch—led developing countries to open a new front against intellectual property barriers in the World Trade Organization. Since October, the WTO’s Trade-Related Aspects of Intellectual Property Rights Council has been center ring in a dramatic north-south standoff over rights to control vaccine knowledge, technology, and markets. More than 100 low- and middle-income countries support a call by India and South Africa to waive certain provisions related to Covid-19 intellectual property for the duration of the pandemic. Although Gates and his organization do not have an official position on the debate roiling the WTO, Gates and his deputies have left little doubt about their opposition to the waiver proposal. Just as he did following the rollout of the WHO’s C-TAP, Gates has chosen to stand with the drug companies and their government patrons.
Technically housed within the WHO, the ACT-Accelerator is a Gates operation, top to bottom. It is designed, managed, and staffed largely by Gates organization employees. It embodies Gates’s philanthropic approach to widely anticipated problems posed by intellectual property–hoarding companies able to constrain global production by prioritizing rich countries and inhibiting licensing. Companies partnering with COVAX are allowed to set their own tiered prices. They are subject to almost no transparency requirements and to toothless contractual nods to “equitable access” that have never been enforced. Crucially, the companies retain exclusive rights to their intellectual property. If they stray from the Gates Foundation line on exclusive rights, they are quickly brought to heel. When the director of Oxford’s Jenner Institute had funny ideas about placing the rights to its COVAX-supported vaccine candidate in the public domain, Gates intervened. As reported by Kaiser Health News, “A few weeks later, Oxford—urged on by the Bill & Melinda Gates Foundation—reversed course [and] signed an exclusive vaccine deal with AstraZeneca that gave the pharmaceutical giant sole rights and no guarantee of low prices.”
Considering the alternatives being discussed, it is no surprise that drug companies have been the most enthusiastic boosters of the ACT-Accelerator and COVAX. The speakers at the ACT-Accelerator launch ceremony in March 2020 included Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations, who hailed the initiative as a “landmark global partnership.” Since vaccines started coming online, the IFPMA’s member companies have lost interest in the Accelerator, preferring bilateral deals with rich countries. But they continue to benefit from the halo effect of their association with Gates, which has proved priceless throughout the pandemic, especially at a crucial juncture in its first year.
Bill Gates addresses the opening session of the WHO’s annual assembly in 2005, some six years after he entered the global public health scene as a defender of intellectual property rights during the AIDS crisis.
On May 29, Donald Trump announced U.S. withdrawal from the WHO. This was in response, he said, to China’s “total control” of the agency. The drug industry, meanwhile, was displeased with the WHO for entirely different reasons. The same day, the WHO director general had unveiled the C-TAP with a “Solidarity Call to Action” for governments and companies to share all intellectual property related to Covid-19 treatments and vaccines. The pharmaceutical companies didn’t attack the initiative directly. Instead, their global trade association, the IFPMA, preempted the announcement with a livestreamed media event on the evening of May 28. The event featured the heads of AstraZeneca, GlaxoSmithKline, Johnson & Johnson, and Pfizer, and Thomas Cueni.
The evening’s sixth participant was the specter of Bill Gates.
As anticipated, the questions submitted by journalists touched repeatedly on the much-anticipated launch of C-TAP the following morning, as well as related issues of intellectual property, vaccine access and equity, and debates over the extent and ways intellectual property posed barriers to ramping up production. Mostly, the executives evinced ignorance and surprise over the imminent launch of C-TAP; only Pfizer CEO Albert Bourla openly denounced the pooling of intellectual property as “dangerous” and “nonsense.”
All of the executives, however, shared a playbook in which they quickly pivoted to affirmations of their support for Bill Gates and the ACT-Accelerator. The association with Gates was submitted as evidence of industry commitment to equity and access—as well as proof of the complete lack of need for overlapping or competing initiatives, such as the “dangerous” C-TAP.
“We already have platforms,” Cueni said during the May 28 event. “The industry is already doing all the right things.”
As the questions about C-TAP and intellectual property piled up, the industry’s Gates rap started to sound less like a shared P.R. script than a broken record. Confronted for the second time about intellectual property, GlaxoSmithKline CEO Emma Walmsley emitted an undigested stream of Gatesian word salad. “We are absolutely committed to this question of access,” she stammered, “and deeply welcome the formation of ACT, which is this multilateral organization that is going to be a mechanism with multiple stakeholders, whether it’s heads of state or organizations like [the Gates-funded] CEPI or the Gates and [the Gates-funded] Gavi and others and the WHO, of course, where we actually look at these principles of, uh, access and so clearly, we’re engaged in that as well.”
Without the Gates and COVAX associations to lean on, the stammering would have been much worse. Pfizer’s Albert Bourla seemed to recognize this, at one point interrupting himself to express his industry’s gratitude and admiration. “I want to take the opportunity to emphasize the role that Bill Gates is playing,” he said. He went on to call him “an inspiration for all.”
Gates can hardly disguise his contempt for the growing interest in intellectual property barriers. In recent months, as the debate has shifted from the WHO to the WTO, reporters have drawn testy responses from Gates that harken back to his prickly performances before congressional antitrust hearings a quarter-century ago. When a Fast Company reporter raised the issue in February, she described Gates “raising his voice slightly and laughing in frustration,” before snapping, “It’s irritating that this issue comes up here. This isn’t about IP.”
In interview after interview, Gates has dismissed his critics on the issue—who represent the poor majority of the global population—as spoiled children demanding ice cream before dinner. “It’s the classic situation in global health, where the advocates all of a sudden want [the vaccine] for zero dollars and right away,” he told Reuters in late January. Gates has larded the insults with comments that equate state-protected and publicly funded monopolies with the “free market.” “North Korea doesn’t have that many vaccines, as far as we can tell,” he told The New York Times in November. (It is curious that he chose North Korea as an example and not Cuba, a socialist country with an innovative and world-class vaccine development program with multiple Covid-19 vaccine candidates in various stages of testing.)
The closest Gates has come to conceding that vaccine monopolies inhibit production came during a January interview with South Africa’s Mail & Guardian. Asked about the growing intellectual property debate, he responded, “At this point, changing the rules wouldn’t make any additional vaccines available.”
[When a reporter raised the issue in February, she described Gates “raising his voice slightly and laughing in frustration,” before snapping, “It’s irritating that this issue comes up here. This isn’t about IP.” ]
The first implication of “at this point” is that the moment has passed when changing the rules could make a difference. This is a false but debatable claim. The same can’t be said for the second implication, which is that nobody could have possibly foreseen the current supply crisis. Not only were the obstacles posed by intellectual property easily predictable a year ago, there was no lack of people making noise about the urgency of avoiding them. They included much of the global research community, major NGOs with long experience in medicines development and access, and dozens of current and former world leaders and public health experts. In a May 2020 open letter, more than 140 political and civil society leaders called upon governments and companies to begin pooling their intellectual property. “Now is not the time … to leave this massive and moral task to market forces,” they wrote.
Bill Gates’s position on intellectual property was consistent with a lifelong ideological commitment to knowledge monopolies, forged during a vengeful teenage crusade against the open-source programming culture of the 1970s. As it happens, a novel use of one category of intellectual property—copyright, applied to computer code—made Gates the richest man in the world for most of two decades beginning in 1995. That same year, the WTO went into effect, chaining the developing world to intellectual property rules written by a handful of executives from the U.S. pharmaceutical, entertainment, and software industries.
By 1999, Bill Gates was in his final year as CEO of Microsoft, focused on defending the company he founded from antitrust suits on two continents. As his business reputation suffered high-profile beatings from U.S. and European regulators, he was in the process of moving on to his second act: the formation of the Bill & Melinda Gates Foundation, which commenced his unlikely rise to the commanding apex of global public health policy. His debut in that role occurred during the contentious fifty-second General Health Assembly in May 1999.
It was the height of the battle to bring generic AIDS drugs to the developing world. The central front was South Africa, where the HIV rate at the time was estimated as high as 22 percent and threatened to decimate an entire generation. In December 1997, the Mandela government passed a law giving the health ministry powers to produce, purchase, and import low-cost drugs, including unbranded versions of combination therapies priced by Western drug companies at $10,000 and more. In response, 39 drug multinationals filed suit against South Africa alleging violations of the country’s constitution and its obligations under the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS. The industry suit was backed by the diplomatic muscle of the Clinton administration, which tasked Al Gore with applying pressure. In his 2012 documentary Fire in the Blood, Dylan Mohan Gray notes it took Washington 40 years to threaten apartheid South Africa with sanctions and less than four to threaten the post-apartheid Mandela government over AIDS drugs.
Though South Africa barely registered as a market for the drug companies, the appearance of cheap generics produced in violation of patents anywhere was a threat to monopoly pricing everywhere, according to the drug industry’s version of Cold War “domino theory.” Allowing poor nations to “free ride” on Western science and build parallel drug economies would eventually cause problems closer to home, where the industry spent billions of dollars on a propaganda operation to control the narrative around drug prices and keep the lid on public discontent. The companies suing Mandela had devised TRIPS as a long-term strategic response to the south-based generics industry that arose in the 1960s. They had come too far to be set back by the needs of a pandemic in sub-Saharan Africa. U.S. and industry officials paired old standby arguments about patents driving innovation with claims that Africans posed a public health menace because they couldn’t keep time: Since they could not be relied on to take their medicines on a schedule, giving Africans access to the drugs would allow for the emergence of drug-resistant HIV variants, according to industry and its government and media allies.*
In Geneva, the lawsuit was reflected in a battle at the WHO, which was divided along a north-south fault line: on one side, the home countries of the Western drug companies; on the other, a coalition of 134 developing countries (known collectively as the Group of 77, or G77) and a rising “third force” of civil society groups led by Médecins Sans Frontières and Oxfam. The point of conflict was a WHO resolution that called on member states “to ensure equitable access to essential drugs; to ensure that public health interests are paramount in pharmaceutical and health policies; [and] to explore and review their options under relevant international agreements, including trade agreements, to safeguard access to essential drugs.”
Western countries saw the resolution as a threat to the recent conquest of monopoly medicine, achieved four years earlier with the establishment of the WTO. The industry grew increasingly helpless, however, as global public opinion and WHO member-state sentiment shifted in favor of the resolution and against the South Africa lawsuit. In the weeks leading up to the assembly, the companies and their parent embassies floundered as they sought to turn the tide. Their growing anxiety is captured in a series of leaked cables sent to Washington by the U.S. ambassador in Geneva, George Moose, that April and May. In a diplomatic telegram dated April 20, Moose expressed alarm over the growing number of WHO delegations making
STATEMENTS THAT PUBLIC HEALTH SHOULD HAVE PRIMACY OVER COMMERCIAL INTERESTS UNDER WTO TRADE AGREEMENTS SUCH AS THE TRIPS (TRADE-RELATED ASPECTS OF INTELLECTUAL PROPERTY RIGHTS) … THEREBY POTENTIALLY UNDERMINING INTELLECTUAL PROPERTY RIGHTS (IPR).
Moose was concerned that drug companies were not helping their own cause and seemed incapable of doing anything but parrot old talking points about intellectual property as the driver of innovation. The pharmaceutical industry, Moose wrote,
SHOULD BE CARRYING MORE OF ITS OWN WATER ON THIS ISSUE, ESPECIALLY IN DEVELOPING COUNTRIES, AND NOT SOLELY DEPEND ON THE ARGUMENT THAT IPR PROTECTS PROFITS THAT THEN ARE USED FOR DEVELOPMENT OF NEW DRUGS IN THE FUTURE. NOT 10 YEARS FROM NOW. THE SOUTH AFRICANS AND OTHERS ARE MOSTLY CONCERNED ABOUT AVAILABILITY OF DRUGS NOW. PROBLEMS RELATED TO LOCAL AVAILABILITY AND PRICING OF DRUGS THAT ARE UNRELATED TO TRIPS WILL UNDOUBTABLY REQUIRE FURTHER DISCUSSION.
Over the course of weeks, a picture emerges from Moose’s accounts of a pharmaceutical industry against the ropes, punch drunk and out of ideas. In the U.S. ambassador’s view, the problem wasn’t moral bankruptcy so much as incompetence. “RECOMMEND THE USG PUSH THE PHARMACEUTICAL INDUSTRY TO ARGUE ITS POINTS MORE CONVINCINGLY IN DEVELOPING COUNTRIES,” the exasperated ambassador wrote. “AND ESPECIALLY DEAL WITH THEIR CONCERNS ABOUT LOCAL DRUG AVAILABILITY AND PRICING.”
Following the raucous buzz saw of the 1999 WHO Assembly, the drug companies would make a humiliating climbdown from their scandalous lawsuit in South Africa, reduced to what The Washington Post called “close to pariah status.”
At the same time, the industry was richer than ever. The Clinton administration had approved a long Big Pharma wish list, from broadening the avenues for privatizing government-funded science to opening the age of direct marketing of prescription drugs. The corresponding profits went to reinforce already historically rich D.C. and Geneva lobbying operations. And yet, for all their combined might, the companies were incapable of producing a mask resembling a credible human face. A global activist movement continued to gather public opinion on its side and chip away at the legitimacy of the monopoly model that underlay the industry’s enormous power. By every nonfinancial measure, it was an industry in distress. To borrow a phrase from a future Bill Gates production, you might say it was waiting for its Superman.**
The Clinton administration was instrumental in safeguarding Big Pharma’s intellectual property rights on the global stage—and Gates would become the campaign’s benevolent face.
When Moose was ringing the alarm over the future of TRIPS in the spring of 1999, Gates was preparing to fund the launch of a public-private partnership called Gavi, the Vaccine Alliance, with a seed grant of $750 million, marking his arrival in the worlds of infectious disease and public health. At the time, he was still best known for being the richest man in the world and the owner of a software company engaged in anti-competitive practices. This profile didn’t mean much in a raucous WHO Assembly hall packed with civil society groups and G77 delegations, which together booed the U.S. delegation when it tried to speak. At most, it was a source of brief consternation when officers from the William H. Gates Foundation began distributing a glossy brochure touting the role of intellectual property in driving biomedical innovation.
James Love, who organized many of the civil society events around the 1999 Assembly, remembers seeing the Gates staffers joined in the distribution effort by Harvey Bale, a former U.S. trade official serving as director general of the International Federation of Pharmaceutical Manufacturers Associations.
“It was this nice full-color pamphlet about why patents don’t present an access problem, with the Gates Foundation logo at the bottom,” says Love. “It was strange, and I just thought, ‘OK, I guess this is what he’s doing now.’ Looking back, that’s when the pharma-Gates consortium set the markers down on intellectual property. He’s been sticking his nose into every intellectual property debate since, telling everyone they can go to heaven by paying lip service to a few discounts to poor countries.”
Following the 1999 WHO Assembly, the industry tried to salvage its reputation by offering African countries discounts on the antiretroviral combination therapies that cost $10,000 or more in rich countries. The compromise prices it offered were still outrageously high, but even raising the issue of price concessions was too much for Pfizer, whose representatives stormed out of the industry coalition on principle. Public opinion swung harder against the companies, the result of a loud, ingenious, and effective direct-action campaign. Similar to the first months of the Covid-19 pandemic, there was a sense of possibility—a hope that a forced breakdown of a morally obscene and bloodstained system was within grasp.
“The movement was very focused and successfully building pressure for structural, more decisive solutions into the aughts,” says Asia Russell, a veteran HIV-AIDS activist and director of Health Gap, an HIV medicines access group. “And just when we started to secure some progress, a new version of the industry narrative emerged from Gates and Pharma. It was all about how pricing policies, generic competition, anything that interferes with industry profits, will undermine research and development, when the evidence shows that that argument doesn’t hold water. Gates’s talking points aligned with those of the industry.”
Adds Manuel Martin, the Médecins Sans Frontières policy adviser, “Gates defused the real issue of decolonizing global health. Instead, drug companies could just give money to his institutions.”
Even after the drug companies withdrew their lawsuit against the South African government and Indian-made generics began flowing to Africa, Gates stayed cool toward compromises that he saw as threats to the intellectual property paradigm. This included his attitude toward the Unitaid Medicines Patent Pool, a voluntary intellectual property pool founded in 2010 that enlarged access to some patented HIV/AIDS medicines. Though not a complete answer to the problem, the MPP was the first working example of a voluntary intellectual property pool, one that many observers expected to serve as a model framework for the WHO-administered Covid-19 pool.
Brook Baker, a law professor at Northeastern University and senior policy analyst for Health GAP, says Gates has always been wary of the Unitaid pool as going too far in the direction of infringing on intellectual property.
“Initially, Gates was unsupportive and even hostile toward the AIDS Medicines Patent Pool,” says Baker. “He brought that hostility to relaxing industry’s iron-fist control over its technologies into the pandemic. His explanation for rejecting models to counteract this control never added up. If I.P. isn’t important, why are companies refusing to voluntarily give it up when it could be used to expand supply in the middle of the world’s worst public health crisis in a century? It’s not important, or it’s so important it has to be closely guarded and protected. You can’t have it both ways.”
This winter, while Gates assured the world that intellectual property was a red herring, a bloc of developing countries at the WTO explained the need for a waiver on certain intellectual property provisions by pointing to the “rather large gap [that] exists between what COVAX or ACT-A can deliver and what is required in developing and least developed countries.”
The forceful statement continued:
The model of donation and philanthropic expediency cannot solve the fundamental disconnect between the monopolistic model it underwrites and the very real desire of developing and least developed countries to produce for themselves.… The artificial shortage of vaccines is primarily caused by the inappropriate use of intellectual property rights.
Another statement by a different bloc of countries added, “COVID19 reveals the deep structural inequality in access to medicines globally, and a root cause is IP that sustains and dominates industry’s interests at the cost of lives.”
Gates is certain he knows better. But his failure to anticipate a crisis of supply, and his refusal to engage those who predicted it, have complicated the carefully maintained image of an all-knowing, saintly mega-philanthropist. COVAX presents a high-stakes demonstration of Gates’s deepest ideological commitments, not just to intellectual property rights but also to the conflation of these rights with an imaginary free market in pharmaceuticals—an industry dominated by companies whose power derives from politically constructed and politically imposed monopolies. Gates has been tacitly and explicitly defending the legitimacy of knowledge monopolies since his first Gerald Ford–era missives against open-source software hobbyists. He was on the side of these monopolies during the miserable depths of the 1990s African AIDS crisis. He’s still there today, defending the status quo and running effective interference for those profiting by the billions from their control of Covid-19 vaccines.
His latest move is to institutionalize the ACT-Accelerator as the central organizing institution in future pandemics. The shortages have made this effort a little awkward, however, and Gates is now forced to reckon with the question of technology transfer. This is an aspect of the equitable access debate that doesn’t concern intellectual property as commonly perceived—as a simple matter of patents and licenses—but access to the components and technical knowledge related to practical manufacture, including biological material and other areas otherwise protected under the category of intellectual property known as trade secrets. The global south and civil society groups have been calling for tech transfer for months—either mandatory tech transfer that could have been written into contracts or through a voluntary mechanism associated with C-TAP—but Gates has predictably arrived on the scene with a more familiar plan in hand.
In early March, senior Gates staff joined pharma executives for a “Global C19 Vaccine Supply Chain and Manufacturing Summit” convened by Chatham House in London. The main agenda item: plans for a new arm within the ACT-Accelerator, the Covid Vaccine Capacity Connector, that seeks to address the tech-transfer question within the usual frame of monopoly rights and bilateral licensing.
“The tech transfer debate is being decisively seized and shaped by those who want to set the terms and conditions under which knowledge can be transferred,” writes Priti Patnaik in her Geneva Health Files newsletter. A Gates-directed tech-transfer mechanism without meaningful input from WHO members states, she writes, would be a “body blow” to C-TAP and similar future initiatives that promote open licensing and knowledge sharing to maximize production and access.
There are signs of overdue scrutiny of Gates’s role in public health and lifelong commitment to exclusive intellectual property rights. But so far these are blips. More common is the deference on display in a March 21 New York Times article about the U.S. government’s role in developing the mRNA vaccines now under the monopoly control of Moderna and Pfizer. When the piece turned to Gates’s inevitable cameo, the Times reporter was hovering right over the target—and somehow managed to miss wide by a mile. Instead of probing Gates’s central role in preserving this paradigm, the paper linked to gentle boilerplate about pricing and access found on the Gates Foundation website. In response to a request for comment, a Gates Foundation spokesperson pointed me to a piece by its CEO, Mark Suzman, arguing that “IP fundamentally underpins innovation, including the work that has helped create vaccines so quickly.”
Any change in media coverage of Gates’s second career may produce a delayed echo within the world he has come to dominate. Here Gates not only controls the narratives, he controls most of the payroll. This may sound conspiratorial or overblown to outsiders but not to campaigners who have witnessed Gates’s ability to shift gravity on major issues.
“If you said to an ordinary person, ‘We’re in a pandemic. Let’s figure out everyone who can make vaccines and give them everything they need to get online as fast as possible,’ it would be a no-brainer,” says James Love. “But Gates won’t go there. Neither will the people dependent on his funding. He has immense power. He can get you fired from a U.N. job. He knows that if you want to work in global public health, you’d better not make an enemy of the Gates Foundation by questioning its positions on I.P. and monopolies. And there are a lot of advantages to being on his team. It’s a sweet, comfortable ride for a lot of people.”
*Among journalists echoing this argument was former New Republic editor Andrew Sullivan. When The New York Times reported Sullivan was defending the companies’ lawsuit while taking undisclosed funding from PhRma, the industry trade association, Sullivan remained defiant in the face of evidence-based accusations that he was an unethical journalist. “It behooves me to say I see absolutely no problems with [drug industry sponsorship],” he told Salon. “In fact, I am extremely proud to get some support from a great industry.” It later turned out that Africans adhered more closely to the twice-daily pill regimens than patient populations in rich countries.
**In 2010, the Gates Foundation would bankroll a documentary advocating the privatization of U.S. public education, titled Waiting for Superman.
Alexander Zaitchik is a freelance journalist. His next book, Owning the Sun: A People’s History of Monopoly Medicine, from Aspirin to Covid-19, will be published by Counterpoint in 2022.
ILLUSTRATION BY KELSEY DAKE
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