The head of one of the world’s largest vaccine manufacturers had a problem. Adar Poonawalla, chief executive of the Serum Institute of India, needed $850 million for everything from glass vials to stainless steel vats so he could begin producing doses of promising coronavirus vaccines for the world’s poor. Poonawalla calculated that he could risk $300 million of his company’s money but would still be more than a half-billion dollars short. So he looked to a retired software executive in Seattle.
Bill Gates, the Microsoft founder turned philanthropist, had known Poonawalla for years. Gates had spent billions to help bring vaccines to the developing world, working closely with pharmaceutical executives to transform the market. In doing so, he became the most powerful — and provocative — private player in global health. By the end of their conversation this summer, Gates had made a promise: The Bill and Melinda Gates Foundation would provide a $150 million guarantee so the Indian factory could move ahead with production. By September, the foundation had doubled its commitment.
It is part of an $11 billion effort to lay the groundwork to procure coronavirus vaccines for more than 150 countries, though it could eventually cost far more when the doses come through. Funded largely with public money, the initiative is led by two global non-profits that Gates helped launch and bankroll, along with the World Health Organization, which relies on the Gates Foundation as one of its largest donors.
Working behind the scenes is the world’s second-richest man, neither a scientist nor a doctor, who sees himself and his $50 billion foundation as uniquely prepared to take a central part. Gates and his team are drawing on connections and infrastructure the foundation has built over two decades to help guide the effort.
“We know how to work with governments, we know how to work with pharma, we’ve thought about this scenario,” Gates said in a recent interview. “We need — at least in terms of expertise and relationships — to play a very, very key role here.” As the first vaccine candidates sprint toward regulatory approval, the question of how to immunise much of the world population has taken on added urgency. But nine months in, the success of the vaccine effort, known as Covax, is not at all certain.
So far, it has pulled in only $3.6 billion in funding for research, manufacturing and subsidies for poor countries. Three companies have promised to deliver vaccines, but it is not yet known whether they will be effective. And it may be difficult to secure the necessary billions of doses in an affordable, timely way because the United States and other wealthy countries have cut separate deals for their citizens. In recent months, Gates, who emphasises that he is one of many involved in the vaccine effort, has hosted online round tables with drug company officials. He has pursued financial commitments from world leaders: In one week alone, he and his wife and co-chair, Melinda Gates, spoke with President Emmanuel Macron of France, Chancellor Angela Merkel of Germany, President Ursula von der Leyen of the European Commission and Crown Prince Mohammed bin Zayed of Abu Dhabi.
In Washington, he has consulted frequently with Dr Anthony S. Fauci, the nation’s chief infectious disease expert and a long-time collaborator on vaccine initiatives, and talked to Senator Mitch McConnell, a polio survivor who has been supportive of programs to eradicate that and other scourges. And to help staff the vaccine effort, his foundation has provided millions of dollars for McKinsey & Company consultants.
“Some people will say, ‘Why should it be him?’” said Dr Ariel Pablos-Mendez, former director of knowledge management at the W.H.O. “He has the star power. He has the resources. He cares. There are many players that do things, but not at the scale of Gates.” If the initiative, aided by Gates’s fortune and focus, manages to help protect the world’s poor from a virus that has already killed more than 1.3 million people, it will affirm the strategies he has promoted in his philanthropic work, including incentives for drug companies.
If the endeavour falls short, however, it could intensify calls for a more radical approach. Amid the pandemic, some public health officials and advocates argue that vaccine makers, many of which have benefited from unprecedented public funding, should be compelled to share their technology, data and know-how to maximise production. India and South Africa, for example, are pushing to suspend the global enforcement of intellectual property rights involving the virus.
Dr Zweli Lawrence Mkhize, South Africa’s health minister, said that the usual practices did not apply in this crisis. “There has to be a degree of broader consultation that looks at what is best for humanity,” he said in an interview. In the current plan for a global vaccine deal, poor countries would receive only enough doses to inoculate 20 per cent of their populations by the end of next year. Some models show that there will not be enough vaccines to cover the entire world until 2024.
“The consequence of long-time Gates strategies is that they go along with corporate control over supply,” said Brook Baker, a Northeastern University law professor and policy analyst for Health GAP, which advocates equitable access to drugs. “In a pandemic, that is a real problem.” Meanwhile, officials from some countries participating in the vaccine initiative complain that they were barely consulted until recently.
“They are pushing us, cornering us, in order to make us pay,” Juan Carlos Zevallos, Ecuador’s health minister, said of the deal-makers. “We don’t have a choice about which vaccine we would like to use. It is whatever they impose on us.” As Gates has made public appearances to win support for the initiative, he has increasingly become the target of conspiracy theories that could undermine vaccination efforts.
Some falsely claim that his foundation tested vaccines that killed thousands of children in Africa and India, while others link him to bogus depopulation efforts. One poll from May found 44 per cent of
Republicans believed that the global immunisation effort was a cover for Gates to implant microchips to track people. That claim is baseless.
Gates remains undaunted. “I’ve never heard either Bill or Melinda say anything to the effect of ‘We’ll just work on something else, this is too tough,’” said the billionaire investor Warren Buffett, who entrusted the Gates Foundation with $31 billion of his own fortune to give away. “The job is to work on tough problems.”
Nicholas Kulish is an enterprise reporter covering immigration issues for NYT©2020
The New York Times