The bill gates problem, p.39
The Bill Gates Problem, page 39
Noting the “monopolistic nature” of the HPV vaccine—controlled by Merck and GSK, which donated six million dollars’ worth of vaccines to the Gates-PATH study—the parliamentary report described a “well planned scheme to commercially exploit a situation” through “subterfuge.”
The criticism landed back on the Gates Foundation, which, with its endless partnerships with Big Pharma, was in no position to defend itself as an independent charity. In a rare moment of clarity—the likes of which we have never had in the United States—Indian legislators, policy makers, and journalists began very publicly interrogating the phenomenal financial conflicts of interest underpinning the Gates Foundation’s charitable enterprise.
The foundation makes charitable donations and engages in a wide variety of other financing mechanisms that help Big Pharma grow their businesses. At the same time, the foundation is positioned to benefit financially from some of these corporate partnerships because its $54 billion endowment includes stocks and bonds in pharmaceutical companies. Bill Gates may also hold investments in pharmaceutical companies through his private $100 billion fortune, the details of which are not public.
PATH called the charge of ethical misconduct “inaccurate in many details,” saying it “incorrectly implies violations of approved practices.” The Gates Foundation, meanwhile, called the allegations of wrongdoing “misinformation.” PATH is one of the single-largest recipients of funding from the Gates Foundation—more than three billion dollars reported in grant records, though the full number could be significantly higher—and at times seems to function almost as a subsidiary of Gates. The organization did not respond to my request for an interview about its relationship with the Gates Foundation.
The fallout from the scandal may have created public distrust in Indian medical regulators. Public health experts noted at the time that the HPV uproar would make it harder to do clinical trials in India. This, in turn, could make it harder to bring new lifesaving drugs to market. To date, the HPV vaccine has not been included in India’s national immunization program, though the Gates Foundation and the Serum Institute have developed a new HPV vaccine that may change this in the years ahead.
Even if we take the charitable view that Gates and PATH did nothing wrong in the HPV trial in India, we at least have to acknowledge that it is a bad idea for the foundation to play so many roles in India’s vaccine policy. Can you imagine if, say, the richest man in India decided to host and fund a key technical advisory unit that helped inform national vaccine policy in your home country while also funding the development and testing of new vaccines, brokering deals with major pharmaceutical companies, and helping direct Gavi, one of the world’s leading vaccine distribution mechanisms?
Readers living in wealthy nations probably can’t imagine this level of foreign influence. If such a thing happened in my home country, the United States, there would be congressional investigations. Legislators would pass new laws to clamp down on foreign influence. The news media would scream vaguely xenophobic headlines about foreign oligarchs meddling in domestic affairs. And public distrust in vaccines would likely rapidly expand.
The HPV scandal appears to have provided a long-overdue vent for well-founded frustrations around Bill Gates’s imperial excursions, which some in India may place in the context of the country’s history as a British colony. “One man deciding what is good for the entire world is highly problematic,” one source in India who worked on a Gates-funded vaccine project told me. “It is the same philosophy which dictators around the world have used—and still use. How does one man know what is good for everybody?”
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IN THE AFTERMATH of the HPV scandal, the government of India imposed a series of changes that altered the foundation’s work there. Officials in the Ministry of Home Affairs raised sharp questions about the Gates Foundation’s outsize influence over civic life—and also scrutinized whether the foundation was exploiting a loophole in the law that allowed it to operate in India without the level of government oversight normally imposed on international groups. Specifically, India asks foreign-based organizations to register with the Foreign Contribution (Regulation) Act (FCRA), which the Gates Foundation didn’t do.
“Since it is not registered under the FCRA, the funding of NGOs doesn’t come under the government’s watch list. It is not clear where and what they are funding. It is a loophole and it can open gates for other NGOs as well to use this route to escape scrutiny,” an anonymous government official told the news media. “No inspections can take place and thus no taxes are paid. The BMGF works as a marketing office for U.S. pharmaceutical vaccines.”
Indian media reported that the Gates Foundation, instead of registering under the FCRA, found a different modus operandi—as a “liaison office” under the jurisdiction of the Reserve Bank of India. Reporting at that time, as far as I can tell, didn’t mention the fact that the director of Gates’s India office, Nachiket Mor, according to Mor’s LinkedIn profile, sat on the board of the Reserve Bank of India between 2013 and 2018, a period that overlapped with his work at the Gates Foundation between 2015 and 2019. This conflict of interest did surface later and prompted a lobbying effort to remove him from the bank’s board. Mor ended up stepping down from the bank before his term was completed. He declined a request to be interviewed for this book.
It’s not clear that the Gates Foundation did anything wrong in its registration, and it appears that other international foundations, like the Ford Foundation, also operate through the Reserve Bank. But the high-profile criticism from Indian government officials, nevertheless, shows how deeply anti-Gates sentiment had circulated.
In 2017, government scrutiny also came to bear on Gates’s close ally, if not surrogate, Public Health Foundation of India, to which the Gates Foundation has given at least $82 million. Ministry officials told journalists that they were concerned about Gates’s financial influence over Public Health Foundation, and the government went on to place new restrictions on its ability to receive foreign funds. (These restrictions were lifted in 2022.)
The Indian government also announced a plan that seemed designed to reduce Gates’s role in India’s Immunization Technical Support Unit, moving the project from the Gates-funded PHFI into a government ministry. Srinath Reddy of PHFI noted that Gates actually continued to fund the program, simply moving it from PHFI to JSI, a private consultancy. At the end of 2021, the foundation gave a two-year, $1.75 million grant to JSI to support the transition of the unit to the government. This suggests that the earliest that the government might take it over would be late 2023, many years after public criticism of Gates’s role first emerged. In short, whatever efforts the Indian government took to rein in the foundation went only so far.
One reason for this may be Gates’s cunning political response to all the negative attention it was receiving. As public sentiment against the foundation gathered steam, the foundation did not sit on its hands. In 2019, it stunned the world by giving Indian prime minister Narendra Modi a high-profile humanitarian award—at the same time that Modi was in the midst of an international PR crisis related to human rights abuses in Kashmir, India’s only Muslim-majority region. So many news outlets covered the controversy that even NPR, funded by Gates, was compelled to tell the story, reporting that three Nobel Peace Prize winners had condemned the Modi award. The issue escalated further when a communications officer in the Gates Foundation’s India office resigned in protest, publishing a long essay about her decision in the New York Times.
“I had joined the Bill & Melinda Gates Foundation because I truly believed in its mission—that every life has equal value and all people deserve healthy lives. I resigned from it for the exact same reason. By presenting Mr. Modi with this award, the Gates Foundation is going against its own core belief,” Sabah Hamid wrote. “The Gates Foundation has crossed the wide gulf between working with a regime and endorsing it. That is not the pragmatic agnosticism of an organization working with the government of the day, but a choice of siding with power. I will choose to walk a different path.”
It’s difficult to believe that the Gates Foundation, with its army of PR flacks, did not foresee the major fallout from this award. We can presume that the foundation made a calculation, believing that the political benefits of honoring Modi outweighed the costs. Under public scrutiny around its political influence in India, the foundation perhaps saw that its future in the country appeared to be in jeopardy. But it had too much invested in India, and too much of its legacy in global health depended on its projects working there. Some of the foundation’s most important partners, including the for-profit Serum Institute, the largest vaccine manufacturer in the world, are located in India. And, again, India is the largest destination for Gates funding outside the United States and Europe. If the foundation were blackballed in India, its entire global health portfolio would be significantly diminished—and, who knows, it might even create a domino effect, with other nations questioning the foundation’s outsize influence.
We might also ask what the Gates Foundation’s waning influence in India might have meant for Microsoft. In the same way that Bill Gates’s philanthropic endeavors seem to create a halo that shines brightly on Microsoft, we could argue that the Gates Foundation’s significantly reduced role in India might have diminished Microsoft’s influence. Manjari Mahajan’s research notes that when the Indian government gave Bill Gates the Padma Bhushan Award for distinguished service—ostensibly for his philanthropic work—many government sources saw it as a recognition of his work with Microsoft. When Gates returned the favor, offering Prime Minister Modi a humanitarian award, it seems fair to ask whether such an award, at such a precarious time for Modi, might also have won favor for Microsoft.
However we view the award, it is very difficult to understand the logic of this decision outside the idea that, for Bill Gates, the ends justify the means. Getting Modi’s blessing means moving obstacles out of the foundation’s way, clearing a path to allow the foundation to seek new avenues of influence.
In 2022, the headhunter Flexing It announced that it was recruiting two “strategy consultants” for an unnamed “American private foundation” to assist the Indian government with its upcoming duties leading the G20, a meeting of political leaders from twenty powerful countries to discuss the global economy. The job description suggests that the unnamed foundation would work directly with the Indian government:
Specialist will be attached to dedicated G20 working groups, and would develop concept notes/issue notes/background documents, themes and key priorities in respective areas for India’s G20 forthcoming presidency.
Would need to prepare draft outcome documents for the G20 meetings, and to help with negotiation process and negotiation strategy, including live drafting of document during negotiations.
Develop knowledge on the state of play on issues discussed in G20 Working Group and to work towards proposals that would garner consensus in G20.
Responsible to cover meetings and perform liaison duties with various Line Ministries/Departments of GoI, Think Tanks, International Organisations and G20 member & invitee countries etc.
A source with direct knowledge confirmed that the unnamed “American private foundation” was the Gates Foundation.
15
Covid-19
Years before the word Covid burned itself into public consciousness, researchers at the University of Oxford’s Jenner Institute had been developing a new way to make vaccines and had even begun work on an earlier strain of the coronavirus.
Throughout the early days of Covid-19, news reports profiled Oxford’s promising vaccine and the possibility that it would be academic researchers, not Big Pharma, who would deliver us from the unfolding global crisis. In those early media profiles, the Oxford lab acknowledged one weakness: it didn’t have the full confidence of the marketplace. “What we struggle against all the time is the perception from funders that we can’t do this,” Adrian Hill, director of the Jenner Institute, said.
As the pandemic marched on, however, many naysayers seemed to have come around to the university’s vaccine’s enormous potential. A big feature in the New York Times cited the institute’s early and broad efforts to line up agreements with foreign manufacturers to produce the vaccine—if and when it got regulatory approval. Looming in the background of the Times story was the Gates Foundation, the only expert source cited. “It is a very, very fast clinical program,” said Emilio Emini, then a top vaccine executive at the Gates Foundation. The Times noted in passing that Gates was “providing financial support to many competing efforts.”
It would be months before Gates’s full role at Oxford became public knowledge, but the foundation’s appearance in the article was a clear signal of its growing role in the wider response effort, where it was flexing the muscles it had developed after decades of work on vaccines. The foundation was expanding its ties to competing vaccine companies and also positioning itself at the center of a loosely organized WHO effort that promised to deliver vaccines to the global poor.
Gates’s leadership role gave it influence over the direction of billions of dollars in taxpayer funds that flowed into the pandemic response. As one example, nearly 90 percent of the $3.2 billion lifetime budget (through December 2022) of the Coalition for Epidemic Preparedness Innovations has come from taxpayers, most of which is then used to subsidize pharmaceutical industry research and development. In 2022, CEPI confirmed via email that the Gates Foundation sits on all four of its internal committees that control how that money is spent.
Both behind the scenes and in the public spotlight, Bill Gates emerged as one of the most influential actors in the pandemic, and the media welcomed him with open arms, viewing him as a potent counterpoint to U.S. president Donald Trump, who had sought to downplay the novel coronavirus’s severity. “We know how to work with governments, we know how to work with pharma, we’ve thought about this scenario,” Gates said in 2020. “We need—at least in terms of expertise and relationships—to play a very, very key role here.”
Neither the World Health Organization nor wealthy nations were prepared for Covid-19, Gates said, and the pandemic couldn’t realistically be solved through governments. It needed to be a public-private partnership—and Gates needed to be at the head of the table. “We’re always talking with WHO,” he said, “but a lot of the work here to stop this epidemic has to do with innovation in diagnostics, therapeutics and vaccines, which isn’t really [the WHO’s] bailiwick.”
Arguably, one reason that the WHO didn’t have the expertise or capacity to manage the pandemic is that its authority had been eroded by the rise of the Gates Foundation. Gates has far more money than the WHO and has taken over key functions of its work. The foundation had also become the second-largest funder of the WHO, which allowed it to shape what the organization worked on and what it didn’t. As the New York Times reported, the WHO had “wanted to take more of a leadership role in the vaccine deal making [during the pandemic], but the Gates Foundation and global nonprofits said they worried that drugmakers would not cooperate. They worked to focus the agency’s role on regulating products and advising countries on distributing them, among other responsibilities.”
Bill Gates doesn’t particularly respect the WHO—in one public appearance during the pandemic, he casually noted, “If you’re not very good, you’ll stay working there for a long time”—but he appears to treat it as a necessary evil. By funding the WHO, the Gates Foundation can buy its blessing (or silence), gain the imprimatur of legitimacy, and, to a significant extent, control its work.
What all this meant is that, when the Covid-19 pandemic arrived, the fate of the global poor, and their ability to access vaccines, was not in the hands of governments or an intergovernmental multilateral body like the WHO. It was in the hands of Bill Gates. “He had enough money and enough presence in the area for a long enough period of time to be positioned as the first mover and the most influential mover. So, people just relied upon his people and his institutions,” James Love, director of the NGO Knowledge Ecology International, told me. “In a pandemic, when there is a vacuum of leadership, people that move fast and seem to know what they’re doing, they just acquire a lot of power. And [Bill Gates] did that in this case.”
What Love is describing is not leadership, of course. It’s a coup. And, as usual, the Gates Foundation locked down its power by erecting walls to prevent others from meaningfully participating in the response effort or even understanding what was happening. “You have an enormous amount of power that affects everyone around the globe, and there should be some accountability, some transparency. People are not asking unreasonable things,” Love told me in 2020. “Can you explain what you’re doing, for example? Can you show us what these contracts look like? Particularly since [Gates is] using their money to influence policies that involve our money.”
Kate Elder, a vaccine policy adviser at Médecins Sans Frontières, echoed these same concerns in a 2020 interview: “Increasingly, I see less information coming from the Gates Foundation. They don’t answer most of our questions. They don’t make their technical staff available for discussions with us when we’re trying to learn more about their technical strategy [on Covid-19] and how they’re prioritizing certain things.… They have blocked many discussions we’ve proposed with technical experts, instead putting us through to a PR person.”
