The bill gates problem, p.41
The Bill Gates Problem, page 41
Throughout 2021, Bill Gates became the most visible public apologist for Big Pharma’s patent rights, repeatedly giving media interviews in which he argued that patents didn’t matter. “The thing that’s holding things back in this case is not intellectual property. There’s not, like, some idle vaccine factory with regulatory approval that makes magically safe vaccines,” he told Sky News. “There’s only so many vaccine factories in the world, and people are very serious about the safety of vaccines. And so, moving something that had never been done—moving a vaccine, say, from a J and J [Johnson and Johnson] factory into a factory in India—it’s novel—it’s only because of our grants and expertise that that can happen at all.” Showing just how far removed he was from reality, Gates even went so far as to assert that his pandemic response effort was succeeding, saying it “doesn’t get a perfect grade, but it does get a very high grade.… We’re going to get to the point of equity.”
As Gates conjured up the image of a well-functioning response effort led by his foundation, one in which every capable manufacturer was already up and running at maximum capacity, companies began going public almost as whistleblowers, saying that they, in fact, were being boxed out of production. “We have the facilities and equipment, bioreactors, we have fill-and-finish capability. Depending on how much help we get with technology transfer, we could be ready in a few months,” the Canadian company Biolyse told the press. “I don’t understand pharma’s stance on this. Everyone needs to make money, sure. But this is a very serious situation and there’s no reason to be this harsh.”
The Associated Press and then the New York Times and then the Intercept began profiling manufacturing facilities around the world that appeared capable of producing vaccines, some of them explicitly saying they were ready, willing, and able. Human Rights Watch, MSF, and others pulled together another list of one hundred facilities around the globe that could potentially be put into production. Nobel-winning economist Joseph Stiglitz, citing evidence of spare capacity, wrote, “Any delay in ensuring the greatest availability of vaccines and therapeutics is morally wrong and foolish—both in terms of public health and the economy. The [patent] waiver is a critical first step.”
Even Chelsea Clinton jumped into the fray. With her coauthor, Achal Prabhala, of AccessIBSA, Clinton argued that, to help production, President Biden should force U.S. companies to share their vaccine technology with companies that have manufacturing capacity. The piece profiled how Russia had worked with India to rapidly and cheaply retrofit a manufacturing facility that had not previously made vaccines.
Against the growing evidence that patents were, in fact, a major bottleneck, Bill Gates doubled down, recklessly burning through all the political capital he’d built during the first year of the pandemic. Again and again, Gates put himself in front of news reporters to campaign for the preservation of patents, at times becoming emotional. In one interview, he drew on his most famous put-down from his days at Microsoft to attack calls for a patent waiver: “That’s the stupidest thing I’ve ever heard.”
Gates’s position seemed to boil down to the borderline racist idea that poor nations were not sophisticated enough to produce vaccines and that if we opened up manufacturing too broadly, it might lead to safety issues that could hurt people and increase vaccine hesitancy. As one former Gates Foundation employee told me, even if we accepted the foundation’s argument that there was no spare manufacturing capacity to produce vaccines safely, why hadn’t the Gates Foundation, as a self-professed leading expert and visionary on pandemics, foreseen this problem and addressed it? The foundation had been working on vaccines for two decades. It was sitting on a $54 billion endowment. And Bill Gates, we’d been told again and again, had “predicted” the pandemic. Did it really never occur to the Gates Foundation to help build advanced, sophisticated manufacturing facilities in poor nations?
In May 2021, the United States, under pressure to respond to the growing appearance of vaccine apartheid, publicly announced it would join the growing number of countries calling for a patent waiver. This shifted the political balance for the Gates Foundation, which, a day later, cravenly announced it now supported a “narrow” waiver—an astonishing reversal for a foundation that had zealously claimed that patents didn’t matter.
The failures of the foundation and the visuals of insincerity—or incompetence—became so apparent that, at some point, even the news media began stating the obvious: the emperor has no clothes. While journalists in 2020 had viewed the Gates Foundation as too important to criticize—I personally had enormous difficulty getting editors to publish my work—something broke loose in 2021. The New Republic published a six-thousand-word story—featuring a cartoon portrait of Bill Gates wearing devil’s horns—looking at Gates’s history of destructive and obstructive advocacy around intellectual property in public health. Critical stories also appeared in places like the Intercept, the Observer, and the Seattle Times. For the first time in more than a decade, journalists were building a news cycle that put the Gates Foundation under real scrutiny. Critical voices that had long been on the margins of the news media began to find a place in more mainstream outlets. And Twitter became a hotbed of viral threads about Gates’s driving role in vaccine apartheid. The message was as clear as it was common: Bill Gates was on the wrong side of history.
“What we’re seeing [in the Gates Foundation’s role in the pandemic] is the accumulation of twenty years of very careful expansion into every aspect in global health—all of the institutions, all of the different companies that often have these early-stage technologies, as well as all of the advocacy groups that speak to these issue, and all of the research institutions,” said Rohit Malpani, a global health consultant and, at the time I interviewed him, a board member of the global health initiative Unitaid. “It also therefore reflects the failure of the Gates Foundation. The fact that they exert so much influence and even control over so many aspects of the [pandemic] response … and the fact that we are seeing so much inequity speaks to the influence that they have and [suggests that] the strategies that they’ve set out have not worked. And they have to own that failure.”
But the Gates Foundation never did have to own that failure. As quickly as critical reporting about its work in the pandemic appeared, a far bigger story broke: the Gateses’ divorce. The news media’s short attention span quickly pivoted from Bill Gates’s failed philanthropic leadership to his so-called wandering eye and allegations of sexual misconduct.
Journalists went on to widely pen autopsies of the faceless COVAX, but they virtually never put a hard critical lens on the Gates Foundation. In early 2023, for example, the New York Times reported that COVAX had paid out $1.4 billion to pharmaceutical companies for vaccine orders that were never delivered, Exhibit Z of the dysfunction and waste in the Gates-led effort. But the story mentioned the Gates Foundation only once, in passing.
One of the longest and highest-profile stories came from the Bureau of Investigative Journalism. Co-published with El País, STAT, and Ojo Público, the story had the potential to reach millions of readers, to shape public understanding about the failures of COVAX, and to point to policy solutions. The editors and journalists, however, made the editorial decision to completely bury the foundation’s leading role in COVAX in the eighty-third paragraph of the story.
By minimizing Gates’s role, the journalists misinformed the public—and failed to hold the Gates Foundation to account. (Full disclosure: I had been invited to co-report this story, but I declined because I knew Gates’s funding would make it virtually impossible for me to independently report on the foundation’s role in COVAX.) The bureau, like virtually every outlet, claims that its funders have no editorial influence over the work it publishes.
It wasn’t long before the foundation was funding scientific research boasting of the millions of lives COVAX had saved; Gavi, which in 2020 had called COVAX the “only truly global solution to this pandemic,” amplified the lives-saved PR. And Bill Gates announced that he would remain the leading authority on pandemics with the publication of his book How to Prevent the Next Pandemic. Naturally, there was never any accounting of how many lives could have been saved had we had a people’s vaccine—nor how many lives were lost under the deeply inequitable vaccine distribution plan Bill Gates designed.
If we wanted to be exceedingly generous to the Gates Foundation, we could argue that it deserves some credit for having spent years prior to the Covid-19 pandemic shoring up the vaccine industry, which could be seen as giving the world a head start against the novel coronavirus. This was the argument Melinda French Gates tacitly made at the beginning of the pandemic: “Thank goodness we’re not starting from where we were 20 years ago, with a crumbling vaccine system [and having] to rebuild it.”
It is worth asking how the world might have fared in the Covid-19 pandemic without the Gates Foundation. If Gates hadn’t intervened at the University of Oxford, might Oxford’s Jenner Institute, in fact, have pursued an open license? Would that plan have worked? If Gates didn’t exist, would Big Pharma still have had sufficient PR firepower to bend the knee of the global economy to its monopoly patents? If Gates hadn’t inserted itself so forcefully in the pandemic response, might we have been able to imagine an alternative pathway to producing and distributing vaccines? Before the next pandemic comes, don’t we owe it to ourselves to run out these counterfactuals? Shouldn’t we accept that Bill Gates’s master plan didn’t work with Covid-19, and shouldn’t we bet that his plan won’t work in the next pandemic?
While the Gates Foundation created financial ties to many competing Covid-19 vaccine developers, we can nevertheless point to examples of vaccines that succeeded without Gates’s help. Throughout the pandemic, the international media looked to the success of Cuba, where young children were vaccinated before those in the United States, for example. The Gates Foundation has never funded work in Cuba—its grant agreements explicitly state that the U.S. embargo prohibits it from doing so. It is this same embargo that has, for decades, cut off Cuba’s access to much of global commerce, which is why the state had to develop its own public biotech sector, including homegrown research and development capabilities. After producing its own Covid-19 vaccine, Cuba exported doses to Vietnam, Venezuela, Syria, and Nicaragua. If Cuba can do this—without Bill Gates’s help—can’t other poor nations also build their own capacity, not just in manufacturing vaccines but also in doing the research and development to innovate new ones?
Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, in Houston, Texas, said building up this capacity is part and parcel of his lab’s efforts, including its Covid-19 vaccine, Corbevax. Produced in partnership with the Indian company Biological E Limited, Corbevax was a late-arriving vaccine, but nevertheless boasted delivering more than 75 million shots through the fall of 2022. With a per-dose price of $1.90, Corbevax appears to be less expensive than other vaccines, including the Gates-Oxford-AstraZeneca-Serum shot. To boot, Hotez’s effort focused on making the vaccine available to manufacturers in poor nations. For example, the Indonesian company Bio Farma announced that it would produce the vaccine under the name IndoVac.
Hotez’s team accomplished all this despite having been largely boxed out of most major funding streams. Corbevax secured only five million dollars from CEPI and four hundred thousand dollars from the NIH, Hotez told me. By comparison, Gates, CEPI, and taxpayers pledged two billion dollars to Bill Gates’s top-pick vaccine manufacturer, Novavax. Despite this massive help, Novavax told me it had delivered only around 73 million doses through early August 2022, about the same level of distribution as Corbevax.
“We could have gone much further and faster had we had a higher level of support from Gates and CEPI,” Hotez told me. “The impression that Gates gives is that they think only the multinational vaccine companies have the chops to get the job done, and therefore that’s where the focus is…, and to which I say, Look, it’s also equally wrong to demonize the multinational pharma companies. They do a lot of good, and they provide a lot of access to the Gavi alliance. The mistake, I think, is not recognizing the role of low- and middle-income country vaccine producers.”
Hotez said all his work on vaccines is organized around partnerships with poor nations. Corbevax, for example, boasts using a relatively easy technology that can be quickly scaled up. The idea is to move beyond the simplistic model of charity, not just donating doses to poor nations but empowering those nations to produce their own. “We’ve provided a different model, and now there’s proof of concept that it works through Corbevax. There’s a need to balance the portfolio more. It’s not only the Gates Foundation, it’s also Operation Warp Speed [the U.S. federal funding program for Covid-19 vaccines].… The mistake was it’s all about speed and innovation, it’s all about incentivizing pharma companies. The mistake was an upstream science policy failure,” Hotez said, “not recognizing that the LMIC [low- and middle-income country] producers had an important role.”
Helping poor nations produce their own Covid-19 vaccines, Hotez notes, puts them on the pathway to develop other vaccines—for other diseases. Some diseases affect only a few poor nations. There will never be a major incentive for pharmaceutical companies to work on these projects. If vaccines are to be an integral part of solving these diseases, shouldn’t poor nations be able to make their own, in response to local needs and according to local decision-making? Or do we ask poor nations to sit on their hands awaiting the goodwill of foreign philanthropists and pharmaceutical companies, expecting them to slowly take action?
“The whole point is balancing that vaccine ecosystem. That includes the multinational pharma companies—they’ll also have an important role—but also embracing other types of organizations,” Hotez said. “We do something that Gates and others have not been interested in, which is training and doing that capacity building, which I think is probably as important as the actual products.”
What’s particularly notable about Peter Hotez is that, years ago, he was a rising star in the Gates Foundation’s orbit, someone who had received tens of millions of dollars in foundation funding. Throughout the early 2000s, Hotez and Bill Gates almost appeared to be part of a mutual admiration society. “In fact, I’d like to acknowledge Professor Peter Hotez,” Gates said in a 2008 speech at George Washington University, “who’s doing inspiring work on tropical diseases here at GW and is an important partner of our foundation.” Two years earlier, Hotez told the news media, “The great thing about the Gateses is they are funding the diseases no one else will fund.”
For reasons that are not clear, the foundation stopped funding his work a decade ago. Hotez insists there was no falling-out, saying the foundation simply decided to go in a different direction. Leading up to the big win with Corbevax, Hotez said, morale dropped as his lab struggled to advance their work. But he still credits the foundation for much of his success, and in our interview, he was always careful to sandwich any criticism of the foundation with praise. “If it wasn’t for the Gates Foundation, Peter Hotez wouldn’t be Peter Hotez. What that did for us was not only support the hookworm vaccine, but supported us with the infrastructure to make vaccines in the first place—with the quality control, quality assurance, and also the methods of how you get a vaccine through regulatory authorities. All of that infrastructure was supported by Gates for the purposes of hookworm, but we’ve been able to repurpose it to all of our other vaccines as well. If you were to say to me, ‘What’s the first thing you would do if you saw Bill Gates right now?’ I would say, ‘I would just thank him for making all that possible’ [laughing]. Then I’d tell him how some things need to get fixed.”
On social media, where Hotez counts hundreds of thousands of followers, critics sometimes attack him as a kept man of Bill Gates, citing his previous funding from the Gates Foundation and his eagerness to publicly praise Gates’s work. The reality of their relationship seems quite different. While Hotez’s and Gates’s passions and work do seem to be in lockstep—they are perhaps the world’s two leading public champions for vaccines, both focused on diseases affecting poor nations—Bill Gates and the Gates Foundation, to my eye, almost seem to be competing with Hotez.
One year after Hotez published his book Preventing the Next Pandemic, for example, Bill Gates published an almost identically titled book, How to Prevent the Next Pandemic. Similarly, the Gates Foundation is funding the development of a schistosomiasis vaccine at Texas Tech University in the same state as Hotez’s lab, which also has a leading schistosomiasis vaccine candidate. I asked Hotez about this.
“I guess the frustration I have is they miss opportunities to partner with fellow travelers, almost like they’re going into competition,” he said. “The schistosomiasis vaccine is a great example. It’d be easy for them to add on our vaccine candidate to what they’re doing. Instead, we have to go off on our own and seek funding. And, let’s face it, when Gates gets involved, there’s no one who can put up that level of support like Gates. With the Gates Foundation, you’re dealing with ten to the seven dollars. [107 translates to 10,000,000.] Having to go out after to grants for ten to the five and ten to the six dollars [$100,000 and $1,000,000], you’ve got to get a lot of those make up the difference. It’s not easy. It would be so much more straightforward if they would just add on our antigen [to the trials they’re currently funding], and test them in combination or separately,” he said, explaining that he has specifically asked the foundation to support his vaccine. “We’re not interested in competing, by any means. It’s ridiculous. We would love to partner with them. I was very grateful when we were funded by the Gates Foundation because they can do a lot of good.”
