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How Bill Gates impeded global access to Covid vaccines

Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine. 

by Alexander Zaitchik

Part 2 -Gates and his deputies have left little doubt about their opposition to the waiver proposal

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. 

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.

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