“Bill & Melinda Gates Foundation, Seattle,” Marc Smith

October 5, 2020; The Nation

Public health was on the agenda of the Bill and Melinda Gates Foundation from its inception. So, it was not surprising when the foundation stepped forward in May and committed grants of more than $125 million to the world effort to combat COVID-19. While other foundations and individual philanthropists have also made large commitments to the global response, this is the world’s largest foundation (with an endowment of $50 billion), controlled by one of the world’s richest couples (worth in excess of $100 billion), which makes their role unique. Their size allows them to change their role from supporter to leader, able to not just provide needed financial resources but to also influence public health policies significantly, as the Gates family sits alongside presidents, prime ministers, and corporate leaders.

And there the questions begin.

The holy grail here is an effective vaccine. As NPQ noted earlier this month, 64 nations are backing this project through the COVAX Facility Initiative, which funds “development, manufacturing, and distribution of COVID-19 vaccines.” The Initiative wants “quicker results” along with “access and affordability for lower-income nations,” and the Gates Foundation is on board:

There is no such thing as a national solution to a global crisis. All countries must work together to end the pandemic and begin rebuilding economies. The longer it takes us to realize that the longer it will take (and the more it will cost) to get back on our feet.

But the Gates Foundation is more than just a funder; it’s also an investor—a large strategic investor. Those two roles, as Tim Schwab, writing in the Nation, asserts, may not be compatible, which leaves us to ponder serious concerns about conflicts of interest and foundation overreach.

Total investments amounting to more than $300 million, Schwab notes, put the Gates Foundation “in a position to potentially reap considerable financial gains from the COVID-19 pandemic,” even as Big Pharma races to hit the market with a safe and scalable vaccine first. As “the world’s most visible charity, and one of the world’s most influential voices in the pandemic response,” the Foundation has used its position to support and increase the power of corporate interests over that of national and international governments.

According to Kate Elder, senior vaccines policy adviser to Doctors Without Borders:

Gates’s priorities in developing and distributing a COVID vaccine…are increasingly the world’s priorities, as multilateral institutions like the World Health Organization have ceded leadership to a group of public-private partnerships where Gates provides key funding. These organizations, the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance, are working with the WHO to develop the largest and most diverse COVID-19 vaccine portfolio in the world, which they hope can deliver billions of vaccine doses in the year ahead, including to many poor countries.

Thus, rather than stand behind the leadership of WHO and other public bodies in their effort to effectively control the international response and ensure key treatments and new vaccines are distributed fairly and remain affordable for everyone, the Gates Foundation has built its alliance directly with corporate entities. Together, they will have a unified voice as they bargain with governments.

In a press briefing he gave in June, Gates sounded more like a political leader than the head of a Foundation in his work to coordinate with the corporate sector.

Every week we’re talking with AstraZeneca about, okay, what’s going on in India, what’s going on in China, and so that we can get, assuming that the Phase Two data and eventually the Phase Three data, is promising, that we’re ready to go with that.

Our foundation has a lot of vaccine expertise and deep relationships with the manufacturers, and so, we’ve taken our staff and now are looking at each of these [potential vaccine] constructs and the data and making sure that for the ones that are the most promising, there is a plan to have multiple factories in Asia, multiple factories in the Americas, multiple factories in Europe….

We understand which of these vaccines we can scale up the production, and I’m hopeful that it will be at that large number, because the cooperation from the pharma companies, of saying, “yes, you can use my factory to make someone else’s vaccine,” we’re getting a very good response to that, and that’s really unprecedented.

At a time when the WHO and national governments were scrambling to develop strategies, build trust, and create a coordinated response, the Gates Foundation was, based on its history, in a powerful position to determine strategy and policy. Schwab cites James Love, director of the NGO Knowledge Ecology International, who told him the “foundation’s decades of work on vaccines, along with its sprawling financial ties, allowed it to assert influence early in the pandemic.”

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. 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 he did that in this case.

But, as Elder asks, “Who are they accountable to? They don’t even have a governance structure that’s clear.”

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] and how they’re prioritizing certain things.

Love has a similar perspective. “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…‘Can you explain what you’re doing, for example? Can you show us what these contracts look like?’ Particularly since they’re using their money to influence policies that involve our money.”

In the end, a portion of the public may get its vaccines faster because Gates and his foundation didn’t wait for governments to sort out relationships and agree on an equitable strategy. But, K.M. Gopakumar, legal adviser to the Third World Network, reflects on the longer-term effect, saying, “If we change the way in which you regulate the industry, or the ways in which you want medicines or vaccines to be produced and delivered, it’s definitely going to affect these companies’ business model—and also the investments of the Gates Foundation. So, they are using their money to reinforce the status quo.”—Martin Levine