for slate.com, | October 27, 2021

How Did a Billionaire in Seattle Gain So Much Power Over Global Public Health?

This goes beyond the botched vaccine rollout.

Read at slate.com

I called up Tim Schwab because I was hoping he could tell me the origin of this phrase I’ve been hearing more and more of recently: vaccine apartheid. I’ve heard it from the head of the World Health Organization. I’ve heard it on the floor of the United Nations.

But Schwab had heard it way before all of that: first, in conversation with friends and colleagues, and then in this article in a South African newspaper called the Mail & Guardian. This article was written by a journalist who has been warning that Africa could become “the continent of COVID.” He was angry. This resonated with Schwab, because the article didn’t just blame structural inequality or manufacturing delays for vaccine apartheid. It blamed Bill Gates.

Tim Schwab has spent the past few years investigating Gates and his foundation. “It is giving charitable grants,” he says. “But it’s just operating in such a complicated way that on paper sometimes it feels more like an investment bank than it does a charity.”

If you ask Schwab, having one of the world’s biggest global health charities work like an investment bank, that’s the real origin of “vaccine apartheid.” And the cost is high. As of this month, only 27 percent of people in low-income counties have received a single coronavirus vaccine dose. Compare that to 70 percent of people in some high-income countries.

On Wednesday’s episode of What Next, I spoke with Schwab about how the global response to COVID was shaped by the charity of Bill Gates. And when we talk about “vaccine apartheid,” is an American billionaire to blame? Our conversation has been edited and condensed for clarity.

Tim Schwab: Bill Gates, he had decades of experience working with vaccines. That has always been an important essential feature of the Gates Foundation’s work. They had contacts and networks with pharmaceutical companies with which they worked closely for decades. They’ve worked on R&D. They’ve worked on distribution.

It sounds like they were prepared to help.

Yeah, they came in and they were the first mover. They had the network. They had the people on staff. They had a plan, when a lot of government leaders didn’t have a plan. And everyone just looks to them for leadership because they seem to know what they’re doing.

In previous outbreaks—like when Ebola hit, in 2014—governments were calling the Gates Foundation begging for help. So this time around, they were prepared. They’d already set up something called Coalition for Epidemic Preparedness Innovations, and then, to address COVID, they popped open COVAX, a global vaccine distribution project.

All in all, the Gates Foundation spent $1.8 billion on global public health in 2020 alone. But that meant there were few checks or balances on what Gates-funded groups were up to.  

If you look across global health, they’re funding everybody. Nobody is more than one degree removed from the Gates Foundation. So it’s really difficult to avoid the foundation’s money. And that’s also the case for journalists. If you’re a journalist writing about global health, you might end up getting a fellowship or a grant to do reporting that’s funded by the Gates Foundation. So it’s really hard to overstate how much influence that gives the foundation.

So COVID struck. My understanding is that the Gates Foundation was kind of like, “This is what we do. We do innovation. And so we should really be leading this.” Almost to the chagrin of someone like the World Health Organization that was saying, “Hold it. This is what we do. Is that your impression as well? 

The World Health Organization is the obvious place where this pandemic response should be happening for the global poor because they have a mandate. It has some semblance of a democratic institution, where you have member states and you have votes. This should be the place where this is happening. But the World Health Organization has really been hollowed out over the decades because it hasn’t been well-funded. And what that’s meant is that Bill Gates, and the Gates Foundation, has become one of the most important funders—the second-largest funder, I think—of the World Health Organization, which gives it a really outsized role in influencing how it works. So at the point that the pandemic came, the Gates Foundation had certainly felt like it had more of a network and more of a background and better capacity to be leading this pandemic. So the response did end up being routed nominally through the World Health Organization. But all the phone calls, all the working groups, all the meetings, it was really the Gates Foundation that was directing.

It seems like a shadow government. 

I don’t know if I’d call it a shadow government, but there is certainly something that’s fundamentally undemocratic about it. The Gates Foundation doesn’t have a constituency that elects it or that can unelect it. There’s virtually no checks and balances over a private foundation. There’s no transparency. So I would say it’s undemocratic and maybe even anti-democratic. And in some important ways, the growing institutionalized influence of the foundation in fields like global health and other public policies is really eroding democratic institutions and the power of democracy to solve these problems. Instead, we’re looking to a private billionaire in Seattle for solutions.

I understand that from the very beginning the Gates Foundation ethos of open markets influenced how some of these projects worked. The vaccine that they got behind was the AstraZeneca vaccine. But my understanding was that was supposed to be an open license—anyone could make it. But that didn’t happen. Why? 

This is part and parcel of these halcyon early days of the pandemic response when there was this really rich discourse around a people’s vaccine and not doing a business-as-usual approach. And one of the early vaccine innovators, it wasn’t a pharmaceutical company. It was a university, the University of Oxford in the U.K. And early in the pandemic, there were all these stories about how they had a head start against the coronavirus compared to other vaccine companies because they had a research lab that had been doing work that so closely related to the coronavirus. And as these stories were coming out, you had the researchers in this lab saying that this can’t be a profit-driven pandemic response. This really needs to be about public goods and public health. And certainly, the message that they were telegraphing was that you could develop this vaccine and have it available as an open license, which would mean that any capable manufacturer anywhere around the world could get a hold of the vaccine technology and start producing it.

Sounds smart. 

Yeah, it does sound smart. It sounds super resilient. This idea that you could have manufacturing facilities, you can build them or retrofit them in sub-Saharan Africa and Southeast Asia. So you’d have these manufacturing facilities getting on stream all over the world because they knew they could access the vaccine technology and start producing it. And if the University of Oxford had gone that direction that could have really changed the direction of the pandemic. It could have really inspired other players to go in that direction also. But that’s not what happened.

What you’re saying is that in the beginning, if a big mover had said, “Hey, we’re putting our stake in the ground. Let’s share all of our information,” that might have influenced beyond their specific vaccine.

It would have been a really different pandemic response if they had made that decision. But the story that came out was that Bill Gates and the Gates Foundation came to the University of Oxford—they’d been funding the University of Oxford and their work on vaccines for years. So Bill Gates and the Gates Foundation had a relationship. You could even say they had leverage there, and they talked to the university and they encouraged them. They pushed them, really. And they said, “You should really be partnering up with a major multinational pharmaceutical company, somebody who has the wherewithal, the resources, the experience to get this over the finish line and out into people’s arms.” And not long after that they partnered with AstraZeneca. And the die was cast. Now it was an exclusive license with AstraZeneca, and so they ended up going down this business-as-usual route to patents, exclusive license, the way the pharmaceutical industry has always operated.

Locking up intellectual property has been a key criticism of the Gates Foundation approach to every public health crisis. How has Bill Gates responded to that criticism?

One of the arguments that Bill Gates continues to make is that there simply are not available manufacturing facilities around the world that could scale up production. So, he wants to say there’s no reason that we should be having this conversation about waiving intellectual property and patents because it’s not like they’re all of these idle manufacturing facilities out there that could be producing these vaccines.

And to a lot of people, that smacks of a certain patriarchy or colonialism. This idea that poor nations aren’t sophisticated enough or smart enough to produce this complicated vaccine, which just doesn’t make sense because at the same time that Bill Gates is saying this, the New York Times is coming out with a big investigation, highlighting 10 vaccine manufacturers around the world, which could be producing these mRNA vaccines—that have the capacity, that have the professional expertise, that have all the ingredients in place to be producing these vaccines. And this is not a new story. Throughout the spring of this year, you had all these vaccine companies who were waving their hands saying, “If these vaccine companies would waive the patents and share the technology, my facility could be producing this many doses this year.”

Bill Gates doesn’t really engage with that. He just reverts back to this talking point to say that there’s no such facilities out there

But then there was this other desire to speed up vaccine distribution. Was the Gates Foundation able to help do that? 

Well, vaccine distribution is limited by the supply, and so the supply was all being snapped up by rich nations, which were making all these advance purchases against Pfizer and Moderna and everyone else. The Gates Foundation had a long-standing relationship with the Serum Institute of India, the largest vaccine manufacturer in the world. So the foundation leaned on this Serum Institute and made several deals that they were going to start producing vaccines, and those vaccines would go into the arms of the global poor. But then a second wave of the COVID hit India. They had a major problem. The Indian government issued an export ban, which basically meant everything the Serum Institute was producing was going to the arms of Indians.

So now that we’re starting to do an autopsy of everything that went wrong with COVAX and the pandemic response, people are saying, where is the risk assessment to put all of our eggs in one basket? So much of this Gates-led project went to this one manufacturer in India. And when things went wrong, they went really wrong for everybody.

Some people might listen to your criticisms and say, “Does this guy really have it in for Bill Gates?” What would you say to someone who heard you and thought that?

Well, it’s not just me saying this. All these news stories are coming out right now providing this autopsy of what went wrong with COVAX. But what’s not at the front and center of this is Bill Gates and the Gates Foundation.

I noticed that too. There’s a lot of conversation about inequity but not a lot of conversation about how we got there.

That’s part of the autopsy. You have to do that to figure out how do we pivot and move forward in this pandemic, and how do we prepare for the next pandemic? And in my mind, as a general principle, if you want to step up and be a leader, when things go wrong, you should take responsibility. And the Gates Foundation clearly is incapable of doing that because they seem to think that the pandemic response is going OK.

But that’s also where journalists need to step up and look at: We know if you go back to 2020, there were several news articles talking about how the Gates Foundation was really the chief architect of this program. So now here we are in the other end, let’s ask, “Well, what was the Gates Foundation role in all of this? And does it make sense for a billionaire in Seattle to have as much power as Bill Gates seems to have?” And it goes even beyond this pandemic response, but you could look across U.S. education, African agriculture, global health more broadly, whether you’re looking at malaria control or polio eradication. You have this private institution with Bill Gates’ money in Seattle, and it’s just an incredible amount of power. And in my mind, the pandemic response is just this really important moment that we need to be looking back at the foundation’s role in all this and think, “Well, maybe next time we should have a more democratic response. We shouldn’t depend on billionaire philanthropy that has no checks and balances or transparency to play such an influential role.”

The Gates Foundation is a very top-down technocratic enterprise where Bill Gates sees himself as this really smart guy with these innovative ideas and technology, and he surrounds himself with this elite cadre of highly educated experts. And it’s his view that from this purse in Seattle, they can devise solutions to fix all the problems of the global poor. And that’s a very different approach than going out into a poor nation or a poor community and talking to people and asking them what they need and what they want.

You’ve called it “colonial.

It’s not just me, but a lot of people see that as colonial or neocolonial. I recently did a study looking at the Gates Foundation’s funding—all of the $70 billion in charitable grants they’ve pledged over the last two decades. The face of the foundation is very much these poor Black and brown faces in the “global south,” as it’s called. But if you start to look at their grant-making, almost all of their money goes to the wealthiest, whitest nations. They’re funding NGOs and companies in the United States and the United Kingdom and Switzerland. Very little of their grant-making actually goes to institutions in sub-Saharan Africa, for example. And I think it’s hard not to raise a question about colonialism when you see it played out in such a striking way. Bill Gates is one of the richest people in the world, and he’s getting richer year over year. He’s not getting poorer. We have this idea that he’s giving away all of his money, but that’s not the case. From such a privileged position and from such an unequal position, Bill Gates has nevertheless managed to brand the Gates Foundation as geared uniquely toward equity, to making sure that all lives have equal value. So there’s a real paradox in how the foundation functions along those lines of wealth and power.

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