Bill Gates in Paris to meet with French President Emmanuel Macron. Frederic Legrand - COMEO /shutterstock
Bill Gates in Paris to meet with French President Emmanuel Macron. Frederic Legrand – COMEO/shutterstock

It was a “no” that echoed around the world.

Bill Gates was asked last week on Britain’s Sky News if companies should share the “recipe” for vaccines—i.e., waive intellectual property rights—to accelerate vaccination campaigns.

The reply from the Microsoft co-founder and philanthropist was quick: “No.”

“The thing that’s holding things back, in this case, is not intellectual property,” Gates added. “It’s not like there’s some idle vaccine factory, with regulatory approval, that makes magically safe vaccines. You’ve got to do the trial on these things. And every manufacturing process needs to be looked at in a very careful way.”

“There’s only so many vaccine factories in the world, and people are very serious about the safety of vaccines,” he added. “Moving a vaccine, say, from a [Johnson & Johnson] factory into a factory in India, it’s novel, it’s only because of our grants and expertise that can happen at all.”

The backlash was fierce—and highlighted the outsized role the Gateses and their foundation have assumed in matters of global importance. That role was only underscored yesterday when Bill and Melinda Gates simultaneously announced on Twitter their decision to end their marriage. Here, a typically private, personal affair is justifiably front-page news, carrying large potential implications for the public sphere.

Bill Gates is a private citizen, not a doctor, a scientist or an elected official. Yet his beliefs—and the roughly $5 billion the Bill and Melinda Gates Foundation gives each year—play a major role in global health policy. For better or worse, the foundation’s decisions can mean the difference for many between sickness and health, or even life and death. While the organization has a large staff, it is governed by only three trustees, Bill and Melinda Gates and Warren Buffet.

The response to Gates’s comments on the COVID vaccine highlights the reality that we live in an era increasingly shaped by mega-philanthropists, both their words and their deeds. Their convictions—and the dollars they put behind them through philanthropy—influence our world in ways typically reserved for governments.

Few donors have as much global sway as Gates. But there are plenty who wield outsized influence in their own chosen spheres. As I covered earlier this year, one of the most powerful people in the city of Detroit is Dan Gilbert, the billionaire philanthropist and Quicken Loans mortgage mogul who has been called the city’s “shadow mayor.”

This is, as my colleague John Freund called it, the paradox of billionaire giving. Calls for the wealthy to give more are growing as their fortunes multiply—and have accelerated amid the suffering wreaked by COVID-19, the climate emergency, and other crises. Yet as Gates and others illustrate, funding at a scale once reserved for nations can grant undemocratic power and influence to those dishing out the dollars.

Bill Gates and public health

Politico once dubbed Gates “the world’s most powerful doctor.” The New York Times recently called him “the most powerful—and provocative—private player in global health.”

Money is, of course, at the root of his influence. The Gates Foundation is the World Health Organization’s second biggest donor—giving more than every nation except the United States. On vaccine programs alone, the foundation has spent more than $16 billion, according to the Times.

He’s also had a hand in guiding international responses. Gates philanthropy helped launch several organizations key to multilateral efforts, such as the Coalition for Epidemic Preparedness Innovations, which helps develop drugs and vaccines, and Gavi, the Vaccine Alliance.

All that money has made many wary of criticizing the foundation and its leader. Some in public health have coined a term for that self-censorship: “The Bill Chill”

Gates’ involvement with vaccines dates back to the 1990s, as Microsoft was facing an antitrust suit. Vaccine production was at a low, with companies calling them unprofitable. Gates funding helped launch a new system that used subsidies, purchase commitments and volume guarantees to ensure more vaccines were created, as documented in a profile of his work in the New York Times. Yet critics say that the model has prioritized corporate control of vaccines over supply.

Money gives Gates, as it does for so many mega-donors, the ability to set agendas. Take polio vaccines. The Gates Foundation has partnered with Rotary International in a bid to rid the world of the disease. It has reduced cases dramatically. Yet, some say the effort has crowded out other priorities and put too much emphasis on full eradication.

Gates’s comment on intellectual property should come as no surprise to anyone who’s followed his career in business and philanthropy. He’s similarly argued against dropping malaria vaccine prices to zero, as we’ve covered. And as many have noted, intellectual property rights were pivotal to the fortune he built at Microsoft.

Gates and the pandemic

The pandemic has underlined the far-reaching influence of the Gateses and their foundation on public health.

To give credit where credit is due, Bill Gates has long been concerned about pandemics, one of the few philanthropic voices sounding the alarm. He famously warned of a pandemic in a 2015 TED Talk. The Gates Foundation, as earlier noted, helped start both Gavi and CEPI, which have played key roles in pandemic response. The Gates Foundation was ahead of the curve on funding COVID responses.

More recently, the foundation bankrolled the Serum Institute of India, one of the world’s largest vaccine manufacturers, to begin producing coronavirus vaccines. And it partnered with Mastercard and the Wellcome Trust to launch the COVID-19 Therapeutics Accelerator, a global effort to identify and develop treatments.

At the same time, critics say the Gates Foundation’s funding has helped the donor’s vision of market-based approaches that preserve intellectual property and profits for pharmaceutical companies triumph over plans to share knowledge and collaborate on vaccine development and distribution.

A recent, detailed investigation in The New Republic argues that Gates was a pivotal figure in elevating the COVID-19 ACT Accelerator, a successor of his earlier accelerator, as the institution to manage scientific work on the pandemic. It crowded out another body, the WHO’s COVID-19 Technology Access Pool, or C-TAP, which would have created a voluntary intellectual property pool. The author argues the result was one that preserved the status quo on intellectual property, rather than make any exceptions to such rights in the face of the pandemic.

The Gates Foundation has also tried to address disparities in vaccine access, but again, following its preferred models. One arm of the accelerator, COVAX, planned to subsidize vaccine purchases by poor countries via the donations and purchases of richer countries. The goal was to provide vaccines for 20% of the population of those nations in need. The rest of the doses would be purchased on the open market.

Its slow pace has also been criticized. Florida, for comparison, with a population of 21.5 million, has received 20 million vaccine doses, more than Covax has delivered to countries on the entire African continent, home to 1.2 billion people, according to The Intercept.

What impact will Gates have?

Bill Gates, of course, is not responsible for vaccinating the world. And the couple and their foundation’s unwavering dedication to this issue is notable. But the concern is that his preferences, not to mention all the money and influence he’s wielded in the response, even in bids to expand vaccine access, will shape how and how quickly that will happen.

To date, wealthy and middle-income nations have received roughly 90% of the almost 400 million vaccines delivered to date. An analysis by The Economist found nations in need of support “will not have widespread access to coronavirus vaccines before 2023.”

Many disagree with Gates and pharmaceutical companies that intellectual property is not a barrier. South Africa and India have asked the WTO to lift patent protections on COVID vaccines, and more than 100 countries have backed the proposal. But the United States, Canada, the United Kingdom and other high-income countries are blocking it.

Accounts in The Guardian and The Intercept suggest there are pharmaceutical manufacturers from Canada to Bangladesh eager to adapt their facilities to start manufacturing COVID vaccines.

“This is self-serving and wrong,” wrote Joseph Stiglitz, Nobel Prize-winning economist, and Lori Wallach, director of Public Citizen’s Global Trade Watch program, in a Washington Post opinion piece arguing against preserving intellectual property protections.

President Biden recently received a major petition advocating relaxing intellectual property rules for the vaccine. Signed by 2 million people, including several senators, Speaker Nancy Pelosi and 100 members of the House, 60 former heads of state and 100 Nobel Prize winners, the letter was organized by a coalition called the People’s Vaccine Alliance that includes Oxfam, Amnesty International and UNAIDS.

Many have pointed out that millions in developing countries, particularly within Africa, died during the height of the HIV/AIDS epidemic because protections kept drugs at astronomically high prices.

One Biden administration official, Katherine Tai, the U.S. trade representative, seems receptive to such concerns. She recently said gaps between access for rich and poor countries caused “unnecessary deaths and suffering” during the HIV/AIDS epidemic that must not be repeated.

Reports say the White House is now considering waiving intellectual property rights to improve supply of COVID-19 vaccine. One of the people they have discussed the idea with? Bill Gates.