Critical reflection on the field of global health

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Our goal throughout the quarter has been to inspire your interest in and commitment to global health, but to do so with a critical eye toward the people and institutions in power, some of whom have an adverse impact on the health of populations.  Without this thoughtful and critical perspective, we cannot make substantive, systemic progress in the field of Global Health.

One institution that receives abundant praise, but also some less audible criticism, is the Bill & Melinda Gates Foundation, which is headquartered in Seattle and has a very close relationship with the University of Washington and our own Department of Global Health.  The Foundation has taken an active role in the response to the covid-19 pandemic, ostensibly attempting to spread testing and vaccine access, among other priorities.  However, the means have been question, especially if they are benefitting the poorest people the foundation claims to aim to serve.

For this assignment, we ask you to read this article, entitled “Bill Gates, Vaccine Actions” (file I uploaded) as a prompt to provide some reflections on the field of global health.  The article obviously takes a critical perspective on the Gates Foundation.  Your job is to decide, in the context of this course, how you feel about this critique (there are no right or wrong answers).  

In up to one single-spaced page, please consider the following questions:

  • Did the article make a convincing case that the Gates Foundation’s role in the covid-19 pandemic and vaccine access is problematic?  Explain.
  • How has this class given you some tools or perspectives through which to critically analyze both the article and the Gates Foundation?
  • How would you like to see the covid-19 vaccine rollout proceed, especially knowing that the vast majority of people who are poor remain unvaccinated and will for some time?

You job with this assignment is to show critical thinking skills, meaning we encourage you to offer your perspective, but in a way that links to what you’ve learned in class.  There are no right or wrong answers–how you defend your position matters most!

5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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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.

ILLUSTRATION BY KELSEY DAKE

Alexander Zaitchik / April 12, 2021

On February 11, 2020, public health and infectious disease experts gathered by the hundreds
at the World Health Organization’s Geneva mothership. The official pronouncement of a
pandemic was still a month out, but the agency’s international brain trust knew enough to be
worried. Burdened by a sense of borrowed time, they spent two days furiously sketching an
“R&D Blueprint” in preparation for a world upended by the virus then known as 2019-nCoV.

The resulting document summarized the state of coronavirus research and proposed ways to
accelerate the development of diagnostics, treatments, and vaccines. The underlying
premise was that the world would unite against the virus. The global research community
would maintain broad and open channels of communication, since collaboration and
information-sharing minimize duplication and accelerate discovery. The group also drew up
plans for global comparative trials overseen by the WHO, to assess the merits of treatments
and vaccines.

One issue not mentioned in the paper: intellectual property. If the worst came to pass, the
experts and researchers assumed cooperation would define the global response, with the

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WHO playing a central role. That pharmaceutical companies and their allied governments
would allow intellectual property concerns to slow things down—from research and
development to manufacturing scale-up—does not seem to have occurred to them.

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They were wrong, but they weren’t alone. Battle-scarred veterans of the medicines-access
and open-science movements hoped the immensity of the pandemic would override a global
drug system based on proprietary science and market monopolies. By March, strange but
welcome melodies could be heard from unexpected quarters. Anxious governments spoke of
shared interests and global public goods; drug companies pledged “precompetitive” and “no-
profit” approaches to development and pricing. The early days featured tantalizing glimpses
of an open-science, cooperative pandemic response. In January and February 2020, a
consortium led by the National Institutes of Health and the National Institute of Allergy and
Infectious Diseases collaborated to produce atomic-level maps of the key viral proteins in
record time. “Work that would normally have taken months—or possibly even years—has
been completed in weeks,” noted the editors of Nature.

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When the Financial Times editorialized on March 27 that “the world has an overwhelming
interest in ensuring [Covid-19 drugs and vaccines] will be universally and cheaply available,”
the paper expressed what felt like a hardening conventional wisdom. This sense of possibility
emboldened forces working to extend the cooperative model. Grounding their efforts was a
plan, started in early March, to create a voluntary intellectual property pool inside the WHO.
Instead of putting up proprietary walls around research and organizing it as a “race,” public
and private actors would collect research and associated intellectual property in a global
knowledge fund for the duration of the pandemic. The idea became real in late May with the
launch of the WHO Covid-19 Technology Access Pool, or C-TAP.

By then, however, the optimism and sense of possibility that defined the early days were long
gone. Advocates for pooling and open science, who seemed ascendant and even unstoppable
that winter, confronted the possibility they’d been outmatched and outmaneuvered by the
most powerful man in global public health.

In April, Bill Gates launched a bold bid to manage the world’s scientific response to the
pandemic. Gates’s Covid-19 ACT-Accelerator expressed a status quo vision for organizing the
research, development, manufacture, and distribution of treatments and vaccines. Like other
Gates-funded institutions in the public health arena, the Accelerator was a public-private
partnership based on charity and industry enticements. Crucially, and in contrast to the C-
TAP, the Accelerator enshrined Gates’s long-standing commitment to respecting exclusive
intellectual property claims. Its implicit arguments—that intellectual property rights won’t
present problems for meeting global demand or ensuring equitable access, and that they
must be protected, even during a pandemic—carried the enormous weight of Gates’s
reputation as a wise, beneficent, and prophetic leader.

How he’s developed and wielded this influence over two decades is one of the more
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pandemic. Entering year two, this response has been defined by a zero-sum vaccination
battle that has left much of the world on the losing side.

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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.

Advocates for pooling and open science, who seemed
ascendant and even unstoppable early in the crisis, have been

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outmatched and outmaneuvered by the most powerful man in
global public health.

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 theSupport our issue-driven, independent journalism and subscribe today.

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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

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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.

Technically housed within the WHO, the ACT-Accelerator is a Gates operation, top to bottom.
It is designed, managed, and staffed largely by Gates organization employees. It embodies
Gates’s philanthropic approach to widely anticipated problems posed by intellectual
property–hoarding companies able to constrain global production by prioritizing rich
countries and inhibiting licensing. Companies partnering with COVAX are allowed to set
their own tiered prices. They are subject to almost no transparency requirements and to
toothless contractual nods to “equitable access” that have never been enforced. Crucially, the
companies retain exclusive rights to their intellectual property. If they stray from the Gates
Foundation line on exclusive rights, they are quickly brought to heel. When the director of
Oxford’s Jenner Institute had funny ideas about placing the rights to its COVAX-supported
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News, “A few weeks later, Oxford—urged on by the Bill & Melinda Gates Foundation—
reversed course [and] signed an exclusive vaccine deal with AstraZeneca that gave the
pharmaceutical giant sole rights and no guarantee of low prices.”

Considering the alternatives being discussed, it is no surprise that drug companies have been
the most enthusiastic boosters of the ACT-Accelerator and COVAX. The speakers at the ACT-
Accelerator launch ceremony in March 2020 included Thomas Cueni, director general of the
International Federation of Pharmaceutical Manufacturers and Associations, who hailed the
initiative as a “landmark global partnership.” Since vaccines started coming online, the
IFPMA’s member companies have lost interest in the Accelerator, preferring bilateral deals
with rich countries. But they continue to benefit from the halo effect of their association with
Gates, which has proved priceless throughout the pandemic, especially at a crucial juncture
in its first year.

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On May 29, Donald Trump announced U.S. withdrawal from the WHO. This was in response,
he said, to China’s “total control” of the agency. The drug industry, meanwhile, was
displeased with the WHO for entirely different reasons. The same day, the WHO director
general had unveiled the C-TAP with a “Solidarity Call to Action” for governments and
companies to share all intellectual property related to Covid-19 treatments and vaccines. The
pharmaceutical companies didn’t attack the initiative directly. Instead, their global trade

Bill Gates addresses the opening session of the WHO’s annual assembly in 2005, some six years after he
entered the global public health scene as a defender of intellectual property rights during the AIDS crisis.

JEAN-PIERRE CLATOT/AFP/GETTY IMAGES

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association, the IFPMA, preempted the announcement with a livestreamed media event on
the evening of May 28. The event featured the heads of AstraZeneca, GlaxoSmithKline,
Johnson & Johnson, and Pfizer, and Thomas Cueni.

The evening’s sixth participant was the specter of Bill Gates.

As anticipated, the questions submitted by journalists touched repeatedly on the much-
anticipated launch of C-TAP the following morning, as well as related issues of intellectual
property, vaccine access and equity, and debates over the extent and ways intellectual
property posed barriers to ramping up production. Mostly, the executives evinced ignorance
and surprise over the imminent launch of C-TAP; only Pfizer CEO Albert Bourla openly
denounced the pooling of intellectual property as “dangerous” and “nonsense.”

All of the executives, however, shared a playbook in which they quickly pivoted to
affirmations of their support for Bill Gates and the ACT-Accelerator. The association with
Gates was submitted as evidence of industry commitment to equity and access—as well as
proof of the complete lack of need for overlapping or competing initiatives, such as the
“dangerous” C-TAP.

“We already have platforms,” Cueni said during the May 28 event. “The industry is already
doing all the right things.”

As the questions about C-TAP and intellectual property piled up, the industry’s Gates rap
started to sound less like a shared P.R. script than a broken record. Confronted for the second
time about intellectual property, GlaxoSmithKline CEO Emma Walmsley emitted an
undigested stream of Gatesian word salad. “We are absolutely committed to this question of
access,” she stammered, “and deeply welcome the formation of ACT, which is this
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whether it’s heads of state or organizations like [the Gates-funded] CEPI or the Gates and [the
Gates-funded] Gavi and others and the WHO, of course, where we actually look at these
principles of, uh, access and so clearly, we’re engaged in that as well.”

Without the Gates and COVAX associations to lean on, the stammering would have been
much worse. Pfizer’s Albert Bourla seemed to recognize this, at one point interrupting
himself to express his industry’s gratitude and admiration. “I want to take the opportunity to
emphasize the role that Bill Gates is playing,” he said. He went on to call him “an inspiration
for all.”

Gates can hardly disguise his contempt for the growing interest in intellectual property
barriers. In recent months, as the debate has shifted from the WHO to the WTO, reporters
have drawn testy responses from Gates that harken back to his prickly performances before
congressional antitrust hearings a quarter-century ago. When a Fast Company reporter raised
the issue in February, she described Gates “raising his voice slightly and laughing in
frustration,” before snapping, “It’s irritating that this issue comes up here.
This isn’t about IP.”

In interview after interview, Gates has dismissed his critics on the issue—who represent the
poor majority of the global population—as spoiled children demanding ice cream before
dinner. “It’s the classic situation in global health, where the advocates all of a sudden want
[the vaccine] for zero dollars and right away,” he told Reuters in late January. Gates has larded
the insults with comments that equate state-protected and publicly funded monopolies with
the “free market.” “North Korea doesn’t have that many vaccines, as far as we can tell,” he
told The New York Times in November. (It is curious that he chose North Korea as an example

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and not Cuba, a socialist country with an innovative and world-class vaccine development
program with multiple Covid-19 vaccine candidates in various stages of testing.)

The closest Gates has come to conceding that vaccine monopolies inhibit production came
during a January interview with South Africa’s Mail & Guardian. Asked about the growing
intellectual property debate, he responded, “At this point, changing the rules wouldn’t make
any additional vaccines available.”

When a reporter raised the issue in February, she described
Gates “raising his voice slightly and laughing in frustration,”
before snapping, “It’s irritating that this issue comes up here.
This isn’t about IP.” 

The first implication of “at this point” is that the moment has passed when changing the
rules could make a difference. This is a false but debatable claim. The same can’t be said for
the second implication, which is that nobody could have possibly foreseen the current supply
crisis. Not only were the obstacles posed by intellectual property easily predictable a year
ago, there was no lack of people making noise about the urgency of avoiding them. They
included much of the global research community, major NGOs with long experience in
medicines development and access, and dozens of current and former world leaders and
public health experts. In a May 2020 open letter, more than 140 political and civil society
leaders called upon governments and companies to begin pooling their intellectual property.
“Now is not the time … to leave this massive and moral task to market forces,” they wrote.

Bill Gates’s position on intellectual property was consistent with a lifelong ideological
commitment to knowledge monopolies, forged during a vengeful teenage crusade against
the open-source programming culture of the 1970s. As it happens, a novel use of one category
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in the world for most of two decades beginning in 1995. That same year, the WTO went into
effect, chaining the developing world to intellectual property rules written by a handful of
executives from the U.S. pharmaceutical, entertainment, and software industries.

By 1999, Bill Gates was in his final year as CEO of Microsoft, focused on defending the
company he founded from antitrust suits on two continents. As his business reputation
suffered high-profile beatings from U.S. and European regulators, he was in the process of
moving on to his second act: the formation of the Bill & Melinda Gates Foundation, which
commenced his unlikely rise to the commanding apex of global public health policy. His
debut in that role occurred during the contentious fifty-second General Health Assembly in
May 1999.

It was the height of the battle to bring generic AIDS drugs to the developing world. The
central front was South Africa, where the HIV rate at the time was estimated as high as 22
percent and threatened to decimate an entire generation. In December 1997, the Mandela
government passed a law giving the health ministry powers to produce, purchase, and
import low-cost drugs, including unbranded versions of combination therapies priced by
Western drug companies at $10,000 and more. In response, 39 drug multinationals filed suit
against South Africa alleging violations of the country’s constitution and its obligations
under the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights, or
TRIPS. The industry suit was backed by the diplomatic muscle of the Clinton administration,
which tasked Al Gore with applying pressure. In his 2012 documentary Fire in the Blood,
Dylan Mohan Gray notes it took Washington 40 years to threaten apartheid South Africa with
sanctions and less than four to threaten the post-apartheid Mandela government over AIDS
drugs.

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Though South Africa barely registered as a market for the drug companies, the appearance of
cheap generics produced in violation of patents anywhere was a threat to monopoly pricing
everywhere, according to the drug industry’s version of Cold War “domino theory.” Allowing
poor nations to “free ride” on Western science and build parallel drug economies would
eventually cause problems closer to home, where the industry spent billions of dollars on a
propaganda operation to control the narrative around drug prices and keep the lid on public
discontent. The companies suing Mandela had devised TRIPS as a long-term strategic
response to the south-based generics industry that arose in the 1960s. They had come too far
to be set back by the needs of a pandemic in sub-Saharan Africa. U.S. and industry officials
paired old standby arguments about patents driving innovation with claims that Africans
posed a public health menace because they couldn’t keep time: Since they could not be relied
on to take their medicines on a schedule, giving Africans access to the drugs would allow for
the emergence of drug-resistant HIV variants, according to industry and its government and
media allies.*

In Geneva, the lawsuit was reflected in a battle at the WHO, which was divided along a north-
south fault line: on one side, the home countries of the Western drug companies; on the
other, a coalition of 134 developing countries (known collectively as the Group of 77, or G77)
and a rising “third force” of civil society groups led by Médecins Sans Frontières and Oxfam.
The point of conflict was a WHO resolution that called on member states “to ensure equitable
access to essential drugs; to ensure that public health interests are paramount in
pharmaceutical and health policies; [and] to explore and review their options under relevant
international agreements, including trade agreements, to safeguard access to essential
drugs.”

Western countries saw the resolution as a threat to the recent conquest of monopoly
medicine, achieved four years earlier with the establishment of the WTO. The industry grew
increasingly helpless, however, as global public opinion and WHO member-state sentiment

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shifted in favor of the resolution and against the South Africa lawsuit. In the weeks leading
up to the assembly, the companies and their parent embassies floundered as they sought to
turn the tide. Their growing anxiety is captured in a series of leaked cables sent to
Washington by the U.S. ambassador in Geneva, George Moose, that April and May. In a
diplomatic telegram dated April 20, Moose expressed alarm over the growing number of
WHO delegations making

Moose was concerned that drug companies were not helping their own cause and seemed
incapable of doing anything but parrot old talking points about intellectual property as the
driver of innovation. The pharmaceutical industry, Moose wrote,

Over the course of weeks, a picture emerges from Moose’s accounts of a pharmaceutical
industry against the ropes, punch drunk and out of ideas. In the U.S. ambassador’s view, the
problem wasn’t moral bankruptcy so much as incompetence. “RECOMMEND THE USG

STATEMENTS THAT PUBLIC HEALTH SHOULD HAVE PRIMACY OVER COMMERCIAL
INTERESTS UNDER WTO TRADE AGREEMENTS SUCH AS THE TRIPS (TRADE-RELATED
ASPECTS OF INTELLECTUAL PROPERTY RIGHTS) … THEREBY POTENTIALLY UNDERMINING
INTELLECTUAL PROPERTY RIGHTS (IPR).

SHOULD BE CARRYING MORE OF ITS OWN WATER ON THIS ISSUE, ESPECIALLY IN
DEVELOPING COUNTRIES, AND NOT SOLELY DEPEND ON THE ARGUMENT THAT IPR
PROTECTS PROFITS THAT THEN ARE USED FOR DEVELOPMENT OF NEW DRUGS IN THE
FUTURE. NOT 10 YEARS FROM NOW. THE SOUTH AFRICANS AND OTHERS ARE MOSTLY
CONCERNED ABOUT AVAILABILITY OF DRUGS NOW. PROBLEMS RELATED TO LOCAL
AVAILABILITY AND PRICING OF DRUGS THAT ARE UNRELATED TO TRIPS WILL
UNDOUBTABLY REQUIRE FURTHER DISCUSSION.

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PUSH THE PHARMACEUTICAL INDUSTRY TO ARGUE ITS POINTS MORE CONVINCINGLY
IN DEVELOPING COUNTRIES,” the exasperated ambassador wrote. “AND ESPECIALLY
DEAL WITH THEIR CONCERNS ABOUT LOCAL DRUG AVAILABILITY AND PRICING.”

Following the raucous buzz saw of the 1999 WHO Assembly, the drug companies would make
a humiliating climbdown from their scandalous lawsuit in South Africa, reduced to what The
Washington Post called “close to pariah status.”

At the same time, the industry was richer than ever. The Clinton administration had
approved a long Big Pharma wish list, from broadening the avenues for privatizing
government-funded science to opening the age of direct marketing of prescription drugs. The
corresponding profits went to reinforce already historically rich D.C. and Geneva lobbying
operations. And yet, for all their combined might, the companies were incapable of
producing a mask resembling a credible human face. A global activist movement continued
to gather public opinion on its side and chip away at the legitimacy of the monopoly model
that underlay the industry’s enormous power. By every nonfinancial measure, it was an
industry in distress. To borrow a phrase from a future Bill Gates production, you might say it
was waiting for its Superman.**

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When Moose was ringing the alarm over the future of TRIPS in the spring of 1999, Gates was
preparing to fund the launch of a public-private partnership called Gavi, the Vaccine
Alliance, with a seed grant of $750 million, marking his arrival in the worlds of infectious
disease and public health. At the time, he was still best known for being the richest man in
the world and the owner of a software company engaged in anti-competitive practices. This

The Clinton administration was instrumental in safeguarding Big Pharma’s intellectual property rights on the
global stage—and Gates would become the campaign’s benevolent face.

CHIP SOMODEVILLA/GETTY IMAGES

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profile didn’t mean much in a raucous WHO Assembly hall packed with civil society groups
and G77 delegations, which together booed the U.S. delegation when it tried to speak. At
most, it was a source of brief consternation when officers from the William H. Gates
Foundation began distributing a glossy brochure touting the role of intellectual property in
driving biomedical innovation.

James Love, who organized many of the civil society events around the 1999 Assembly,
remembers seeing the Gates staffers joined in the distribution effort by Harvey Bale, a former
U.S. trade official serving as director general of the International Federation of
Pharmaceutical Manufacturers Associations.

“It was this nice full-color pamphlet about why patents don’t present an access problem, with
the Gates Foundation logo at the bottom,” says Love. “It was strange, and I just thought, ‘OK, I
guess this is what he’s doing now.’ Looking back, that’s when the pharma-Gates consortium
set the markers down on intellectual property. He’s been sticking his nose into every
intellectual property debate since, telling everyone they can go to heaven by paying lip
service to a few discounts to poor countries.”

Following the 1999 WHO Assembly, the industry tried to salvage its reputation by offering
African countries discounts on the antiretroviral combination therapies that cost $10,000 or
more in rich countries. The compromise prices it offered were still outrageously high, but
even raising the issue of price concessions was too much for Pfizer, whose representatives
stormed out of the industry coalition on principle. Public opinion swung harder against the
companies, the result of a loud, ingenious, and effective direct-action campaign. Similar to
the first months of the Covid-19 pandemic, there was a sense of possibility—a hope that a
forced breakdown of a morally obscene and bloodstained system was within grasp.

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“The movement was very focused and successfully building pressure for structural, more
decisive solutions into the aughts,” says Asia Russell, a veteran HIV-AIDS activist and
director of Health Gap, an HIV medicines access group. “And just when we started to secure
some progress, a new version of the industry narrative emerged from Gates and Pharma. It
was all about how pricing policies, generic competition, anything that interferes with
industry profits, will undermine research and development, when the evidence shows that
that argument doesn’t hold water. Gates’s talking points aligned with those of the industry.”

Adds Manuel Martin, the Médecins Sans Frontières policy adviser, “Gates defused the real
issue of decolonizing global health. Instead, drug companies could just give money to his
institutions.”

Even after the drug companies withdrew their lawsuit against the South African government
and Indian-made generics began flowing to Africa, Gates stayed cool toward compromises
that he saw as threats to the intellectual property paradigm. This included his attitude
toward the Unitaid Medicines Patent Pool, a voluntary intellectual property pool founded in
2010 that enlarged access to some patented HIV/AIDS medicines. Though not a complete
answer to the problem, the MPP was the first working example of a voluntary intellectual
property pool, one that many observers expected to serve as a model framework for the
WHO-administered Covid-19 pool.

Brook Baker, a law professor at Northeastern University and senior policy analyst for Health
GAP, says Gates has always been wary of the Unitaid pool as going too far in the direction of
infringing on intellectual property.

“Initially, Gates was unsupportive and even hostile toward the AIDS Medicines Patent Pool,”
says Baker. “He brought that hostility to relaxing industry’s iron-fist control over its
technologies into the pandemic. His explanation for rejecting models to counteract thisSupport our issue-driven, independent journalism and subscribe today.

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control never added up. If I.P. isn’t important, why are companies refusing to voluntarily give
it up when it could be used to expand supply in the middle of the world’s worst public health
crisis in a century? It’s not important, or it’s so important it has to be closely guarded and
protected. You can’t have it both ways.”

This winter, while Gates assured the world that intellectual property was a red herring, a bloc
of developing countries at the WTO explained the need for a waiver on certain intellectual
property provisions by pointing to the “rather large gap [that] exists between what COVAX or
ACT-A can deliver and what is required in developing and least developed countries.”

The forceful statement continued:

Another statement by a different bloc of countries added, “COVID19 reveals the deep
structural inequality in access to medicines globally, and a root cause is IP that sustains and
dominates industry’s interests at the cost of lives.”

Gates is certain he knows better. But his failure to anticipate a crisis of supply, and his refusal
to engage those who predicted it, have complicated the carefully maintained image of an all-
knowing, saintly mega-philanthropist. COVAX presents a high-stakes demonstration of
Gates’s deepest ideological commitments, not just to intellectual property rights but also to
the conflation of these rights with an imaginary free market in pharmaceuticals—an industry
dominated by companies whose power derives from politically constructed and politically

The model of donation and philanthropic expediency cannot solve the fundamental disconnect
between the monopolistic model it underwrites and the very real desire of developing and least
developed countries to produce for themselves.… The artificial shortage of vaccines is primarily
caused by the inappropriate use of intellectual property rights.

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imposed monopolies. Gates has been tacitly and explicitly defending the legitimacy of
knowledge monopolies since his first Gerald Ford–era missives against open-source software
hobbyists. He was on the side of these monopolies during the miserable depths of the 1990s
African AIDS crisis. He’s still there today, defending the status quo and running effective
interference for those profiting by the billions from their control of Covid-19 vaccines.

His latest move is to institutionalize the ACT-Accelerator as the central organizing institution
in future pandemics. The shortages have made this effort a little awkward, however, and
Gates is now forced to reckon with the question of technology transfer. This is an aspect of
the equitable access debate that doesn’t concern intellectual property as commonly
perceived—as a simple matter of patents and licenses—but access to the components and
technical knowledge related to practical manufacture, including biological material and
other areas otherwise protected under the category of intellectual property known as trade
secrets. The global south and civil society groups have been calling for tech transfer for
months—either mandatory tech transfer that could have been written into contracts or
through a voluntary mechanism associated with C-TAP—but Gates has predictably arrived
on the scene with a more familiar plan in hand.

In early March, senior Gates staff joined pharma executives for a “Global C19 Vaccine Supply
Chain and Manufacturing Summit” convened by Chatham House in London. The main
agenda item: plans for a new arm within the ACT-Accelerator, the Covid Vaccine Capacity
Connector, that seeks to address the tech-transfer question within the usual frame of
monopoly rights and bilateral licensing.

“The tech transfer debate is being decisively seized and shaped by those who want to set the
terms and conditions under which knowledge can be transferred,” writes Priti Patnaik in her
Geneva Health Files newsletter. A Gates-directed tech-transfer mechanism without
meaningful input from WHO members states, she writes, would be a “body blow” to C-TAPSupport our issue-driven, independent journalism and subscribe today.

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and similar future initiatives that promote open licensing and knowledge sharing to
maximize production and access.

There are signs of overdue scrutiny of Gates’s role in public health and lifelong commitment
to exclusive intellectual property rights. But so far these are blips. More common is the
deference on display in a March 21 New York Times article about the U.S. government’s role in
developing the mRNA vaccines now under the monopoly control of Moderna and Pfizer.
When the piece turned to Gates’s inevitable cameo, the Times reporter was hovering right
over the target—and somehow managed to miss wide by a mile. Instead of probing Gates’s
central role in preserving this paradigm, the paper linked to gentle boilerplate about pricing
and access found on the Gates Foundation website. In response to a request for comment, a
Gates Foundation spokesperson pointed me to a piece by its CEO, Mark Suzman, arguing that
“IP fundamentally underpins innovation, including the work that has helped create vaccines
so quickly.”

Any change in media coverage of Gates’s second career may produce a delayed echo within
the world he has come to dominate. Here Gates not only controls the narratives, he controls
most of the payroll. This may sound conspiratorial or overblown to outsiders but not to
campaigners who have witnessed Gates’s ability to shift gravity on major issues.

“If you said to an ordinary person, ‘We’re in a pandemic. Let’s figure out everyone who can
make vaccines and give them everything they need to get online as fast as possible,’ it would
be a no-brainer,” says James Love. “But Gates won’t go there. Neither will the people
dependent on his funding. He has immense power. He can get you fired from a U.N. job. He
knows that if you want to work in global public health, you’d better not make an enemy of the
Gates Foundation by questioning its positions on I.P. and monopolies. And there are a lot of
advantages to being on his team. It’s a sweet, comfortable ride for a lot of people.”

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Alexander Zaitchik is a freelance journalist. His next book, Owning the Sun: A People’s History of Monopoly
Medicine, from Aspirin to Covid-19, will be published by Counterpoint in 2022.

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Sign up for TNR’s Sold Short weekly newsletter.

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Read More: Sold Short, Covid-19, Bill Gates, Bill & Melinda Gates Foundation, World Health Organization,
World Trade Organization, Coronavirus Vaccine, Pandemic, Big Pharma, Pharmaceutical, AstraZeneca,
GlaxoSmithKline, Johnson & Johnson, P�zer, HIV, AIDS, Nelson Mandela, South Africa, Oxfam, Médecins
Sans Frontieres, The Insecurity Complex

*Among journalists echoing this argument was former New Republic editor Andrew Sullivan.
When The New York Times reported Sullivan was defending the companies’ lawsuit while
taking undisclosed funding from PhRma, the industry trade association, Sullivan remained
defiant in the face of evidence-based accusations that he was an unethical journalist. “It
behooves me to say I see absolutely no problems with [drug industry sponsorship],” he told
Salon. “In fact, I am extremely proud to get some support from a great industry.” It later turned
out that Africans adhered more closely to the twice-daily pill regimens than patient
populations in rich countries.

**In 2010, the Gates Foundation would bankroll a documentary advocating the privatization of
U.S. public education, titled Waiting for Superman.

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