Gates Gives Away His Money, Still Gets Shit On

Sandi Doughton, writing in the Seattle Times, asks Have Gates Foundation efforts to vaccinate the world against COVID-19 helped — or hindered? Let’s see how she answers her rhetorical question.

For more than two decades, ever since it set out to boost childhood vaccinations in the developing world, … the [Bill & Melinda Gates] Foundation helped bankroll a new, global entity — Gavi, The Vaccine Alliance — to broker deals with pharmaceutical companies, pool donations from wealthy countries and provide low-cost shots for the world’s poorest kids.

The tin-foil hatters will claim this is part of Bill Gates evil plan to implant mind control chips in the world’s population. In realty, Gavi has done immense good in most cases, though, like any institution, it’s not perfect.

Faced with the first pandemic of the modern era, the foundation and its partners relied on the same blueprint to create an entity called COVAX that would operate in a similar way to ensure access to COVID-19 vaccines in low- and middle-income countries. But as of mid-June, COVAX has shipped fewer than 90 million doses to countries with a collective population of about 6 billion. It’s unlikely the initiative will meet even its original, modest goal of providing 2 billion doses by the end of this year — enough to fully vaccinate just 20% of those people.

The missed target was largely due to one of the manufactures they were partnered with, the Serum Institute of India, withholding doses due to the massive outbreak of the delta strain in that country. But even the 90 million doses COVAX has delivered, assuming they were given to front line medical people, will save a lot of lives, both of the medics themselves and the patients who might otherwise have to be turned away.

Now, the Gates Foundation itself is coming in for an unprecedented level of criticism from activists who say the powerful philanthropy helped create the crisis. By staunchly supporting the patent rights of vaccine developers, Bill Gates and his team prevented more widespread production and hindered global access to the lifesaving shots, journalist Alexander Zaitchik argued.

Zaitchik is an idiot. Gates understands that if you want for profit companies to invest their time and money into creating new drugs, they have to be allowed to profit from their work. It was up to governments contributing funds to develop the vaccines to negotiate access with these companies. One can argue that Gates should have been promoting government research into vaccines, rather than corporate research. Well, it’s Bill’s money. If you want to donate to government research projects, nothing is stopping you.

Other critics give the foundation credit for devoting $1.8 billion to pandemic response and for its early investments in messenger RNA vaccines and other technologies that have proved instrumental in fighting the novel coronavirus.

Good for them, but real kudos to Gates for putting his money where his mouth was. If I gave billions to a cause for the global good, I’d expect more than ‘credit’.

But as the most powerful private player in global health, Gates and the foundation share in the responsibility for COVAX’s shortcomings and the huge gap between vaccination rates in rich and poor countries, they say.

What a load of ungrateful assholes. Gates is in no way responsible for the fact that rich countries can afford things that poor countries cannot. He is a rich man, but even he can’t afford to pay for all vaccines required by poor countries. Countries are responsible for their own citizens.

“The Gates Foundation’s footprint has been all over the COVID response with respect to access in low- and middle-income countries,” said Northeastern University law professor Brook Baker, a policy analyst for the nonprofit Health GAP, which advocates for equitable access to medicines. “And what we’ve seen, because of the intellectual property controls Bill Gates and the Gates Foundation have supported … is artificially restricted capacity and supplies, needlessly high prices and grotesquely inequitable distribution.”

You don’t have a right to freely distribute something that belongs to someone else. Lord knows that the patent system is garbage. Working to reform it would greatly benefit humanity. But, if someone develops something at their cost under the assumption that it will remain their property, advocating that it be freely distributed is wrong. You can ask them to waive their rights, by they’re under no obligation to do so. If Pfizer, Moderna, J&J or Astrozenica new that they wouldn’t be able to profit from their research, would they have undertaken it?

The outspoken critiques are unusual. Almost every organization in global development and health receives — or hopes for — funding from the Gates Foundation. Few dare voice concerns about its approach.

If you don’t want his money, feel free to criticize. If you want funding, it behooves you to work with the source of funding, not against it.

The foundation’s leading role in the pandemic response has subjected it to greater scrutiny than ever before. Bill and Melinda Gates’ impending divorce, along with revelations about Bill Gates’ infidelity and allegations of a toxic culture at the firm that manages his $130 billion fortune, have also undermined the foundation’s carefully curated image and weakened its moral credibility, said Lawrence Gostin, an expert in public health law at Georgetown University Law.

I couldn’t give a hoot about Gate’s divorce. His personal indiscretions show that he’s only human. As for a toxic culture at a financial institution, that hardly reflects on Gates. If I found out my banker was mistreating their employees, I wouldn’t feel the need to perform a mia culpa.

“Overall, I think the Gates Foundation has recently taken a significant reputational hit,” Gostin wrote in an email. But he still believes the foundation has been a positive force in the pandemic and in their broader mission to improve health and well-being around the world.

While I’m sure Gates cares about the foundation’s image, I’d bet he is much more concerned with his legacy. In the future, what will he be remembered for? For founding Microsoft, surely, but probably for the good works done by his foundation. I doubt anyone will remember that he opposed forcing companies to waive their patent rights.

Patents give companies total control over their formulas and where, how and at what prices products are produced — which pharma insists is vital to ensure profits and encourage development of new drugs. Participation in COVAX is voluntary. Companies set the terms, and details about the deals are kept secret.

While there are plenty of problems with the patent system, it is part of the system under which multiple vaccines were developed in record time. Creating drugs is expensive; without some system that compensates those who do this work, we likely wouldn’t have the vaccines to squabble over.

Citing the global emergency, in December India and South Africa called for patents to be suspended (or “waived”) to increase production and reduce prices by forcing companies to share their technology.

What right do they have to do so? A starving man doesn’t have the right to help himself to a farmer’s crop, or to ask that farmer’s lord to waive the farmer’s right to his crop.

“The market model, when it comes to medical care, drugs and vaccines, will always fail the poor,” Mukherjee said.

Wrong. The market model gave us the vaccines we have. This allowed charities like the Gates Foundation to provide some to poor countries, in turn allowing them to vaccinate their front line workers and keep their hospitals running.

Indeed, rich countries quickly snapped up the COVID-19 vaccine supply, pricing out COVAX. The Trump administration refused to provide funding, and donations from other nations were slow to trickle in. COVAX was initially able to broker only a few deals.

Countries are responsible to their own citizens. I haven’t received my second dose of vaccine yet. If I heard that I was going to have to wait longer to receive it because my government had donated the resources needed to procure it to another country, I think I’d be rightfully upset, since my government is funded by my taxes, and answers to me.

The coalition’s first focus was the Oxford-AstraZeneca vaccine, which doesn’t require extreme low temperatures. The Gates Foundation put up $300 million to jump-start production at the Serum Institute of India — the world’s largest vaccine manufacturer — with the goal of producing 200 million shots.

And thanks to this donation, vaccines were produced that would have gone to other poor countries, had they not been needed in India.

With COVAX forced to delay shipments and vaccination rates in poor countries averaging under 1%, the Biden administration did an about-face in early May and announced support for patent waivers. The Gates Foundation followed suit the next day — even though Bill Gates told an interviewer just a week earlier he didn’t think waivers would be helpful.

My suspicion is that Biden’s statement is political theater, and that nothing will actually change. The Democrats are beholden to big pharma. I wish they would reform the system, but if you change the rules mid game, don’t be surprised when the players quit.

The Gates Foundation is just one player in a complex, international web of intellectual patent law — but it wields enormous influence. Had Gates supported the idea earlier, the situation in the developing world might not be as dire today, activists argue.

Gates believes in capitalism and the current system. He made his fortune with them. Is it surprising that he doesn’t support tearing them down?

If companies knew they would be required to share their “secret recipes,” many might have entered voluntary agreements that opened up additional production, said Dr. Joia Mukherjee.

And likely, we would have fewer and less effective vaccines.

“What we need is essentially generic manufacturing of these vaccines,” Mukherjee said.

You don’t have the right to steal them. If you want the right to manufacture another person’s invention without stealing from them, you must first abolish the existing patent system.

But neither the Gates Foundation nor any major companies supported a voluntary, technology-sharing pool established by the World Health Organization. And when scientists at Oxford University announced plans to offer nonexclusive, royalty-free licenses to the vaccine they developed, Gates officials urged them to partner exclusively with a pharma company experienced in conducting clinical trials so effectiveness could be determined quickly. Oxford chose AstraZeneca.

If Oxford had not partnered with AstraZeneca, would we have their vaccine yet? I admire Oxford for wanting to offer their vaccine to the world, but I don’t blame AstraZeneca for wanting to make a return on their investment. Oxford chose to partner with them, and that certainly can’t be blamed on Gates.

Critics say the foundation’s intervention sent a clear signal to other vaccine developers who might have been willing to make their technology more widely available.

A signal of what?

“We’re fine with companies getting money when they license their technology. The problem we have is with exclusivity,” said James Love, founder and director of Knowledge Ecology International, which focuses on intellectual property and access to drugs. “If Oxford had gone nonexclusive, it would have been easier for others to do that, too.”

If you want to limit exclusivity, you need to reform patent laws or make agreements with companies in advance. For example, President Trump’s Project Warp Speed gave tax money to Pfizer, Moderna, and J&J. A condition of these grants could have been to limit their right to exclusivity.

A software billionaire whose fortune was rooted in intellectual property, Bill Gates is a firm believer that patent protections ensure innovation. Foundation officials point to the success of Gavi, which is based on voluntary licensing, in expanding childhood vaccinations and saving millions of lives.

Patents actually prevent a lot of innovation. The cost of generating a patent puts them out of range of individuals. They have largely become a tool of large corporations to prevent competition, and patent trolls to extort money. That said, moving from the current broken system to wild west free piracy would probably hurt innovation in space like the pharmaceutical industry, where massive up front investments need to be made. If companies have no way to recoup their investments, they won’t make them.

“I think there’s an assumption that we waive the (intellectual property) and suddenly vaccines are going to start flowing,” said Violaine Mitchell, a foundation staffer. “But it’s not as if we currently have a lot of vaccine manufacturing facilities sitting in mothballs.”

Canadian manufacturer Biolyse and three others were ready and willing to start making the vaccine but were unable to, so I have to call bullshit on Mitchell.

Pharma companies made similar arguments in the 1990s, when they were fighting to maintain patents on AIDS drugs that were out of reach for people in the developing world, Mukherjee pointed out. Today there’s a thriving generic industry because waivers forced the companies to share.

Today, those drugs are no longer protected by patents. Patents only give the inventor exclusive rights to their intellectual property for a limited time. Using waivers to force companies to license their products to others, like using the war measures act to force them to do the governments bidding, is a dangerous game, and likely to have unintended negative consequences.

Even though most COVID-19 vaccines were backed by massive public investments, the profits have enriched a handful of companies and individuals, said Asia Russell, executive director of Health Gap. Yet Uganda, where she lives, had received just 100,000 doses by early June for a population of more than 47 million people.

Did Uganda make massive public investments in COVID-19 vaccines? If so, why did they not make receiving more doses a condition of those investments. If not, why should they benefit from them? Since President Trump had the foresight to invest US taxpayer’s money into developing the vaccines, I have no problem with Americans getting early access to them, even though that means I’m still waiting for my second dose while my American colleges are now fully vaccinated.

[A patent waiver is] not a done deal, though. They must be negotiated through the World Trade Organization and many European nations remain opposed. Even if granted, all the waivers will do is allow individual countries to compel vaccine makers to license their technology to other companies for a fee. 

Pharmaceutical companies are powerful institutions the spend a lot of money to ensure they have political influence. Though Biden has mouthed support for waiving patents, he did the same for the 15 dollar minimum wage and for a public health option, but has failed to deliver on either promise.

The Gates Foundation and its critics agree on the need for additional vaccine manufacturing plants in the developing world, particularly Africa. Mundel said the foundation is exploring whether it might be possible to modify a plant in Senegal that produces yellow fever vaccine and expand the capacity of a South African facility under contract to perform the final step in production of the Johnson & Johnson vaccine — filling vials and packaging.

Despite being shit on for wanting to work within the existing system, they continue to do so, even though they are a non-profit institution. They may not be taking the most expedient approach to the problem, but one must admire them for their dedication to their mission.

More short-term relief will arrive as the major vaccine companies reach their peak production levels, which Mundel estimates will occur by the second quarter of 2022. Most of those companies — including Moderna and Pfizer — now have contracts to provide doses to COVAX. The Novavax vaccine, which recently reported stellar results, could also be in production soon.

So the waiver was only needed to avoid paying for the doses.

Donated shots from wealthy countries with vaccine to spare are also likely to increase. The 500 million doses pledged by President Biden will be purchased at cost from Pfizer and mostly distributed through COVAX.

I’m not a fan of governments “donating” money they’ve taken from their citizens to other countries, but in this case, there is benefit to the citizen: reduction of the opportunity for new, more dangerous strains to form in unvaccinated populations.

Now that the initial vaccination frenzy in the Western world is abating, the plight of people elsewhere is getting more attention from wealthy countries, which have stepped up financial commitments to COVAX. Not least among their worries is a selfish one: As long as the virus flourishes in any part of the globe, it creates opportunities for nastier new variants to evolve.

It’s not selfish to want your tax dollars to benefit your people. This is a win-win.

“By and large we do remain convinced that (intellectual property protection) has been a major source of innovations in public health, as well as in terms of getting people to invest at-risk,” Dr. Trevor Mundel said. “So I don’t think that position has changed at all.”

While I think the current patent system would best be scrapped entirely, I do see the need for something like it, assuming we want the free market to be able to drive innovation. With today’s technology, copying artistic and literary works has made piracy endemic and has fundamentally changed writing, film, and music. With chromatography and electron microscopes, pharmaceuticals can be reverse engineered as well. If we want people to invest in innovation, they need to find it worthwhile.

About jimbelton

I'm a software developer, and a writer of both fiction and non-fiction, and I blog about movies, books, and philosophy. My interest in religious philosophy and the search for the truth inspires much of my writing.
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