"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 the 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.
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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 vaccine candidate in the public domain, Gates intervened. As reported by Kaiser Health 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.”
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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 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.)
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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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.
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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.
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“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.”