How Bill Gates and partners used their clout to control the global Covid response
Geplaatst: 23 sep 2022 00:35
https://www.politico.com/news/2022/09/1 ... s-00053969
How Bill Gates and partners used their clout to control the global Covid response — with little oversight
Four health organizations, working closely together, spent almost $10 billion on responding to Covid across the world. But they lacked the scrutiny of governments, and fell short of their own goals, a POLITICO and WELT investigation found.
By ERIN BANCO, ASHLEIGH FURLONG and LENNART PFAHLER
09/14/2022
When Covid-19 struck, the governments of the world weren’t prepared.
From America to Europe to Asia, they veered from minimizing the threat to closing their borders in ill-fated attempts to quell a viral spread that soon enveloped the world. While the most powerful nations looked inward, four non-governmental global health organizations began making plans for a life-or-death struggle against a virus that would know no boundaries.
What followed was a steady, almost inexorable shift in power from the overwhelmed governments to a group of non-governmental organizations, according to a seven-month investigation by POLITICO journalists based in the U.S. and Europe and the German newspaper WELT. Armed with expertise, bolstered by contacts at the highest levels of Western nations and empowered by well-grooved relationships with drug makers, the four organizations took on roles often played by governments — but without the accountability of governments.
While nations were still debating the seriousness of the pandemic, the groups identified potential vaccine makers and targeted investments in the development of tests, treatments and shots. And they used their clout with the World Health Organization to help create an ambitious worldwide distribution plan for the dissemination of those Covid tools to needy nations, though it would ultimately fail to live up to its original promises.
The four organizations had worked together in the past, and three of them shared a common history. The largest and most powerful was the Bill & Melinda Gates Foundation, one of the largest philanthropies in the world. Then there was Gavi, the global vaccine organization that Gates helped to found to inoculate people in low-income nations, and the Wellcome Trust, a British research foundation with a multibillion dollar endowment that had worked with the Gates Foundation in previous years. Finally, there was the Coalition for Epidemic Preparedness Innovations, or CEPI, the international vaccine research and development group that Gates and Wellcome both helped to create in 2017.
(Left to right) Gavi CEO Seth Berkley, former German Chancellor Angela Merkel, Gates Foundation Co-founder Bill Gates, and former President Donald Trump.
KEY TAKEAWAYS
1 The four organizations have spent almost $10 billion on Covid since 2020 – the same amount as the leading U.S. agency tasked with fighting Covid abroad.
2 The organizations collectively gave $1.4 billion to the World Health Organization, where they helped create a critical initiative to distribute Covid-19 tools. That program failed to achieve its original benchmarks.
3 The organizations’ leaders had unprecedented access to the highest levels of governments, spending at least $8.3 million to lobby lawmakers and officials in the U.S. and Europe.
4 Officials from the U.S., EU and representatives from the WHO rotated through these four organizations as employees, helping them solidify their political and financial connections in Washington and Brussels.
5 The leaders of the four organizations pledged to bridge the equity gap. However, during the worst waves of the pandemic, low-income countries were left without life-saving vaccines.
6 Leaders of three of the four organizations maintained that lifting intellectual property protections was not needed to increase vaccine supplies – which activists believed would have helped save lives.
FOLLOW THE MONEY | METHODOLOGY
Civil society organizations active in poorer nations, including Doctors Without Borders, expressed discomfort with the notion that Western-dominated groups, staffed by elite teams of experts, would be helping guide life-and-death decisions affecting people in poorer nations. Those tensions only increased when the Gates Foundation opposed efforts to waive intellectual property rights, a move that critics saw as protecting the interests of pharmaceutical giants over people living poorer nations.
“What makes Bill Gates qualified to be giving advice and advising the U.S. government on where they should be putting the tremendous resources?” asked Kate Elder, senior vaccines policy adviser for the Doctors Without Borders’ Access Campaign.
Bill Gates (center), shown above with Britain's Prince Charles (right) and Canada's Prime Minister Justin Trudeau (left) in November 2021, co-founded one of the largest philanthropies in the world.
Soon, however, governments in the United States and Europe were offering their own crucial support to the four groups. The organizations spent at least $8.3 million lobbying the U.S. and E.U., according to an analysis of lobbying disclosures. When, this past spring, the leaders of CEPI sought to replenish the group’s coffers, it spent $50,000 in part to advocate for $200 million in yearly funding from the U.S. government, according to filings and interviews with Capitol Hill staff.
The overtures worked. While President Joe Biden’s efforts to obtain an additional $5 billion in funding for the administration’s international work combatting the virus were floundering in Congress, he still managed to slip $500 million for CEPI into his budget proposal — $100 million a year for five years.
The money, which has yet to be approved, would help what most global health experts agree is an important cause, not only in humanitarian terms but in helping prevent poorer nations from becoming breeding grounds for new variants. And most believe that the Gates Foundation and the other groups deserve credit not only for their work to help save lives but for being almost the only game in town with sufficient scope to fight a pandemic.
But the groups’ extensive politicking and financial might in the U.S. and Europe helped to enable them to direct the international response to the most important health event of the past century at a time when governments were caught flat-footed, according to the investigation.
Many people believe that the Gates Foundation and the other groups deserve credit not only for their work to help save lives but for being almost the only game in town with sufficient scope to fight a pandemic
The investigation, which relied on more than four dozen interviews with U.S. and European officials and global health specialists, charted the step-by-step journey through which much of the international response to the Covid pandemic passed from governments to a privately overseen global constituency of non-governmental experts. It also detailed the significant financial and political connections that enabled them to achieve such clout at the highest levels of the U.S. government, the European Commission and the WHO.
The officials who spoke to POLITICO and WELT hail from the top tiers of the governments in the U.S. and in Europe, including in the health agencies. They were granted anonymity to speak candidly about how their respective administrations approached the international response to Covid and what missteps occurred during the course of their tenure. Many of them dealt directly with representatives of the four global health agencies, some on a daily basis.
POLITICO and WELT examined meeting minutes as well as thousands of pages of financial disclosures and tax documents, which revealed that the groups have spent nearly $10 billion since 2020 — the same amount as the leading U.S. agency charged with fighting Covid abroad. It is one of the first comprehensive accountings of expenditures by global health organizations on the global fight against the pandemic.
Now, critics are raising significant questions about the equity and effectiveness of the group’s response to the pandemic — and the serious limitations of outsourcing the pandemic response to unelected, privately-funded groups.
“I think we should be deeply concerned,” said Lawrence Gostin, a Georgetown University professor who specializes in public-health law. “Putting it in a very crass way, money buys influence. And this is the worst kind of influence. Not just because it’s money — although that’s important, because money shouldn’t dictate policy — but also, because it’s preferential access, behind closed doors.”
Gostin said that such power, even if propelled by good intentions and expertise, is “anti-democratic, because it’s extraordinarily non-transparent, and opaque” and “leaves behind ordinary people, communities and civil society.”
While dozens of global health organizations participated in the world’s response to Covid, the POLITICO and WELT investigation focused on these four organizations because of their connections to one another — both Gavi and CEPI received seed funding from the Bill & Melinda Gates Foundation — and because they together played a critical role in advising governments and the WHO.
The WHO was crucial to the groups’ rise to power. All had longstanding ties to the global health body. The boards of both CEPI and Gavi have a specially designated WHO representative. There is also a revolving door between employment in the groups and work for the WHO: Former WHO employees now work at the Gates Foundation and CEPI; some, such as Chris Wolff, the deputy director of country partnerships at the Gates Foundation, occupy important positions.
Much of the groups’ clout with the WHO stems simply from money. Since the start of the pandemic in 2020, the Gates Foundation, Gavi, and the Wellcome Trust have donated collectively more than $1.4 billion to the WHO — a significantly greater amount than most other official member states, including the United States and the European Commission, according to data provided by the WHO.
“You have to remember that when you’re dealing with the Gates Foundation, it’s almost like you’re dealing with another major country in terms of their donations to these global health organizations,” a former senior U.S. health official said.
Working closely with the WHO, the four groups played a central role in creating an initiative known as the Access to Covid-19 Tools Accelerator, or ACT-A, that focused on securing and delivering tests, treatments and vaccine doses to low- and middle-income countries across the world. COVAX — a special consortium operated by Gavi, CEPI and UNICEF — is the vaccine pillar of the ACT-A initiative.
But ACT-A missed its delivery goals for 2021 on all three fronts — for testing, vaccine distribution and treatments, according to an independent review by Dalberg Global Development Advisors, a policy advisory firm based in New York.
The ACT-A diagnostics team set a target of making 500 million tests accessible to low-and middle-income countries by the middle of 2021. It procured just 84 million tests by June 2021, only 16 percent of its target, according to the report. The therapeutics team originally set a goal of delivering 245 million treatments to low- and middle-income countries by 2021 but later changed the target to 100 million new treatments by the end of 2021. As of June of that year, the therapeutics team had allocated only about 1.8 million treatments.
COVAX set the aim of delivering 2 billion vaccine doses by the end of 2021. By September of that year, it had only delivered 319 million doses.
Although COVAX significantly accelerated the delivery of doses later in 2021 and in 2022, governments have struggled to get shots into arms. As of August 2022, only about 20 percent of Africans were vaccinated — a dangerously low percentage — according to the Africa CDC.
The leaders of the groups say that they were unable to meet their goals largely because wealthy, Western governments were slow to step up and make available the huge tranches of vaccine and therapeutics that were needed to protect the world. The groups say they provided a crucial voice for the suffering and needs of poorer nations, without which the progress may have been far slower.
“Putting it in a very crass way, money buys influence. And this is the worst kind of influence. Not just because it’s money […] but also, because it’s preferential access, behind closed doors.”
Lawrence Gostin, Georgetown University professor who specializes in public-health law
“The Gates Foundation focused on supporting a global response that would ensure low- and middle-income countries had affordable, equitable access to the best data and tools available to tackle the crisis,” Mark Suzman, CEO of the Gates Foundation, said in a statement. “In some areas we saw successes. On the most critical issue of equitable vaccine access, the world as a whole failed as high-income countries initially monopolized available supply.” The foundation declined to make Gates available for comment.
On the struggle to deliver vaccine doses to low- and middle-income countries on time, Seth Berkley, the CEO of Gavi, said in an interview that the organization actually met one of its original targets of distributing 950 million doses by the end of 2021 to low-income countries, even though it failed to deliver on one of its original promises to distribute 2 billion doses. (COVAX delivered the 950 million doses by January 2022.)
“It’s very easy to sit there outside and to criticize what we’re doing. What we need to do is to be evaluated fairly based upon the actions we took at the time with the knowledge we had at the time,” Berkley said.
A spokesperson for CEPI put it this way: “While there is much that we can improve upon, it would be inaccurate to apportion all the blame for the failures of the global response to the very organizations that did more than anyone else to try and solve the problems of vaccine supply and inequity.”
”The challenge we faced was the need to bake in access to vaccines for poor countries right at the point when companies were able to sell promising product to the highest bidder,” the spokesperson said.
Jeremy Farrar, the Wellcome Trust director, struck a similar note. “Comprehensive pandemic preparedness and response requires the sort of funding and international cooperation that only governments can muster,” he said.
Farrar, however, defended the ACT-A partnership as “the best mechanism we have for delivering lifesaving Covid-19 tools across the world.”
“Before ACT-A was set up, there was no formal mechanism in place to coordinate and accelerate the development, production and equitable access to Covid-19 interventions globally,” he said. “While ACT-A may not be perfect … the global response would have been poorer and far more fragmented without it.”
The POLITICO and WELT investigation found, however, that ACT-A’s structure diminished accountability. ACT-A representatives set funding priorities and campaigned for donations. But the money — $23 billion in total — went directly to the entities involved in the initiative, such as Gavi and CEPI. Although ACT-A’s website keeps track of how much money was raised, it is nearly impossible to tell exactly where all of it went.
Based on each organization’s individual Covid database, it is not possible to delineate exactly how the groups spent the money raised through ACT-A. It is also difficult to determine in the organization’s grants and investment data how much they donated specifically for ACT-A programming. For example, the organizations do not use “ACT-A” or similar terminology in their descriptions of their grants and investments.
“In theory, I think that was a great idea,” said Gayle Smith, who led the U.S. State Department’s global Covid-19 response last year, referring to ACT-A. But she questioned its accountability.
“In practice … there was no single director,” Smith said. “Who’s the big boss of this whole enterprise? In a global emergency like this, we need to be able to get the countermeasures to everyone everywhere as quickly as possible.”
Bruce Aylward, who coordinates the work of the ACT-Accelerator at the WHO, said ACT-A was purposely set up with a decentralized structure in order to cut down on bureaucracy. He said that each agency was in charge of their own accounting and solidifying agreements directly with donors.
Smith and others closely involved in the global Covid fight say there should have been a stronger hand at the tiller.
When vaccine doses started flowing into COVAX, many poor countries and provinces were ill-equipped to handle them. And during the long delays, many potential beneficiaries lost faith in the global health system.
“I think that if we had had the vaccine earlier the coverage would have been much, much, much better,” said Stephen Bordotsiah, the municipal director of health services in the Bolgatanga region of Ghana, which received significant doses from COVAX.
While ACT-A devoted most of its time and resources to securing doses, little money went to improving health systems on the ground. Of the $23 billion that ACT-A and its receiving agencies — including Gavi and CEPI — raised, only $2.2 billion went to the strengthening of health systems, according to the WHO initiative’s own funding tracker.
Aylward blamed any of ACT-A’s deficiencies on “factors that were beyond the control of the accelerator,” he said, including a lack of government financing for distribution of Covid tools to low-income countries. “Every politician stood up there and said all the right things. They wanted to do the right things,” Aylward said. “We got to create the enabling environment to let them do that.”
Now, the four groups are spending millions of dollars to lobby the U.S. and EU to embrace their priorities for the next pandemic, some of which include strengthening local health systems. Other initiatives involve investing more money in research and development, hoping to create next-generation vaccines and expanding surveillance networks across the globe.
Meanwhile, many global health specialists question whether the groups are capable of performing the rigorous post-mortems necessary to build a stronger global response system for the future.
“No one’s actually holding these actors to account. And they’re the ones that are really shaping our ability to respond to pandemics.”
Sophie Harman, professor of international politics, Queen Mary University of London
“No one’s actually holding these actors to account,” said Sophie Harman, professor of international politics at Queen Mary University of London. “And they’re the ones that are really shaping our ability to respond to pandemics.”
Each of the four organizations said they are doing at least some internal reflection of their Covid work.
CEPI is wrapping up an assessment of its work over the past five years, including on Covid, and plans to publish it in full in September. Representatives for the Gates Foundation and Wellcome said their respective organizations have completed internal reviews, though no formal publication of those findings exist on the groups’ websites. Gavi has also commissioned an outside firm to conduct a review of COVAX and plans to publish its findings. It’s unclear when that report will be made public. The group published a general document about lessons learned from Covid on its website on Wednesday.
Representatives of ACT-A said the consortium reviewed its Covid work following the publishing of the Dalberg report in 2021. It addressed its recommendations and said how it would improve in a strategic planning document published on its website in October 2021. It is also tracking that work internally, a spokesperson for ACT-A said.
CHAPTER 1
Filling a Void
Just days before New Year’s Eve 2019, a man in France checked himself into a hospital, complaining of a fever and shortness of breath. Doctors didn’t know at the time — and wouldn’t realize until months later — that the man had likely developed one of the first cases of Covid-19.
The virus had been circulating in China in the weeks preceding the man’s hospitalization, but the Beijing government refused to share details about the newly dubbed SARS-CoV-2. It wasn’t until New Year’s Eve that the WHO was first notified about the cases of “viral pneumonia,” which was spreading at an alarming pace.
Top officials across the U.S. and Europe watched the news from afar, viewing the virus as a problem for Beijing — not the rest of the world. Top Trump administration officials, including the president, brushed off warnings. In Europe, a risk assessment from the European Center for Disease Control and Prevention on Jan. 9 stated “the likelihood of introduction to the EU is considered to be low, but cannot be excluded.”
Then, on Jan. 18, the CDC confirmed the first U.S. case of Covid.
Public health officials in the U.S. and Europe scrambled to figure out how to respond, frantically attempting to close borders and isolate people who tested positive.
The faltering response shouldn’t have been a surprise: In 2019, the Trump administration concluded an exercise in which top health officials determined the U.S. was unprepared to fight a global pandemic. Three years earlier, in 2016, the United Kingdom had carried out a simulation exercise for a hypothetical influenza pandemic, which showed that its health system would become overwhelmed in such an event.
Top officials across the U.S. and Europe viewed the virus, which originated in Wuhan, China, shown above in January 2020, as a problem for the Chinese government — not the rest of the world.
Neither the U.S. nor Europe had done much in the interim to boost their preparedness — though they were considered by the global health community as perhaps the most capable of all regions of the world to handle a pandemic. But there were other players — non-governmental organizations — who were far better prepared, having dedicated themselves to fighting Zika, Ebola and similar outbreaks that crossed national boundaries.The largest was the Bill & Melinda Gates Foundation, whose vast influence is also the connective thread between the groups.
Bill Gates and Melinda French Gates started the foundation in 2000, using money from Bill Gates’ Microsoft days to kickstart the philanthropy. In 2006, Warren Buffett, the CEO of Berkshire Hathaway, a large holding company, announced that he would donate most of his fortune to the foundation.
The foundation draws on a $70 billion endowment to grant billions of dollars every year to organizations working on some of the world’s toughest health problems. Bill Gates recently pledged that he would give virtually all of his fortune to the foundation and that the organization would increase its spending from nearly $6 billion annually to about $9 billion by 2026.
One of the largest philanthropies in the world, the Gates Foundation helped create both Gavi and CEPI and has representatives on both of their boards.
Gavi was founded in 1999 with $750 million from the Gates Foundation to strike vaccine deals with pharmaceutical companies for low-income countries. The vast majority of its financing is made up of donations from governments. The organization focuses solely on immunization and its board is made up of multiple representatives from the global south.
CEPI launched in 2017 with the financial backing from the Gates Foundation, the Wellcome Trust, Norway and India, with the mission of funding vaccine research and development. In the last five years, the organization, which is helmed by Richard Hatchett, a former Obama administration official, has become one of the world’s leading nonprofits in vaccine development, garnering donations from powerful, Western governments.
Dawn O’Connell (right), a former CEPI employee, is the leader of one of the most important branches in the Department of Health and Human Services for pandemic preparedness in the U.S.
The Wellcome Trust, which was created in the 1930s in the United Kingdom by a founder of what was one of the largest pharmaceutical companies in the world, operates with an endowment of about $38 billion, according to its website. It is one of the largest charitable foundations in the world and dedicates significant funding to biomedical research and scientific data modernization. The director of the trust, infectious disease expert Jeremy Farrar, until recently was an adviser to the British government on health emergencies.
Staff members at Wellcome, CEPI and the Gates Foundation include former U.S. and European officials — employees who now help the organizations draw on political and financial support for their missions. Former staffers of the organizations work in government, too. For example, Dawn O’Connell is the leader of one of the most important branches in the Department of Health and Human Services for pandemic preparedness in the U.S. She used to work for CEPI, helping raise funds for the organization. And Nicole Lurie, the current U.S. director of CEPI, used to work in that same position in the health department.
The global health nonprofits moved quickly in 2020 to fill the leadership void left by governments still grappling with their domestic responses, according to lobbying disclosures, meeting minutes and interviews.
Leaders of the Gates Foundation, Gavi, CEPI and Wellcome deployed their lobbying and advocacy networks and used their political connections to push U.S. and European officials to commit billions of dollars to Covid programs the organizations helped envision and lead.
The extent of their access to global decision-makers attests to their central role in helping establish the global Covid response: The groups briefed top officials in the European Commission about investments in tests, treatments, shots and the importance of sharing those products with the rest of the world. In the U.K., the organizations usually met several times a month with ministers to discuss topics such as Covid testing, clinical trials and manufacturing capacity. Some of those meetings included Prime Minister Boris Johnson. Bill Gates and Melinda French Gates — his former wife — spoke directly to then-German Chancellor Angela Merkel about the distribution of Covid vaccine, according to German government documents obtained by POLITICO and WELT.
Meanwhile, in the U.S., leaders of the organizations were also in contact with senior U.S. health officials. Emails obtained by Republicans on Capitol Hill illustrate the extent to which Farrar, the director of Wellcome, was in touch with officials in some of the highest levels of the U.S. government on a sensitive health and national security issue. The emails, released this year, show Farrar in the early weeks of the pandemic discussing the possibility of Covid having leaked from a lab in China with top U.S. health officials including Anthony Fauci and National Institutes of Health Director Francis Collins.
Top Trump officials also said they spoke often with Bill Gates and his foundation’s staff about how to fast-track the development of medical countermeasures, including vaccines, and how to distribute them to developing countries. These meetings would grow in number and intensity as the pandemic unraveled. During the Biden administration, officials met with members of the four organizations on a weekly basis, according to two current and one former senior U.S. officials. The U.S. government is also on Gavi’s board and met with the organization often to discuss internal matters.
“We relied heavily on their advice throughout the pandemic, but especially in the early days,” said a former U.S. official about the federal government’s interactions with representatives from the organizations.
But even though the foundation’s expertise was obvious — Bill Gates and Melinda French Gates had made fighting viruses a major part of their life’s work — the fact that crucial decisions were being refracted through American billionaires and the massive network they’d established raised concerns among some officials as well as grassroots activists on the outside.
“These big men of global health and how they … captured the agenda and managed to influence what people are thinking around pandemic preparedness and response – I think that’s really important [to consider],” Harman said. “[There’s] a revolving door of where these people are educated, where these people have worked, how they get the jobs that they’re in – it’s all a really close network.”
The foundation’s clout and that of its allies wasn’t merely a function of being the only game in town; it was also the product of concerted lobbying and advocacy work.
“They’re very good lobbyists. The people are very capable and passionate about their goals. They, of course, also come for funds.”
A European Union official
“They’re very good lobbyists. The people are very capable and passionate about their goals,” a European Union official said. “They, of course, also come for funds.”
Over the last two years, Gavi and CEPI have spent at least $1.3 million on lobbying aimed at obtaining U.S. and European cash to fund their own enterprises and the causes they supported, according to lobbying records. Wellcome also lobbied in Europe — spending at least $1.1 million — to gain political support for its programs.
Meanwhile, the Gates Foundation in 2019 set up a lobbying firm known as the Gates Policy Initiative, led by Rob Nabors, former White House deputy chief of staff for policy in the Obama administration. There are no lobbying disclosure forms on file for the firm.
A spokesperson for the foundation said U.S. law prohibits private foundations from engaging in lobbying and that the Gates Policy Initiative is a separate organization from the foundation that does not coordinate with it on programmatic activities. In a statement, a spokesperson for the Gates Policy Initiative said the organization is funded through a “direct gift” provided from Bill Gates and Melinda French Gates and that it has not engaged in activities that would require the filing of lobbying disclosure forms.
The Gates Foundation’s leaders were also their own best lobbyists. Multiple former Trump officials and staff on Capitol Hill said Gates and his team frequently met with lawmakers and administration officials, including Health Secretary Alex Azar, about the government’s spending priorities in fighting the pandemic. Azar could not be reached for comment.
In the EU and the U.K., from 2020 to early 2022 there were over 100 meetings related to Covid or pandemic preparedness between officials of the four organizations and senior Commission or U.K. officials, according to lobbying records. Leaders of the organizations attended some of the meetings, as did the U.K. prime minister and the head of the European Commission, Ursula von der Leyen. In Germany, CEPI and Gavi sent numerous letters to the German chancellor’s office over a two-year period in an effort to elicit more funding for their respective organizations.
European Commission President Ursula von der Leyen was one of the many leaders who attended meetings related to Covid or pandemic preparedness with officials from the four global health organizations.
All the concerted outreach paid off, both in terms of money and clout.
Since 2020, CEPI and Gavi have raised billions of dollars as a result of their lobbying. Between 2020 and 2021, the European Commission gave CEPI over $100 million, while the U.K. contributed more than $330 million, Germany paid over $430 million and the U.S. gave $8 million. In the case of Gavi, for the period of 2021 to 2025, the U.S. has pledged over $4.8 billion, the U.K. has allocated over $2.6 billion, Germany has promised over $2 billion and the European Commission over $1 billion.
Making plans
From the very first weeks of the Covid crisis, the organizations served as coordinators for the global health community. They convened meetings with key health organizations and made calls to researchers and officials across the globe. They also reached out to pharmaceutical companies to gauge their willingness and ability to quickly scale the production of medical countermeasures should it be required. Bill Gates gave television interviews in the early months of the pandemic, taking on the posture of a world leader.
On its website, the Gates Foundation says it believes working with governments is an “effective tool” but that “philanthropy doesn’t — and shouldn’t — take the place of government.”
But throughout the first three months of the pandemic, the four organizations jumped ahead of the governments in charting the global nature of the response. They identified companies to work with to develop medical countermeasures. The Gates Foundation and Wellcome began to invest and announce grants to companies working to produce tests and treatments for Covid, according to the POLITICO and WELT financial analysis.
A spokesperson for the foundation said one of the advantages of its grants was the ability to “deliver fast and flexible funding” and to “fill resource gaps,” adding that before the Covid pandemic was even declared, the organization had granted $10 million to the global response.
By the end of January, CEPI had already decided to invest $5 million in four vaccine development projects, according to its board minutes. The Gates Foundation would go on to invest in vaccine development as well by extending grants to, for example, the University of Washington and NYU, and to Oxford University.
Meanwhile, in the recesses of the Trump administration’s health agencies, officials in January 2020 began discussing vaccine development with pharmaceutical companies, but contracts with those entities would not finalize until months later. It would take until April to fully develop Operation Warp Speed —the team that worked in coordination with the Department of Health and Human Services to fast-track the development of the vaccine and to scale its production. In the meantime, the U.S. focused primarily on responding to Covid domestically, dedicating limited resources to fighting the virus abroad.
By contrast, the leaders of the organizations began to develop systems for distributing those tools abroad, particularly to low- and middle-income countries.
“In previous global health crises, the U.S. government really had played that lead role of helping organize the world around getting vaccines and drugs, and other countermeasures to where they’re most needed. But the U.S. under the Trump administration wasn’t playing that role,” said Tom Bollyky, director of the global health program at the Council on Foreign Relations and an adviser to CEPI. “It really was left to organizations like the Bill and Melinda Gates Foundation, Gavi and others, to try to help marshal governments around a plan.”
Former Trump officials said Gates and his team frequently met with people in the administration, including Health Secretary Alex Azar (right), about the government’s spending priorities in fighting the pandemic.
Paul Mango, former deputy chief of staff for policy at the health department under Trump, confirmed that the U.S. did not start developing a plan for international vaccine distribution until July of 2020 —more than five months after the virus first emerged. But, he said, the U.S. began working as early as February of 2020 to identify potential vaccine candidates, though the administration did not finalize its financial investments in those companies until months later.
“We had to evaluate a number of different characteristics of the company and the vaccine before we invested,” he said in an interview. “We wanted to see if phase one and two of the clinical trials revealed good data. That took a couple of months.”
A seat at the table
Beyond beginning to grant millions of dollars, CEPI and the other organizations set up international consortiums to shapeshift the world’s initial response to the pandemic through the WHO.
While governments are responsible for developing their own domestic responses to infectious disease outbreaks, the WHO acts as a conduit for member states — composed of 194 countries — to receive guidance as well as financial help in investigating, containing and fighting viruses like Covid. The WHO receives billions of dollars annually, operates out of 150 country offices across the globe and employs thousands to work on health issues from child mortality to HIV to nutrition.
Member states vote on policy provisions at the yearly World Health Assembly in Geneva. The Gates Foundation and the other three organizations do not have voting power, but their donations give them an important seat at the table. Wellcome, the Gates Foundation and Gavi have collectively donated $1.4 billion to the WHO since 2020 and about $170 million specifically for Covid-related programs since 2020, according to WHO data.
On a policy level, their clout is even more visible. Until October of last year, Farrar, the CEO of Wellcome, led one of the WHO’s scientific advisory groups that explored research and development priorities on Covid.
“They have very, very powerful influence within multilateral organizations — equal to or above governments,” said another former senior U.S. health official. “When you’re talking about … combined … over a billion dollars, that carries with it a lot of hope and sway.”
Wellcome, the Gates Foundation and Gavi have collectively donated $1.4 billion to the WHO since 2020. |
At the end of January, 2020, representatives from the Gates Foundation and Wellcome were a regular presence at meetings with the WHO and top officials from the U.S. about the virus’ spread, Covid sample sharing and vaccine and drug clinical trials, according to meeting minutes. They even helped organize and fund the first truly international meeting at the WHO to lay the groundwork for the world’s response to the virus.
Wellcome, in collaboration with the Gates Foundation, offered the WHO funding to host a research meeting in Geneva to connect top health officials from governments across the world with researchers, scientists and other major global organizations, according to WHO meeting minutes. The goal of the meeting: begin a worldwide conversation about how to begin to study and invest in Covid tests, therapeutics and vaccines.
David Vaughn, deputy director of vaccine development at the Gates Foundation, and Josie Golding, the lead of Wellcome’s epidemic responses, hosted a preparatory meeting Feb. 4, 2020, with U.S. officials and members of the WHO Scientific Advisory Group, according to another set of WHO meeting minutes. In the meeting, the organizations’ representatives suggested that potential funders come together to discuss the WHO’s research and development blueprint — a framework for how the international community could respond to the virus.
By the end of the global conference in the second week of February, attendees had agreed on a comprehensive road map for the world’s response to Covid, including how funders would support vaccine, drug and test development. WHO officials called for $675 million to respond to Covid.
The Gates Foundation announced that it would dedicate $100 million to the effort. At a CEPI board meeting, Hatchett said the organization had signed four agreements for Covid vaccine development and that the organization was working closely with the WHO, dispatching two staff members to work on vaccine development.
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How Bill Gates and partners used their clout to control the global Covid response — with little oversight
Four health organizations, working closely together, spent almost $10 billion on responding to Covid across the world. But they lacked the scrutiny of governments, and fell short of their own goals, a POLITICO and WELT investigation found.
By ERIN BANCO, ASHLEIGH FURLONG and LENNART PFAHLER
09/14/2022
When Covid-19 struck, the governments of the world weren’t prepared.
From America to Europe to Asia, they veered from minimizing the threat to closing their borders in ill-fated attempts to quell a viral spread that soon enveloped the world. While the most powerful nations looked inward, four non-governmental global health organizations began making plans for a life-or-death struggle against a virus that would know no boundaries.
What followed was a steady, almost inexorable shift in power from the overwhelmed governments to a group of non-governmental organizations, according to a seven-month investigation by POLITICO journalists based in the U.S. and Europe and the German newspaper WELT. Armed with expertise, bolstered by contacts at the highest levels of Western nations and empowered by well-grooved relationships with drug makers, the four organizations took on roles often played by governments — but without the accountability of governments.
While nations were still debating the seriousness of the pandemic, the groups identified potential vaccine makers and targeted investments in the development of tests, treatments and shots. And they used their clout with the World Health Organization to help create an ambitious worldwide distribution plan for the dissemination of those Covid tools to needy nations, though it would ultimately fail to live up to its original promises.
The four organizations had worked together in the past, and three of them shared a common history. The largest and most powerful was the Bill & Melinda Gates Foundation, one of the largest philanthropies in the world. Then there was Gavi, the global vaccine organization that Gates helped to found to inoculate people in low-income nations, and the Wellcome Trust, a British research foundation with a multibillion dollar endowment that had worked with the Gates Foundation in previous years. Finally, there was the Coalition for Epidemic Preparedness Innovations, or CEPI, the international vaccine research and development group that Gates and Wellcome both helped to create in 2017.
(Left to right) Gavi CEO Seth Berkley, former German Chancellor Angela Merkel, Gates Foundation Co-founder Bill Gates, and former President Donald Trump.
KEY TAKEAWAYS
1 The four organizations have spent almost $10 billion on Covid since 2020 – the same amount as the leading U.S. agency tasked with fighting Covid abroad.
2 The organizations collectively gave $1.4 billion to the World Health Organization, where they helped create a critical initiative to distribute Covid-19 tools. That program failed to achieve its original benchmarks.
3 The organizations’ leaders had unprecedented access to the highest levels of governments, spending at least $8.3 million to lobby lawmakers and officials in the U.S. and Europe.
4 Officials from the U.S., EU and representatives from the WHO rotated through these four organizations as employees, helping them solidify their political and financial connections in Washington and Brussels.
5 The leaders of the four organizations pledged to bridge the equity gap. However, during the worst waves of the pandemic, low-income countries were left without life-saving vaccines.
6 Leaders of three of the four organizations maintained that lifting intellectual property protections was not needed to increase vaccine supplies – which activists believed would have helped save lives.
FOLLOW THE MONEY | METHODOLOGY
Civil society organizations active in poorer nations, including Doctors Without Borders, expressed discomfort with the notion that Western-dominated groups, staffed by elite teams of experts, would be helping guide life-and-death decisions affecting people in poorer nations. Those tensions only increased when the Gates Foundation opposed efforts to waive intellectual property rights, a move that critics saw as protecting the interests of pharmaceutical giants over people living poorer nations.
“What makes Bill Gates qualified to be giving advice and advising the U.S. government on where they should be putting the tremendous resources?” asked Kate Elder, senior vaccines policy adviser for the Doctors Without Borders’ Access Campaign.
Bill Gates (center), shown above with Britain's Prince Charles (right) and Canada's Prime Minister Justin Trudeau (left) in November 2021, co-founded one of the largest philanthropies in the world.
Soon, however, governments in the United States and Europe were offering their own crucial support to the four groups. The organizations spent at least $8.3 million lobbying the U.S. and E.U., according to an analysis of lobbying disclosures. When, this past spring, the leaders of CEPI sought to replenish the group’s coffers, it spent $50,000 in part to advocate for $200 million in yearly funding from the U.S. government, according to filings and interviews with Capitol Hill staff.
The overtures worked. While President Joe Biden’s efforts to obtain an additional $5 billion in funding for the administration’s international work combatting the virus were floundering in Congress, he still managed to slip $500 million for CEPI into his budget proposal — $100 million a year for five years.
The money, which has yet to be approved, would help what most global health experts agree is an important cause, not only in humanitarian terms but in helping prevent poorer nations from becoming breeding grounds for new variants. And most believe that the Gates Foundation and the other groups deserve credit not only for their work to help save lives but for being almost the only game in town with sufficient scope to fight a pandemic.
But the groups’ extensive politicking and financial might in the U.S. and Europe helped to enable them to direct the international response to the most important health event of the past century at a time when governments were caught flat-footed, according to the investigation.
Many people believe that the Gates Foundation and the other groups deserve credit not only for their work to help save lives but for being almost the only game in town with sufficient scope to fight a pandemic
The investigation, which relied on more than four dozen interviews with U.S. and European officials and global health specialists, charted the step-by-step journey through which much of the international response to the Covid pandemic passed from governments to a privately overseen global constituency of non-governmental experts. It also detailed the significant financial and political connections that enabled them to achieve such clout at the highest levels of the U.S. government, the European Commission and the WHO.
The officials who spoke to POLITICO and WELT hail from the top tiers of the governments in the U.S. and in Europe, including in the health agencies. They were granted anonymity to speak candidly about how their respective administrations approached the international response to Covid and what missteps occurred during the course of their tenure. Many of them dealt directly with representatives of the four global health agencies, some on a daily basis.
POLITICO and WELT examined meeting minutes as well as thousands of pages of financial disclosures and tax documents, which revealed that the groups have spent nearly $10 billion since 2020 — the same amount as the leading U.S. agency charged with fighting Covid abroad. It is one of the first comprehensive accountings of expenditures by global health organizations on the global fight against the pandemic.
Now, critics are raising significant questions about the equity and effectiveness of the group’s response to the pandemic — and the serious limitations of outsourcing the pandemic response to unelected, privately-funded groups.
“I think we should be deeply concerned,” said Lawrence Gostin, a Georgetown University professor who specializes in public-health law. “Putting it in a very crass way, money buys influence. And this is the worst kind of influence. Not just because it’s money — although that’s important, because money shouldn’t dictate policy — but also, because it’s preferential access, behind closed doors.”
Gostin said that such power, even if propelled by good intentions and expertise, is “anti-democratic, because it’s extraordinarily non-transparent, and opaque” and “leaves behind ordinary people, communities and civil society.”
While dozens of global health organizations participated in the world’s response to Covid, the POLITICO and WELT investigation focused on these four organizations because of their connections to one another — both Gavi and CEPI received seed funding from the Bill & Melinda Gates Foundation — and because they together played a critical role in advising governments and the WHO.
The WHO was crucial to the groups’ rise to power. All had longstanding ties to the global health body. The boards of both CEPI and Gavi have a specially designated WHO representative. There is also a revolving door between employment in the groups and work for the WHO: Former WHO employees now work at the Gates Foundation and CEPI; some, such as Chris Wolff, the deputy director of country partnerships at the Gates Foundation, occupy important positions.
Much of the groups’ clout with the WHO stems simply from money. Since the start of the pandemic in 2020, the Gates Foundation, Gavi, and the Wellcome Trust have donated collectively more than $1.4 billion to the WHO — a significantly greater amount than most other official member states, including the United States and the European Commission, according to data provided by the WHO.
“You have to remember that when you’re dealing with the Gates Foundation, it’s almost like you’re dealing with another major country in terms of their donations to these global health organizations,” a former senior U.S. health official said.
Working closely with the WHO, the four groups played a central role in creating an initiative known as the Access to Covid-19 Tools Accelerator, or ACT-A, that focused on securing and delivering tests, treatments and vaccine doses to low- and middle-income countries across the world. COVAX — a special consortium operated by Gavi, CEPI and UNICEF — is the vaccine pillar of the ACT-A initiative.
But ACT-A missed its delivery goals for 2021 on all three fronts — for testing, vaccine distribution and treatments, according to an independent review by Dalberg Global Development Advisors, a policy advisory firm based in New York.
The ACT-A diagnostics team set a target of making 500 million tests accessible to low-and middle-income countries by the middle of 2021. It procured just 84 million tests by June 2021, only 16 percent of its target, according to the report. The therapeutics team originally set a goal of delivering 245 million treatments to low- and middle-income countries by 2021 but later changed the target to 100 million new treatments by the end of 2021. As of June of that year, the therapeutics team had allocated only about 1.8 million treatments.
COVAX set the aim of delivering 2 billion vaccine doses by the end of 2021. By September of that year, it had only delivered 319 million doses.
Although COVAX significantly accelerated the delivery of doses later in 2021 and in 2022, governments have struggled to get shots into arms. As of August 2022, only about 20 percent of Africans were vaccinated — a dangerously low percentage — according to the Africa CDC.
The leaders of the groups say that they were unable to meet their goals largely because wealthy, Western governments were slow to step up and make available the huge tranches of vaccine and therapeutics that were needed to protect the world. The groups say they provided a crucial voice for the suffering and needs of poorer nations, without which the progress may have been far slower.
“Putting it in a very crass way, money buys influence. And this is the worst kind of influence. Not just because it’s money […] but also, because it’s preferential access, behind closed doors.”
Lawrence Gostin, Georgetown University professor who specializes in public-health law
“The Gates Foundation focused on supporting a global response that would ensure low- and middle-income countries had affordable, equitable access to the best data and tools available to tackle the crisis,” Mark Suzman, CEO of the Gates Foundation, said in a statement. “In some areas we saw successes. On the most critical issue of equitable vaccine access, the world as a whole failed as high-income countries initially monopolized available supply.” The foundation declined to make Gates available for comment.
On the struggle to deliver vaccine doses to low- and middle-income countries on time, Seth Berkley, the CEO of Gavi, said in an interview that the organization actually met one of its original targets of distributing 950 million doses by the end of 2021 to low-income countries, even though it failed to deliver on one of its original promises to distribute 2 billion doses. (COVAX delivered the 950 million doses by January 2022.)
“It’s very easy to sit there outside and to criticize what we’re doing. What we need to do is to be evaluated fairly based upon the actions we took at the time with the knowledge we had at the time,” Berkley said.
A spokesperson for CEPI put it this way: “While there is much that we can improve upon, it would be inaccurate to apportion all the blame for the failures of the global response to the very organizations that did more than anyone else to try and solve the problems of vaccine supply and inequity.”
”The challenge we faced was the need to bake in access to vaccines for poor countries right at the point when companies were able to sell promising product to the highest bidder,” the spokesperson said.
Jeremy Farrar, the Wellcome Trust director, struck a similar note. “Comprehensive pandemic preparedness and response requires the sort of funding and international cooperation that only governments can muster,” he said.
Farrar, however, defended the ACT-A partnership as “the best mechanism we have for delivering lifesaving Covid-19 tools across the world.”
“Before ACT-A was set up, there was no formal mechanism in place to coordinate and accelerate the development, production and equitable access to Covid-19 interventions globally,” he said. “While ACT-A may not be perfect … the global response would have been poorer and far more fragmented without it.”
The POLITICO and WELT investigation found, however, that ACT-A’s structure diminished accountability. ACT-A representatives set funding priorities and campaigned for donations. But the money — $23 billion in total — went directly to the entities involved in the initiative, such as Gavi and CEPI. Although ACT-A’s website keeps track of how much money was raised, it is nearly impossible to tell exactly where all of it went.
Based on each organization’s individual Covid database, it is not possible to delineate exactly how the groups spent the money raised through ACT-A. It is also difficult to determine in the organization’s grants and investment data how much they donated specifically for ACT-A programming. For example, the organizations do not use “ACT-A” or similar terminology in their descriptions of their grants and investments.
“In theory, I think that was a great idea,” said Gayle Smith, who led the U.S. State Department’s global Covid-19 response last year, referring to ACT-A. But she questioned its accountability.
“In practice … there was no single director,” Smith said. “Who’s the big boss of this whole enterprise? In a global emergency like this, we need to be able to get the countermeasures to everyone everywhere as quickly as possible.”
Bruce Aylward, who coordinates the work of the ACT-Accelerator at the WHO, said ACT-A was purposely set up with a decentralized structure in order to cut down on bureaucracy. He said that each agency was in charge of their own accounting and solidifying agreements directly with donors.
Smith and others closely involved in the global Covid fight say there should have been a stronger hand at the tiller.
When vaccine doses started flowing into COVAX, many poor countries and provinces were ill-equipped to handle them. And during the long delays, many potential beneficiaries lost faith in the global health system.
“I think that if we had had the vaccine earlier the coverage would have been much, much, much better,” said Stephen Bordotsiah, the municipal director of health services in the Bolgatanga region of Ghana, which received significant doses from COVAX.
While ACT-A devoted most of its time and resources to securing doses, little money went to improving health systems on the ground. Of the $23 billion that ACT-A and its receiving agencies — including Gavi and CEPI — raised, only $2.2 billion went to the strengthening of health systems, according to the WHO initiative’s own funding tracker.
Aylward blamed any of ACT-A’s deficiencies on “factors that were beyond the control of the accelerator,” he said, including a lack of government financing for distribution of Covid tools to low-income countries. “Every politician stood up there and said all the right things. They wanted to do the right things,” Aylward said. “We got to create the enabling environment to let them do that.”
Now, the four groups are spending millions of dollars to lobby the U.S. and EU to embrace their priorities for the next pandemic, some of which include strengthening local health systems. Other initiatives involve investing more money in research and development, hoping to create next-generation vaccines and expanding surveillance networks across the globe.
Meanwhile, many global health specialists question whether the groups are capable of performing the rigorous post-mortems necessary to build a stronger global response system for the future.
“No one’s actually holding these actors to account. And they’re the ones that are really shaping our ability to respond to pandemics.”
Sophie Harman, professor of international politics, Queen Mary University of London
“No one’s actually holding these actors to account,” said Sophie Harman, professor of international politics at Queen Mary University of London. “And they’re the ones that are really shaping our ability to respond to pandemics.”
Each of the four organizations said they are doing at least some internal reflection of their Covid work.
CEPI is wrapping up an assessment of its work over the past five years, including on Covid, and plans to publish it in full in September. Representatives for the Gates Foundation and Wellcome said their respective organizations have completed internal reviews, though no formal publication of those findings exist on the groups’ websites. Gavi has also commissioned an outside firm to conduct a review of COVAX and plans to publish its findings. It’s unclear when that report will be made public. The group published a general document about lessons learned from Covid on its website on Wednesday.
Representatives of ACT-A said the consortium reviewed its Covid work following the publishing of the Dalberg report in 2021. It addressed its recommendations and said how it would improve in a strategic planning document published on its website in October 2021. It is also tracking that work internally, a spokesperson for ACT-A said.
CHAPTER 1
Filling a Void
Just days before New Year’s Eve 2019, a man in France checked himself into a hospital, complaining of a fever and shortness of breath. Doctors didn’t know at the time — and wouldn’t realize until months later — that the man had likely developed one of the first cases of Covid-19.
The virus had been circulating in China in the weeks preceding the man’s hospitalization, but the Beijing government refused to share details about the newly dubbed SARS-CoV-2. It wasn’t until New Year’s Eve that the WHO was first notified about the cases of “viral pneumonia,” which was spreading at an alarming pace.
Top officials across the U.S. and Europe watched the news from afar, viewing the virus as a problem for Beijing — not the rest of the world. Top Trump administration officials, including the president, brushed off warnings. In Europe, a risk assessment from the European Center for Disease Control and Prevention on Jan. 9 stated “the likelihood of introduction to the EU is considered to be low, but cannot be excluded.”
Then, on Jan. 18, the CDC confirmed the first U.S. case of Covid.
Public health officials in the U.S. and Europe scrambled to figure out how to respond, frantically attempting to close borders and isolate people who tested positive.
The faltering response shouldn’t have been a surprise: In 2019, the Trump administration concluded an exercise in which top health officials determined the U.S. was unprepared to fight a global pandemic. Three years earlier, in 2016, the United Kingdom had carried out a simulation exercise for a hypothetical influenza pandemic, which showed that its health system would become overwhelmed in such an event.
Top officials across the U.S. and Europe viewed the virus, which originated in Wuhan, China, shown above in January 2020, as a problem for the Chinese government — not the rest of the world.
Neither the U.S. nor Europe had done much in the interim to boost their preparedness — though they were considered by the global health community as perhaps the most capable of all regions of the world to handle a pandemic. But there were other players — non-governmental organizations — who were far better prepared, having dedicated themselves to fighting Zika, Ebola and similar outbreaks that crossed national boundaries.The largest was the Bill & Melinda Gates Foundation, whose vast influence is also the connective thread between the groups.
Bill Gates and Melinda French Gates started the foundation in 2000, using money from Bill Gates’ Microsoft days to kickstart the philanthropy. In 2006, Warren Buffett, the CEO of Berkshire Hathaway, a large holding company, announced that he would donate most of his fortune to the foundation.
The foundation draws on a $70 billion endowment to grant billions of dollars every year to organizations working on some of the world’s toughest health problems. Bill Gates recently pledged that he would give virtually all of his fortune to the foundation and that the organization would increase its spending from nearly $6 billion annually to about $9 billion by 2026.
One of the largest philanthropies in the world, the Gates Foundation helped create both Gavi and CEPI and has representatives on both of their boards.
Gavi was founded in 1999 with $750 million from the Gates Foundation to strike vaccine deals with pharmaceutical companies for low-income countries. The vast majority of its financing is made up of donations from governments. The organization focuses solely on immunization and its board is made up of multiple representatives from the global south.
CEPI launched in 2017 with the financial backing from the Gates Foundation, the Wellcome Trust, Norway and India, with the mission of funding vaccine research and development. In the last five years, the organization, which is helmed by Richard Hatchett, a former Obama administration official, has become one of the world’s leading nonprofits in vaccine development, garnering donations from powerful, Western governments.
Dawn O’Connell (right), a former CEPI employee, is the leader of one of the most important branches in the Department of Health and Human Services for pandemic preparedness in the U.S.
The Wellcome Trust, which was created in the 1930s in the United Kingdom by a founder of what was one of the largest pharmaceutical companies in the world, operates with an endowment of about $38 billion, according to its website. It is one of the largest charitable foundations in the world and dedicates significant funding to biomedical research and scientific data modernization. The director of the trust, infectious disease expert Jeremy Farrar, until recently was an adviser to the British government on health emergencies.
Staff members at Wellcome, CEPI and the Gates Foundation include former U.S. and European officials — employees who now help the organizations draw on political and financial support for their missions. Former staffers of the organizations work in government, too. For example, Dawn O’Connell is the leader of one of the most important branches in the Department of Health and Human Services for pandemic preparedness in the U.S. She used to work for CEPI, helping raise funds for the organization. And Nicole Lurie, the current U.S. director of CEPI, used to work in that same position in the health department.
The global health nonprofits moved quickly in 2020 to fill the leadership void left by governments still grappling with their domestic responses, according to lobbying disclosures, meeting minutes and interviews.
Leaders of the Gates Foundation, Gavi, CEPI and Wellcome deployed their lobbying and advocacy networks and used their political connections to push U.S. and European officials to commit billions of dollars to Covid programs the organizations helped envision and lead.
The extent of their access to global decision-makers attests to their central role in helping establish the global Covid response: The groups briefed top officials in the European Commission about investments in tests, treatments, shots and the importance of sharing those products with the rest of the world. In the U.K., the organizations usually met several times a month with ministers to discuss topics such as Covid testing, clinical trials and manufacturing capacity. Some of those meetings included Prime Minister Boris Johnson. Bill Gates and Melinda French Gates — his former wife — spoke directly to then-German Chancellor Angela Merkel about the distribution of Covid vaccine, according to German government documents obtained by POLITICO and WELT.
Meanwhile, in the U.S., leaders of the organizations were also in contact with senior U.S. health officials. Emails obtained by Republicans on Capitol Hill illustrate the extent to which Farrar, the director of Wellcome, was in touch with officials in some of the highest levels of the U.S. government on a sensitive health and national security issue. The emails, released this year, show Farrar in the early weeks of the pandemic discussing the possibility of Covid having leaked from a lab in China with top U.S. health officials including Anthony Fauci and National Institutes of Health Director Francis Collins.
Top Trump officials also said they spoke often with Bill Gates and his foundation’s staff about how to fast-track the development of medical countermeasures, including vaccines, and how to distribute them to developing countries. These meetings would grow in number and intensity as the pandemic unraveled. During the Biden administration, officials met with members of the four organizations on a weekly basis, according to two current and one former senior U.S. officials. The U.S. government is also on Gavi’s board and met with the organization often to discuss internal matters.
“We relied heavily on their advice throughout the pandemic, but especially in the early days,” said a former U.S. official about the federal government’s interactions with representatives from the organizations.
But even though the foundation’s expertise was obvious — Bill Gates and Melinda French Gates had made fighting viruses a major part of their life’s work — the fact that crucial decisions were being refracted through American billionaires and the massive network they’d established raised concerns among some officials as well as grassroots activists on the outside.
“These big men of global health and how they … captured the agenda and managed to influence what people are thinking around pandemic preparedness and response – I think that’s really important [to consider],” Harman said. “[There’s] a revolving door of where these people are educated, where these people have worked, how they get the jobs that they’re in – it’s all a really close network.”
The foundation’s clout and that of its allies wasn’t merely a function of being the only game in town; it was also the product of concerted lobbying and advocacy work.
“They’re very good lobbyists. The people are very capable and passionate about their goals. They, of course, also come for funds.”
A European Union official
“They’re very good lobbyists. The people are very capable and passionate about their goals,” a European Union official said. “They, of course, also come for funds.”
Over the last two years, Gavi and CEPI have spent at least $1.3 million on lobbying aimed at obtaining U.S. and European cash to fund their own enterprises and the causes they supported, according to lobbying records. Wellcome also lobbied in Europe — spending at least $1.1 million — to gain political support for its programs.
Meanwhile, the Gates Foundation in 2019 set up a lobbying firm known as the Gates Policy Initiative, led by Rob Nabors, former White House deputy chief of staff for policy in the Obama administration. There are no lobbying disclosure forms on file for the firm.
A spokesperson for the foundation said U.S. law prohibits private foundations from engaging in lobbying and that the Gates Policy Initiative is a separate organization from the foundation that does not coordinate with it on programmatic activities. In a statement, a spokesperson for the Gates Policy Initiative said the organization is funded through a “direct gift” provided from Bill Gates and Melinda French Gates and that it has not engaged in activities that would require the filing of lobbying disclosure forms.
The Gates Foundation’s leaders were also their own best lobbyists. Multiple former Trump officials and staff on Capitol Hill said Gates and his team frequently met with lawmakers and administration officials, including Health Secretary Alex Azar, about the government’s spending priorities in fighting the pandemic. Azar could not be reached for comment.
In the EU and the U.K., from 2020 to early 2022 there were over 100 meetings related to Covid or pandemic preparedness between officials of the four organizations and senior Commission or U.K. officials, according to lobbying records. Leaders of the organizations attended some of the meetings, as did the U.K. prime minister and the head of the European Commission, Ursula von der Leyen. In Germany, CEPI and Gavi sent numerous letters to the German chancellor’s office over a two-year period in an effort to elicit more funding for their respective organizations.
European Commission President Ursula von der Leyen was one of the many leaders who attended meetings related to Covid or pandemic preparedness with officials from the four global health organizations.
All the concerted outreach paid off, both in terms of money and clout.
Since 2020, CEPI and Gavi have raised billions of dollars as a result of their lobbying. Between 2020 and 2021, the European Commission gave CEPI over $100 million, while the U.K. contributed more than $330 million, Germany paid over $430 million and the U.S. gave $8 million. In the case of Gavi, for the period of 2021 to 2025, the U.S. has pledged over $4.8 billion, the U.K. has allocated over $2.6 billion, Germany has promised over $2 billion and the European Commission over $1 billion.
Making plans
From the very first weeks of the Covid crisis, the organizations served as coordinators for the global health community. They convened meetings with key health organizations and made calls to researchers and officials across the globe. They also reached out to pharmaceutical companies to gauge their willingness and ability to quickly scale the production of medical countermeasures should it be required. Bill Gates gave television interviews in the early months of the pandemic, taking on the posture of a world leader.
On its website, the Gates Foundation says it believes working with governments is an “effective tool” but that “philanthropy doesn’t — and shouldn’t — take the place of government.”
But throughout the first three months of the pandemic, the four organizations jumped ahead of the governments in charting the global nature of the response. They identified companies to work with to develop medical countermeasures. The Gates Foundation and Wellcome began to invest and announce grants to companies working to produce tests and treatments for Covid, according to the POLITICO and WELT financial analysis.
A spokesperson for the foundation said one of the advantages of its grants was the ability to “deliver fast and flexible funding” and to “fill resource gaps,” adding that before the Covid pandemic was even declared, the organization had granted $10 million to the global response.
By the end of January, CEPI had already decided to invest $5 million in four vaccine development projects, according to its board minutes. The Gates Foundation would go on to invest in vaccine development as well by extending grants to, for example, the University of Washington and NYU, and to Oxford University.
Meanwhile, in the recesses of the Trump administration’s health agencies, officials in January 2020 began discussing vaccine development with pharmaceutical companies, but contracts with those entities would not finalize until months later. It would take until April to fully develop Operation Warp Speed —the team that worked in coordination with the Department of Health and Human Services to fast-track the development of the vaccine and to scale its production. In the meantime, the U.S. focused primarily on responding to Covid domestically, dedicating limited resources to fighting the virus abroad.
By contrast, the leaders of the organizations began to develop systems for distributing those tools abroad, particularly to low- and middle-income countries.
“In previous global health crises, the U.S. government really had played that lead role of helping organize the world around getting vaccines and drugs, and other countermeasures to where they’re most needed. But the U.S. under the Trump administration wasn’t playing that role,” said Tom Bollyky, director of the global health program at the Council on Foreign Relations and an adviser to CEPI. “It really was left to organizations like the Bill and Melinda Gates Foundation, Gavi and others, to try to help marshal governments around a plan.”
Former Trump officials said Gates and his team frequently met with people in the administration, including Health Secretary Alex Azar (right), about the government’s spending priorities in fighting the pandemic.
Paul Mango, former deputy chief of staff for policy at the health department under Trump, confirmed that the U.S. did not start developing a plan for international vaccine distribution until July of 2020 —more than five months after the virus first emerged. But, he said, the U.S. began working as early as February of 2020 to identify potential vaccine candidates, though the administration did not finalize its financial investments in those companies until months later.
“We had to evaluate a number of different characteristics of the company and the vaccine before we invested,” he said in an interview. “We wanted to see if phase one and two of the clinical trials revealed good data. That took a couple of months.”
A seat at the table
Beyond beginning to grant millions of dollars, CEPI and the other organizations set up international consortiums to shapeshift the world’s initial response to the pandemic through the WHO.
While governments are responsible for developing their own domestic responses to infectious disease outbreaks, the WHO acts as a conduit for member states — composed of 194 countries — to receive guidance as well as financial help in investigating, containing and fighting viruses like Covid. The WHO receives billions of dollars annually, operates out of 150 country offices across the globe and employs thousands to work on health issues from child mortality to HIV to nutrition.
Member states vote on policy provisions at the yearly World Health Assembly in Geneva. The Gates Foundation and the other three organizations do not have voting power, but their donations give them an important seat at the table. Wellcome, the Gates Foundation and Gavi have collectively donated $1.4 billion to the WHO since 2020 and about $170 million specifically for Covid-related programs since 2020, according to WHO data.
On a policy level, their clout is even more visible. Until October of last year, Farrar, the CEO of Wellcome, led one of the WHO’s scientific advisory groups that explored research and development priorities on Covid.
“They have very, very powerful influence within multilateral organizations — equal to or above governments,” said another former senior U.S. health official. “When you’re talking about … combined … over a billion dollars, that carries with it a lot of hope and sway.”
Wellcome, the Gates Foundation and Gavi have collectively donated $1.4 billion to the WHO since 2020. |
At the end of January, 2020, representatives from the Gates Foundation and Wellcome were a regular presence at meetings with the WHO and top officials from the U.S. about the virus’ spread, Covid sample sharing and vaccine and drug clinical trials, according to meeting minutes. They even helped organize and fund the first truly international meeting at the WHO to lay the groundwork for the world’s response to the virus.
Wellcome, in collaboration with the Gates Foundation, offered the WHO funding to host a research meeting in Geneva to connect top health officials from governments across the world with researchers, scientists and other major global organizations, according to WHO meeting minutes. The goal of the meeting: begin a worldwide conversation about how to begin to study and invest in Covid tests, therapeutics and vaccines.
David Vaughn, deputy director of vaccine development at the Gates Foundation, and Josie Golding, the lead of Wellcome’s epidemic responses, hosted a preparatory meeting Feb. 4, 2020, with U.S. officials and members of the WHO Scientific Advisory Group, according to another set of WHO meeting minutes. In the meeting, the organizations’ representatives suggested that potential funders come together to discuss the WHO’s research and development blueprint — a framework for how the international community could respond to the virus.
By the end of the global conference in the second week of February, attendees had agreed on a comprehensive road map for the world’s response to Covid, including how funders would support vaccine, drug and test development. WHO officials called for $675 million to respond to Covid.
The Gates Foundation announced that it would dedicate $100 million to the effort. At a CEPI board meeting, Hatchett said the organization had signed four agreements for Covid vaccine development and that the organization was working closely with the WHO, dispatching two staff members to work on vaccine development.
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