After weeks of immense pressure, the Biden administration came out in support of waiving intellectual property rights to coronavirus vaccines. Shortly after the Biden announcement earlier this month, the Bill and Melinda Gates Foundation also reversed course and endorsed the patent waiver. But Bill Gates himself, subject to revived scrutiny around sexual misconduct and perhaps the most powerful person in global health, hasn’t budged.
While United States residents are being quickly vaccinated and may see an end to the pandemic in sight, most countries in the world will likely have to wait years for many of their vaccine doses, in a situation being described as “vaccine apartheid.” Almost half of all vaccine shots have been administered in just 16 rich countries, and India is weathering a horrific coronavirus crisis.
Mohit Mookim is a student at Stanford Law School and former researcher at the Stanford Center for Ethics in Society.
This could have been avoided. Early last year, countries in the Global South compelled the World Health Organization to unveil a technology sharing pool, C-TAP, that would have removed intellectual property barriers for accessing Covid-19 treatments and vaccines.
Global health czar Bill Gates had other thoughts. Maintaining his steadfast commitment to intellectual property rights, Gates pushed for a plan that would permit companies to hold exclusive rights to lifesaving medicines, no matter how much they benefited from public funding. Given the enormous influence Gates has in the global public health world, his vision ultimately won out in the Covax program—which enshrines monopoly patent rights and relies on the charitable whims of rich countries and pharmaceutical giants to provide vaccines to most of the world. A chorus of support from pharmaceutical companies and the Trump administration didn’t hurt.
Should we be surprised that a monopolist-turned-philanthropist maintains his commitment to monopoly patent rights as a philanthropist too?
In 2001, Gates emerged from an antitrust saga determined to vindicate his reputation. The federal government’s case against Microsoft was novel in that it targeted what was at the time a new type of monopolistic practice: “intellectual property antitrust.” In Microsoft’s case, this looked like the manipulation of its software in anticompetitive ways, and it painted Gates as a ruthless monopolist. (Microsoft ended up settling with the government.)
Gates chose to launder his reputation by tried and true philanthropic giving. But as he pivoted to global health, his faith in exclusive IP rights remained unchanged. If they helped him build a global software empire, apparently they should help him save lives in the Global South too—despite evidence from the AIDS and polio epidemics to the contrary.
Gates’ first foray began unexpectedly in 1999, on the heels of a failed Western crackdown on South Africa after it flouted AIDS medicine patents due to outrageous drug prices and a debilitating HIV outbreak. Ultimately, a global activist movement succeeded in pressuring the US government and large pharmaceutical interests to back down—despite the fact that the Gates Foundation was concurrently handing out pamphlets at the WHO touting the benefits of monopoly patent rights and investing in approaches to the AIDS crisis that would preserve companies’ property rights in the future.
Throughout the last two decades, Gates has repeatedly advocated for public health policies that bolster companies’ ability to exclude others from producing lifesaving drugs, including allowing the Gates Foundation itself to acquire substantial intellectual property. This continues through the Covid-19 pandemic. On top of steering the global health community towards Covax rather than patent-free technology sharing, last year Gates bragged about convincing Oxford University not to open-license its vaccine. Gates leveraged his $750 million donation to the university for vaccine research—even though its vaccine was developed in a publicly funded lab. Eventually, Oxford sold the sole right of production to AstraZeneca, with no guarantee of low prices and an extraordinary opportunity for profit.
Last October, recognizing that monopoly vaccine patents would be the norm and countries would have to compete against each other to purchase doses, a coalition of countries led by India and South Africa brought a patent waiver proposal to the World Trade Organization’s TRIPS (Trade Related Aspects of Intellectual Property Rights) council. As recently as a couple weeks ago, Bill Gates has continued to speak out against this proposal.
Gates’ argument about the TRIPS waiver—and the one being vociferously lobbied by pharmaceutical companies—is that waiving patent rights would not help poor countries scale up manufacturing and would instead eliminate incentives for future research. South Africa has strongly rebutted concerns about manufacturing capacity, and it is undeniable that waiving patent rights could only increase vaccination rates worldwide. Although this alone wouldn’t give poorer countries the instructions to make that vaccine, that is exactly why Biden must support a crucial aspect of the TRIPS proposal—mandating technology transfer for how to produce the vaccine.
Moreover, vaccine companies have profited more than enough from their investments. Pfizer spent $3 billion in vaccine research but stands to make $26 billion in vaccine sales in 2021. As economist Jayati Ghosh explained, massive government subsidies, including $12 billion from the US alone, seemed to almost entirely cover the cost of vaccine research. It is no secret that Moderna’s vaccine was basically entirely funded by the US government.
It should come as no surprise that a monopolist billionaire-philanthropist is committed to the monopolistic status quo—Rob Reich and I had Bill Gates in mind when we wrote about the risks of relying on elite philanthropists to make decisions crucial to our health and democracy early in the pandemic. Prior to the Biden administration’s reversal, there was mounting criticism of Bill Gates’ role in the West’s vaccine hoarding. In the wake of the political reversal and news of Gates’ big-dollar divorce, that critical eye has seemed to move on. Yet full tech transfer hasn’t happened, TRIPS negotiations are extremely slow, and we can only assume that we will have this same dilemma in the next public health crises (or for that matter, in Bill Gates’ other main philanthropic area of interest, climate change).
Going forward, how do we reckon with the global consequences of elite philanthropy when they have an imperialist flavor? Given the long history of the West’s extraction of wealth and resources from other countries, it should also not surprise us that those Western countries want to hoard scientific innovations that they have the wealth and stability to produce (often drawing on talent from the Global South).
The question is not whether people in rich, Western countries will be prioritized over people in the Global South. Rather, it’s whether large Western corporations will benefit to the detriment of people everywhere—indeed, everyone loses if restrictive patents and vaccine nationalism allow new strains to continue to extend the pandemic and its human toll. Again: Not even most Westerners are better off when corporate elites like Bill Gates and the pharmaceutical lobby seem consistently to call the shots. A patent-free People’s Vaccine that all countries do their part to aggressively distribute is the best way out.
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