The Daily - Can Bill Gates Vaccinate the World?

Episode Date: March 3, 2021

When the coronavirus pandemic hit, the Microsoft founder Bill Gates was the most powerful and provocative private individual operating within global public health.Today, we look at the role he has played in public health and his latest mission: procuring Covid-19 vaccines for countries in the developing world.Guest: Megan Twohey, an investigative reporter for The New York Times; and Nicholas Kulish, an enterprise correspondent covering philanthropy, wealth and nonprofits for The Times.Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: Bill Gates is working with the World Health Organization, drugmakers and nonprofits to tackle the coronavirus, including in the world’s poorest nations. Can they do it?An operation to supply billions of vaccine doses to poorer countries got underway last week. But as rich countries buy most of the available supply, stark inequalities remain.For more information on today’s episode, visit nytimes.com/thedaily.Transcripts of each episode will be made available by the next workday.

From The New York Times, I'm Michael Barbaro. This is The Daily. Over the past few decades, the world's most powerful philanthropist became the most powerful private citizen in public health. Today, my colleagues Megan Toohey and Nick Coolish examine how Bill Gates is changing the way the world is vaccinated, and potentially, the course of the pandemic. It's Wednesday, March 3rd. So, Megan and Nick, how did this reporting start for both of you? Well, I'm an investigative reporter who last year started doing reporting on the pandemic.

who last year started doing reporting on the pandemic. And by the summer, I decided to turn my attention to the world of vaccines. And as I started digging, almost immediately, I started to hear the name Bill Gates over and over again. And it wasn't clear exactly what he was doing, but it was clear that he seemed to have his hands in everything vaccine related. And also there were these crazy conspiracy theories about him, about how he was using the pandemic and vaccines to put microchips in people so that he could track them. Now that's patently false, right? But it was clear that people didn't know what he was actually doing. And I write about philanthropy for The Times.

And, you know, in the world of philanthropy, there's no group as big or as important, really, as the Bill and Melinda Gates Foundation. Right. And from my reporting on the philanthropy side, I kept hearing Gates, Gates, Gates. And pretty soon we realized there was a big piece to the pandemic story that wasn't being told.

And maybe it's a story that we need to tell together. And so what did you find? Hello, I'm Bill Gates, chairman of Microsoft. In this video, you're going to see the future. Windows. You know, the story of Bill Gates and vaccine development really started in the late 90s. In the next 10 years, computers may change the way you do just about everything, and no one will shape that change more than Bill Gates, the chairman of Microsoft. You know, at the time, he was known as the CEO of Microsoft.

Bill Gates is about $200 million richer this morning. That's hard to believe. You know, the world's richest man, and... The U.S. Justice Department asked a federal court today to fine Microsoft Corporation a record $1 million a day. The target of a giant antitrust case. Attorney General Reno says Microsoft, the 800-pound gorilla of the computer software industry, has broken a 1995 agreement not to squeeze out its competition. Microsoft is telling PC manufacturers,

if you want to use our operating system, you must also install our browser. Just think if somebody had a monopoly on hot dogs, would you want them to decide what kind of mustard to put on your hot dog? That's what this is all about. You want them to decide what kind of mustard to put on your hot dog? That's what this is all about. The government said that he had been abusing the monopoly power that his powerful software company wielded

to the detriment of other technology companies. In one Microsoft computer game, the object is to build an empire by obliterating your rivals. Whether Bill Gates is too good at that in true life may turn into the biggest antitrust battle ever. It was the big case. It was the big thing of the moment, the U.S. government versus the world's richest man. At the time, I was actually a young reporter covering antitrust for the Wall Street Journal. And the government repeatedly ran clips from a videotaped deposition that showed him to be evasive and even arrogant.

I have no idea what you're talking about when you say ask. He wasn't coming over very well. Do you recognize that this is a document produced from Microsoft's files? Do you not, sir? No. You don't? Well, how would I know that? He seemed like he didn't like being told what to do. They're jealous competitors.

And in a competitive market, you know, when one company does super well. And he and his company could do no wrong. And of course, that case does not end well for Bill Gates. No. It certainly does not go directly to jail for Bill Gates, but a federal judge has stated it plainly. Microsoft is a monopoly. It was found that Microsoft was a monopoly

and that Microsoft had abused its power as a monopoly to restrict competition. There is even a site on the web now for a group calling itself Spogie, the society for preventing Gates from getting everything. And it's around this time that Gates begins to get involved in vaccines. And why would Bill Gates, who is known really for just one thing at this point in his life, which is making massively successful computer software, end up leaping into the world of vaccines and public health? Well, a cynical take would be that he makes this pivot at a moment when he is suffering the biggest PR crisis of his entire life. I mean, the government is successfully coming after his

company. He is being painted as a robber baron of the times and that he wants to do something that's going to change his image and public health and making the world a better, safer place was a surefire way to do that. In truth, our understanding is that he was also genuinely attracted and pulled into the world of public health. Bill and his wife, Melinda, had already started this foundation in which they were channeling some of the many, many dollars that they had made in building up Microsoft into charitable causes that they thought were worthwhile. And especially when he started to learn more about vaccines, he was seeing a vacuum,

a vacuum that he thought he might be uniquely positioned to help fill. And what was that vacuum? Well, in the previous decades, the World Health Organization, the global public health agency, had made a lot of effort working with drug companies to help bring new vaccines into the market and to get them to poor countries to address infectious diseases like smallpox. But by the 90s, the WHO, the World Health Organization, had kind of decided that they didn't really need to make this a top priority. And many Western drug companies had actually stopped producing vaccines because they had determined that they were unprofitable.

Yeah. And so you're Bill Gates and you're sitting there and you're like, there's a problem. And it's a problem with developing technology and distributing it and helping companies make a profit. And he's like, wait a minute, I'm the richest guy in the world and I'm great at all of these things. I'm the man at this moment who can help with this issue. Okay, so a light bulb has gone off in his head.

He's starting to think about vaccines. What happens next? Well, you know, there was this really amazing moment that happened in late 1998 where Bill and Melinda Gates had just given $100 million for vaccines for children, which that's a big number in any era, but it was even bigger then. It was just a stunning number. And all of these experts gather at Bill and Melinda Gates' $127 million lakeside mansion, which people have nicknamed Xanadu 2.0, like in Citizen Kane. I've heard people jokingly refer to it as the lamb chop dinner.

I know exactly what you're talking about. I couldn't tell you we had lamb chops. We actually talked to Melinda Gates about this, and we'd heard from other sources that they called it the lamb chop dinner because they're seated at this massive table eating this, apparently decades later, memorably great dinner of lamb chops. We had such a robust discussion about vaccines apparently decades later, memorably great dinner of lamb chops. It's that moment, right?

It's that moment when the napkins are on the table, which kind of means we're getting ready to go. Bill Gates says, what if we gave more? What if we gave a lot more? And this whole new conversation starts amongst all these experts. And out of this conversation, We turned to each other after dinner was over and just said, we're going to give so much more to vaccines. Like, it was just natural for both of us. Comes a $750 million investment.

And then became Gov after that. Wow. To start a new organization, a global vaccine nonprofit that they're going to call Govi. going to call Gavi. This investment helped to really revolutionize the world of vaccines and the vaccine market. And it did so within the capitalist system. What do you mean? Remember the vacuum that Gates discovered? This idea that, you know, making vaccines for poor countries, it's not always profitable. And the drug companies are like, we're not charities, right? Gates kind of solves that

problem by guaranteeing them, we're going to be your buyers. You're not just going to be dealing with, you know, Botswana here or Namibia there. We're going to guarantee you some volume. And for good measure, you're going to get to keep the intellectual property rights for your vaccines. Because he is stepping in and saying, I'm going to ensure that you pharmaceutical companies are actually going to make money by undertaking vaccine production. That's exactly right. I mean, he is creating this intermediary organization that ends up serving as a crucial link between the drug companies and the developing world. And along the way, he's forming some really powerful alliances. He starts to form really close relationships with the executives of these big drug companies. He starts having actually annual meetings where they all get together

and discuss what the priorities should be in the upcoming years. And he's also going to world leaders, the leaders of other wealthy countries, and saying, you know, you should actually be investing in this new structure to help get vaccines around the world. And a lot of them are saying yes. And he's cultivating some serious,

powerful relationships with those figures as well. And, you know, also here at home in the United States, talking to members of Congress on both sides of the aisles, presidents, congressional leaders. I spoke with Senator Mitch McConnell about their relationship. You know, Mitch McConnell is himself a polio survivor. And one of Bill Gates's biggest efforts has been trying to eradicate polio. And, you know, Mitch McConnell told me that Gates has immediate access to people on the Hill because of his fame, because of his reputation, because of what he's doing with his own money and the way that he's inspiring other rich people to

do similar things with theirs. Yeah. And alongside these political figures, he is also, you know, when did you first meet Bill Gates? Making strong relationships with scientists around the world. Okay, so I'm really bad at years. Including Dr. Anthony Fauci. Must be anywhere from 10 to 15 years ago. Fauci talked to us about the first time that he met Gates. He had a bunch of international global health leaders that he invited to his home. He had been invited to that big mansion in Seattle for a conversation about

tuberculosis. Melinda was showing everyone in the tour of the house and he said, can I have some time with you in my library, this amazingly beautiful library? I kind of wanted to see the current house. Yeah. I need a house. For sure. So we went into his library and we sat down. And it was there that he said, you know, Tony, you run the biggest infectious disease institute in the world.

And I want to make sure the money I spend is well spent. He was intent on learning more about what exactly Fauci did and what his agency did. It was the beginning of a very, very strong partnership. closer and closer with tuberculosis, with HIV, with the vaccine trial. So as Gates is kind of becoming his own one-man global health organization, how are the actual global health organizations responding? How are they regarding his sudden ascension in their field? Well, it's an interesting analogy and comparison. And in fact, the relationship between Bill Gates and the Gates Foundation

and the World Health Organization is a complicated one. There is this concern and actually complaint among some people that he is usurping the role of the World Health Organization, that this private individual is gaining too much power in the world of public health. But what makes it even more complicated is that the Gates Foundation is pouring more and more money into the WHO. In fact, by the time we were doing our story, it was the second biggest donor. Wow. Yeah. Bigger than most countries.

Right. Exactly. And now they will say the WHO and the Gates Foundation will insist that doesn't affect the decisions that the WHO makes. But, you know, does it make the WHO and the officials who work there reluctant to criticize Gates and his foundation? I mean, we found time and again that there were a lot of people in the world of public health who would talk to us off the record about their concerns about Gates and his growing power and influence in the world of public health. But they were very reluctant to say so on the record, in large part because his money was everywhere. Right. I mean, how could receiving that much money not make it difficult to criticize a donor?

Yeah, exactly. Exactly. It even had a nickname for this. The Bill Chill is what people would call it, you know, in private. And so Gates, you know, really elbowed his way into the world of public health. And he left a lot of people unsettled, but he also was doing a whole lot of good. And it's clear, you know, that the foundation is the biggest private actor in the world of global public health. And that's where things stand when, at the beginning of 2020, COVID arrives.

We'll be right back. So, Nick, as the pandemic begins in 2020, what role does the Gates Foundation play in the effort to develop a vaccine for what becomes COVID-19? I mean, you have to understand that the Gates Foundation, by this point, is this giant, almost like health agency of its own there in Seattle with this huge headquarters with all these people who have come from places like the CDC and the FDA and drug companies. So all of them, Bill, Melinda Gates, the top executives, they're all watching this develop in China. They actually have an office in Beijing themselves. Oh, wow.

Yeah. I mean, so it's like this is a global operation. office in Beijing themselves. Oh, wow. Yeah. I mean, so it's like, this is a global operation. But if you ask the foundation executives and Mr. Gates himself, like when it really got going, they would probably point to February 14th, Valentine's Day. And on that day, top foundation staff arrive at Bill Gates's personal office just outside Seattle. And they get together for this working dinner. They bring in an expert from a nearby university who is showing them the modeling. And as Bill Gates told Megan and me,

he said, from this point on, we're on code red. And what does code red look like for Bill Gates? You know, the picture that they painted for us is that they're just starting to work the phones. They're springing into action and starting to tap into these strategic relationships and alliances that they had formed over the previous two decades. They're talking to, you know, high-ranking officials. Bill Gates is calling Congress members and saying, don't sleep on this thing. It's big. It's coming. They're kind of operating at every level, from private industry to the public sector, trying to raise the alarms and

figure out ways that they and their money can help. When COVID hit, do you recall your first conversation with Bill? And for Gates, many of the calls went to his good friend, Dr. Anthony Fauci. the vaccine. What are you doing? But his main thing was he wanted to make sure, which has been the classic Bill Gates point, is that we got to make sure that we do the vaccines, that it's the kind of vaccines that could be used in the developing world. They're starting to talk about how they can start to get COVID-19 vaccines to the developing world. When Bill Gates comes and says we're interested in a particular area, people listen. I mean, that's it. In the coming weeks and the coming months, a new global vaccine initiative takes shape, which is ultimately called COVAX.

And what exactly is COVAX? This is a global infrastructure that's coming together that's saying we are going to invest in promising COVID vaccines that can help serve the world, much like Operation Warp Speed here in the United States. The goal of COVAX is to get ultimately 2 billion doses of COVID vaccines to countries around the world. Indeed, it's ambitious in scale. It's trying to basically address what they anticipated was going to be vast inequity in the ability of countries to purchase vaccines. It's trying to gather as many poor and middle-income countries together and structure global deals so that the countries can purchase vaccines as a collective unit.

And with the poorer countries getting crucial subsidies to make the process more equitable. And so who makes up COVAX, this global initiative? So there are three organizations that become the pillars of COVAX. There's Gavi, remember the global vaccine nonprofit that Gates helped found. There's actually another global nonprofit called CEPI that Gates also helped found. And then there's the World Health Organization. Of which, as you've told us, Gates is a leading funder. Yes.

And to just put in a couple more asterisks there, the Gates Foundation is also providing private consultants to staff COVAX and also getting involved in a little bit of jostling for power that's going on among these groups. What do you mean? As this global vaccine initiative was coming together, the WHO actually wanted to play more of a leadership role. And the Gates Foundation and these two other global nonprofits that it had helped establish blocked that. They blocked that. establish, blocked that. They blocked that. And what was the logic of making sure that the WHO doesn't play too big a role in this global vaccine initiative? Well, when we talked to Mr. Gates about this, I mean, he said, listen, you know, of course, we're always talking to the WHO. And of

course, they can and should and are playing a meaningful role in this COVAX initiative. But a lot of the work here to stop this epidemic, he told us, has to do with innovation. Innovation in diagnostics, therapeutics, and especially in vaccines. And he made the point that this just is not really the WHO's realm. He was saying, like, listen, this is us. This is what we're good at. This is what we have been at. This is what we have been paying attention to over the last 20 years. So now with COVAX, Gates starts going to the wealthy nations, goes to Angela Merkel of Germany, goes to Prime Minister Boris Johnson of the United

Kingdom and, you know, gets commitments for billions of dollars, you know, to help pay for these things, goes to producers, you know, in countries like India and tries to line up production deals, you know, in advance for them. In a way, you know, Bill Gates and the Gates Foundation kind of play a middleman role in all of this, trying to prevent gaps in the market or lack of information from derailing what is in many ways an incredibly complex global as well as scientific operation. And so does this work? What happens with COVAX? Well, this global vaccine initiative does in fact get off the ground. There are more than 100 countries that ultimately sign up to purchase vaccines through it.

countries that ultimately sign up to purchase vaccines through it. There are companies, Johnson & Johnson, Novavax, AstraZeneca, Pfizer, and Sanofi that agree to do deals. Wow. So all the big players are involved. Yeah, major players. Yeah. And so heading into this new year, as the vaccines are really starting to roll out of the manufacturing sites. COVAX has in place deals and countries and financial support to start to get hundreds of millions of doses out to participating countries. That sounds like a kind of triumph, right? To do all of that in less than a year. Yeah, absolutely. I mean, I think a lot of people would see this as a huge success, right?

I mean, more than 330 million doses are supposed to be delivered to these countries by the end of June. That's more than 150 million people who are going to get vaccinated against this deadly disease, who otherwise might not have been. And when you look at all the lives that that's going to save,

it's very hard to see that as anything other than an unqualified success. But, you know, at the same time, you have to look at, you know, what was the goal of this, right? And the goal of this was equity. If you think about it, right, the United States has deals in place that should give it more than enough vaccines to inoculate every single eligible person in the country this year.

And if COVAX hits its goal of two billion doses, which, you know, two dose regimens might only be enough for about a billion people, that's likely only 20% of the people eligible in these countries by the end of the year. In countries like Haiti, you know, or Afghanistan, or Congo, it could be 2023 or 2024 that people are still waiting, you know, to get these vaccines. Right. That's not equity. No. And what is the alternative? I mean, clearly this is not solving that problem. So what

would? Well, that raises this fascinating question of whether desperate times call for desperate measures. And should we start saying this is a global emergency, so the companies that have come up with these vaccines need to share the recipes far and wide so that all over the world people can be producing as many as possible, as quickly as possible, to save as many lives as they can? And indeed, countries like India and South Africa have led a big push to temporarily suspend these patent rights. have led a big push to temporarily suspend these patent rights. But that would be breaking into the intellectual property of the pharmaceutical companies, which is something they certainly don't want. And it's also something very clearly that Bill Gates doesn't want. Why not use the crisis to create a more equitable system

of developing vaccines? We talked to Gates about this, and he was also recently asked about it by our colleague Kara Swisher on her podcast, Sway. Well, making vaccines is very, very hard. He thinks that if you wrestled control away from these major drug makers, they wouldn't have incentives to follow through on the development of new vaccines. And so the notion that you're going to open source vaccine manufacturers, there's not a single additional vaccine that would have come out of that. We did fund the biggest vaccine factories in the world, which happened to be in India,

to pick and make the same vaccine. So it's important to know that there is cooperation going on. Some of the major vaccine makers, like AstraZeneca, for example, are doing partnerships with manufacturers around the world. Believe me, IP did not limit anything that was being done here. You know, I'd give pharma a very high grade for how they cooperated with each other and how they built up capacity here. And no free IP would have improved anything related to this pandemic.

So my last question. Bill Gates believes in this. This isn't a strategy. I mean, he believes that you get innovation by protecting intellectual property. It's a core central tenet. You know, he found his success through this. And so asking him to throw all of that out, I think that that would probably be impossible for him. It feels like in seeking to create, in the middle of this pandemic, a fairer system

of vaccine distribution, and in doing it to a pretty remarkable degree, Bill Gates has raised the question of whether even his success in doing all that is not enough. And it feels like he has put a spotlight on the question of whether the entire system top to bottom needs to change. But the question is whether Bill Gates is the guy to do that. But the question is whether Bill Gates is the guy to do that. The simple answer, the very straightforward answer is no. And Bill Gates would be the first person to tell you that. But as he's become more powerful, it has also become very difficult for people to imagine any more radical reform without his support. any more radical reform without his support.

Bill Gates is in many ways a representative figure, right, of an era where private companies have such a huge say in public health. He represents the limitations of what we're willing to do, which is we don't want to hurt the bottom lines of industry. And so as the essential player that he has built himself into in the past 20 years in global public health, to some extent, things are going to be done on his terms. Megan, Nick, thank you both very much. Thanks, Michael.

Thanks, Michael. Thank you. This week, the African nations of Ghana and Ivory Coast became the first countries to administer vaccines from COVAX. We'll be right back. Here's what else you need to know today. On Tuesday, President Biden announced that by the end of May, the United States will have enough doses of COVID-19 vaccines to inoculate the entire adult population of the country.

A faster timetable than previously thought. But Biden cautioned that it would likely take far longer to actually administer those doses across all 50 states. And. Too many Texans have been sidelined from employment opportunities. Too many small business owners have struggled to pay their bills. As vaccination rates improve, the governor of Texas, Greg Abbott, said he would immediately allow businesses across the state to reopen at full capacity

and would end the state's requirement that masks be worn in public. This must end. It is now time to open Texas 100%. The decision flies in the face of warnings from federal officials not to ease restrictions too quickly and potentially trigger a new spike in infections. Today's episode was produced by Austin Mitchell, Rochelle Bonja, and Leslie Davis. It was edited by M.J. Davis-Lynn

and engineered by Corey Schreppel. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.