Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine.
by Alexander Zaitchik
Part 1 - Advocates for pooling and open science confronted the possibility they’d been outmatched and outmaneuvered by the most powerful man in global public health
On February 11, 2020, public health and infectious disease experts gathered by the hundreds at the World Health Organization’s Geneva mothership. The official pronouncement of a pandemic was still a month out, but the agency’s international brain trust knew enough to be worried. Burdened by a sense of borrowed time, they spent two days furiously sketching an “R&D Blueprint” in preparation for a world upended by the virus then known as 2019-nCoV.
The resulting document summarized the state of coronavirus research and proposed ways to accelerate the development of diagnostics, treatments, and vaccines. The underlying premise was that the world would unite against the virus. The global research community would maintain broad and open channels of communication, since collaboration and information-sharing minimize duplication and accelerate discovery. The group also drew up plans for global comparative trials overseen by the WHO, to assess the merits of treatments and vaccines.
One issue not mentioned in the paper: intellectual property. If the worst came to pass, the experts and researchers assumed cooperation would define the global response, with the WHO playing a central role. That pharmaceutical companies and their allied governments would allow intellectual property concerns to slow things down—from research and development to manufacturing scale-up—does not seem to have occurred to them.
They were wrong, but they weren’t alone. Battle-scarred veterans of the medicines-access and open-science movements hoped the immensity of the pandemic would override a global drug system based on proprietary science and market monopolies. By March, strange but welcome melodies could be heard from unexpected quarters. Anxious governments spoke of shared interests and global public goods; drug companies pledged “precompetitive” and “no-profit” approaches to development and pricing. The early days featured tantalizing glimpses of an open-science, cooperative pandemic response. In January and February 2020, a consortium led by the National Institutes of Health and the National Institute of Allergy and Infectious Diseases collaborated to produce atomic-level maps of the key viral proteins in record time. “Work that would normally have taken months—or possibly even years—has been completed in weeks,” noted the editors of Nature.
When the Financial Times editorialized on March 27 that “the world has an overwhelming interest in ensuring [Covid-19 drugs and vaccines] will be universally and cheaply available,” the paper expressed what felt like a hardening conventional wisdom. This sense of possibility emboldened forces working to extend the cooperative model. Grounding their efforts was a plan, started in early March, to create a voluntary intellectual property pool inside the WHO. Instead of putting up proprietary walls around research and organizing it as a “race,” public and private actors would collect research and associated intellectual property in a global knowledge fund for the duration of the pandemic. The idea became real in late May with the launch of the WHO Covid-19 Technology Access Pool, or C-TAP.
By then, however, the optimism and sense of possibility that defined the early days were long gone. Advocates for pooling and open science, who seemed ascendant and even unstoppable that winter, confronted the possibility they’d been outmatched and outmaneuvered by the most powerful man in global public health.
In April, Bill Gates launched a bold bid to manage the world’s scientific response to the pandemic. Gates’s Covid-19 ACT-Accelerator expressed a status quo vision for organizing the research, development, manufacture, and distribution of treatments and vaccines. Like other Gates-funded institutions in the public health arena, the Accelerator was a public-private partnership based on charity and industry enticements. Crucially, and in contrast to the C-TAP, the Accelerator enshrined Gates’s long-standing commitment to respecting exclusive intellectual property claims. Its implicit arguments—that intellectual property rights won’t present problems for meeting global demand or ensuring equitable access, and that they must be protected, even during a pandemic—carried the enormous weight of Gates’s reputation as a wise, beneficent, and prophetic leader.
How he’s developed and wielded this influence over two decades is one of the more consequential and underappreciated shapers of the failed global response to the Covid-19 pandemic. Entering year two, this response has been defined by a zero-sum vaccination battle that has left much of the world on the losing side.