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Critical reflection on the field of Global Health Our goal throughout the quarter has been to inspire your interest in and commitment to global health, but

Critical reflection on the field of Global Health Our goal throughout the quarter has been to inspire your interest in and commitment to global health, but

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Critical reflection on the field of Global Health Our goal throughout the quarter has been to inspire your interest in and commitment to global health, but to do so with a critical eye toward the people and institutions in power, some of whom have an adverse impact on the health of populations.  Without this thoughtful and critical perspective, we cannot make substantive, systemic progress in the field of Global Health.
One institution that receives abundant praise, but also some less audible criticism, is the Bill & Melinda Gates Foundation, which is headquartered in Seattle and has a very close relationship with the University of Washington and our own Department of Global Health.  The Foundation has taken an active role in the response to the covid-19 pandemic, ostensibly attempting to spread testing and vaccine access, among other priorities.  However, the means have been question, especially if they are benefitting the poorest people the foundation claims to aim to serve.
For this assignment, we ask you to read this article, entitled “Bill Gates, Vaccine Actions” (file I uploaded) as a prompt to provide some reflections on the field of global health.  The article obviously takes a critical perspective on the Gates Foundation.  Your job is to decide, in the context of this course, how you feel about this critique (there are no right or wrong answers).  
In up to one single-spaced page, please consider the following questions:

Did the article make a convincing case that the Gates Foundation’s role in the covid-19 pandemic and vaccine access is problematic?  Explain.
How has this class given you some tools or perspectives through which to critically analyze both the article and the Gates Foundation?
How would you like to see the covid-19 vaccine rollout proceed, especially knowing that the vast majority of people who are poor remain unvaccinated and will for some time?

You job with this assignment is to show critical thinking skills, meaning we encourage you to offer your perspective, but in a way that links to what you’ve learned in class.  There are no right or wrong answers–how you defend your position matters most! 5/13/2021 Bill Gates, Vaccine Monster | The New Republic

https://newrepublic.com/article/162000/bill-gates-impeded-global-access-covid-vaccines 1/31

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5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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How Bill Gates Impeded Global Access to Covid
Vaccines
Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly
medicine.

ILLUSTRATION BY KELSEY DAKE

Alexander Zaitchik / April 12, 2021

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

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https://newrepublic.com/authors/alexander-zaitchik

https://www.who.int/news-room/events/detail/2020/02/11/default-calendar/global-research-and-innovation-forum-to-mobilize-international-action-in-response-to-the-novel-coronavirus-(2019-ncov)-emergency

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5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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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.

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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.

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5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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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-19Support our issue-driven, independent journalism and subscribe today.

https://www.ft.com/content/4a3bf282-701c-11ea-9bca-bf503995cd6f

https://www.who.int/initiatives/covid-19-technology-access-pool/what-is-c-tap

https://www.who.int/initiatives/act-accelerator

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5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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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.

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Gates’s marquee Covid-19 initiative started relatively small. Two days before the WHO
declared a pandemic on March 11, 2020, the Bill & Melinda Gates Foundation announced
something called the Therapeutics Accelerator, a joint initiative with Mastercard and the
charity group the Wellcome Trust to identify and develop potential treatments for the novel
coronavirus. Doubling as a social branding exercise for a giant of global finance, the
Accelerator reflected Gates’s familiar formula of corporate philanthropy, which he has
applied to everything from malaria to malnutrition. In retrospect, it was a strong indicator
that Gates’s dedication to monopoly medicine would survive the pandemic, even before he
and his foundation’s officers began to say so publicly.

Advocates for pooling and open science, who seemed
ascendant and even unstoppable early in the crisis, have been

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5/13/2021 Bill Gates, Vaccine Monster | The New Republic

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outmatched and outmaneuvered by the most powerful man in
global public health.

This was confirmed when a bigger version of the Accelerator was unveiled the following
month at the WHO. The Access to Covid-19 Tools Accelerator, or ACT-Accelerator, was
Gates’s bid to organize the development and distribution of everything from therapeutics to
testing. The biggest and most consequential arm, COVAX, proposed to subsidize vaccine
deals with poor countries through donations by, and sales to, richer ones. The goal was
always limited: It aimed to provide vaccines for up to 20 percent of the population in low-to-
middle-income countries. After that, governments would largely have to compete on the
global market like everyone else. It was a partial demand-side solution to what the movement
coalescing around a call for a “people’s vaccine” warned would be a dual crisis of supply and
access, with intellectual property at the center of both.

Gates not only dismissed these warnings but actively sought to undermine all challenges to
his authority and the Accelerator’s intellectual property–based charity agenda.

“Early on, there was space for Gates to have a major impact in favor of open models,” says
Manuel Martin, a policy adviser to the Médecins Sans Frontières Access Campaign. “But
senior people in the Gates organization very clearly sent out the message: Pooling was
unnecessary and counterproductive. They dampened early enthusiasm by saying that I.P. is
not an access barrier in vaccines. That’s just demonstratively false.”

Few have observed Bill Gates’s devotion to monopoly medicine more closely than James
Love, founder and director of Knowledge Ecology International, a Washington, D.C.–based
group that studies the broad nexus of federal policy, the pharmaceutical industry, and
intellectual property. Love entered the world of global public health policy around the same
time Gates did, and for two decades has watched him scale its heights while reinforcing theSupport our issue-driven, independent journalism and subscribe today.

https://msfaccess.org/

https://www.keionline.org/

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system responsible for the very problems he claims to be trying to solve. The through-line for
Gates has been his unwavering commitment to drug companies’ right to exclusive control
over medical science and the markets for its products.

“Things could have gone either way,” says Love, “but Gates wanted exclusive rights
maintained. He acted fast to stop the push for sharing the knowledge needed to make the
products—the know-how, the data, the cell lines, the tech transfer, the transparency that is
critically important in a dozen ways. The pooling approach represented by C-TAP included
all of that. Instead of backing those early discussions, he raced ahead and signaled support
for business-as-usual on intellectual property by announcing the ACT-Accelerator in March.”

One year later, the ACT-Accelerator has failed to meet its goal of providing discounted
vaccines to the “priority fifth” of low-income populations. The drug companies and rich
nations that had so much praise for the initiative a year ago have retreated into bilateral deals
that leave little for anybody else. “The low- and middle-income countries are pretty much on
their own, and there’s just not much out there,” said Peter Hotez, dean of the National School
of Tropical Medicine in Houston. “Despite their best efforts, the Gates model and its
institutions are still industry-dependent.”

As of this writing in early April, fewer than 600 million vaccine doses have been
administered around the world; three-quarters of those in just 10 mostly high-income
countries. Close to 130 countries containing 2.5 billion people have yet to administer a single
dose. The timeline for supplying poor and middle-income countries with enough vaccines to
achieve herd immunity, meanwhile, has been pushed into 2024. These numbers represent
more than the “catastrophic moral failure” the director general of the WHO warned about
this January. It is a stark reminder than any policy that obstructs or inhibits vaccine
production risks being self-defeating for the rich countries defending exclusive rights and

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https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-5-february-2021

https://www.bcm.edu/education/national-school-of-tropical-medicine

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-press-conference-with-dr-gerd-m%C3%BCller-federal-minister-of-economic-cooperation-and-development-(bmz)-germany—29-march-2021

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-5-february-2021

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board

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gobbling up the lion’s share of available vaccine supplies. The truth repeated so often
throughout the pandemic—no one is safe until everyone is safe—remains in force.

This easily anticipated market failure—together with the C-TAP’s failure to launch—led
developing countries to open a new front against intellectual property barriers in the World
Trade Organization. Since October, the WTO’s Trade-Related Aspects of Intellectual Property
Rights Council has been center ring in a dramatic north-south standoff over rights to control
vaccine knowledge, technology, and markets. More than 100 low- and middle-income
countries support a call by India and South Africa to waive certain provisions related to
Covid-19 intellectual property for the duration of the pandemic. Although Gates and his
organization do not have an official position on the debate roiling the WTO, Gates and his
deputies have left little doubt about their opposition to the waiver proposal. Just as he did
following the rollout of the WHO’s C-TAP, Gates has chosen to stand with the drug companies
and their government patrons.

Technically housed within the WHO, the ACT-Accelerator is a Gates operation, top to bottom.
It is designed, managed, and staffed largely by Gates organization employees. It embodies
Gates’s philanthropic approach to widely anticipated problems posed by intellectual
property–hoarding companies able to constrain global production by prioritizing rich
countries and inhibiting licensing. Companies partnering with COVAX are allowed to set
their own tiered prices. They are subject to almost no transparency requirements and to
toothless contractual nods to “equitable access” that have never been enforced. Crucially, the
companies retain exclusive rights to their intellectual property. If they stray from the Gates
Foundation line on exclusive rights, they are quickly brought to heel. When the director of
Oxford’s Jenner Institute had funny ideas about placing the rights to its COVAX-supported
vaccine candidate in the public domain, Gates intervened. As reported by Kaiser HealthSupport our issue-driven, independent journalism and subscribe today.

https://www.wto.org/english/tratop_e/trips_e/trips_e.htm

They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma

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News, “A few weeks later, Oxford—urged on by the Bill & Melinda Gates Foundation—
reversed course [and] signed an exclusive vaccine deal with AstraZeneca that gave the
pharmaceutical giant sole rights and no guarantee of low prices.”

Considering the alternatives being discussed, it is no surprise that drug companies have been
the most enthusiastic boosters of the ACT-Accelerator and COVAX. The speakers at the ACT-
Accelerator launch ceremony in March 2020 included Thomas Cueni, director general of the
International Federation of Pharmaceutical Manufacturers and Associations, who hailed the
initiative as a “landmark global partnership.” Since vaccines started coming online, the
IFPMA’s member companies have lost interest in the Accelerator, preferring bilateral deals
with rich countries. But they continue to benefit from the halo effect of their association with
Gates, which has proved priceless throughout the pandemic, especially at a crucial juncture
in its first year.

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They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma

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On May 29, Donald Trump announced U.S. withdrawal from the WHO. This was in response,
he said, to China’s “total control” of the agency. The drug industry, meanwhile, was
displeased with the WHO for entirely different reasons. The same day, the WHO director
general had unveiled the C-TAP with a “Solidarity Call to Action” for governments and
companies to share all intellectual property related to Covid-19 treatments and vaccines. The
pharmaceutical companies didn’t attack the initiative directly. Instead, their global trade

Bill Gates addresses the opening session of the WHO’s annual assembly in 2005, some six years after he
entered the global public health scene as a defender of intellectual property rights during the AIDS crisis.

JEAN-PIERRE CLATOT/AFP/GETTY IMAGES

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https://www.politico.com/news/2020/05/29/us-withdrawing-from-who-289799

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association, the IFPMA, preempted the announcement with a livestreamed media event on
the evening of May 28. The event featured the heads of AstraZeneca, GlaxoSmithKline,
Johnson & Johnson, and Pfizer, and Thomas Cueni.

The evening’s sixth participant was the specter of Bill Gates.

As anticipated, the questions submitted by journalists touched repeatedly on the much-
anticipated launch of C-TAP the following morning, as well as related issues of intellectual
property, vaccine access and equity, and debates over the extent and ways intellectual
property posed barriers to ramping up production. Mostly, the executives evinced ignorance
and surprise over the imminent launch of C-TAP; only Pfizer CEO Albert Bourla openly
denounced the pooling of intellectual property as “dangerous” and “nonsense.”

All of the executives, however, shared a playbook in which they quickly pivoted to
affirmations of their support for Bill Gates and the ACT-Accelerator. The association with
Gates was submitted as evidence of industry commitment to equity and access—as well as
proof of the complete lack of need for overlapping or competing initiatives, such as the
“dangerous” C-TAP.

“We already have platforms,” Cueni said during the May 28 event. “The industry is already
doing all the right things.”

As the questions about C-TAP and intellectual property piled up, the industry’s Gates rap
started to sound less like a shared P.R. script than a broken record. Confronted for the second
time about intellectual property, GlaxoSmithKline CEO Emma Walmsley emitted an
undigested stream of Gatesian word salad. “We are absolutely committed to this question of
access,” she stammered, “and deeply welcome the formation of ACT, which is this
multilateral organization that is going to be a mechanism with multiple stakeholders,Support our issue-driven, independent journalism and subscribe today.

3rd GLOBAL BIOPHARMA CEO / TOP EXECS VIRTUAL PRESS BRIEFING – COVID-19 (28 May 2020)

3rd GLOBAL BIOPHARMA CEO / TOP EXECS VIRTUAL PRESS BRIEFING – COVID-19 (28 May 2020)

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whether it’s heads of state or organizations like [the Gates-funded] CEPI or the Gates and [the
Gates-funded] Gavi and others and the WHO, of course, where we actually look at these
principles of, uh, access and so clearly, we’re engaged in that as well.”

Without the Gates and COVAX associations to lean on, the stammering would have been
much worse. Pfizer’s Albert Bourla seemed to recognize this, at one point interrupting
himself to express his industry’s gratitude and admiration. “I want to take the opportunity to
emphasize the role that Bill Gates is playing,” he said. He went on to call him “an inspiration
for all.”

Gates can hardly disguise his contempt for the growing interest in intellectual property
barriers. In recent months, as the debate has shifted from the WHO to the WTO, reporters
have drawn testy responses from Gates that harken back to his prickly performances before
congressional antitrust hearings a quarter-century ago. When a Fast Company reporter raised
the issue in February, she described Gates “raising his voice slightly and laughing in
frustration,” before snapping, “It’s irritating that this issue comes up here.
This isn’t about IP.”

In interview after interview, Gates has dismissed his critics on the issue—who represent the
poor majority of the global population—as spoiled children demanding ice cream before
dinner. “It’s the classic situation in global health, where the advocates all of a sudden want
[the vaccine] for zero dollars and right away,” he told Reuters in late January. Gates has larded
the insults with comments that equate state-protected and publicly funded monopolies with
the “free market.” “North Korea doesn’t have that many vaccines, as far as we can tell,” he
told The New York Times in November. (It is curious that he chose North Korea as an example

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https://www.reuters.com/article/us-health-coronavirus-gates/bill-gates-sees-6-8-month-lag-for-poor-countries-to-get-covid-19-shots-idUSKBN29W0QJ

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and not Cuba, a socialist country with an innovative and world-class vaccine development
program with multiple Covid-19 vaccine candidates in various stages of testing.)

The closest Gates has come to conceding that vaccine monopolies inhibit production came
during a January interview with South Africa’s Mail & Guardian. Asked about the growing
intellectual property debate, he responded, “At this point, changing the rules wouldn’t make
any additional vaccines available.”

When a reporter raised the issue in February, she described
Gates “raising his voice slightly and laughing in frustration,”
before snapping, “It’s irritating that this issue comes up here.
This isn’t about IP.” 

The first implication of “at this point” is that the moment has passed when changing the
rules could make a difference. This is a false but debatable claim. The same can’t be said for
the second implication, which is that nobody could have possibly foreseen the current supply
crisis. Not only were the obstacles posed by intellectual property easily predictable a year
ago, there was no lack of people making noise about the urgency of avoiding them. They
included much of the global research community, major NGOs with long experience in
medicines development and access, and dozens of current and former world leaders and
public health experts. In a May 2020 open letter, more than 140 political and civil society
leaders called upon governments and companies to begin pooling their intellectual property.
“Now is not the time … to leave this massive and moral task to market forces,” they wrote.

Bill Gates’s position on intellectual property was consistent with a lifelong ideological
commitment to knowledge monopolies, forged during a vengeful teenage crusade against
the open-source programming culture of the 1970s. As it happens, a novel use of one category
of intellectual property—copyright, applied to computer code—made Gates the richest manSupport our issue-driven, independent journalism and subscribe today.

https://www.npr.org/sections/goatsandsoda/2021/03/25/980789381/cubas-revolutionary-dream-making-its-own-covid-vaccine

https://www.unaids.org/en/resources/presscentre/featurestories/2020/may/20200514_covid19-vaccine-open-letter

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in the world for most of two decades beginning in 1995. That same year, the WTO went into
effect, chaining the developing world to intellectual property rules written by a handful of
executives from the U.S. pharmaceutical, entertainment, and software industries.

By 1999, Bill Gates was in his final year as CEO of Microsoft, focused on defending the
company he founded from antitrust suits on two continents. As his business reputation
suffered high-profile beatings from U.S. and European regulators, he was in the process of
moving on to his second act: the formation of the Bill & Melinda Gates Foundation, which
commenced his unlikely rise to the commanding apex of global public health policy. His
debut in that role occurred during the contentious fifty-second General Health Assembly in
May 1999.

It was the height of the battle to bring generic AIDS drugs to the developing world. The
central front was South Africa, where the HIV rate at the time was estimated as high as 22
percent and threatened to decimate an entire generation. In December 1997, the Mandela
government …

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