Bill Gates’s efforts to fight coronavirus, explained

The Gates Foundation has emerged as a leader in the coronavirus response.

Bill Gates saw this coming.

“I rate the chance of a widespread epidemic, in my lifetime, as well over 50 percent,” he told Ezra Klein in 2015. “Something like the Spanish flu in the modern day — health systems are far better, so you think, okay, that wouldn’t be very bad. What we showed [when infectious disease researchers working with the Gates Foundation modelled the scenario] was that the force of the infection, because of modern transport … within days, it’s basically in all urban centers of the entire globe.”

The world’s second–richest man (he recently lost the top spot to Jeff Bezos) has, in the years since he and his wife founded the Bill and Melinda Gates Foundation in 2000, made a name for himself in philanthropy, especially in the field of public health. The foundation funds vaccinations through programs like GAVI, which Gates set up with a $750 million grant program in 1999 and which is estimated to have saved millions of lives. (The foundation’s support to GAVI has totaled $4.1 billion to date.) It funds fights against diseases like malaria and polio. In its first 20 years of existence, the Gates Foundation has spent some $40 billion on global development and public health programs.

And when the pandemic Gates long warned us about arrived, he got to work on philanthropic initiatives to fight it. He’s not the only one — many companies and rich individuals have pledged eye-popping sums to the global fight against the coronavirus. But Gates deserves special attention. He has more money than all but one, more experience working in public health and infectious disease response, stellar approval ratings among the American public, and — thanks to his early warnings about the disease — a resource that may be just as important as money: credibility.

In a February letter published in the New England Journal of Medicine, he urged the government to start a strong policy response at home, and to contribute to preparedness in lower-middle-income countries, which is where Gates has dedicated much of the $100 million he pledged in February to the coronavirus fight. He called for accelerated work on treatment and vaccines. And he laid out a plan for how to make sure a situation like this doesn’t happen again.

It’s the sort of response many people would have liked to see from the US government; the Trump administration was still insisting in late February that there was no cause for concern in the United States. It is catastrophic that the federal government has failed as badly as it has. Into the breach have stepped private actors — Gates leading among them — to address the problems the government has failed to address.

Billionaire philanthropists like Gates have attracted justified criticism, but it’s crucial to look at the good side, too: The crisis has been an example of how, at its best, billionaire philanthropy can do critical work that democratic systems are failing to get done. It’s fair to say that things would be much better off if President Donald Trump had mounted a competent response — and much worse off if Bill Gates weren’t around to help fill the void the incompetence at the top has created.

The Gateses’ fight against coronavirus

One of the many early heroes in the fight against coronavirus in the United States was the Seattle Flu Study, a Gates-funded research project that studied influenza-like illness in the Seattle area. The group spent most of February seeking permission to test the samples it had acquired for their study of influenza in Seattle for the novel coronavirus (government regulations prevented them from using those samples for a different purpose, in this case tracking the spread of a new disease). Eventually, the Seattle Flu Study did a test — and found a person with coronavirus.

The state reacted fast once the detection of early cases were announced, and implemented social distancing measures earlier than most of the country. The positive tests from the flu study resulted in cases being detected sooner, and might have helped the state react in time: It went from the nation’s leader in coronavirus cases to its current 14th place.

That effort is emblematic of many of Gates’s coronavirus response programs. Because the Gates Foundation was already working in infectious disease response and global health, it had connections with scientists and researchers and preexisting expertise in vaccine deployment and public health response. Confronting a new threat in the Covid-19 coronavirus, he has put those resources to use.

In the developing world, global health teams Gates has funded, like the Global Polio Eradication Initiative (GPEI), have pivoted to working on a coronavirus response as the virus has made their original work unsafe (they could spread the coronavirus) and created pressing new needs in the communities they serve.

“The GPEI will use our tools, our workforce, and our laboratory and surveillance network to support countries as they respond to COVID-19,” Dr. Erin Stuckey, epidemiologist and program officer at the Bill & Melinda Gates Foundation, said. “What that looks like will depend on the situation in each country and the extent of the polio operations that are up and running there — but in general, the systems we’ve built for polio eradication will help support things like coordination of response operations, surveillance of suspected cases, training for healthcare workers, and standing up data systems.”

The Gates Foundation, headquartered in Seattle, has done additional work at home, too. In March, it partnered with the University of Washington’s Seattle Flu Study again to explore home testing kits for the virus; the FDA has since banned at-home testing, but the team is currently working on a test that can be self-administered at a testing site.

The foundation has also launched the Covid-19 Therapeutics Accelerator to study the most effective treatments for the virus, with $125 million in initial funding. Already, it has shown some promising results. While most studies have explored treatments, some early studies launched by the accelerator have looked at prophylaxis — drug treatments that prevent people from getting sick in the first place, likely for health care workers and people at similarly high risk.

“We’re not expecting to find a 100-percent-effective solution right off the bat,” Trevor Mundel, president of the Gates Foundation’s Global Health program, explained, noting that other viruses like HIV, as well as other lung infections like tuberculosis, have proven most responsive to cocktails of several drugs.

“That’s why the Accelerator is looking to identify a shortlist of about 50–100 FDA-approved drugs, and then narrow this down to a few that could be scaled up. And what this will look like is, first trying to use individual drugs, and then of course combinations of those individual drugs,” he added.

Like the program it was modeled on — the Coalition for Epidemic Preparedness Innovations (CEPI), an international collaboration to make vaccines available quickly when disease outbreaks happen — the Therapeutics Accelerator is an international project, with contributions from Gates as well as many national governments.

CEPI is also a Gates Foundation initiative. As you might expect, Gates has also started directing resources at finding a vaccine for the coronavirus. “I do think manufacturing, construction, a lot of things we’ll do, but large public gatherings may have to await until we have that vaccine,” Gates told NPR last week. “Until we get a vaccine that almost everybody’s had, the risk of a rebound will be there.”

With that in mind, Gates has been airing another big idea. Usually, only the vaccine that is going to be used is manufactured. That means a delay in the vaccine rollout between when a vaccine is chosen and when the vaccine is actually available at the necessary scale.

Gates’s proposal is to build seven factories, for all the leading vaccine candidates, and manufacture lots of each of them. It will mean some wasted money — but it’ll be worth it, to get a vaccine to patients sooner. He estimates this will cost billions. Though the foundation hasn’t disclosed how much it will personally be spending, a project of this magnitude will require other stakeholders — as have most of Gates’s public health projects.

“The Gates Foundation is working with a range of national and multilateral stakeholders who are funding the development of vaccines for COVID-19. Enhancements of global manufacturing capacity are clearly required given the population-level scale at which a COVID-19 vaccine will need to be given,” the Gates Foundation told Vox in a statement. “Many of the current vaccine approaches are novel and have never been scaled for a commercialized product. In addition, governments need to continue to provide important vaccines for other diseases while scaling a successful COVID-19 vaccine.”

Billionaire philanthropy’s critics

Gates has, of course, attracted critics. That includes conspiracy theorists who believe that he engineered the whole pandemic, possibly so that he can inject us all with a surveillance system as part of the vaccines. Another conspiracy theory has seized on the fact that a nonprofit Gates funded did a tabletop pandemic response exercise in 2019 that imagined the emergence of a new coronavirus. Needless to say, these are fictions.

But there are legitimate critiques. One line of criticism is familiar. Gates, it acknowledges, is plainly doing great stuff. But a lot has gone wrong in our society if we are in the position of relying on individuals to make eye-popping sums of money starting tech companies and then devote their retirement to bailing the rest of us out. Shouldn’t we have institutions that solve our problems more systematically?

And there’s a related critique, prominently articulated in recent years by Anand Giridharadas, among others: When billionaires donate to charity, they’re not just buying vaccines — they’re also buying good PR. If you think that addressing the most pressing problems in society requires changing how wealth works so there aren’t any billionaires, then this looks like a bad trade — we’re accepting gifts from billionaires in exchange for entrenching them.

But there are problems with this critique. In particular, it’s not low taxes that hampered the US response. The Food and Drug Administration didn’t refuse to approve private tests for critical weeks because they were short on budget. What they were short on was a sense of what was at stake. This critique also doesn’t acknowledge that the administration in power might not necessarily share your priorities for where taxes should go — witness Donald Trump’s budgets, which have sought to cut funding for the Centers for Disease Control and Prevention.

From the top down, the official US government response has been slow, incompetent, and poorly suited to what was at stake. Abolishing billionaires would not magically make Donald Trump more competent.

In that context, I find it hard to wish that Bill Gates had been taxed until he no longer had the resources he’s now spending to try to attack this pandemic. And until the problems that produced this government response are fixed, I’m opposed to tearing down the philanthropic safety net that has been there to catch us when the Trump administration failed. To be sure, Gates isn’t representative of his class. But the point remains: Abolishing his class hardly guarantees the kind of competent government response needed in a crisis like this.

Additionally, it’s worth nothing that Gates has been touring the world begging us to increase funding for those agencies, and warning us that a dangerous global pandemic might happen if we don’t. (More broadly, Gates has also pushed for higher taxes on the billionaire class.)

But that’s not to say there’s no space for accountability.

“With the prospect of catastrophic numbers of deaths, any effective response, no matter the source, is to be wished for,” Stanford philosopher Rob Reich, who criticized the dynamics of billionaire giving in his book Just Giving, told me. “When government is as ineffective as it has proven to be, responses from individuals, corporations, philanthropies, should be welcomed, insofar as they are effective.”

But, he pointed out, it’s important that we target our accolades at the projects that actually are effective. We don’t want to uncritically praise or uncritically criticize — we want to ask questions, elevate the best projects, and assign credit where it’s genuinely due.

“Whatever the source of a large scale response is, we should direct scrutiny at it. Just as when [New York Governor] Cuomo or Trump or [California Governor] Gavin Newsom stand up to offer their own responses, there’s a critical and question-asking press corps debating whether their responses are worthy — so too should we be directing that scrutiny at corporations and philanthropists,” he told me.

So there are some good questions to ask Gates. Are vaccines the best focus here, when realistically we cannot keep the country locked down until one is ready? Should there be more focus on low-tech measures like cloth masks and reminders to stay away from people? Even as we acknowledge Gates’s good deeds, we should continue pressing him and other philanthropists on these questions — in the spirit of helping identify what works, what can work even better, and what most deserves assistance from other funders.

Why good government is still needed

But for all the good Gates and other billionaires might be doing, it’s important to remember that it will not be nearly enough to meet the current crisis.

In a catastrophe of this magnitude, no billionaire can actually do a fraction as much as the US government can. If Gates liquidated all his wealth — no more vaccine programs, no more Gates Foundation — to distribute to every American, we’d each get less than $300. The $2 trillion coronavirus stimulus package spends far more money than all of the billionaires in America combined could.

So the sensible role for philanthropists is not replacing the government. They can’t do that. It’s filling in the gaps — moving faster than the government, moving around bureaucratic red tape, making sure that good ideas break ground immediately instead of waiting weeks for approval. Gates pledged some initial money toward his idea of building seven factories for the seven most common vaccine candidates, knowing most of the vaccines produced would fail clinical trials, but he won’t put up most of the money for the project.

“The foundation is exploring using its catalytic funding to get the process moving, recognizing that any large-scale projects will require multilateral and/or government funding,” the foundation told Vox in a statement. As Gates has acknowledged, the factory plan will cost billions that even he would struggle to put up personally — so while he can donate the seed money to kick it off, it will only really happen if governments pitch in.

“From the perspective of a foundation,” Reich wrote in 2013, “successful philanthropic giving consists not in funding social innovations and then sustaining the most successful of them forever. Because the assets of even the largest foundations are dwarfed by the assets of the marketplace and of rich states, success consists in seeing proven policy innovations ‘scaled up’ by private firms or by the state.”

But Reich was imagining a process that took place over the course of years or decades. What’s happening now is that same process, but happening on the scale of weeks. Gates sets up a trial for therapeutics — and then the results are seized upon by states and by doctors desperate for insight into how to treat coronavirus patients.

I asked Reich if the events of the pandemic had changed his understanding of the role charitable giving should play in a democratic society. “I had written about philanthropy and defended it as a distinctive source of risk capital for long time horizons,” he told me. “In general emergency responses are not the sort of thing where you’d want risk capital for long time horizons. And yet given the abject failures of the government, I’m glad they’re doing disaster relief.”

Foundations can’t do it all. But extreme circumstances like the one we find ourselves in highlight the need for their logjam breaking, research-boosting, government-guiding role even in short-term and fast-moving situations — at least if the government is falling down on the job.

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