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Working closely with the World Health Organisation (“WHO”), four global health organisations – the Bill & Melinda Gates Foundation, Gavi, The Wellcome Trust and CEPI – played a central role in creating the Access to Covid-19 Tools Accelerator (“ACT-A”).  And a consortium operated by Gavi, CEPI and UNICEF named COVAX is the vaccine pillar of ACT-A.

Throughout the spring and summer of 2020, the four global health organisations poured money into vaccine development and lobbied governments to pour money into them and their ACT-A initiative.  However, from its inception, ACT-A has lacked transparency and accountability an investigation by Politico and Welt has found.

Throughout the spring and summer of 2020, the global health organisations poured money into vaccine development. In July, CEPI announced it would donate $66 million to Clover Biopharmaceuticals to help the company through its clinical trials. CEPI, Wellcome and the Gates Foundation invested up to $449 million in Oxford University — including partnerships with the school and other companies — for vaccines. Wellcome granted $2.4 million to the Wits Health Consortium in South Africa to help with research on detecting and surveilling Covid.

During the pandemic, the Gates Foundation pushed back publicly on pressuring pharmaceutical companies to share its intellectual property, saying doing so would do little to spur rigorous vaccine development in the short term.

In one instance, the Gates Foundation appears to have helped urge a vaccine maker to partner with a pharmaceutical company to help scale production, according to a report by Bloomberg News, which cites a call between Bill Gates and reporters. That urging led Oxford University — a longtime Gates grantee — to share its rights with just one company — AstraZeneca — rather than sticking to the university’s own guidance that any deal it makes include non-exclusive and royalty-free licensing.

When the university struck the deal, it gave AstraZeneca sole rights — a step that scientists at the university had resisted early on in the development of the vaccine, according to a report by the Wall Street Journal.

“[Bill Gates] flipped the Oxford position on open licensing,” said James Love, director of Knowledge Ecology International, a non-governmental organisation that focuses on intellectual property, who played a key role in negotiations around generic HIV treatments in the early 2000s. “He had access to heads of state. He had outsized influence on CEPI and Gavi.”

Soon after the announcement of the deal, CEPI and Gavi revealed plans to give $750 million to AstraZeneca to secure 300 million doses for COVAX. AstraZeneca also reported reaching a deal with the Serum Institute of India — an institute that received significant funding from the Gates Foundation — to supply one billion doses to low- and middle-income countries.

Gavi launched the COVAX Facility in June 2020. It would go on to sign two additional advance purchase agreements with some of the first vaccines on the market, including Pfizer.

A few weeks before, on 15 May 2020, the US officially launched Operation Warp Speed. By the summer it began expanding its vaccine development portfolio, investing $1.6 billion in Novavax’s manufacturing and an initial $1.95 billion to Pfizer for the large-scale manufacturing and nationwide distribution of 100 million doses. It pledged $2.1 billion to support the development of Sanofi and GSK’s vaccine.

Representatives from the Gates Foundation pushed US officials to share the immune correlates of protection from Covid vaccines — immune markers that can help other institutions develop their own vaccine products.  The Gates Foundation had granted money to organisations working on Covid vaccine development across the world that needed the correlates to help develop the shots.

If shared, the immune correlates of protection can help the company establish efficacy without going through an efficacy trial — one that can take months to complete. US officials agreed and NIH eventually published the correlates in 2021.

On 10 September 2020, representatives of the four global health organisations, including Melinda French Gates, appeared at the first official meeting of ACT-A — five months after its creation. The event marked the official push by the consortium to begin ramping up donation campaigns and pressing governments to build out their international responses to the virus. ACT-A’s finance committee, made up of government officials and leaders of the agencies, called for a total of $38 billion to be donated to the agencies involved in the initiative, including CEPI and Gavi.

ACT-A Lacks Transparency and Accountability

Working closely with the WHO, the four groups played a central role in creating an initiative known as the Access to Covid-19 Tools Accelerator, or ACT-A, that focused on securing and delivering tests, treatments and vaccine doses to low- and middle-income countries across the world. COVAX — a special consortium operated by Gavi, CEPI and UNICEF — is the vaccine pillar of the ACT-A initiative.

Oversight and political leadership for ACT-A came through the facilitation council, a committee co-hosted by the WHO and the European Commission.

But ACT-A missed its delivery goals for 2021 on all three fronts — for testing, vaccine distribution and treatments, according to an independent review by Dalberg Global Development Advisors, a policy advisory firm based in New York.

The ACT-A diagnostics team set a target of making 500 million tests accessible to low-and middle-income countries by the middle of 2021. It procured just 84 million tests by June 2021, only 16 per cent of its target, according to the report.

The therapeutics team originally set a goal of delivering 245 million treatments to low- and middle-income countries by 2021 but later changed the target to 100 million new treatments by the end of 2021. As of June of that year, the therapeutics team had allocated only about 1.8 million treatments.

COVAX set the aim of delivering 2 billion vaccine doses by the end of 2021. By September of that year, it had only delivered 319 million doses.

The leaders of the groups say that they were unable to meet their goals largely because wealthy, Western governments were slow to step up and make available the huge tranches of vaccines and therapeutics that were “needed to protect the world.”

Jeremy Farrar, the Wellcome Trust director, said: “Comprehensive pandemic preparedness and response requires the sort of funding and international cooperation that only governments can muster.”

Farrar defended the ACT-A partnership as “the best mechanism we have for delivering lifesaving Covid-19 tools across the world.”

The Politico and Welt investigation found, however, that ACT-A’s structure diminished accountability. ACT-A representatives set funding priorities and campaigned for donations. But the money — $23 billion in total — went directly to the entities involved in the initiative, such as Gavi and CEPI. Although ACT-A’s website keeps track of how much money was raised, it is nearly impossible to tell exactly where all of it went. Based on each organisation’s individual Covid database, it is not possible to delineate exactly how the groups spent the money raised through ACT-A.

In WHO readouts from ACT-A facilitation council meetings in the autumn of 2020, the consortium announced internally that it had struck deals to make more than 120 million Covid tests available to low-income countries for $5 per unit. The Gates Foundation, through two separate volume guarantees, helped finance the deal with SD Biosensor and Abbott. The agreement marked one of the first major wins for the WHO consortium.

But as the ACT-A fundraising began to grow in strength over the course of the autumn of 2020, representatives from civil society and health advocates in the broader global health community began to raise questions about the inner workings of the consortium and how decisions were being made.

“A lot of them [ACT-A meetings] are not formal meetings. … We have struggled to gain access to the documents and the correspondence… [that would have made it] possible to scrutinise how decision-making processes have actually happened, and to establish whether they have been subject to democratic control,” said Katerini Storeng, associate professor at the University of Oslo’s Centre for Development and the Environment, and head of a research project on public-private partnerships for pandemic preparedness.

One EU official said the organisations — at least in the early days of ACT-A — were not transparent about their decision-making. While there were almost daily exchanges between EU officials and the organisations, the person said, there was a lack of consultation on major decisions, with not enough detail on where the donations from countries were going.

“They received huge amounts of funds and they should have been more transparent [about] what it was used for,” the official said.

In November 2020, ACT-A still faced a significant financial gap. It only had $10 billion in the bank. “Urgent and stronger political support and full financing of the ACT-Accelerator is needed,” according to a WHO summary of an ACT-A facilitation council meeting that month.

Despite new commitments from the European Union (EUR100 million) and the US Congress ($4 billion) to Gavi at the end of 2020, ACT-A said it needed $4 billion immediately and an additional $23 billion in 2021 to help end the pandemic, according to a report its facilitation council put out that month.

Now the four groups are spending millions of dollars to lobby the US and EU to embrace their priorities for the next pandemic.  A message Bill Gates and Melinda French Gates had been plugging to politicians since at least early 2021: “It is not too soon to start thinking about the next pandemic,” Bill and Melinda Gates wrote in their annual letter to then German Chancellor Angela Merkel.

Meanwhile, many global health specialists question whether the groups are capable of performing the rigorous post-mortems necessary to build a stronger global response system for the future.

“No one’s actually holding these actors to account,” said Sophie Harman, professor of international politics at the Queen Mary University of London. “And they’re the ones that are really shaping our ability to respond to pandemics.”

The above is a brief overview of Chapter 2 of a Politico/Welt investigation titled ‘How Bill Gates and partners used their clout to control the global Covid response – with little oversight’.  It details the shift in power from governments “overwhelmed” by Covid to a group of four non-governmental organisations: The Bill & Melinda Gates Foundation; Gavi; the Wellcome Trust; and, CEPI.

Featured image: Launch of the Access to COVID-19 Tools (ACT) accelerator (video)