Today, the Gates Foundation is making its largest single contribution to fight the pandemic—$250 million. Why so much? And why now? It’s been roughly a year since COVID-19 first appeared. The rationale has to do with where the public health effort is at the end of 2020.
In the pandemic’s first year, the work of ending the pandemic was confined to a relatively small domain: Labs and clinical trials. That’s where researchers were developing new drugs, tests, and vaccines to fight COVID-19. Around the world, public health experts were doing hero’s work, setting up field hospitals; treating and testing patients; securing supplies of oxygen and existing drugs like dexamethasone. But no one thought those efforts were sustainable or that they’d neutralize the threat of COVID-19. They were aimed at suppressing the virus’ spread until researchers succeeded in developing medical solution to the disease, and now they have.
As of today, three vaccine candidates have emerged from the trials with high efficacy rates: Pfizer’s, Moderna’s, and AstraZeneca’s. Two antibody treatments have been authorized for emergency use. Another antiviral has been FDA approved.
The world now has much of the science it needs to end this pandemic, and as regulators start to put their stamp of approval on it, the field of action is widening beyond the lab. It’s expanding to the factories that will make the drugs, tests, and vaccines; to the warehouses, planes, and refrigerator trucks that will deliver them; to the clinics and health workers that will sit at the end of the supply chain and administer them to patients.
The planet is about to be crisscrossed by a massive anti-covid manufacturing and delivery network. In some places, it’s already up-and-running. The world’s richest nations have pre-purchased enough vaccine supply to cover their populations; some will be able to cover everybody two or three times over.
But the situation is very different for the majority of human beings that live in low- and middle-income nations, which include everywhere from South Sudan to Peru. In these countries, the supply chain hasn’t started to hum. Few deals have been cut with pharmaceutical companies, and the forecasts for vaccine supply are low. As things stand now, these countries will only be able to cover 20% of their people at most, according to our foundation’s projections.
Fair access to vaccines is part of our origin story. One of Bill and Melinda’s first big philanthropic acts was to help create Gavi, the organization that works with low-income countries to immunize hundreds of millions of kids. Part of today’s $250 million commitment will go towards funding a similar delivery operation for COVID-19 drugs and vaccines.
In fact, this announcement brings the Gates Foundation’s total contribution towards fighting the pandemic to $1.75 billion, and much of it has gone towards the production and procurement of crucial medical supplies. (The breakdown is visualized above; some of the funding, including today’s commitment, comes in the form of new direct grants; another tranche is repurposed funding from elsewhere in our budget, while still more is not direct funding at all; it’s in the form of loans and other financing measures. You can read more about our sources of funding here).
It’s also important to point out that there is not a hard break between the scientific phase of the fighting the pandemic and this new, more logistical one. In 2021, R&D funding will still be needed for new drugs, vaccines, and tests, in part because some of these initial ones aren’t ideally suited for low-income nations. The Pfizer vaccine, for instance, needs to be kept at sub-zero temperatures, which will be very difficult when transporting it to very rural areas. Our foundation will keep funding innovation.
Where our foundation’s role stops—and others’ start
How is our money actually transformed into new COVID-19 drugs, medical supplies, and the network to deliver them? We’re not doing the work ourselves. The Gates Foundation employs many talented people, but none of them are the researchers running the clinical trials or the health workers who will administer the shot of vaccine into a patient’s arm. Our partners do that.
In the early days of the pandemic, a good example of how we worked was with the Africa CDC. In early February, only two countries in sub-Saharan Africa had the lab facilities to test for COVID-19—Senegal and South Africa. But our foundation was able to release some emergency funding; it helped the countries build up the capacity of their labs and procure diagnostic kits, while the ACDC set up a training program for public health officials in the region. By the end of February, more than 40 African countries had the ability to test for COVID-19.
Today, the big effort to manufacture and deliver these supplies is the ACT-Accelerator, which is operated by organizations like the WHO, Gavi, and the Global Fund to Fight AIDS, TB, and Malaria. For 20 years, they’ve specialized in the task of procuring drugs, vaccines, and other lifesaving science. They also work with lower-income countries to transport them to health centers. These groups are the ones leading this work while our foundation assists with expertise and funding.
In fact, we cannot even be their main source of funding. The task is too big.
It’s hard to give a sense of scale of the public health effort needed to end the pandemic. The closest analogue might be India’s campaign to vaccinate 400 million kids with the measles-rubella vaccine. The project took two years, with another of planning. For COVID-19, the world must cover almost 18x the population—and do it in hopefully half the time. It will be a very expensive job. The ACT-Accelerator estimates that it needs another $28 billion next year. National governments are the only institutions with that kind of budget.
While wealthy countries donated in 2020, they have good reason give more in 2021. A new study from the Eurasia Group found that fair access to COVID-19 vaccines won’t just benefit low-income nations; it will also benefit the world’s 10 largest economies to the tune of $153 billion of extra GDP created in 2021 alone. Against the $28 billion that the Accelerator needs, that’s a jaw-dropping return on investment: 446%.
The shape of our recovery
The world should feel hopeful that we’ve reached this point. Even though we’re entering a costlier phase, it’s one we can be more confident about. It was never a given that researchers would develop safe and effective COVID-19 vaccines so quickly. The world’s experts doubted it could be done by the end of 2020. The work ahead isn’t the same in this respect. Thanks to groups like Gavi and the Global Fund, the world has known how to deliver vaccines and other supplies around the world for a long time.
2020 was a year that saw COVID-19 on the march. The pandemic got progressively worse. We can be confident that 2021 will play out in the opposite way. With new drugs, vaccines, and improved testing, the world will get progressively better.
But how fast will “better” happen?
The shape of our recovery—whether it looks like a “V” or “U” or a line that drags far too low, far too long—depends on how generous and committed world leaders are to this principle: That, in 2021, everyone, everywhere deserves to benefit from the science developed in 2020.
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