October 4, 2022

There are dozens of global health organizations that have worked on Covid; those included in POLITICO-WELT’s financial analysis played an important role in devising and establishing critical programs, including at the World Health Organization, to develop, secure and disseminate tests, vaccines and treatments.

Money and power

tThe four organizations have collectively spent just under $10 billion fighting Covid since January 2020 — the same amount as the U.S. Agency for International Development, the main agency supporting U.S. Covid efforts abroad. Their financial power enabled them to access some of the highest levels of government in the US and in Europe.

Gavi spent more than any other three organizations operating COVAX, the initiative to help low- and middle-income countries secure vaccine doses against Covid. More than 90 percent of the group’s $6 billion in Covid spending took place in 2021, after it lobbied US and European governments for donations to get doses to low-income countries. The organization helped vaccinate millions of people around the world, but missed its overall target of delivering 2 billion doses by the end of 2021.

POLITICO-WELT’s financial analysis found that the Gates Foundation spent a total of $2.1 billion. A spokesperson for the foundation confirmed the POLITICO and WELT team’s findings on its Covid investments, but said the larger financial analysis was not “fully consistent” with its own breakdown of Covid spending. Earlier this year, the foundation published some details of his releases on his website.

In addition to their massive contributions to global health efforts, these organizations’ lobbying resources enabled them to easily access some of the leading officials in the US and Europe. Over the past two years, the leaders of the four organizations have spent at least $8.3 million lobbying lawmakers and officials in the US and Europe, according to lobbying revelations. They held dozens of meetings with health and political leaders, not only to raise more money for their organizations, but also to push governments to rethink how they approached the fight against Covid.

For example, all leaders of the organizations urged governments to spend more money and donations for the distribution of vaccine doses in low-income countries. The Gates Foundation also urged the US to share publicly the immune correlates of protection — immune markers that could help other institutions develop their own vaccine products.

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The organizations also have significant influence at WHO. Their funding to the WHO, including paying staff positions there, gives them access to leaders of the multilateral organization, with whom they often talk about how to improve pandemic preparedness. The WHO sets international policy on how countries should respond to large-scale outbreaks of infectious diseases such as Covid.

Together, the four organizations donate billions of dollars to the WHO every year. The Gates Foundation was the second largest donor to the WHO, after Germany, from 2020 to 2021. Gavi also donated a significant amount to the organization — a total of $432 million from 2020 to 2021. Jeremy Farrar, Wellcome’s director , previously chaired a scientific advisory group for research and development at WHO, and advised its director-general on the global fight against Covid.

CEPI is the only organization of the four that has not given to the WHO.

Because the three organizations were already connected to WHO, they were able to help set up a program at WHO that would allow for more funding for their operations during Covid. The Gates Foundation has prepared white papers on its creation.

In 2020, the groups, along with several other global health organizations and representatives of the WHO, created the Covid-19 Tools Accelerator, also known as ACT-A. That initiative, which leaders of the four organizations describe as a loose collaboration, aimed to accelerate the development and distribution of tests, treatments and injections. The WHO oversaw the effort, but leaders from the partner organizations, including Gavi and CEPI, played a vital role in the day-to-day operations of the initiative. Wellcome employees, including Farrar, were also heavily involved in ACT-A meetings.

Representatives of the organizations, WHO, as well as government officials from Norway and South Africa, developed a budget and funding framework for ACT-A that encouraged donors to provide funds for the development of the medical countermeasures.

CEPI and Gavi would then receive billions of dollars in funding, primarily from governments, to work on the development, procurement and distribution of vaccine doses to low- and middle-income countries through the COVAX efforts.

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Of the $23 billion that ACT-A partners — such as Gavi and CEPI — received, the vast majority went to develop and distribute vaccines, including COVAX. Only $2.2 billion went to strengthening health systems.

COVAX failed to deliver on its promise to deliver 2 billion doses to the world by the end of 2021, but it did achieve its goal of vaccinating 20 percent of the population in the low-income countries it serves. Because of delays in vaccine production and hoarding by Western countries, leaders of the ACT-A vaccine initiative say millions of people in low-income countries have missed doses. Today, only about 20 percent of people in Africa are fully vaccinated.

Ties between the money

tThe strength of these organizations is partly rooted in the way they support each other’s missions.

The four organizations differ in the way they raise funds, allocate funds and generally operate. Two of them – Wellcome and the Gates Foundation – are philanthropists profiting from billions of dollars. They are among the largest charities in the world.

CEPI uses money from both the public and private sectors to fund its research and development activities. And Gavi, an organization that focuses strictly on immunization, takes mainly public money – its board is made up of government representatives from donor and recipient countries.

Three of the organizations are directly affiliated. The Gates Foundation has helped fund the creation of both Gavi and CEPI. Founded in the 1930s in the UK, the Wellcom Trust worked with the Gates Foundation to develop Covid treatments and individually donated $22 million to CEPI to help accelerate vaccine dose development.

The Gates Foundation and Wellcome Trust have financially supported the COVAX effort – led by Gavi, CEPI and UNICEF – to broaden access to Covid shots.

The organizations often collaborate on pandemic initiatives and coordinate strategies to combat infectious disease outbreaks around the world. During the Covid pandemic, they also overlap investments and grants, according to POLITICO-WELT’s financial analysis. They gave millions of dollars to dozens of the same organizations, including pharmaceutical companies and academic institutions.

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The overlap underscores the extent to which the decisions of the four organizations benefited certain groups over others. For example, it shows how they viewed certain pharmaceutical organizations as critical, such as China-based Clover Biopharmaceuticals and UK-based AstraZeneca.

A priority for vaccine

tThe four organizations have invested heavily in the development and procurement of a Covid vaccine and have spent $2.4 billion. About 75 percent of the funding that went to develop and purchase medical countermeasures — including injections, tests and drugs — went to vaccines.

CEPI has made the most commitment, according to the financial analysis, funding more than $1.7 billion in vaccine development and procurement. Almost his entire Covid portfolio was focused on it. More than 30 percent of the Gates Foundation’s total Covid spending went to vaccine development, including $400 million in loans and volume guarantees to secure doses for distribution around the world.

(An important note: POLITICO and WELT were unable to independently verify how much Gavi spent on purchasing vaccine doses for COVAX. It did not release details about how much it paid drug companies for its advanced dose purchase agreements. See our methodology for more information).

Far fewer resources went into developing and purchasing treatments and tests, indicating how heavily the four organizations are putting their financial weight behind the vaccine. Some of the leaders of the organizations, including Bill Gates in a February 2022 interview with POLITICO, have said more should have been done globally to invest in both the development and distribution of therapies.

The four organizations are currently lobbying lawmakers and officials in the US and Europe to allocate more resources to pandemic efforts, including funding a next-generation vaccine. In his new book, Gates is calling on governments to fund a team of pandemic experts, including epidemiologists and other scientists and public health experts who can travel to help countries respond to health crises. He also calls on the world to do more to strengthen health systems around the world to ensure they are prepared for the next large-scale outbreak of infectious diseases.