When Covid-19 struck, four non-governmental global health organizations took on duties traditionally played by governments, but without any official responsibility, to construct a worldwide distribution strategy for Covid instruments to poor nations. 

They are the Bill & Melinda Gates Foundation, Gavi, Wellcome Trust, and CEPI. Gavi is the international vaccine organization that Gates initiated to inoculate people in low-income nations. The Wellcome Trust is a British research foundation that has multibillion dollar funds and had worked with the Gates Foundation previously. The Coalition for Epidemic Preparedness Innovations (CEPI), is the global vaccine R&D group that Gates helped in 2017.

The Gates Foundation opposed waiving vaccination IP (intellectual property rights, giving the formula for free), and civil society groups opposed Western-dominated committees guiding life-and-death decisions in impoverished nations. Soon, U.S. and European governments backed the four groups.

Due to their political and financial power, the Gates Foundation and other groups directed the international response to the century's most important health event. 

Since the epidemic began in 2020, the Gates Foundation, Gavi, and the Wellcome Trust have donated more to WHO than any other official member state. The ACT-A diagnostics and therapeutics teams only purchased 84 million tests and 1.8 million treatments by June 2021.

COVAX targeted 2 billion vaccine doses by 2021 but only delivered 319 million. Only 20% of Africans were immunized. Leaders of the groups allege wealthier Western countries were slow to supply immunizations and treatments.

“The ACT Accelerator is a multinational collaboration, and 

Coalition for Epidemic Preparedness Innovations

 and governments, to raise financial support of accelerated 

, production, and globally-equitable access to COVID-19 tests, therapies, and vaccines. In April 2020 it was launched by WHO, the European Commission, France and the Bill & Melinda Gates Foundation.”

The Gates Foundation stated that they concentrated on inexpensive, equitable vaccine availability for low- and middle-income nations, but then neglected vaccine supply to them. POLITICO and WELT determined that ACT-structure A's reduced accountability because money went directly to initiative participants. 

Gayle Smith, who oversaw the US State Department's global Covid-19 response, questioned ACT-A responsibility. Many poor countries and provinces were ill-equipped to handle the vaccination when the WHO decentralized the ACT-Accelerator program, leaving them to run things on their own without having the capacities to do so. Many potential beneficiaries lost faith in the global health system due to the delays. Only $2.2 billion of ACT- A's $23 billion went to modernizing other countries health services. 

The four groups spent millions to urge the U.S. and EU to adopt their pandemic goals, but global health experts disputed their ability to perform. CEPI will publish its assessment on the four organizations' Covid activities in September. The Gates Foundation and Wellcome have performed internal reviews, but neither has published the results.

Some officials and campaigners worried that the Gates Foundation's network of American billionaires could influence pandemic preparedness and reaction. The Gates Foundation set up a lobbying business in 2019 helmed by a former Obama White House policy aide. No lobbying disclosures have been filed. Throughout these past years, The Gates Foundation met with lawmakers and administration officials to explore pandemic spending.

CEPI and Gavi lobbied U.K. authorities at over 100 meetings from 2020 to 2022. Their organizations received billions in cash. From the beginning of the Covid crisis, the organizations served as coordinators for the global health community and contacted pharmaceutical businesses to gauge their readiness and ability to fast expand medical countermeasure manufacturing.

The Gates Foundation and Wellcome helped organize the first truly multinational WHO meeting on the virus. The symposium brought together global health leaders, researchers, and scientists. By February's end, WHO authorities had agreed on a global response to Covid, and The Gates Foundation had donated $100 million. CEPI signed four vaccine development agreements with the WHO.

With government backing and funding, what did they do?

The four groups spent a lot of money lobbying Congress for money to help low-income countries. The Gates Foundation issued a paper outlining COVAX, which would subsequently become ACT-A’s vaccination pillar. Early on, the effort went slowly, and civil society groups worried about exclusion.

One EU official claimed the organizations' decision-making wasn't transparent and that they should have been more public. ACT-A disputed claims that the consortium's decision-making was opaque. The structure baffled U.S. and European officials.

The WHO consortium established ACT-A without a head, and agencies handled their own budgets, programming, and donor negotiations. Money didn't flow to ACT-A or program organizations fast enough to distribute life-saving Covid equipment.

CEPI and its allies faced questions regarding fair distribution of vaccinations among low-income countries, but defended initial agreements without full equitable access provisions by stating speed was necessary in an imminent global health emergency.

In September 2020, approximately 1 million individuals had perished from Covid and four pharmaceutical companies were in clinical studies. Officials were worried. WHO and Global Fund representatives believe ACT-A was never a recognized organization or legal body and lacked checks and balances.

The four organizations guaranteed everyone equal access to life-saving medications and injections, but Western countries devoted resources to national initiatives rather than the virus fight abroad.

By October 2020, the U.S. had committed few resources to the worldwide response to Covid, and the CDC was one of the few institutions helping low-income countries battle the virus.

The Covid virus spread to Europe before the U.S. election, filling ICU beds and increasing death rates. 

COVAX tried to buy vaccination doses on the open market, but manufacturing capacity hampered progress. Western countries had placed orders, delaying production, and African authorities began to doubt COVAX.

In January 2021, Covid dosages hit the U.S. and Europe. Eastern Europe hadn't received any dosages, causing a crisis in March. The vaccine was initially given in the U.S. and EU on January 1, 2021. First doses weren't enough for vulnerable populations in low-income countries.

African governments battled to contain Covid while the U.S. and Europe received shots. WTO representatives from around the world debated whether to waive Covid's intellectual property.

Pharmaceutical business and top worldwide health institutions opposed waiving intellectual property protections, stating it wouldn't expand manufacturing. Some health activists regarded sharing IP and technological know-how as a way to improve self-sufficiency in traditionally excluded countries.

The WHO launched C-TAP to share intellectual property and how to make Covid products. The Gates Foundation wanted C-TAP to omit vaccinations, a source said. Global health advocates blamed the failure of C-TAP on drug corporations' refusal to share intellectual property or grant more open licensing. Not only Bill Gates opposed an IP waiver, Pharmaceutical CEOs called C-TAP "nonsense" and "hazardous."

The U.S. had enough vaccine doses to start sharing with the globe by March 2021, but the Biden administration opposed.

The U.S. didn't commit substantial doses to COVAX in spring 2021, which disappointed COVAX employees who believed the consortium was the best way to provide the shots.

The Biden administration decided to share dosages with the globe after dozens of meetings and conversations, but only after acquiring enough to meet demand.

The next pandemic is already being discussed: 

Four global health groups convened in 2022 to discuss the next pandemic. They promised to construct virus-detection and vaccine-delivery technologies for the next pandemic.

Still spreading, the Covid pandemic was beginning to decline. Bill Gates stated the next epidemic should be fought using next-generation vaccines. Since 2022, CEPI has spent $230,000 pushing for more money for the COVID-19 pandemic and the following pandemic. 

In March, world leaders, CEOs, and global health employees met at CEPI's donor conference to discuss the next pandemic. CEPI asked for $3.5 billion to establish a vaccine library for future pandemics, but raised less than half during its most recent fundraiser. 

Health activists say the mission to prepare for the next pandemic is already repeating mistakes from the current crisis, such as failing to invest in public-health services to deliver doses.

Critics believe ACT-A leaders identified the problem late. ACT-A aimed to build health systems in low-income countries during the pandemic, but financing was late. The Gates Foundation has been accused of not improving traditional health systems. 

It’s worrying to me that governments were not ready for a global pandemic, and the private sector had to step in. The narrative is that it was philanthropy, but the end results are clear: vaccines were not given away for free and business was made with rich countries. 

Reviewing Covid: Governments weren't prepared, Bill Gates ran the show

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