Gates' impact on global health and biologics manufacturing to increaseGates' impact on global health and biologics manufacturing to increase

Bill Gates plays an outsized role in global health despite the fact that he has no formal training in medicine or science. Nevertheless, he has cemented his place in global health policy. He has particular influence over poorer countries through the Bill & Melinda Gates Foundation and his personal assets.  

The Foundation is the second largest donor to the World Health Organization (WHO) at $638.2 million, following the United States ($678.4 million) and nearly quintupling contributions from countries like Germany ($129.9 million) and the UK ($108.1 million). This position has allowed Gates to directly influence policy on vaccine patents in a way that has negatively affected mRNA vaccine manufacturing in low- and middle-income countries (LMICs).  

For example, as reported on by The New Republic, the “Gates-directed tech-transfer mechanism without meaningful input from WHO members states […] would be a "body blow" to [the COVID-19 Technology Access Pool] and similar future initiatives that promote open licensing and knowledge sharing to maximize production and access.” 

With US President Donald Trump preparing to pull the US from the WHO, the Gates Foundation will become its primary funder. Mark Suzman, CEO of the Foundation, responded to the news: 

“We believe engaged US leadership is essential to helping build a more effective and efficient global health system with the WHO playing a central role,” he said. “As we look to the future, we will continue to make the case that instead of retreating, leaders in the United States should prioritize strengthening WHO’s capacity to address global health challenges, ensuring that US investments continue to build a healthier, safer future for all.” 

James Love, director at Knowledge Ecology International (KEI), reflected on the Gates Foundation’s reversal on patent policy mid-pandemic. 

“I’m not sure how durable or consequential the Gates statement was on COVID,” he told Tides Global, “although it was welcomed, even though pretty late and narrow.” Love believes the statement was a “a PR move, but not a real change in Foundation policy or Bill Gates' thinking.” 

Love believes patents are only part of the story when it comes to drug access.  

“The IP issues are one thing, but I think a significant challenge is more demand related,” he explained. “You can build facilities, train staff, and even acquire know-how, but if you don't have a market for the generic products, it is not sustainable.” 

“Regulatory barriers are significant for some products, certainly for vaccines, and procurement policies,” he continued. “To make diversified manufacturing feasible, there has to be some realistic analysis of the demand for products over time.” 

Meanwhile, questions remain as to whether efforts from Gates and his affiliates to fund manufacturing initiatives will, on balance, facilitate manufacturing of mRNA vaccines. In the face of a potential avian flu pandemic, these questions may need answers sooner than we think. 

Quotes have been lightly edited for clarity. 

Søren Hough is the editor of Tides Global, which covers emerging peptide, mRNA, oligo, and genome editing therapeutic.