Covid: Bill Gates and Vaccine Production

by ZviDon't Worry About the Vase10 min read28th Jan 202118 comments

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Covid-19
Personal Blog

Vaccine production, and in particular vaccine production by Pfizer and Moderna, has languished for want of a few billion dollars, well within the budget of many individual philanthropists. It is an important fact about the world that none of them stepped up and fixed the problem. At most one of them is known to have perhaps made a serious attempt, with that one being Bill Gates.

So what exactly has he been up to, as a longtime proponent (to his credit) of vaccines and vaccination efforts? 

I want to be clear: This is not me going after Bill Gates and saying he is bad. This is investigating the question of why it seems that no one with power can do anything useful, and investigating the person who appears to have power who people thought might be doing useful things, and who looks like he is in a strong position to do useful things, with a stated priority and even explicit commitment of spending his money to do exactly the most useful things. 

I also want it to be clear that Gates has far from full control over the actions of his foundation, and for reasons he is unwilling or unable to act outside of the foundation, a pattern that seems to be common among the wealthy.

This is not about Gates being unusually terrible. Quite the opposite, he seems unusually well-meaning. Especially for his reference class. 

It’s important to note that this was not enough.

Early on Gates was planning on spending billions to ramp up production capacity on seven distinct vaccine candidates, despite not knowing which one will work. That seemed like exactly the right thing to do.

That didn’t end up fully happening. Gates did not do it, as evidenced by this press release which puts total Gates contributions to all Covid-19 efforts prior to the tail end of 2020 at 1.5 billion. Which isn’t enough, and mostly went to other things. And for him, this was definitely a case of ‘someone has to, and no one else will.’

Indeed, no one else did, and these graphics comes from a BBC article asking the question “Will drug companies make bumper profits?” because somehow that’s what everyone cares about:

The “no one else will” part was especially true once Gates said it loudly enough that everyone (at the time including me) vaguely thought he would do it, seemingly without calling on anyone else to help do it, thus taking any remaining pressure off everyone else to do it, given he was now the Reasonable Authority Figure it was now definitively Someone Else’s Problem.

There was even a Metaculus question about this, which hasn’t resolved, and predicts that some facility partly funded by Gates will begin making vaccine within a few months, but hasn’t done so yet:

That market has only about a 6.7% chance this doesn’t happen at all, which seems super low if there is no path that will clearly work.

The comments suggest he did make the non-zero investment in seven options.I couldn’t figure out which facilities he actually funded other than SK Bioscience, but clearly it wasn’t Moderna, Pfizer or AstraZeneca, and the timing here is too delayed to be Johnson & Johnson. And it looks like SK Bioscience only got $3.6 million, with an M, which is helpful but not the thing that we are looking for here.

Here are the other things I could find that he’s been up to:

1:

This seems to essentially be foreign aid to low-income countries, dedicated to vaccine purchases, which presumably partially does increase the amount of vaccine purchased, although it will also be partially offset by reduced other counterfactual vaccine spending getting redirected. Since such purchases are not going to pay a premium for doses, and all doses that are going to be produced are spoken for indefinitely, it won’t speed up vaccine production.

2 (the press release above) was an announcement of an additional $250 commit on December 9th:

Distribution is a problem but the limiting factor is vaccine production. If we could scale up, especially the AstraZeneca and Johnson & Johnson vaccines, that would be far more helpful, and the economic savings from accelerating vaccination in the first world would more than pay for all needed efforts to then accelerate things globally. Yet all these efforts seem directed at third world distribution efforts, where one can pitch oneself and be seen as caring primarily about equity rather than efficiency, thus providing the deniability to provide at least some helpfulness.

That theory can be reinforced by looking at the front of the Gates Foundation website:

Pictured: An old rich straight white man claims that all lives matter.

This plausibly prevents Gates from doing anything that could benefit those in the first world before then benefiting those in the third world, no matter how effective or efficient it might be. 

They are spending their bandwidth this week warning about immunity inequality. 

It also likely makes it pretty hard to write a ten-figure check to Pfizer or Moderna.

It is a standard Effective Altruist take and a highly reasonable argument to look to save lives in the third world, because you can usually save more lives there for less money. Current inequality creates an opportunity for us to have more leverage and do more good, while this process of putting effort where it has the biggest marginal impact then reduces that inequality. That’s very different from treating the inequality as the problem, rather than my preferred perspective of treating people suffering and dying as the problem, and leads to different choices with different outcomes.

(I also noticed he had an old call for lockdowns to follow a fixed policy across the country (WaPo) which doesn’t seem appropriate given the different conditions that are often in place in different regions or states, that don’t seem mainly to be caused by policy variations. A uniform policy early might have helped but by June seems like it would have backfired even under better conditions. I’m guessing the reception helped push Gates towards inaction and staying quiet.)

3:

Again, it’s all well and good to care about providing care to the third world, much better to do that than to do nothing, but if you focus on the logistics of distribution and on the places that pharma companies do not make money, you are not going to accelerate the production of vaccines.

4: The third link then leads into this detailed list of grants. It looks like (it’s a super long list and you need to scroll through manually so I could have missed something) they gave millions to vaccine development (it’s a category of grant) but I don’t see any major emphasis on vaccine production.

So, something happened that directed the Gates Foundation away from its stated priority of supporting the thing that matters most, towards other priorities that matter less, including mattering less to the third world, since the best way to get them their vaccine doses is to produce enough for everyone as quickly as possible.

It seems perfectly reasonable to have been initially skeptical of mRNA and not fund those efforts in January, it was an unproven technology and that’s a judgment call, but as data came in that got less reasonable, especially with the contacts Gates has access to.  

At a minimum, tt seemed clear enough mid-year (let’s say mid-May for Moderna, mid-July for Pfizer) that some combination of Pfizer, Moderna and Oxford had top candidate vaccines, it seems clear that a few billion could have vastly accelerated production, and as far as I can tell, Gates did not make any visible public attempt to spend that money or get others, either in government or other individuals or corporations, to spend that money. 

I find it highly implausible that Gates, if he was making an effort to pay attention to developments and gather information (which I assume he was, and if he wasn’t one would ask why he wasn’t), would be unaware that those particular vaccines were probably both safe and highly effective, or that he wouldn’t at least know they were winning the race while having huge potential and potentially working, or that he would have been unaware of the opportunity to spend money to ramp up production, especially since he explicitly (and correctly) was the first loud voice to endorse the concept of spending money to ramp up production in advance in the public discourse, and also pledged to spend to do so. 

I also find it impossible that Gates does not understand the urgent need for speed, yet he issues statements like this one on his website, falling in line with senseless public messaging he knows is both false and killing people:

It seems more plausible that the Gates Foundation saw that those vaccines were going to help the first world first, and had corporate backing, and thus considered them to be invalid targets that they weren’t allowed to help. 

Then there’s the situation with the Oxford vaccinewhich it seems they… kind of… sabotaged?   


I’m sure there were good reasons at the time for choosing AstraZeneca, and no one expected them to botch the vaccine trials, or to fail to ramp up production as scheduled. I’m not even saying it’s their fault that they are struggling to ramp up supply or meet the expectations they set. Except it is totally the fault of everyone involved in the sense that they signed an exclusive contract rather than being one of many that was allowed to make the drug. 

I’m all for using temporary monopolies as a reward for new discoveries, and allowing companies (and in some cases universities) to profit from it. AstraZeneca is pledging to not make any money from the vaccine until the ‘end of the pandemic’ and therefore giving itself so little incentive to scale up quickly that it actually makes more money by scaling up more slowly, then it scales up slowly, we really really shouldn’t be acting so surprised. What was wrong with the original plan to open source the vaccine to any company that wanted to make it and have them compete to scale up production? 

Would the competition have been so intense no one would have done it? That seems highly implausible at best.

So what the hell were Oxford and the Gates Foundation doing here? Why let a pharma company get exclusivity, get most of the glory and effective credit, and give them an active incentive to slow roll production, rather than the option to foster competition? 

If the issue was that AstraZeneca paid them money for a vaccine they can’t make money off of except with a slow roll, I don’t know the terms of that deal, but Gates should have been putting together a competitive compensation package, rather than urging Oxford to make the deal. Seriously, if you need to, you can straight up Cut Lex Luther a Check

It’s almost as if some invisible force is pushing decisions towards being unhelpful.

Gates has what look like easy answers available here, but they’re not easy answers, because there are massive forces pushing against him, including attempts to alter his perception of reality so the easy answers don’t look like the things to do, and also active forces that threaten to punish him for trying to implement the easy answers or other intentionally helpful actions.

Gates is already the target of massive amounts of ludicrous conspiracy theory regarding vaccines. He literally has to put in his FAQ that he isn’t planning to microchip people. Perhaps that’s a large part of how the message was implicitly given to him by the world to stop being seen as being motivated by a desire to be helpful, or else. 

It could well be wise of him to respect such forces. He’s an old, rich, immensely nerdy straight white male who made his fortune off a product most closely associated with an annoying talking paperclip and being broken up as an illegal monopoly, with enough money and prestige to make him be seen as a threat. Again, there’s already a double digit percentage of Americans who think he’s part of a (completely nonsensical and nonexistent) evil plot to microchip them, among other things. I understand why he’s afraid, and whether or not he ever reads this, I want him to know that I sympathize and wish him the best. 

And also that it’s not too late to help ramp up that vaccine production. 

(Note: This was originally part of the weekly post, but stands on its own and is not time sensitive, so I have made it to its own post. The full post will go up on schedule later today.)

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I mostly think you are asking good and appropriate questions, but wanted to add some important context that is missing from the writeup here. In March, the Global Preparedness Monitoring Board, on which the Gates Foundation serves, announced an $8 billion fundraising effort for a range of priorities including vaccine manufacturing capacity. After committing $250 million of its own, Gates shortly afterwards co-launched the COVID-Zero campaign with Wellcome Trust which was intended to be the private-sector fundraising component for this effort. While a specific goal for COVID-Zero was not disclosed publicly, it raised only $27 million; almost all of the remaining gap was covered by national governments and the European Commission on a giant virtual telethon on May 4. By that point, this international effort had morphed into what is now known as the ACT-Accelerator, one of the planks of which was to spur vaccine production by offering Advance Market Commitments (AMCs) to vaccine producers globally through Gavi's COVAX Facility. Although this didn't involve paying for manufacturing capacity directly, the thinking was that with money in hand, vaccine producers would be more likely to ramp up production sooner. It's important to note that COVAX includes both rich and poor countries; the whole idea was to make an attractive pooled global market for vaccine makers that wasn't distorted by individual countries' purchasing power. However, COVAX has struggled to raise the money it needs, mostly because under Trump the US was extremely disinterested in funding it and preferred to invest in the US-specific Operation Warp Speed instead (but underfunded that too). In the December stimulus bill, however, the US earmarked another $4 billion for the ACT-Accelerator and the Biden administration has planned more in the next round of stimulus it's proposed.

While contributing a minority of the funds itself, the Gates Foundation has contributed, to my understanding, a great deal to the reality of this shared fundraising commitment among world governments. It's not enough, but it's about 15-20x what the foundation has done on its own and unprecedented in the context of previous pandemics. Now, your post is asking why the foundation hasn't done even more. I doubt very much that it's because of equity considerations; it seems much more likely that it just didn't want to take away too much from its core programming; its longstanding fights against polio, TB, malaria, etc., have faced significant setbacks from being overshadowed by COVID, and it's generally quite difficult for foundations to radically shift their programming in a short period of time. A statement from the foundation at the above link provides some clues here:

The Bill & Melinda Gates Foundation remains committed to its core areas of focus including reducing infectious disease, eliminating extreme poverty, and improving U.S. public education. The COVID-19 pandemic is affecting all areas of our work and the ripple effects will be felt for years to come. While we’ve announced $250 million in funding to date and a commitment to leverage our Strategic Investment Fund toward the pandemic, we are increasingly focusing the expertise of our staff and leveraging our partnerships toward the urgent efforts needed to end this pandemic.

"We are increasingly focusing the expertise of our staff and leveraging our partnerships" -- i.e., instead of giving money. I think Gates concluded, reasonably so, that the foundation could have more impact trying to get governments to give more than taking away from its own investments.

With that being said, your core argument that Gates could have done more still stands. The US government certainly could have done a lot more. And so could have the Europeans. It is indeed quite puzzling that vaccine production and distribution attracted so much less investment than economic supports across the world, despite their obvious importance. It seems like the global coordination on vaccines we saw last year represented a major step forward from past practice, but is still far away from what would be ideal.

This is investigating the question of why it seems that no one with power can do anything useful, and investigating the person who appears to have power who people thought might be doing useful things, and who looks like he is in a strong position to do useful things, with a stated priority and even explicit commitment of spending his money to do exactly the most useful things. 

I also want it to be clear that Gates has far from full control over the actions of his foundation, and for reasons he is unwilling or unable to act outside of the foundation, a pattern that seems to be common among the wealthy.

At some point I'm going to write a post on a generalization of the message here. Roughly speaking: money and status mostly provide the appearance of power, not actual power. They are often necessary conditions for actually being able to change things (because the appearance of power is often exactly what is needed to solve coordination problems), but not sufficient. Once you have enough money/status, the limiting factor becomes understanding things thoroughly enough to engineer ways around the barriers, and that understanding largely cannot be outsourced to people you hire.

To elaborate on your last point: beyond the benefits of appearing to have power, there's a difference between being in a high-power world state (having billions of dollars) and being able to actually compute (and then follow) policies which exercise your power in order to achieve your goals (see Appendix B.4 of Optimal Policies Tend to Seek Power for a formal example of this in reinforcement learning). 

Vaccine production, and in particular vaccine production by Pfizer and Moderna, has languished for want of a few billion dollars

Is this actually true? Money is necessary but not sufficient. Concrete problems e.g. of industrial process have to be solved too. 

According to BioNTech it's not true and they add no room for funding in 2020.

I also want it to be clear that Gates has far from full control over the actions of his foundation, and for reasons he is unwilling or unable to act outside of the foundation, a pattern that seems to be common among the wealthy.

That's a curious pattern, anyone has more to say about it?

In order to qualify as a non-profit, a foundation needs to have decisions made by a board, not a single individual. 

I'm not sure to what extent this also plays in to vaccine production specifically, but the requirement for being a foundation at all is you need to give 5% of your endowment annually to charitable causes. If vaccine production is not being carried out by qualifying 501(c)(3) non-profits, then any money you give them doesn't count toward that requirement. 

Why is the Gates foundation a charity, as opposed to just a non-profit? If he wants to take Buffett's money and give him a tax benefit, then it has to be charity, but for spending his own money, he doesn't need this status.

He gets a tax benefit due to timeshifting. If he puts stock into the foundation he gets the tax benefit immediately even though the foundation will pay out that money over time. In return he has given up some control and is legally obligated to give away 5% every year.

It's definitely not the only way. Zuck's equivalent is an LLC, which is less tax efficient but more flexible.

What was wrong with the original plan to open source the vaccine to any company that wanted to make it and have them compete to scale up production?

Bill Gates himself addresses this question here: https://youtu.be/Grv1RJkdyqI?t=558

The reasoning as I understand it: Vaccine production is too complicated for open access to work well. There is a significant risk that something goes wrong and the vaccine factory has to shut down, so it is better for that factory to be producing a vaccine they know exactly how to do. Oxford partnering with AstraZeneca ensures they can work closely together to get the production right.

Could they have made a non-exclusive deal? Probably, but (a) AstraZeneca might not have been interested in that case and (b) Oxford might not even have the capacity to work with more than one partner.

Could they have ensured better incentives to ramp up production quickly? Definitely, but that seems like a decision mostly independent of making an exclusive deal.

I suspect that Gates had a long-standing specific plan for manufacturing old-fashioned vaccines, but was unable to pivot to funding new vaccines. It's a lot harder to spend money to speed up deployment of new technologies, especially at arm's length.

AZ claims this week that the EU negotiations being delayed for a couple months delayed their factories. Why couldn't they just start earlier? This is a clear claim that money would have mattered. But maybe there is a lot more to this than physical construction. The EU is currently threatening to confiscate AZ vaccine, so maybe AZ didn't see any point in building factories in countries that hadn't pre-paid.

It seems perfectly reasonable to have been initially skeptical of mRNA and not fund those efforts in January, it was an unproven technology and that’s a judgment call, but as data came in that got less reasonable, especially with the contacts Gates has access to.  

CEPI is partly founded and funded by the Gates Foundation even when the linked article doesn't say so explicitly. Pretending like Gates was skeptical of mRNA in January seems like you didn't look at who the players are.

I'm trying to be charitable, and I also see 'excited enough to do research but skeptical enough to not pre-build the factory' as a reasonable position. 

(And I think it's clear that this was me attempting to learn about the players. Gates Foundation declined my request for information, saying they lacked time to schedule an interview, despite my offer to postpone for up to a week.)

So dumb is the world. Pick a goal, pursue it. If Gates wanted to make sure the world's poor got vaccine, he could have commissioned new vaccine manufacturing plants located in (the rich parts of) poor countries, with guarantees offered to the governments of said countries that all locally manufactured vaccine would go to that country first. Make 32 million doses (about 2 months of production) in Ghana, for Ghana, and then start exporting.

There's no such thing as a general vaccine factory. It also might very well take years to get a new vaccine factory build in Ghana where there's little existing talent and infrastructure. You generally build factories in locations that actually lend itself to effective production.

Maybe. Building takes time, but we had 3 months there between "oh shit" in March (when siting, decision making, and planning could start) and "ok, these vaccines look promising" in June, and another 6 months before they were getting approved. Which is plenty of time to physically ship building materials and production equipment, train local people to use it, and start manufacturing.

Note: I picked Ghana because that's the name that came to mind, but 5 minutes of reading wikipedia indicates that it's actually not a bad choice to site a pharmaceutical manufacturing facility. In fact, Gates (or whoever) wouldn't even need to pay the majority of the costs - just paying the salary of 2-3 experts / coordinators and greasing the wheels to get the deals made, and the Ghana government could pick up the construction & staffing costs (and, thereby, reap the benefits)

There's no such thing as a general vaccine factory. 

Out of curiosity, how true is that if we limit ourselves to mRNA vaccines (AKA what seemed to be the leading possibility from May-June onward)? The production processes for mRNA molecules themselves are quite general, and mixing the salts, acids, sugars, and stabilizers shouldn't require unusual equipment. As I understand it the lipid production is more specialized, but it seems likely that the same or similar lipids would be needed for a wide spectrum of mRNA vaccines?

The production processes for mRNA molecules themselves are quite general, and mixing the salts, acids, sugars, and stabilizers shouldn't require unusual equipment.

Mixing the mRNA molecules with the lipids needs specialized equipment. Derek Lowe writes in Myths of Vaccine Manufacturing:

My own guess as to what such a Vaccine Machine involves is a large number of very small reaction chambers, running in parallel, that have equally small and very precisely controlled flows of the mRNA and the various lipid components heading into them. You will have to control the flow rates, the concentrations, the temperature, and who knows what else, and you can be sure that the channel sizes and the size and shape of the mixing chambers are critical as well.