The head of one of the world’s largest vaccine manufacturers had a problem. Adar Poonawalla, executive director of the Serum Institute of India, needed $ 850 million on everything from glass vials to stainless steel tanks so he could make doses of promising coronavirus vaccines for the world’s poor.

Mr. Poonawalla reckoned he could risk $ 300 million of his company’s money, but would still be more than half a billion dollars missing. So he found a retired software manager in Seattle.

Bill Gates, the philanthropist Microsoft founder, had known Mr. Poonawalla for years. Mr. Gates had spent billions getting vaccines to the developing world and worked closely with pharmaceutical executives to transform the market. In doing so, he has become the most powerful – and provocative – private actor in global health.

At the end of their conversation that summer, Mr. Gates had made a promise: The Bill and Melinda Gates Foundation would provide a $ 150 million guarantee to allow the Indian factory to move forward with production.

It’s part of a $ 11 billion effort to lay the groundwork for coronavirus vaccine sourcing for more than 150 countries, though it could ultimately cost far more if the doses get through. The initiative is led by two global not-for-profit organizations, which Mr. Gates helped create and fund, and the World Health Organization, which has the Gates Foundation as one of its largest donors.

Behind the scenes, the second richest man in the world works, neither a scientist nor a doctor, who sees himself and his 50 billion dollar foundation as uniquely ready to play a central role.

“We know how to work with governments, we know how to work with pharmaceuticals, we have been thinking about this scenario,” Gates said in a recent interview.

As the first vaccine candidates move towards approval, the question of how much of the world’s population can be immunized has become more urgent. But nine months later, the success of the vaccination effort known as Covax is by no means certain.

So far, only $ 3.6 billion has been raised for research, production and subsidies for poor countries. Three companies have promised to supply vaccines, but it is not yet known whether they will be effective. And securing the billions of doses needed in an affordable and timely manner can be difficult because the United States and other wealthy countries have separate treaties for their citizens.

If the initiative, backed by Mr. Gates’ fortune and focus, helps protect the world’s poor from a virus that has already killed more than 1.3 million people, it will validate the strategies he is using in his philanthropic Promoted work, including incentives for drug companies.

If the effort falls short, however, it could reinforce the need for a more radical approach.


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