For decades, the United States has been at the forefront of global health initiatives, leading the fight against diseases such as HIV, malaria and Ebola. That changed with COVID-19, with the Trump administration focused on reserving treatments and vaccines for Americans.

But tucked into the latest Republican coronavirus stimulus proposal is $3 billion for coronavirus vaccines for poor countries.

“That’s the most impactful money ever” when it comes to bringing the pandemic to an end, Bill Gates told USA TODAY.

Since early May, Gates has been quietly advocating for the United States to retake its leadership role in global public health. He said this week’s proposal represents a return to that role – though the commitment falls short of what he believes is needed.

“The world’s not going to come together on this without the U.S.,” he said.

Gates said he has pressed the matter with Republicans, Democrats and administration officials including Dr. Anthony Fauci, Dr. Deborah Birx and people at the National Institutes of Health. Other leaders in the global health community are also working to get the United States more involved with the global effort to halt the coronavirus. 

The Republican stimulus proposal is the first to include significant funding to fight COVID-19 internationally. The $3 billion is earmarked for Gavi, the Vaccine Alliance. The Swiss-based global health group works to ensure that poor nations have access to vaccines, including ones to fight SARS-CoV-2, the virus that causes COVID-19. 

Fauci, the nation’s top infectious disease expert, said Gates is a friend and they talk “a fair amount” about the importance of vaccine availability.

“I’m very much in favor of the kinds of things that Bill is doing to make sure that when we get a coronavirus vaccine, that it is made widely available to the rest of the world,” he said.

The main reason, he said, is that it’s the right thing to do from a humanitarian perspective. And “if we don’t get this outbreak under control – eliminated – so that most of the world is protect by a vaccine,” it will remain a threat to the United States.

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“It might come back to bite us,” Fauci said.

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Making sure poor countries get coronavirus vaccines

Getting enough vaccines for the 2 billion poorest people in the world will cost an estimated $12 billion to $16 billion. Gavi, originally called the Global Alliance for Vaccines and Immunization, has been raising money for a coronavirus vaccine since spring.

Without U.S. involvement, it has raised just $600 million. Gates is adamant that the U.S. must resume its leadership role and get other nations to contribute. 

“It’s hard to overstate how much the U.S. historically has led all these global health things,” he said. Once other countries see that the U.S. is on board, they’ll step up as well, he said.

If the U.S. committed $4 billion, Gavi could secure volume guarantees and purchase one or more vaccines for poor countries to slow and eventually halt the spread of the virus, said Dr. Seth Berkley, Gavi’s CEO.

“A strong and comprehensive international response now is as urgent as ever, especially in the countries least equipped to combat it,” Berkeley said. “Until we protect people everywhere from the threat of the virus, no one is protected anywhere.”

Gates wants U.S. to contribute more worldwide

The Trump administration has diminished the U.S. role in funding global health initiatives, most pointedly by beginning to withdraw from the World Health Organization this month. 

Gates said he saw this early in the coronavirus pandemic. He became concerned and started making calls.

Every call isn’t answered, but those around him say he’s tenacious on global health and education, which has been the focus of the Bill & Melinda Gates Foundation since 2000. He keeps calling until he reaches the person he believes needs to hear his message – in this case, about the importance of vaccinating everyone worldwide, not just those in wealthy countries. 

The Gates Foundation, one of the largest health charities in the world, has committed more than $350 million to support the global response to COVID-19.

Gates said he’s happy to see $3 billion in the Republican bill, but he wants to see the U.S. contribute $4 billion to the global vaccine effort. That’s a tiny percentage of the $1 trillion coronavirus emergency appropriations bill unveiled Monday by Senate Republicans. 

“If we get the $4 billion in the bill, then you could say the United States is coming through in a strong and bipartisan way to help the world, and help itself,” Gates said.

Whatever the Senate passes will have to be reconciled with the House’s stimulus proposal, known as the HEROES Act, passed in May. 

The House did not include any money for Gavi in its stimulus legislation, though that bill would promote efforts to expand U.S. involvement internationally. It would direct the president to create the position of United States Coordinator for Global Health Security.

‘Vaccine nationalism’ or a global approach?

Gavi serves a crucial role as the gateway for vaccine access for dozens of the world’s poorest countries, said Jason Schwartz, a professor of health policy at the Yale University School of Public Health.

It’s not simply altruism, he said.

“It’s a win-win. It helps the global control of the pandemic and so protects our citizens,” Schwartz said. “And it’s a small investment that helps billions of individuals who otherwise would have very limited or no access to vaccines.”

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As companies near widespread clinical testing for several potential vaccines, time is growing short for the U.S. to step up, said Thomas Bollyky, director of the global health program and senior fellow for global health, economics and development at the Council on Foreign Relations. 

“We really have a six- to 10-week window,” Bollyky said. “After that, it will be harder and harder for countries to avoid the tragedy of vaccine nationalism” by focusing solely on their own citizens.

There’s also a narrow window for the U.S. to fill the strategic vacuum left open by not leading the effort for a worldwide vaccine, Gates said. 

“Our strategic competitors, they come in and fill that vacuum,” he said. 

Building production capability now

The Gavi program is different from the U.S. Operation Warp Speed effort, which is focused on paying in advance for hundreds of millions of doses of COVID-19 vaccine candidates that may or may not pan out.

U.S. leaders are betting, with good evidence, that one of the five to seven candidates funded by the federal government will prove successful. If they’re right, the vaccine can be licensed and distributed immediately. Doses of any vaccine that doesn’t work will be destroyed.

Gavi doesn’t plan on manufacturing vaccine doses in advance; it aims to have money to buy them as soon as a vaccine is licensed. That will encourage vaccine manufacturers to increase production capacity now.

If manufacturers don’t see that Gavi has the money sitting in the bank to buy vaccines, they won’t spend to build the necessary plants now to make them, Gates said.

His behind-the-scenes work would be transformational if it succeeds, said Lawrence Gostin, director of the World Health Organization’s Collaborating Center on Public Health Law and Human Rights.

“The Trump Administration, aided by the Senate, has taken an ‘America First’ approach to the COVID-19 response, including a strategy of vaccine nationalism. We have sidelined international organizations like the WHO,” he said. “If Congress were to allocate real funding to Gavi for vaccine production and distribution, it would be a powerful symbol of global solidarity.”

Contributing: Ledyard King in Washington D.C.

The Bill & Melinda Gates Foundation provides funding for education reporting at USA TODAY. The Gates Foundation does not provide editorial input to USA TODAY, nor funding for any other coverage area.

This article originally appeared on USA TODAY: COVID: Bill Gates pushes US to fund vaccines for poor countries


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