The new coronavirus, which the World Health Organization had named SARS-CoV-2 four days earlier, was the nightmare scenario that Bill Gates had been predicting for years: a deadly virus with the potential to sicken millions of people and devastate the global economy. He had warned, in 2010, that the H1N1 outbreak was a “wake-up call” for the world to prepare for a deadly pandemic. Five years later, as Africa was reeling from an Ebola outbreak, he told an audience at the TED conference that the biggest killer the world was likely to face in the near future was “a highly infectious virus rather than a war,” and that a coming virus could potentially be far worse than Ebola: Ebola doesn’t spread through the air, and only the sickest patients, those likely to be bedridden, are infectious.

However, he told the crowd, “you can have a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market.” He echoed the same concerns at other conferences and to politicians, including, in 2018, President Donald Trump. “When I spoke to the current administration,” Bill Gates says, “I highlighted that this is something that they can show leadership on, and connected it to a desire to improve [U.S.] security defense. I thought it was a theme that might play well, but we see now that we weren’t ready.

Being right, Bill and Melinda have learned during the 20 years they’ve

spent battling to improve global health, offers little comfort.

And yet they continue to describe themselves as “impatient optimists,” believing both that major challenges are solvable and that change needs to happen as soon as possible. The couple, who make all major decisions together, have devoted their lives to putting this philosophy into action to fight global inequities, even when that comes at a personal cost, such as becoming the subject of scrutiny and outlandish conspiracy theories.

The pandemic has forced them and their foundation to move even faster. Strategy “usually evolves over years, and not weeks,” says Jennifer Alcorn, the foundation’s deputy director of philanthropic partnerships. When the outbreak became a pandemic, it presented the biggest challenge that the Bill & Melinda Gates Foundation has ever faced. The world has never confronted the need to create a vaccine for nearly the entire global population. But Bill Gates believed that the organization was in a unique position to help.

Today, the Gates Foundation has become enmeshed in every aspect of the fight against COVID-19. It has poured more than $680 million into the development of vaccines, drugs, and low-cost COVID tests, along with work to strengthen health systems and mitigate the economic effects of the crisis. It has also helped set up new systems designed to make vaccines and antivirals available and accessible to the whole world, despite the growing tide of “vaccine nationalism”—competition between countries to hoard supplies. In fact, the organization provided an additional $300 million forgivable loan to help make vaccines that cost no more than $3 a dose, to be distributed through networks that the foundation helped create.

How the Gates Foundation has responded to the pandemic offers a rare window into the way in which this powerful philanthropic organization operates: how it places its bets, how it dispenses its $49.8 billion endowment, and how it uses its soft power to further larger aims. The foundation’s outsize presence has inspired hope, suspicion, and meaningful critiques—mainly for its ability to influence outcomes without the same accountability citizens expect of public health officials.

“A fundamental question is, Well, because you have the money, should you be able to control the architecture of global health?” asks Brook Baker, a North eastern University law professor focused on intellectual property rights and universal access to treatments for HIV/AIDS and COVID-19. “In many people’s minds, the Gates Foundation is playing a bigger role in establishing the foundation of global health than anything else, including the WHO.” (The foundation is one of WHO’s largest funders as well.) Counters Rajeev Venkayya, president of the global vaccine development unit at Takeda Pharmaceutical and a former director of vaccine delivery at the Gates Foundation, “They have a seat at the table, not just because they have money, but because they add value in helping to design very effective programs.” Both of these perspectives have merit. As the COVID-19 crisis continues, with more than 1 million deaths so far and governments struggling to manage the problem, the Gates Foundation has helped fill critical gaps. But the pandemic response also raises questions about philanthropy’s function in public health, and what it will take for the world to be prepared for the next deadly virus.

This is an extract from the latest Fast Company (SA) magazine.

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Bill Gates vs The Pandemic: Inside the Gates Foundation fight against the Pandemic