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   Biotech / MedicalCoronavirus / COVID-19 Pandemic


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To: Paul Senior who wrote (10986)11/27/2020 12:24:19 PM
From: Brumar89
2 Recommendations   of 13866
 
Drug Pushed by Trump for COVID is Tied to Mental DisturbancesSTICK A FORK IN IT

Tracy Connor Executive Editor
Published Nov. 27, 2020 10:59AM ET



George Frey/Getty

Research has already shown that hydroxychloroquine, the drug that President Trump touted as a COVID-19 cure, is ineffective against the coronavirus. Now regulators in Europe are warning that the anti-malarial and an associated chemical, chloroquine, have been tied to mental health disturbances in COVID patients who were given higher-than-normal doses. Spain documented six cases, including some in which suicidal behavior was reported.

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To: Moonray who wrote (11001)11/27/2020 12:35:01 PM
From: abuelita
   of 13866
 
makes perfect sense.

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To: Moonray who wrote (11001)11/27/2020 12:46:07 PM
From: Sam
   of 13866
 
Most people in the US will not be vaccinated by April. Front line workers, sure. But not most.

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From: John Koligman11/27/2020 1:25:40 PM
2 Recommendations   of 13866
 
Their Teeth Fell Out. Was It Another Covid-19 Consequence?
People who already have dental problems may see them aggravated by encounters with the coronavirus, some experts suggest.



Some Covid survivors say loose teeth have fallen out without bleeding. Others claim their gums are more sensitive, or that their teeth are turning grey or chipping.Credit...Ben Hasty/MediaNews Group/Reading Eagle, via Getty Images

By Wudan Yan

Nov. 26, 2020

Earlier this month, Farah Khemili popped a wintergreen breath mint in her mouth and noticed a strange sensation: a bottom tooth wiggling against her tongue.

Ms. Khemili, 43, of Voorheesville, N.Y., had never lost an adult tooth. She touched the tooth to confirm it was loose, initially thinking the problem might be the mint. The next day, the tooth flew out of her mouth and into her hand. There was neither blood nor pain.

Ms. Khemili survived a bout with Covid-19 this spring, and has joined an online support group as she has endured a slew of symptoms experienced by many other “long haulers”: brain fog, muscle aches and nerve pain.

There’s no rigorous evidence yet that the infection can lead to tooth loss or related problems. But among members of her support group, she found others who also described teeth falling out, as well as sensitive gums and teeth turning gray or chipping.

She and other survivors unnerved by Covid’s well-documented effects on the circulatory system, as well as symptoms such as swollen toes and hair loss, suspect a connection to tooth loss as well. But some dentists, citing a lack of data, are skeptical that Covid-19 alone could cause dental symptoms.

“It’s extremely rare that teeth will literally fall out of their sockets,” said Dr. David Okano, a periodontist at the University of Utah in Salt Lake City.

But existing dental problems may worsen as a result of Covid-19, he added, especially as patients recover from the acute infections and contend with its long-term effects.

And some experts say that doctors and dentists need to be open to such possibilities, especially because more than 47 percent of adults 30 years or older have some form of periodontal disease, including infections and inflammation of the gums and bone that surround teeth, according to a 2012 report from the Centers for Disease Control and Prevention.

“We are now beginning to examine some of the bewildering and sometimes disabling symptoms that patients are suffering months after they’ve recovered from Covid,” including these accounts of dental issues and teeth loss, said Dr. William W. Li, president and medical director of the Angiogenesis Foundation, a nonprofit that studies the health and disease of blood vessels.

While Ms. Khemili had become more diligent about her dental care, she had a history of dental issues before contracting the coronavirus. When she went to the dentist the day after her tooth came out, he found that her gums were not infected but she had significant bone loss from smoking. He referred Ms. Khemili to a specialist to handle a reconstruction. The dental procedure is likely to cost her just shy of $50,000.

The same day Ms. Khemili’s tooth fell out, her partner went on Survivor Corp, a Facebook page for people who have lived through Covid-19. There, he found that Diana Berrent, the page’s founder, was reporting that her 12-year-old son had lost one of his adult teeth, months after he had a mild case of Covid-19. (Unlike Ms. Khemili, Ms. Berrent’s son had normal and healthy teeth with no underlying disease, according to his orthodontist.)

Others in the Facebook group have posted about teeth falling out without bleeding. One woman lost a tooth while eating ice cream. Eileen Luciano of Edison, N.J., had a top molar pop out in early November when she was flossing.

“That was the last thing that I thought would happen, that my teeth would fall out,” Ms. Luciano said.

[ Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]

Teeth falling out without any blood is unusual, Dr. Li said, and provides a clue that there might be something going on with the blood vessels in the gums.

The new coronavirus wreaks havoc by binding to the ACE2 protein, which is ubiquitous in the human body. Not only is it found in the lungs, but also on nerve and endothelial cells. Therefore, Dr. Li says, it’s possible that the virus has damaged the blood vessels that keep the teeth alive in Covid-19 survivors; that also may explain why those who have lost their teeth feel no pain.

It’s also possible that the widespread immune response, known as a cytokine storm, may be manifesting in the mouth.

“If a Covid long hauler’s reaction is in the mouth, it’s a defense mechanism against the virus,” said Dr. Michael Scherer, a prosthodontist in Sonora, Calif. Other inflammatory health conditions, such as cardiovascular disease and diabetes, he said, also correlate with gum disease in the same patients.

“Gum disease is very sensitive to hyper-inflammatory reactions, and Covid long haulers certainly fall into that category,” Dr. Scherer said.

Dentists haven’t seen many of these cases, and some dismiss these individual claims. But physicians like Dr. Li say Covid-19’s surprises require that the profession be on the lookout for unexpected consequences of the disease.

“Patients may be bringing in new findings,” he said, and physicians and dentists need to cooperate on understanding the effects of long-term Covid-19 on teeth.

For now, Ms. Khemili hopes her story may serve as a cautionary tale. If people aren’t taking the proper precautions to protect themselves from the coronavirus, “they could be looking at something like this.”

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To: Sam who wrote (11004)11/27/2020 1:35:29 PM
From: Moonray
   of 13866
 
Most people in the US will not be vaccinated by April. Front line workers, sure. But not most
“I think you’re going to get vaccinated within the first
four months, I’d say by April you’d be able to get
vaccinated,” Fauci said in response to a question
from CNN Anchor Jake Tapper over when most
people could expect a vaccine. Message 33034158

I do not pretend to know as much as Fauci.

o~~~ O

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To: Triffin who wrote (10983)11/27/2020 2:09:38 PM
From: Wharf Rat
   of 13866
 
94 deaths at the VA yesterday;4th behind Tx,Ill, and Pa.

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To: John Koligman who wrote (11005)11/27/2020 3:07:19 PM
From: abuelita
   of 13866
 
what a horrible disease this is. :(

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To: Moonray who wrote (11006)11/27/2020 3:25:13 PM
From: Sam
1 Recommendation   of 13866
 
Thanks for the link. We'll see.

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From: Sam11/27/2020 4:43:32 PM
2 Recommendations   of 13866
 
United Begins Flying Pfizer's Covid-19 Vaccine -- Update
DOW JONES & COMPANY, INC. 4:41 PM ET 11/27/2020

Symbol Last Price Change
45.3 -0.34 (-0.745%)
37.23 +0.7 (+1.9162%)
QUOTES AS OF 01:00:00 PM ET 11/27/2020


United Airlines Holdings Inc. (UAL) on Friday began operating charter flights to position doses of Pfizer Inc.'s(PFE) Covid-19 vaccine for quick distribution if the shots are approved by regulators, according to people familiar with the matter.

The initial flights are one link in a vast global supply chain being assembled to tackle the logistical challenge of distributing Covid-19 vaccines. Pfizer has been laying the groundwork to move quickly if it gets approval from the Food and Drug Administration and other regulators around the world.

Pfizer's distribution plan also includes refrigerated storage sites at the drugmaker's final-assembly centers in Kalamazoo, Mich., and Puurs, Belgium, and adding storage capacity at distribution sites in Pleasant Prairie, Wis., and in Karlsruhe, Germany, in addition to dozens of cargo flights and hundreds of truck trips each day. Pfizer declined to comment on United's role in the plan.

United plans to fly chartered cargo flights between Brussels International Airport and Chicago O'Hare International Airport to support distribution of the vaccine, according to a Nov. 24 letter from the Federal Aviation Administration viewed by The Wall Street Journal.

The FAA said in a statement Friday that it was supporting the "first mass air shipment of a vaccine," and that it is working with airlines to safely transport Covid-19 vaccines.

United had sought permission to carry more dry ice than is typically allowed on flights to maintain the extremely low temperatures required to prevent Pfizer's vaccine from spoiling. The FAA said it would allow United to carry 15,000 pounds of dry ice per flight -- five times more than normally permitted. Regulators restrict the amount of dry ice that can be carried on passenger jets because they typically lack equipment to monitor and mitigate any leaked carbon dioxide.

Pfizer designed suitcase-size boxes packed with dry ice to keep its vaccine doses cold, avoiding the larger, temperature-controlling containers used in transportation, giving it more flexibility to ship the vaccines faster.

Last week, Pfizer requested U.S. authorization for emergency use of the Covid-19 vaccine it developed with BioNTech SE of Germany. The FDA has scheduled a Dec. 10 meeting for a panel of outside advisers to help review the evidence behind Pfizer's request and vote whether to recommend that the vaccine be cleared for broad use in the U.S. The FDA could make that determination soon after the advisory panel's vote, setting up the potential for the start of distribution by mid-December.

Unlike traditional vaccine rollouts, Pfizer plans to bypass distribution wholesalers, including McKesson Corp., which has been tapped by the U.S. government to distribute other Covid-19 vaccines through the federal Operation Warp Speed program.

Moderna Inc. has said it expects to request FDA authorization of its Covid-19 vaccine by early December. If the FDA clears it in December, officials are expected to have enough doses of both vaccines to immunize about 20 million Americans.

The U.S. Centers for Disease Control and Prevention has been in talks with state immunization officials to identify sites in each state where vaccine doses can be stored while awaiting FDA clearance.

Other cargo and passenger airlines are also preparing for the global push to get vaccines to the public quickly. FedEx Corp. and DHL International GmBH have introduced temperature-monitoring systems to track future vaccine shipments. United Parcel Service Inc. and Deutsche Lufthansa AG are building "freezer farms" combining multiple refrigerators at their airport hubs to store vaccines in transit.

Write to Alison Sider at alison.sider@wsj.com and Peter Loftus at peter.loftus@wsj.com




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From: Glenn Petersen11/27/2020 6:38:08 PM
2 Recommendations   of 13866
 
Bill Gates, the Virus and the Quest to Vaccinate the World

The billionaire is working with the W.H.O., drugmakers and nonprofits to defeat the coronavirus everywhere, including in the world’s poorest nations. Can they do it?

By Megan Twohey and Nicholas Kulish
New York Times
Published Nov. 23, 2020
Updated Nov. 25, 2020

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

Mr. Poonawalla calculated that he could risk $300 million of his company’s money but would still be more than a half-billion dollars short. So he looked to a retired software executive in Seattle.

Bill Gates, the Microsoft founder turned philanthropist, had known Mr. Poonawalla for years. Mr. Gates had spent billions to help bring vaccines to the developing world, working closely with pharmaceutical executives to transform the market. In doing so, he became the most powerful — and provocative — private player in global health.

By the end of their conversation this summer, Mr. Gates had made a promise: The Bill and Melinda Gates Foundation would provide a $150 million guarantee so the Indian factory could move ahead with production. By September, the foundation had doubled its commitment.

It is part of an $11 billion effort to lay the groundwork to procure coronavirus vaccines for more than 150 countries, though it could eventually cost far more when the doses come through. Funded largely with public money, the initiative is led by two global nonprofits that Mr. Gates helped launch and bankroll, along with the World Health Organization, which relies on the Gates Foundation as one of its largest donors.

Working behind the scenes is one of the world’s richest men, neither a scientist nor a doctor, who sees himself and his $50 billion foundation as uniquely prepared to take a central part. Mr. Gates and his team are drawing on connections and infrastructure the foundation has built over two decades to help guide the effort.



Researchers at the Serum Institute of India working on a coronavirus vaccine developed by Oxford University. Credit...Atul Loke for The New York Times
----------------------------

“We know how to work with governments, we know how to work with pharma, we’ve thought about this scenario,” Mr. Gates said in a recent interview. “We need — at least in terms of expertise and relationships — to play a very, very key role here.”

As the first vaccine candidates sprint toward regulatory approval, the question of how to immunize much of the world population has taken on added urgency. But nine months in, the success of the vaccine effort, known as Covax, is not at all certain.

So far, it has pulled in only $3.6 billion in funding for research, manufacturing and subsidies for poor countries. AstraZeneca, one of three companies that have promised to deliver vaccines for the initiative, just announced impressive results. It is not yet known whether the other two will be effective. And it may be difficult to secure the necessary billions of doses in an affordable, timely way because the United States and other wealthy countries have cut separate deals for their citizens.

In recent months, Mr. Gates, who emphasizes that he is one of many involved in the vaccine effort, has hosted online round tables with drug company officials. He has pursued financial commitments from world leaders: In one week alone, he and his wife and co-chair, Melinda Gates, spoke with President Emmanuel Macron of France, Chancellor Angela Merkel of Germany, President Ursula von der Leyen of the European Commission and Crown Prince Mohammed bin Zayed of Abu Dhabi.

In Washington, he has consulted frequently with Dr. Anthony S. Fauci, the nation’s chief infectious disease expert and a longtime collaborator on vaccine initiatives, and talked to Senator Mitch McConnell, a polio survivor who has been supportive of programs to eradicate that and other scourges. And to help staff the vaccine effort, his foundation has provided millions of dollars for McKinsey & Company consultants.

“Some people will say, ‘Why should it be him?’” said Dr. Ariel Pablos-Méndez, former director of knowledge management at the W.H.O. “He has the star power. He has the resources. He cares. There are many players that do things, but not at the scale of Gates.”

If the initiative, aided by Mr. Gates’s fortune and focus, manages to help protect the world’s poor from a virus that has already killed more than 1.3 million people, it will affirm the strategies he has promoted in his philanthropic work, including incentives for drug companies.

If the endeavor falls short, however, it could intensify calls for a more radical approach.

Amid the pandemic, some public health officials and advocates argue that vaccine makers, many of which have benefited from unprecedented public funding, should be compelled to share their technology, data and know-how to maximize production. India and South Africa, for example, are pushing to suspend the global enforcement of intellectual property rights involving the virus.

Dr. Zweli Lawrence Mkhize, South Africa’s health minister, said that the usual practices did not apply in this crisis. “There has to be a degree of broader consultation that looks at what is best for humanity,” he said in an interview.

In the current plan for a global vaccine deal, poor countries would receive only enough doses to inoculate 20 percent of their populations by the end of next year. Some models show that there will not be enough vaccines to cover the entire world until 2024.

“The consequence of longtime Gates strategies is that they go along with corporate control over supply,” said Brook Baker, a Northeastern University law professor and policy analyst for Health GAP, which advocates equitable access to drugs. “In a pandemic, that is a real problem.”


Meanwhile, officials from some countries participating in the vaccine initiative complain that they were barely consulted until recently. “They are pushing us, cornering us, in order to make us pay,” Juan Carlos Zevallos, Ecuador’s health minister, said of the dealmakers. “We don’t have a choice about which vaccine we would like to use. It is whatever they impose on us.”



A medical tent set up for Covid-19 patients this summer in Quito, Ecuador.Credit...Dolores Ochoa/Associated Press
-----------------------------

As Mr. Gates has made public appearances to win support for the initiative, he has increasingly become the target of conspiracy theories that could undermine vaccination efforts.

Some falsely claim that his foundation tested vaccines that killed thousands of children in Africa and India, while others link him to bogus depopulation efforts. One poll from May found 44 percent of Republicans believed that the global immunization effort was a cover for Mr. Gates to implant microchips to track people. That claim is baseless.

Mr. Gates remains undaunted. “I’ve never heard either Bill or Melinda say anything to the effect of ‘We’ll just work on something else, this is too tough,’” said the billionaire investor Warren Buffett, who entrusted the Gates Foundation with $31 billion of his own fortune to give away. “The job is to work on tough problems.”

‘The Bill Chill’

As a novel coronavirus linked to a live animal market began spreading rapidly in Wuhan, China, Mr. Gates watched from his office outside Seattle.

On Feb. 14, he and leaders at his foundation, fearing a global threat, gathered to plan a response. From that point on, Mr. Gates recalled, “we’re on Code Red.”

Two weeks later, Dr. Seth Berkley — chief executive of Gavi, the Vaccine Alliance, a nonprofit the Gates philanthropy helped found — flew to Seattle. Over breakfast, he and Mr. Gates considered how to get Covid-19 vaccines to the developing world. On March 13, two days after the W.H.O. declared a global pandemic, Mr. Gates conferred online with 12 top pharmaceutical executives, including the heads of Pfizer and Johnson & Johnson, which both have leading vaccine candidates.

He felt prepared for this moment, having built up global institutions and given away $55 billion to date, four times the influential Ford Foundation’s endowment.

Mr. Gates became interested in immunizations in the late 1990s, when Microsoft was facing an antitrust case that cast him as a modern-day robber baron. Vaccines involved creating new technology, his specialty. Their impact was measurable — inexpensive doses could protect hundreds of millions against devastating disease. They were also about making deals.



Bill Gates vaccinating a baby against polio in 2002 in Andhra Pradesh, India. The disease is one of many his foundation has battled around the world.Credit...Jeff Christensen
----------------------------

Many Western drug companies had stopped producing vaccines back then, finding them unprofitable. But through his giving, Mr. Gates helped create a new business model involving subsidies, advance market commitments and volume guarantees. The incentives drew in more manufacturers, including ones from the developing world, resulting in many more lifesaving vaccinations.

He brought a “technocratic expertise and power rather than a discourse of human rights and activism,” said Manjari Mahajan, an associate professor of international affairs at the New School who has written about Mr. Gates’s role in public health.

His foundation has spent more than $16 billion on vaccine programs, a quarter of that going to Gavi, and given $2.25 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Both organizations are based in Geneva, where the W.H.O. has its headquarters.

With a $100 million initial pledge, Mr. Gates helped create the Coalition for Epidemic Preparedness Innovations, in Oslo, to invest in drugs and experimental vaccines. (The coalition and Gavi are leading the coronavirus vaccine effort with the W.H.O.)

The foundation, which has about 1,600 employees, also funded academic researchers, installed its executives on the boards of multiple nonprofits and directly invested in drug companies.

One of them was the German company BioNTech, which got a $55 million equity investment in September 2019. The business, partnering with Pfizer, announced last week that their jointly developed Covid-19 vaccine appeared to be 95 percent effective, and applied to the Food and Drug Administration for emergency authorization.

Some public health officials disagreed with Mr. Gates’s priorities, arguing that he should have directed more money to health systems. Others worried about a private individual wielding so much influence. But few people publicly criticized his foundation, fearful of losing its support. That self-censorship was so widespread it acquired a nickname: “the Bill Chill.”

At times, frictions were evident with the W.H.O., the United Nations agency charged with international public health. Mr. Gates felt frustrated with what he viewed as the organization’s rigid bureaucracy and constraints on dealing with the private sector.

Some at the W.H.O. had concerns about his growing reach. The malaria division chief complained in a 2007 memo that the foundation’s growing dominance of malaria research was stifling a diversity of viewpoints among scientists and undercutting the agency. The same year, the foundation began building up an institute that rivaled the W.H.O.’s role in health metrics.

“The Gates Foundation presence has been, at best, an adjunct to W.H.O. and at worst a hostile takeover and a usurpation,” said Amir Attaran, a University of Ottawa professor of law and medicine.

Today, the foundation and the W.H.O. stress their mutual respect for each other. Publicly, Mr. Gates has made a point of praising the agency. “I can’t think of anything that we disagree with them,” he said in the interview.

Officials from the agency — which receives hundreds of millions of dollars annually from the foundation, its second-largest donor — said Mr. Gates had helped it become more efficient. “Gates pushes the science, pushes for the answers, because that’s a little bit of that private-sector mentality,” said Dr. Bruce Aylward, senior adviser to the W.H.O.’s director general.

As the coronavirus vaccine effort got underway, it was folded into a broader mission, coordinated by the W.H.O., to also provide Covid-19 diagnostic tests and therapies to the developing world. The agency wanted to take more of a leadership role in the vaccine deal making, but the Gates Foundation and global nonprofits said they worried that drugmakers would not cooperate. They worked to focus the agency’s role on regulating products and advising countries on distributing them, among other responsibilities.

“We’re always talking with W.H.O.,” Mr. Gates said. “But a lot of the work here to stop this epidemic has to do with innovation in diagnostics, therapeutics and vaccines, which isn’t really their bailiwick.”

Farah Dakhlallah, a W.H.O. spokeswoman, said that the organization had an “unmatched” ability to coordinate a global health response, and that the initiative leveraged “the comparative advantages” of its partners in the fight against Covid-19.

Capitalism at Work

In March, Mr. Gates was urging drugmakers to move fast, cooperate with one another, open up their libraries of drug compounds and even share production responsibilities.

“The first set of meetings, it was: ‘How are we going to find an active drug? How are we going to kick off vaccine development quickly? How are we going to shift manufacturing capacity?’” recalled Vasant Narasimhan, the chief executive of Novartis.

The Gates Foundation employs former pharmaceutical executives in its top ranks, including Dr. Trevor Mundel, who had been global head of development at Novartis, and Emilio Emini, previously a senior vice president of vaccine research at Pfizer. Working with the Coalition for Epidemic Preparedness Innovations, they helped steer money into Covid-19 vaccine candidates and biotechnologies that could be quickly manufactured and suitable for the developing world.

Oxford University said it would offer “ nonexclusive, royalty-free licenses” of its work to manufacturers. But as it developed one of the most promising vaccine candidates, the university debated whether it was equipped to conduct clinical trials and transfer its technology to manufacturers around the world.

Sir John Bell, who leads the development of Oxford’s health research strategies and chairs the Gates Foundation’s scientific advisory committee, reached out to Dr. Mundel. The advice was direct: “We told Oxford, ‘Hey, you’ve got to find a partner who knows how to run trials,’” Mr. Gates said.

Oxford chose the British-Swedish drugmaker AstraZeneca. The Serum Institute of India, after getting the financial commitment from Mr. Gates, agreed in the summer to start producing the vaccine.

All the while, the United States and other countries were striking their own deals with vaccine makers, even before they got regulatory approval. There was some overlap between the global initiative and the American effort, called Operation Warp Speed. AstraZeneca, Novavax and Sanofi made commitments to both.

Mr. Gates was quick to praise the U.S. government’s enormous investment in expediting coronavirus vaccines, saying it would benefit everyone. But the more that countries locked down bilateral deals, the longer the rest of the world would have to wait for doses.

Mr. Gates had valuable insights from Dr. Fauci, who leads the National Institute of Allergy and Infectious Diseases. More than a decade ago, the billionaire had invited Dr. Fauci to his home to join a discussion about tuberculosis. Since then, they have coordinated efforts aimed at fighting not just that disease but also malaria, polio and AIDS.

The two men spoke every few weeks. Dr. Fauci wanted to know how vaccine trials in foreign countries were playing out. Mr. Gates was interested in how the U.S. regulatory process was going and whether vaccines the American government was purchasing would be suited for poor countries. The Pfizer and BioNTech vaccine, for instance, requires two doses and ultracold storage, obstacles in many places.

“He wanted to make sure, which is the classic Bill Gates, that as we do the vaccines, that it’s the kind of vaccine that could be used in the developing world,” Dr. Fauci said in an interview.

During the pandemic, Latin America has suffered a third of the world’s deaths. Africa has now passed two million cases. Quarantines and trade shutdowns have hit poor countries especially hard, where not working often means not eating.

Some public health advocates and on-the-ground providers like Doctors Without Borders thought Mr. Gates was doing too little to pursue equitable access to vaccines and was too aligned with the pharmaceutical industry.



A protester was focused on Mr. Gates during a London rally against coronavirus restrictions.Credit...David Cliff/NurPhoto via Getty Images
-----------------------

“Part of what they like about him is he’s protecting their way of life,” James Love, director of Knowledge Ecology International, a nonprofit that works to expand access to medical technology, said of Mr. Gates and drug industry executives. “Because this message is always, ‘Big Pharma is awesome.’”

He and others believed that vaccine makers would not maximize production for the developing world, especially when rich countries were clamoring for doses, because it wouldn’t serve their bottom line. India and South Africa, in asking the World Trade Organization not to enforce coronavirus-related intellectual property rights, were seeking a way to wrest control of vaccines from big companies and ramp up local manufacturing. Kenya, Mozambique, Pakistan and Eswatini (formerly Swaziland) recently signed on as co-sponsors to the request, with dozens of other countries expressing support.

But Mr. Gates and many public health experts thought that most companies were taking laudable steps to help ensure access, such as nonprofit pricing and licensing of their technology to other manufacturers. They argued that drugmakers wouldn’t take on the costly process of creating new products if their lucrative patents were jeopardized and that their control over their vaccines would ensure quality and safety.

“This capitalism thing — there actually are some domains that actually works in,” Mr. Gates said. “North Korea doesn’t have that many vaccines, as far as we can tell.”

‘Acting Like a Lobbyist

’It was May 4, and Mr. and Mrs. Gates were on a video call with Boris Johnson. They congratulated the British prime minister on the birth of his son, and asked about the Covid-19 case that had sent him to the hospital.

Then they made their pitch: The world would never be safe from the virus, and the global economy would never recover, unless poor countries received vaccines and treatments, too.

Mr. Gates had a long record of getting rich countries to provide funding for public health initiatives in poorer countries. From Ms. Merkel to Mr. McConnell, politicians saw him as a steward of public dollars with a nose for good investments.



The Microsoft billionaire has made his vaccine pitch to a number of world leaders, including Prime Minister Boris Johnson of Britain.Credit...Andrew Parsons, via 10 Downing Street
-------------------------

“He has immediate access to us because of his fame and reputation and what he’s doing with his own money,” Mr. McConnell, the Senate majority leader, said in an interview. “In many of these countries, he’s way more effective than the government is, and that’s certainly value added for public health all over the world.”

Significant donations came from Britain, the European Union and elsewhere. China pledged its cooperation last month. But Mr. Gates made no headway with his home country.

He had asked the Trump administration and Congress for $8 billion, half for the global vaccine effort and half for therapeutics and diagnostics in poor countries. In private calls, Mr. Gates, who had forged ties with leaders of both parties but remained nonpartisan over the years, made his case to Vice President Mike Pence, House Speaker Nancy Pelosi and others.

He put himself in the public eye more than ever before, often appearing in a pastel sweater that drew comparisons to Mister Rogers, and repeating in interviews that the pandemic required an international response. “He’s made a choice to become very public, very political, where he’s acting like a lobbyist,” said Lawrence Gostin, professor of global health law at Georgetown.

But Mr. Trump had no intention of joining a global response. That became clear in July, when he withdrew the United States from the W.H.O., which it had provided with more than $400 million in annual contributions.

“People aren’t used to not having the U.S. step forward,” Mr. Gates said. On the global vaccine effort, he acknowledged, the nation has been “a no-show.” President-elect Joseph R. Biden Jr. may well take a different position, having vowed to rejoin the W.H.O.

Leaders of wealthy countries were asked not only to help fund the initiative — which was supporting development of nine potential vaccines — but also to buy doses for their own populations. Among the nine was a version from Moderna, which recently announced impressive clinical trial results. As the deal makers framed it, even nations that already had commitments from vaccine makers would benefit by diversifying.

Companies either would charge all countries the same price or set tiered prices for low-, middle- and high-income nations; any could bow out if the price exceeded $21 per dose. Poor countries could get cheap, subsidized doses for up to 20 percent of their populations by the end of next year, but the wealthier nations could sign up for more.

Clemens Martin Auer, a chief negotiator for the European Union, balked, believing that the global vaccine deal was moving too slowly, that prices would be too high and that Europe could do better negotiating on its own.

“I think the Gates Foundation has in many respects a very practical approach when they say this has to be done in a private-public business partnership,” he said. “But I sometimes have my impression that the Gates Foundation doesn’t understand how well-organized governments work.”

With so much attention on wealthy nations, there was little consultation with those the effort was intended to help most. It wasn’t until the fall that lower-income countries learned they would have to pay $1.60 or $2 per dose, a significant price that would require some to secure bank loans or grants.

“It’s going to be subsidized, yes, but countries still have to budget for their co-pay amount,” said Chizoba Barbara Wonodi, the Nigeria director at the Johns Hopkins International Vaccine Access Center. “So they need to be at the table when those discussions are made.”

Some middle-income countries have also felt squeezed, asked to pay prices in a higher tier with little say as to what they would get or when they would get it.

Mr. Zevallos, the Ecuadorean health minister, said he had spoken with fellow ministers in the region about raising concerns through their presidents. “They say, ‘You don’t get to choose, but you pay,’” Mr. Zevallos said. “I’m disappointed.”

Dr. Berkley, the Gavi director, acknowledged the frustration. “Did we communicate with everybody as well as we should? Absolutely not,” he said. “Were we able to convene everybody as often as we could? Absolutely not. But we did our best to try to do that.”

At the same time, Dr. Berkley said: “Have we brought together the entire world to discuss equitable access to vaccines? Have we raised substantial amounts of funds? All of that is true.”



A visit in 2016 to Trump Tower in Manhattan. Mr. Gates said that the United States, which under President Trump withdrew from the W.H.O., had been a “no-show” in the global vaccine effort.Credit...Andrew Kelly/Reuters
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A growing number of countries have committed to the endeavor; in addition to AstraZeneca, the other two drugmakers that have signed on are advancing through trials and the Gates Foundation is also funding a portfolio of second-wave vaccines targeted at the developing world. There is enough money to start buying doses once they are approved, Dr. Berkley and others said, and they hope to pull together the billions more needed to meet their goals.

With coronavirus cases multiplying worldwide, Mr. Gates said there would be one simple way to judge the global vaccine initiative. “When did we stop the pandemic?”

“That’s the thing this all needs to be measured by,” he said.

Sheri Fink contributed reporting from Durban, South Africa, and David D. Kirkpatrick from Guayaquil, Ecuador.

Megan Twohey is a Pulitzer Prize-winning investigative reporter with The New York Times. @mega2e

Nicholas Kulish is an enterprise reporter covering immigration issues. Before that, he served as the Berlin bureau chief and an East Africa correspondent based in Nairobi. He joined The Times as a member of the Editorial Board in 2005. @nkulish

A version of this article appears in print on Nov. 23, 2020, Section A, Page 1 of the New York edition with the headline: Gates Looms Large in Quest For a Vaccine.

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