Gavi, the vaccine alliance,  founded and funded largely by Bill Gates and his wife Melinda, is an appealing option for Governments looking to make donations, according to a paper published in Global Public Health in 2014, because “it can often produce quantified, politically-appealing, easy-to-explain results within an election cycle, which is appealing to public-sector donors.” It is less appealing to other medical organisations because, according to medicines sans frontiers, it “is too focused on new vaccines and neglects the fundamental need to improve basic public health and immunization programs in poor countries.” And for many more reasons, which we’ll come to in a moment.

Of course, developing a vaccine is the number one goal of global medicine at the moment, so it’s no surprise that these guys are the beneficiary of public largesse. But do they need, or deserve, this €18m from the Irish taxpayer?

“An Taoiseach, Leo Varadkar has announced that Ireland has today pledged €18 million as part of global efforts to defeat the coronavirus.

The Government has pledged €18 million in support of GAVI, the Vaccine Alliance, for use between 2021 and 2025.

This funding will support GAVI’s important work in procuring vaccines and distributing them to the world’s poorest and most vulnerable countries, including a vaccine for COVID-19 when it becomes available.”

Probably not, is the answer, to both the question of whether they need the money, and the question of whether they deserve it.

On the “need” front, the largest single donors to Gavi are the Bill and Melinda Gates foundation, which has donated $1.56billion over the past four years – fully 86 times the €18million being provided by Dublin. Even if nobody else made any donations at all, Ireland would be providing one eighty-seventh of GAVI’s total funding, and since many more people do contribute, our proportion of funding is much smaller than that.

Which poses an obvious question: Why, since we can contribute what’s only a relatively tiny amount of the budget for an organisation like GAVI, are we not taking that €18m and giving it to an organisation to which €18m would actually make a phenomenal difference? Wouldn’t funding one single university research project into a vaccine be much more efficient than pouring money into an already vast pool of money, where it will make no difference?

There is absolutely no question of GAVI going bust, or having its work impaired without Ireland’s paltry €18m. But there are plenty of groups doing similar work who could have their work vastly enhanced by that sum, or a fraction of it. Whatever your political leanings, it’s a terribly inefficient way to spend our money.

Second, and perhaps of more relevance, does Gavi deserve our money? There is a wealth of material suggesting that it does not. For example, the organisation has been repeatedly, and credibly, criticised for being in the pockets of big pharmaceutical companies at the expense of actually innovative vaccine and public health work. For example, (this report is from December last year), fully one point two billion dollars of Gavi’s money has ended up in the pockets of Pfizer and Glaxosmithkline:

“MSF demanded the GAVI to immediately stop paying out funds from a remaining US$262m subsidy to Pfizer and GlaxoSmithKline (GSK) for the pneumococcal vaccine. “Pfizer and GSK have reaped more than their fair share of donor money for the pneumococcal vaccine, on top of the combined nearly US$50bn in sales they have made over the last 10 years from the vaccine, so it’s time for Gavi to stop this big pharma payout,” said Kate Elder, Senior Vaccines Policy Advisor, MSF Access Campaign. “Instead of lobbing more money at Pfizer and GSK, Gavi should start supporting countries to prepare for the alternative supplier that promises lower pneumococcal vaccine prices for all countries.”

Gavi, the Vaccines Alliance, uses donor funds to pay for vaccines in the poorest countries. Recognising that newer vaccines often take more than a decade to reach developing countries after their introduction in high-income countries, in 2007 Gavi and six donors set up a special fund called the Advance Market Commitment (AMC) to speed up the global rollout of the lifesaving pneumococcal vaccine in the poorest countries. This special fund, the AMC, also aimed to incentivise vaccine manufacturers to produce suitable and affordable versions of the pneumococcal vaccine. The donors pledged $1.5 billion in a special subsidy fund that is used to top up the base price of the pneumococcal vaccine charged by each company.

Pfizer and GSK charge Gavi roughly $9 for each child to be vaccinated in the poorest countries, and then receive a top up from the subsidy that amounts to each company being paid $21 per child in total. In middle-income countries that don’t qualify for Gavi support, Pfizer and GSK have charged as much as $80 per child (through UNICEF Supply Division) to be vaccinated, with the result that many such countries have not started using the vaccine at all.

So far, $1.2 billion has already been earned by pharmaceutical corporations Pfizer and GSK through the AMC, with $262 million remaining in the special fund. As the AMC fund was supposed to encourage new producers to enter the market and help bring prices down, MSF is calling on Gavi to reserve its remaining funds under the AMC for a new pneumococcal vaccine manufacturer offering a more affordable version in the near future.”

To summarise that: Gavi received a whole bunch of money for the express purpose of encouraging competition to big pharmaceutical companies, to invest in vaccines from other suppliers, as a way to bring global prices down. What did they actually do with that money? They spent it with the very same big pharmaceutical companies they were supposed to be challenging.

The big companies were supposed to be paid $9 for every dose of the vaccine provided. But they then received an extra $21 for every dose from a subsidy fund that was supposed to encourage them to make vaccines cheaper. Can you get your head around that? In order to make the vaccines cheaper, they got paid three times what they had agreed to accept already for those same vaccines. Does that make any sense to you? Because if it does, you’re either much smarter than me, or belong in some form of asylum.

Of course, we come back to the very opening paragraph: GAVI is attractive to people like the Irish Government because it is exceedingly PR-friendly. That’s the whole point of it.

But that €18m could have made a big difference somewhere else.