The Gates Foundation has donated a total of $4.1 billion to Gavi to-date, including $1.6 billion in 2020 for Gavi’s latest 2021-2025 strategic period. Through Gavi, the Gates Foundation has also funded AMCs, for example to expedite the development and availability of pneumococcal vaccines. In addition, the Foundation also funds vaccine development directly through its Global Health division, at an increasing rate. According to the latest published figures, the Gates Foundation donated $220 million to vaccine development in 2020, up from roughly $133 million in 2019 and roughly $94 million in 2018, which indicates that they also see vaccine R&D as an effective way to save lives. The focus is particularly on diseases in low-resource settings such as HIV or Malaria, which recently saw a big breakthrough, and on technical innovation and novel platforms.
The Wellcome Fund's initiatives include funding CEPI to help fill critical gaps within vaccine funding and R&D, working towards the acceleration of a universal flu vaccine, and supporting WHO to create R&D blueprints for tackling Lassa fever, Nipah and Ebola, among others. It is also active in supporting Human Challenge Trials by funding clinical sites and helping to build local research capacity. All in all, Wellcome’s charitable expenditure is much lower than the Gates Foundation’s. Without specifying how much money goes into which projects, the annual reports states that in 2020 GBP 15 million (~$20 million) were allocated to vaccines, down from GBP 17 million (~$23 million) in 2019 (see Full Report 2020, p. 37).
While Gates and Wellcome seem to have a comprehensive range of activities, they are only able to fund a small part of vaccine R&D. It can be assumed there’s quite a bit of way to go until we reach the point of diminishing DALY returns. Here’s a simple calculation: In the case of tuberculosis, where there is a 100-year-old vaccine that is quite ineffective, only $117 million went into TB vaccine research in 2019, against a target of at least $550 million (see p.8) per year to come up with a new, effective vaccine by 2025. So even if all of Gates’ and Wellcome’s vaccine funding in 2020 combined, around $240 million, went into TB vaccine research (which it doesn’t), there would still be a funding gap of about $200 million per year, or $2 billion per decade, and that’s just TB.