When Covid-19 struck ... four organizations took on roles often played by governments but without the accountability of governments. While nations were still debating the seriousness of the pandemic, the groups identified potential vaccine makers and targeted investments in the development of tests, treatments and shots. And they used their clout with the World Health Organization to help create an ambitious worldwide distribution plan. The largest and most powerful was the Bill & Melinda Gates Foundation, one of the largest philanthropies in the world. Then there was Gavi, the global vaccine organization that Gates helped to found to inoculate people in low-income nations, and the Wellcome Trust, a British research foundation with a multibillion dollar endowment that had worked with the Gates Foundation in previous years. Finally, there was the Coalition for Epidemic Preparedness Innovations, or CEPI, the international vaccine research and development group that Gates and Wellcome both helped to create in 2017. The organizations spent at least $8.3 million lobbying the U.S. and E.U., according to an analysis of lobbying disclosures. Now, critics are raising significant questions about the equity and effectiveness of the group's response to the pandemic " and the serious limitations of outsourcing the pandemic response to unelected, privately-funded groups.