How we must respond to the coronavirus pandemic Bill Gates
Transcriber: Ivana Korom
Reviewer: Krystian Aparta
Whitney Pennington Rodgers:
Hello and welcome to everyone
joining us from around the globe.
Thank you for being part of day two
of our special series TED Connects.
This week, we’re bringing you interviews
from some of the world’s greatest minds
to offer tools for us to navigate
through and thrive
in these really uncertain times.
I’m Whitney Pennington Rogers,
TED’s current affairs curator,
and I’ll be one of your hosts
for today’s event.
Yesterday, we kicked off this series
with an interview from acclaimed
psychologist Susan David,
who offered us some tips
on how to really be our best selves
in these trying times.
And we’re going to switch gears
a little bit today
from thinking about
our own personal mental health
to the state of our global
public health systems.
Chris Anderson: Thank you.
I guess we have a pretty
exciting guest to introduce.
On the other side of the country,
let’s bring in Bill Gates.
Bill, they say
the better-known people are,
the less you have to intro them.
It’s great to have you here.
How are you doing?
Bill Gates: I think this is
an unprecedented,
really disconcerting time for everyone,
with things being shut down,
not knowing exactly
how long it’s going to last,
worrying about the health
of all the people we care about.
You know, I’m lucky
that I get to connect up
with video conferencing using Teams a lot,
so the Foundation is stepping up
and there’s a lot of great people
trying to help with this crisis.
But it’s scary for everyone.
CA: Are you basically stuck at home
like many of us watching?
BG: Yeah, almost all my meetings
are using Teams now,
I’m getting used to that.
You know, I’ve gone days
without seeing any coworkers.
CA: Let’s start here, Bill.
Five years ago, you stood on the TED stage
and you gave this chilling warning
that the world was in danger,
at some point, of a major pandemic.
People watching that talk now,
their hair stands up
on the back of their neck –
it is exactly what we’re living through.
What happened, did people
listen to that warning at all?
BG: Basically, no.
You know, I was hopeful
that with the Zika and Ebola
and SARS and MERS,
they all reminded us
that, particularly in a world
where people move around so much,
you can get huge devastation.
And so the talk was to say,
hey, we’re not ready
for the next pandemic,
but in fact, there’s advances in science
that if we put resources against them,
we can be ready.
Sadly, very little was done.
There were some things –
the Coalition for Epidemic
Preparedness Innovation, CEPI,
was funded by our foundation,
Wellcome Trust
and a number of governments,
to do some of the platform vaccine work,
but in the area of diagnostics,
antibodies, antivirals,
basically doing the disease games
that I talked about,
where we’d simulate
what needed to be done.
We hardly did anything,
and so now here we have
a respiratory virus
that is, sadly, fulfilling some
of the more negative predictions I made.
CA: Last month, you said
that this might be the big one.
You wrote that this could be
the sort of once-in-a-century pandemic
that people had been fearing.
Is that how you think of it still?
BG: Well, it’s awful to say this,
but we could have a respiratory virus
whose case fatality rate was even higher,
if this was something like smallpox,
you know, that kills 30 percent of people.
So this is horrific.
But in fact,
most people, even who get
the COVID disease,
are able to survive.
So it’s quite infectious,
way more infectious
than MERS or SARS were.
It’s not as fatal as they were.
And yet, the disruption we’re seeing,
in order to knock it down,
is really completely unprecedented.
So this is going global,
that was –
it’s respiratory,
that was the great fear.
How many people end up dying –
hopefully, if we do the right things,
it won’t be a gigantic number.
So, you know, we should end up
not having the 1918 flu situation.
We should be able to do
a lot better than that.
CA: And that’s because of actions
that we would take.
I mean, left without the right actions,
the prospects are pretty deadly.
If we knew what we knew in 1919,
this thing could take out
tens of millions of people
around the world.
You said –
is the key thing here that it’s got
this sort of a strange combination
of being certainly
more dangerous than flu –
not as dangerous as something
like Ebola or SARS,
but more dangerous than flu
by a factor, but infectious,
and also infectious
before symptoms have started,
is that part of why
it’s been really hard to respond to?
BG: Right.
Ebola,
you’re actually flat on your back
before you’re very infectious.
So you’re not at church
or in a bus or at a store.
With most respiratory viruses
like the flu and COVID,
at first you only feel a little bit
of a fever and a little bit sick,
and so there’s the possibility
you’re going about your normal activities
and infecting other people.
And so human-to-human
transmissible respiratory viruses
that in the early stage
aren’t stopping you from doing things,
that’s kind of a worst case,
and that’s where, you know,
I did a flu simulation in the 2015 talk
and showed how quickly it spread.
You know, versus 1918,
people move around a lot more now
than they used to,
and so that works against us.
Now the medical system
that steps up to treat people
is also far, far better.
CA: But when was it clear to you
that unless we acted,
this could be a really deadly pandemic?
BG: Well, in January it was discussed
that there was human-to-human
transmission taking place.
And so the alarm bells were ringing
that this fits the very scary pattern
that it will be very difficult to contain.
And on January 23,
China did their equivalent
of the shutdown.
Did it in a fairly extreme form.
The very good news
is that they were able to reduce
the infection rates dramatically
because of those actions.
But it’s January where everybody
should have been on notice –
let’s get our act together with testing,
let’s get going on
therapeutics and vaccines,
we’ve got to get organized
because we have this novel
respiratory virus
whose infectiousness and fatality
put it in that superscary range.
CA: And so, what did happen?
Because it’s such a mystery to me
about the “lost month” of preparations
in many countries and certainly in the US,
where we are.
Were you on the phone to people
during early February,
late January, early February,
saying, “Guys, what’s going on,
this is a really big deal,
what are we doing?”
What was happening behind the scenes
during that period?
BG: Well, you’d like to have
government money show up
for the key activities.
We put out 100 million,
we created the Therapeutics Accelerator,
there’s the period between
when we realized it was transmitting
and now, where we should have done more.
I think the most important thing
to discuss today
is that in the area of testing,
we’re still not creating that capacity
and applying it
to the people most in need.
And so we have health workers
who are symptomatic,
who can’t get a test
and so they don’t know
should they go in or not go in,
and yet we have lots of tests
being given to people
who aren’t symptomatic.
So the testing thing to me,
it’s got to be organized,
it’s got to be prioritized,
that is super, super urgent.
The second thing is the isolation
that, you know, various parts,
just focusing on the US,
some parts are doing that
in a fairly strong way
and other parts not yet,
and it’s very hard to do,
it’s tough on people,
it’s disastrous for the economy.
But the sooner you do it in a tough way,
the sooner you can undo it
and go back to normal.
CA: So we’ll come
to the isolation part in a minute,
but just sticking with the testing thing,
I’m just so confused as to why,
with more than a month’s notice –
I mean, there are so many smart
epidemiologists in the US, for example,
you plug numbers
about infectiousness and fatality
into any simulation
and you see that if you don’t do anything,
millions of people will die.
And there’s a month.
So what’s your explanation,
what do you think happened here
as to why there was almost no –
a month later,
there was no viable test in the US.
Was this just government complexity,
too many chefs in the kitchen,
what on earth happened here?
BG: Well, we certainly didn’t take
advantage of the month of February.
The good news is that the actual process,
the PCR machines,
we have a lot in the United States.
And so there’s models like South Korea,
who took advantage of February,
built up the testing capacity,
and they were able to contact-trace
and their infections have gone down,
even without the type of shutdown
that, because we’re late,
we’re having to do.
One thing that is good news just this week
is that people had thought
to do this test,
that you had to have a nurse or doctor
shove a swab way up,
all the way to the back of your throat,
which hurts a lot,
but also, you’re going to cough
and potentially spread the disease
to that health care worker.
So they have to have protective equipment
and change that.
We sent data to the FDA this weekend,
showing that just
an individual, by themselves,
swabbing up to the tip of their nose,
the accuracy of that test
is essentially the same
as having a health care worker do it.
That helps a lot.
We still have to do other things,
but that means that you
don’t have to change protective equipment,
you just hand the patient that swab,
they do it, put it in the test tube,
and if the capacity is right,
within 24 hours,
you should get that result back.
CA: So how do you see that playing out?
Are there people going to massively
scale those tests
and how will ordinary citizens
be able to get hold of them?
Does it still have to be kind of
prescribed by a doctor at some point,
or at some point, will you be able
to order them off Amazon or something?
BG: Well, it’s pretty chaotic today,
because the government hasn’t stepped in
to make sure the testing capacity
is both increased
and it’s used for the right cases.
There will be a website –
and if the federal
government doesn’t do it,
a lot of local governments
will have to do it –
that you go to, you give your situation,
including your symptoms,
you’re told, based on your work
and your symptoms,
are you a priority.
If so, you’re told where
there are kiosks you can go to
and you’ll do the self-swab
and just hand it over,
or eventually, we’ll send
the kits to you at home,
and then you’ll send it back
and hear that result.
Maybe six months from now,
you’ll actually have a strip
where you perform the test in the home,
but for now, they’re sending it back
for the PCR processing.
We can have massive capacity there.
And that’s how you know.
The testing is everything,
because that’s how you know
whether you need to do more shutdown
or you’re starting to get to the point
where you can relieve it.
CA: Some people are trying to argue now
that, almost, the testing
should be dialed back,
because the cat is out of the bag,
testing is bringing people together
and risking infection,
you know, forget that,
let’s just focus on treatment
and on isolation strategies.
You disagree with that.
Testing is still absolutely essential
and needs to be scaled dramatically.
BG: The two that go together are testing,
at very high volume,
and the isolation piece.
If you’re a medical worker,
you want to stay and do your job.
If you’re making sure
the electricity, water, food
is still available,
you want to do your job,
and so testing is what indicates to you,
do you need to go into isolation
and make sure you’re not
the source of spread.
And so, you know,
testing is the key thing.
South Korea did that in this massive way
that everybody should learn from.
And so that is paired
with the isolation piece.
Our goal here is to get to the point
where a very small percentage
of the population is infected.
You know, China, only 0.01 percent
of the population was infected.
If you let it,
if you don’t do these things,
you’re going to get
the majority of people infected
and that huge overload
of the medical system.
CA: Whitney has some questions
from our online audience. Whitney.
WPR: Some of the questions
that we’re seeing
are about how our tech giants and leaders
can play a role in isolating this
and containing this virus.
BG: The tech companies are very involved
in making sure that some work can go on.
People can stay in touch,
you know, they can help
with some of the disease modeling,
they can help with
the visibility of the numbers.
It’s actually very impressive,
you get up there
and you can see those numbers.
Actually, they’re sad numbers,
but everybody’s able
to monitor this thing.
Back in 1918, they didn’t have
this type of visibility,
and ability to share best practices.
But for a lot of people,
the isolation is the key thing.
CA: Bill, one of the riddles
about this isolation strategy
is how long it has to last.
A lot of people are concerned
that the price of victory
by isolating everyone
is that you crash the economy,
and that we have to be, basically,
at home, not doing our regular jobs
for three, six months, maybe all year.
And so much so that there’s now
this big debate in the US
and other countries
about this may just be the wrong strategy,
that we can’t crash
the economy that badly,
we should only isolate
for another couple of weeks,
and then let people back,
and if that means
a lot of other people get sick
and we eventually build up herd immunity,
that may be the right way to go.
What’s your thought on this,
what is the isolation strategy
that eventually leads to us
getting back to normal?
BG: It’s very tough to say to people,
“Hey, keep going to restaurants,”
you know, “Go buy new houses,
ignore that pile of bodies
over in the corner,
just, you know, we want you
to keep spending,”
because there’s some, maybe a politician
who thinks GDP growth
is what really counts.
It’s very hard to tell people,
when there’s an epidemic spreading
that threatens,
particularly, their parents
or elderly people that they know,
that they should go about things
knowing that their activity
is spreading this disease.
I don’t know of any rich countries
that have chosen to use that approach.
It is true, if you did that approach,
over a period of several years,
enough people would be infected
you’d have what’s called herd immunity.
But herd immunity is meaningless
until you infect over half the population.
And so you can take –
You’ll overload your medical system,
so your case fatality rate,
instead of being one percent,
will be like three, four percent.
And so,
the idea, it’s very irresponsible
for somebody to suggest
we can have the best of both worlds.
What we need is the extreme shutdown
so that in six to ten weeks,
if things go well,
then you can start opening back up.
CA: So just putting the math together
from what you just said, Bill,
to get to herd immunity,
you need more than half
the people in the country
to basically get the bug.
So in the case of the US, for example,
that would be 150 million
people, thereabouts.
You said that the fatality rate
in that scenario,
you’re talking about four
to five million people
potential fatalities.
That is just a horrifying scenario
that no one should be contemplating.
BG: Even one percent
of the population getting sick,
they will treat, whoever goes
for this “ignore the disease” strategy,
they will treat them as a pariah state,
so none of their people will go in,
and none of your people will go into that.
And so briefly, a few countries in Europe
that hadn’t really looked at this hard,
considered, “OK, should we be the ones
who kind of go about business as usual?”
It is tempting,
because if you got there early –
South Korea did not have to do
the extreme shutdown,
because they did
such a good job on testing.
CA: Testing and containment.
BG: That’s why it’s so maddening to me
that government
is not allocating the testing
to where it’s needed,
and maybe that will have to happen
at the state level,
because it’s not happening
at the federal level.
But there is no middle course
on this thing.
It is sad that the shutdown
will be harder for poorer countries
than it is for richer countries.
CA: So let’s come into that in minute.
The one exception I’ve heard
the case made for is Japan,
that Japan has not contained it
quite in the same way
that South Korea did
but has allowed people to work.
It’s tried to make extreme measures
for protecting their most
elderly population.
But they’ve tried to find
a middle scenario, haven’t they?
BG: If you act –
When you have hundreds of cases,
you may be able to contain it
by doing great testing
and great contact tracing,
and restricting foreigners coming in,
without as much damage to your economy.
The US is past this opportunity
to control without shutdown.
So the worst case of what was happening
in Wuhan in the beginning
or in northern Italy
over the last few weeks,
that we avoid that.
But we did not act fast enough
to have an ability to avoid the shutdown.
CA: But then what I don’t understand,
in the case of the US, for example,
is that even if we’re successful
in bending the curve and reducing
the number of new cases
from a period of extreme
shutdown, as it were,
no immunity has been built up.
Let’s say that there’s still no vaccine.
Surely when you lift restrictions
and people start going back to work,
the whole thing just blows up again.
BG: The experience that we’re seeing
in China and in South Korea
is that there are not these people
who are asymptomatic
that are causing lots of infections.
And that’s a parameter
that, as you build the model,
you have to put in.
There’s an Imperial model
that people talk about a lot,
which shows that reopening
is very hard to do.
But the results of that model
are not matching what we see in China,
and so very likely,
there aren’t as many
of these infecting asymptomatics.
And that’s why you have to be pragmatic.
There’s a lot we don’t know.
For example, seasonality
may help us in the Northern Hemisphere,
the force of infection will –
Respiratory viruses,
to some degree, they all are seasonal.
We don’t know how seasonal this one is,
but you know, there’s a reasonable chance
that the force of infection
will be going down.
And it’s your testing
that always is telling you,
“Oh, my gosh, do I have to shut down more,
or can I start to open up?”
So particularly, right as you open up,
that testing and contact tracing
is saying to you –
And you can say I’m more
on the optimistic side,
that it will be possible to do
what China’s doing,
where they are starting
to go back to normal.
CA: And help me understand
what happened there
because it seems kind of miraculous to me,
because this virus was exploding,
yes, in Wuhan, but people moved from there
to many other parts of China.
How is it possible
that the combination
of the shutdown in Wuhan
and measures elsewhere
seem to have got to the point
where there are literally
no new cases happening.
I mean, to me,
that implies that literally,
the virus is not circulating at all
between humans in China.
You know, there’s a few tourists
coming in who they deal with,
but I mean, is that literally
your interpretation of what happened,
that it’s no longer circulating in China?
BG: Absolutely.
Take a spreadsheet
and take a number like four –
one person infects four people –
and say the cycle is every 10 days.
Go through eight of those cycles,
and you’re getting the big number.
You know, start with 10,000 and then,
you know, that increase.
If you take the number 0.4 instead,
that is, the average case
infects 0.4 people,
then look at what happens
to that number as you go out.
It drops to zero,
and so things that are exponential
are very, very dramatic.
When they’re above one,
they are growing rapidly.
When they’re below one,
they are shrinking rapidly.
And so the isolation in China
drove that reproductive number
to well below zero.
And so local infection rates –
CA: Below one.
BG: Below one, sorry.
And that quarantine,
you know, quarantine comes from “40 days,”
which is what they thought
would help for black plague,
that is our primary technique.
Thank God we have testing,
if we use it properly.
We are doing therapeutics,
which will help with the death rate,
but in terms of keeping the infections
below one percent of the population,
it really all depends
just on the two things:
isolation and testing.
CA: So to quote a question from
my Twitter feed this morning for you Bill:
If you were president
for a month in the US,
what would be the top
two or three things you would do?
BG: Well, the clear message
that we have no choice
to maintain this isolation
and that’s going to keep going
for a period of time,
you know, probably in the Chinese case,
it was like six weeks,
so we have to prepare ourselves for that,
and do it very well.
And then use the testing
and every week, talk about
what’s going on with that.
If you’re doing isolation well,
within about 20 days,
you’ll see those numbers really change,
you know, instead of this,
you’ll see this,
and that is a sign
that you’re on your way.
Now, you have to stay
to get more generations
that are 0.4 infections
per previous infection.
You have to maintain it
for a number of weeks there.
And you know,
so this is not going to be easy.
We need a clear message about that.
It is really tragic
that the economic effects of this
are very dramatic.
I mean, nothing like this
has ever happened to the economy
in our lifetimes.
But bringing the economy back
and doing money,
that’s more of a reversible thing
than bringing people back to life.
And so, we’re going to take the pain
in the economic dimension,
huge pain,
in order to minimize the pain
in the disease and death dimension.
CA: Whitney.
WPR: We have a lot
of other questions coming in.
One that we’ve been seeing
is a question about what tools
are available for countries
that maybe don’t have the luxury
of being able to social-distance,
don’t have great health systems in place,
how should they be handling this virus?
BG: Yeah, I would say,
if the rich countries
really do their job well,
by the summer, they’ll be like China is,
or some of the other countries
that responded early.
But in the developing countries,
particularly in the Southern Hemisphere,
the seasonality is large.
As you say, the ability to isolate,
you know, when you go out
to get your food every day,
you have to earn your wage,
when you live in a slum
or you’re very nearby each other,
it’s very hard to do,
as you move down the income ladder,
than it is for a country
like the United States.
And so we should all
accelerate the vaccine,
which eventually will come,
and you know, people
are being responsible to say
that that’s going to take 18 months.
And there’s a lot of those being pursued.
I’m talking a lot with Seth Berkley,
who you’re going to have later this week,
who can talk a lot
about the vaccine front,
because he’s definitely
at the center of that,
being the head of GAVI.
We do need to get really cheap testing
out to these countries,
and we need to get therapeutics
so you don’t need to put
five percent of people on respirators.
Because even if they had the equipment,
they don’t have the personnel,
they just don’t have
the beds, the capacity.
And so the only good news
is that the rich countries have this
and so they will be learning
about testing, therapeutics,
and funding the vaccines
for the entire world,
to try and minimize the damage
in developing countries.
WPR: Great, I’ll be back later
with more questions.
CA: Bill, you mentioned
therapeutics there.
What is looking promising,
is anything looking promising?
BG: Yeah, so there’s quite
a range of things going on.
There’s a few that get mentioned a lot,
remdesivir, hydroxychloroquine,
azithromycin,
and the data is still a bit confusing,
but there’s some positive data on those.
Remdesivir is a five-day IV infusion,
and actually kind of hard to manufacture,
so people are looking
at how that can be improved.
The hydroxychloroquine looks like
it works, somewhat,
if you get in early.
There’s a huge list of compounds,
including antibodies,
antiviral drugs,
and so the Gates Foundation
and Wellcome Trust,
with support from Mastercard
and now others,
created this therapeutics accelerator
to really triage out.
You have hundreds of people showing up
and saying, try this, try that.
So we look at lab assays, animal models,
and so we understand which things
should be prioritized
for these very quick human trials
that need to be done all over the world.
So the coordination on that
is very complex, globally.
But I think, you know,
out of the top 20 or so candidates,
probably three or four of them
will work out,
you know, at different
stages of the disease,
to reduce the respiratory distress.
CA: I heard you mentioned
that one possibility
might be treatments
from the serum, the blood serum,
of people who had had
the disease and recovered.
So I guess they’re carrying antibodies.
Talk a bit about that, how that could work
and what it would take to accelerate that.
BG: Yeah, this has always been discussed
as how could you pull that off.
So people who are recovered,
it appears,
have really effective
antibodies in their blood.
So you could go,
transfuse them and only take out
the white cells, the immune cells.
And then the question is,
OK, how many patients' worth
of material could you get?
You know, if you have
that recovered person come in,
say, once a week,
do you get enough
for two people or five people?
Then logistically, you have to take that
and get it to where that need is.
And so it’s fairly complicated,
you know, compared to a drug
that we can make in high volume.
You know, the cost of taking it out
and putting it back in
probably doesn’t scale as well.
But there is work being done on this.
You know, we actually started with Ebola,
and fortunately, it got done
before it was needed.
So that is being pursued
and it will work to some degree,
but it will be hard to scale the numbers.
CA: So it’s almost like,
when you talk about the need
to accelerate testing,
the immediate need
is for testing for the virus.
But is it possible
that in a few months' time,
there’s going to be this growing need
to test for these antibodies in people,
i.e. to see if someone
had the disease and recovered,
maybe they didn’t even know they had it.
Because you could picture
this growing worldwide force of heroes –
let’s call them heroes –
who have been through this experience
and have a lot to offer the world.
Maybe they can offer
blood donation, serum donation.
But also other tasks,
like, if you’ve got overwhelmed
health care systems,
presumably, there are kind of
community health worker type tasks
that people could be trained to do
to relieve the pressure there,
if we knew that they were
effectively immune?
BG: Yes.
Until we came up with the self-swab
and showed FDA that that’s equivalent,
we were thinking that people
who might be able to man those kiosks
would be the recovered patients.
Now we don’t want to have
a lot of recovered people, you know.
To be clear, we’re trying,
through the shutdown,
in the United States,
to not get to one percent
of the population infected.
We’re well below that today,
but with exponentiation,
you could get past that three million.
I believe we will be able to avoid that
with having this economic pain.
Eventually, what we’ll have to have
is certificates of who
is a recovered person,
who is a vaccinated person,
because you don’t want people
moving around the world –
where you’ll have some countries
that won’t have it under control, sadly –
you don’t want to completely block off
the ability for those people to go there
and come back and move around.
CA: Bill, is your foundation helping
to accelerate the manufacture
of these self tests?
What are the prospects
for really seeing scale
on some of this testing soon,
not just in the US, but globally?
BG: Yeah, our foundation,
we’d been funding the thing
called the Flu Study
to really understand
how respiratory viruses spread.
It’s amazing how little was understood
about how important schools are,
different age groups,
different types of interaction.
And that gave us an experience.
In fact, that flu study
actually was the first time
coronavirus was found in the community,
because the government was still saying
you only test people
who’d come from China,
but we ran into people
who had coronavirus,
who hadn’t been travelers.
So, that was like an early warning sign,
even though the regulation said
you weren’t supposed to even look at that.
So yeah, the Foundation is working
with all the private sector people,
the diagnostics people
on this testing piece.
Now that we can do the self-swab,
those swabs are very easy to manufacture.
The one where you had
to jam it into the throat,
deep turbinate,
that was getting into short supply.
So the swab should not be limiting,
neither should the various chemicals
that help run the PCR machines.
So we should be able
to get to a South Korea-type
prioritized testing thing
within a few weeks.
CA: How important is it
that the world’s nations
collaborate right now?
I mean, it seems like, you know,
here’s this common enemy facing humanity,
it does not know
that it just crossed a border,
it does not know what race people are,
what religion they are –
it just knows, “Here’s a human,
I’ve got a manufacturing machine here
that can make me famous.”
And it goes to work.
It’s so terrifying to me to see
signs of countries starting
to blame each other
or the xenophobia, it just seems so toxic.
What’s your take on this, Bill?
Do you see signs of cooperation happening,
or are you also worried about the sort of,
“US versus China” kind of thing
that seems to be going on
if we’re not careful?
BG: Well, I see both.
I see that countries that are recovered
can help other countries.
And that’s fantastic.
If by the summer,
we’ve knocked this thing down,
then great, we can help other countries.
There are vaccine projects
all over the world,
and those should be evaluated
on a very neutral basis,
to which one is the best to help humanity.
And make sure the manufacturing capacity
isn’t just for rich countries,
that it’s scaled up, very low cost stuff
for the entire world,
and that’s the spirit of GAVI,
is getting vaccines out to every person.
So in the science side,
and data-sharing side,
you see this great cooperation going on.
Unfortunately, whenever you have disease,
this sense of other and foreign
and “Oh, stay away from me,”
you know, that sort of
pulling inward is reinforced.
And we have to avoid that.
You know, ironically,
we have to isolate physically,
while in terms of looking
at community groups
that are pooling resources
to help make sure food gets to everyone
and help assure medical care,
you know, if older people need
to be moved out of common facilities,
you help out with that,
and that people aren’t suffering too much
from the psychology of isolation.
So our generosity
has to go up towards others
at the same time we’re less actually
physically interacting with other people.
CA: I mean, thinking about the situation
in many developing countries,
I’m curious how you think of this.
You mentioned, first of all,
that seasonality may help,
i.e. high temperatures.
Is it possible that that is so far
protecting, to some extent,
places like India
or sub-Saharan Africa and so forth?
BG: India’s Northern Hemisphere.
So Southern Hemisphere
is lots of Africa, South America,
Australia, New Zealand, Indonesia.
And it is true,
either the force
of the infection is lower there
or we’re just not seeing it with testing.
You know, a few months from now,
we’ll understand the seasonality question,
which would be good news
for the Northern Hemisphere,
and somewhat bad news
for the Southern Hemisphere.
Now more people live
in the Northern Hemisphere,
including India, Pakistan,
and that would buy us some time,
and time is a big deal,
because all these tools get so much better
if you had to go into
a second season with it.
But yeah, sadly,
we could see, in the next few months,
as the Southern Hemisphere
is moving into its fall and then winter,
we could see a big increase there,
and that is going to be very difficult.
Now they don’t have as many older people,
but they have lots of people
who are HIV positive,
or have malnutrition
or various lung challenges
because of indoor smoke,
and so the wild card
is how well can the developing
countries deal with this.
CA: If you’re in a country
where the majority of your population
is making less than two
or three dollars a day,
can you even afford a strategy
that looks like, basically,
shutting down the economy?
BG: I’m very worried that there will be
a massive number of deaths
in those poorer countries,
because the health systems just aren’t –
you know, the number
of respirators, hospitals,
and of course,
when you overload that system,
your deaths are not just COVID deaths,
but everyone else who’s trying to access
a system that will be somewhat in chaos,
including with health workers
who are getting sick.
CA: OK, we’re getting near
to running out of time with this.
Whitney, maybe a last question
or two from online.
WPR: Sure, we have two from online,
we’re seeing thousands of questions
around these same lines.
One, there’s lots of people
who are really interested to hear
about the kind of work that you’re doing
with your foundation
as far as distributing tests,
but also producing safety gear,
masks and that sort of thing,
to help with this effort
for health workers.
BG: So the Gates Foundation,
you know, we, very early on,
gave out 100 million
to help out with all the pieces:
the testing piece,
the therapeutics and the vaccines.
We are not experts in making masks
and ventilators and gowns,
and it’s great that other people,
including some 3D printing,
and open-source things, that is great.
Our focus, you know,
like this self-swab thing,
nobody had done that before,
people thought it wouldn’t work,
we were quite sure it would work.
And so that, for the globe,
is a huge thing.
We work a lot with both
governments and private sector,
so in some ways, we’re kind of a bridge.
And we’ve been talking to the heads
of the pharmaceutical companies,
the testing companies
and, specifically,
with the ones doing vaccines,
including some of which are these new
type of vaccines, RNA vaccines,
that we’ve been backing
for quite some time,
and CEPI has been backing.
And so our expertise
is in those medical tools
and really getting the best
of the private sector engaged there.
It’s been a little slow.
We can write checks right away,
whereas the government processes,
even in this situation –
you know, there’s still
this notion of bidding,
and not really knowing who has
the unique capabilities of doing things,
and so, an organization
that’s working on this all the time,
lots of new vaccines,
can step in and be helpful.
And it’s really amazing.
When we talk to private-sector partners,
their interest in helping out
has been absolutely fantastic.
And so that’s where we have a unique role.
WPR: And the other question
that we’re seeing a ton of –
before we wrap up here –
is just people are really interested
in your insight, Bill,
on whether you think we are heading
in the right direction,
do you feel like our economy
is heading in the right place,
that humanity is heading
in the right place,
are we in a better position now
than you thought we were in
five years ago?
BG: Well, five years ago,
I said that pandemic
is this unaddressed,
very, very scary thing.
And that if we did the right things,
we could be more prepared.
Science is on our side.
The fact we can be ready
for the next epidemic,
it’s very clear how to do that.
And yes, it will take tens of billions,
but not hundreds or trillions of dollars.
So it will be tiny compared
to the economic cost.
I remember when I did
that presentation 2015,
I put up, “Hey, a big flu epidemic
could cost four trillion,”
and I thought, wow, that’s a big number,
do I really think it’s that big?
And I went and looked up numbers
and thought, yeah, well, that’s big.
This epidemic will cost
that much to the economy.
So in the short run,
we are going to have more pain
and more difficulty
and people are going to have to step up
to help each other.
I’m still very much an optimist, you know,
whether it’s climate change,
countries working together,
biology taking the diseases, malaria, TB,
you know, even advances
for what are more rich-world diseases,
like cancer.
The amount of innovation,
the way we can connect up
and work together –
yes, I’m superpositive about that.
You know, I love my work
because I see progress
on all these diseases all the time.
Now we have to turn
and focus on this, you know.
Sadly, it may interrupt
and the polio situation
might get worse a little bit
because of the distraction here.
We’re using a lot of the great capacity
that was built up
for those polio activities
to try and help the developing countries
respond to this very well.
And that is appropriate,
but the message from me,
although it’s very sober
when we’re dealing with this epidemic,
you know, I’m very positive
that this should draw us together.
We will get out of this,
and then, we will get ready
for the next epidemic.
CA: That’s exactly
what I was going to ask you, Bill,
which is, where is your head,
do you think we will get through this?
Will the leaders that matter
listen to the scientists,
will they?
Will we make it through?
Do you believe that within
a few months' time,
we’re already going to be
looking back and saying,
“Phew, we dodged a pretty bad one there.”
BG: We can’t say for sure
that even the rich countries
will be out of this
in six to ten weeks.
I think that’s likely,
but as we get the testing data,
we’ll get more of a sense of that
and people will continuously
be able to see that.
But you know, the rich countries
will get out of this.
The developing countries
will bear a significant price,
but even they, we will get a vaccine
and GAVI will get that out to everyone.
So you know, two to three years from now,
this thing, even on a global basis,
will essentially be over
with a gigantic price tag.
But now we’re going to know,
OK, next time we see a pathogen,
we can make billions of tests
within two or three weeks.
We can figure out
which antiviral drugs work
within two or three weeks
and get those scaled up.
And we can make a vaccine,
if we’re really ready,
probably in six months,
using these new platforms,
probably the RNA vaccine.
So specifically, there are innovations
that are there
that will get financed,
you know, I hope, quite generously,
coming out of this thing.
And so, three years from now,
we’ll look back and say,
you know, that was awful,
there’s a lot of heroes,
but we’ve learned a lesson
and the world as a whole,
with its great science
and desire to help each other,
was able to try and minimize
what happened there
and avoid it happening again.
CA: That’s certainly
the optimistic scenario
that I’m craving for, myself.
That the world kind of realizes,
one, that there are certain things
that you just have to unite on.
Two, that science really matters
and it’s a miracle that science
can understand this bug,
you know, make a vaccine,
sequence it, make therapeutics,
understand how to model it –
it’s kind of miraculous to me.
So will we learn, now,
to pay attention to scientists,
because if we do,
I’m sure that you feel this as well,
there’s an amazing analogue with climate,
it’s just a different timescale.
That the scientists are out there, saying,
“There’s this huge enemy coming,
if we do nothing,
it’s going to take millions of lives,
it’s going to wreck our planet.
For God’s sake, act, politicians!
Do something.”
And the politicians are going, “Meh, no.
We need a little more GDP,
we need to win an election.”
And they’re not acting.
Do you see a scenario
where this shocks politicians
to actually change their thinking
and their prioritization
of science overall,
or is that asking too much?
BG: Yeah, it’s interesting
how much of this distraction
will delay the urgent innovation agenda
that exists over in climate.
You know, I have freed up
a lot of time to work on climate.
I have to say,
you know, for the last few months,
that’s now shifted,
and until we get out of this crisis,
COVID will dominate,
and so some of the climate stuff,
although it will still go on,
it won’t get that same focus.
As we get past this,
yes, that idea of innovation and science
and the world working together,
that is totally common
between these two problems.
And so I don’t think this has to be
a huge setback for climate.
CA: Last question.
There are thousands of people watching,
many of them living alone,
some quite scared,
there may even be people there
who have this virus
and are suffering symptoms or recovering.
By the way, if that’s you,
we’d love to hear from you,
we really would.
Maybe have a conversation
with some of you,
in a future one of these,
just understanding the experience.
But Bill, what can people do
as individuals from their own homes,
right now, to try and help?
BG: Well, there’s a lot
of creativity, you know –
can you mentor kids who are being forced
into an online format
where the school systems
really weren’t ready for that?
Can you organize some giving activity
that gets the food banks to step up
where there’s problems there?
These are such unprecedented times,
and it really should draw out
that sense of creativity,
while complying
with the isolation mandates.
CA: Bill, I really want to thank you
for spending this time with us
and for the financial investment,
the time investment.
You’ve really invested your life
into trying to solve these big problems.
And this is as big as they get.
I have a hunch that your voice
is really going to be needed
in the next few weeks.
Thank you so much for your time today.
This was really wonderful,
hearing from you.
Thank you.
BG: Thanks, Chris.
CA: OK, thanks, everyone,
thanks for being part
of the TED community.
Look after yourselves,
be smart about this.
You know, get ahead of it.
If you’re in a part of the world
where this thing hasn’t really hit,
listen to Bill Gates.
Get ahead of it.
Keep, you know, if you possibly can,
socially distanced.
No, not – physically distanced
and socially connect.
That’s what the internet is for.
These days are what
the internet was built for.
We can spread love, we can spread ideas,
we can spread relationship,
we can spread thought,
without spreading a dangerous bug.
So get ahead of it,
and let’s figure this out together.
It’s been wonderful
spending time with you.
From Whitney and from me
and from the whole TED team,
thank you, and over and out.