Bill Gates who has recently stepped down from the board of Microsoft, has taken to Reddit to answer the community’s questions about the pandemic.
Over the years I’ve had a chance to study diseases like influenza, Ebola, and now COVID-19—including how epidemics start, how to prevent them, and how to respond to them. The Gates Foundation has committed up to $100 million to help with the COVID-19 response around the world, as well as $5 million to support our home state of Washington – Bill Gates
Bill Gates addresses fears and hope, talking about issues including social distancing, vaccines, the economic fallout as well as what the world can do to be better prepared. He was joined by Dr. Trevor Mundel, who leads the Gates Foundation’s global health work, and Dr. Niranjan Bose, his chief scientific adviser. Below is a transcript of some of the questions he could get to along with his answers.
What about the current crisis worries you the most? What gives you the most hope?
The current phase has a lot of the cases in rich countries. With the right actions including the testing and social distancing (which I call “shut down”) within 2-3 months the rich countries should have avoided high levels of infection. I worry about all the economic damage but even worse will be how this will affect the developing countries who cannot do the social distancing the same way as rich countries and whose hospital capacity is much lower.
Is there any chance that the 18 month timeline for development of a vaccine can be shortened, and by how much?
This is a great question. There are over 6 different efforts going on to make a vaccine. Some use a new approach called RNA which is unproven. We will have to build lots of manufacturing for the different approaches knowing that some of them will not work. We will need literally billions of vaccines to protect the world. Vaccines require testing to make sure they are safe and effective. Some vaccines like the flu don’t for the elderly.
The first vaccines we get will go to health care workers and critical workers. This could happen before 18 months if everything goes well but we and Dr. Fauci and others are being careful not to promise this when we are not sure. The work is going at full speed.
What do you think about China’s response to the outbreak? How would you rate their response on a scale 1-10?
After January 23 when they realized how serious it was they did strong social isolation which made a huge difference. Of course that isolation created a lot of difficulties for the people involved but they were able to stop the case spread. Other countries will do it somewhat differently but a combination of testing and social isolation clearly works and that is all we have until we get a vaccine.
In your opinion, after this pandemic comes to a close, however long that may be, what should be the first step we as a global community take so that we are better prepared for the next pandemic?
The TED talk I did in 2015 talked about this. We need to have the ability to scale up diagnostics, drugs and vaccines very rapidly. The technologies exist to do this well if the right investments are made. Countries can work together on this. We did create CEPI = Coalition for Epidemic Preparedness Innovation which did some work on vaccines but that needs to be funded at higher level to have the standby manufacturing capacity for the world.
Why do you think most world governments weren’t prepared if you and other experts warned of such events such as this?
No one could predict what the chance of a new virus emerging was. However we did know it would happen at some point either with a flu or some other respiratory virus. There was almost no funding. The creation of CEPI which was funded by our foundation, Wellcome, Norway, Japan, Germany, and the UK was a step but tiny compared to what should have happened. We prepare for possible wars and fires and now we have to have preparation for epidemics treated with the same seriousness. The good news is that our biological tools including new ways to make diagnostics, therapeutics and vaccines make it possible to have a strong response system for naturally caused epidemics.
Covid-19 testing standards seem grossly unfair in favor of the rich and famous. Testing is happening for people like professional sports players, even those without any symptoms at all. I’m not talking about health care workers or people in essential jobs- I’m talking about actors, actresses, sports players and so on. On the flip side, the guidance from Kaiser in WA is that you must have a fever of 101.5 and either serious shortness of breath or a bad cough, and even then testing results take 5 days or more.
How is it that even with something like covid-19 testing, which the government is supposed to manage, the rich and famous are getting special treatment? Is there a big stash of tests that are reserved for “people that matter”? Isn’t it hypocritical for everyone else to be told they need to look out for the common good and avoid demanding too much of the health care system, meanwhile the rich and famous get whatever they want, when they want it?
We need to democratize and scale the testing system by having a CDC website that people go to and enter their situation. Priority situations should get tested within 24 hours. This is very possible since many countries have done it. Health care workers for example should have priority. Elderly people should have priority. We will be able to catch up on the testing demand within a few weeks of getting the system in place. Without the system we don’t know what is missing—swabs, reagents etc..
Thoughts on chloroquine/hydroxychloroquine?
There are a lot of therapeutic drugs being examined. This is one of many but it is not proven. If it works we will need to make sure the finite supplies are held for the patients who need it most. We have a study going on to figure this out. We also have a screening effort to look at all the ideas for Therapeutics because the number being proposed is very large and only the most promising should be tried in patients. China was testing some things but now they have so few cases that that testing needs to move to other locations.
How is your foundation helping the current pandemic? Are you donating money, producing products for health workers?
Our foundation is working with all the groups who make diagnostics, therapeutics and vaccines to make sure the right efforts are prioritized. We want to make sure all countries get access to these tools. We donated $100M in February for a variety of things and we will be doing more. One priority is to make sure that there is enough manufacturing capacity for therapeutics and vaccines. We have other efforts like our education group working to make sure the online resources for students are as helpful as they can be.
When will this all end?
To bring it to small numbers globally we need a vaccine. Many rich countries will be able to keep the number of cases small (including the US) if they do the right things but developing countries will find it very difficult to stop the spread so a vaccine is critical. A group called GAVI helps buy vaccines for developing countries and they will play a key role once we have a vaccine being made in volume.
How long will this go on?
This will vary a lot by country. China is seeing very few cases now because their testing and “shut down” was very effective. If a country does a good job with testing and “shut down” then within 6-10 weeks they should see very few cases and be able to open back up.
Can you provide any estimates for how much of the world’s population might become infected?
This will vary a lot by country. Taiwan, Hong Kong and Singapore acted quickly and will have very few cases. Even China will stay at a low level of their population (less than .01%) so far. Thailand is another exemplar. Unfortunately in poorer countries doing social distancing is much harder. People live in close proximity and need to work to get their food so there could be countries where the virus will spread broadly.
Do you believe the news coming out of China though? It’s hard to at this point.
China is doing a lot of testing. South Korea is also doing a good job of testing. Once China got serious in January they have been quite open about their cases so yes the good news is they are seeing very few infections at this point. The US needs to get its testing system organized so we see what is going on.
How is the economy likely to recover after all of this in your opinion?
Yes eventually. The economic impact of the “shut down” will be large but if it is done well (including the testing piece which I keep mentioning) eventually we can open back up.
What do you see as the long-term strategy for fighting this pandemic and do you feel like it will adequately prepare us for the next?
I think that after this is under control that Governments and others will invest heavily in being ready for the next one. This will take global cooperation particularly to help the developing countries who will be hurt the most. A good example is the need to test therapeutics wherever the disease is to help the whole world. The Virus doesn’t respect national boundaries.