I Asked Bill Gates What's The Next Crisis?

Derek: So how did it feel to make this prediction and then have the world essentially not listen and not prepare?

Bill Gates: Well, there's no good feeling that comes on something like this saying, "I told you so." If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war. You know, I just think back and could I have been more persuasive? We've actually invested very little in a system to stop an epidemic. We're not ready for the next epidemic.

Derek: How did you make such a prescient prediction? How did you know this was going to happen?

BG: Well, there's a number of respiratory viruses, and from time to time, one will come along that's very transmissive and causes some level of fatalities. Respiratory diseases are very scary because you're still walking around on a plane, a bus when you're infectious, unlike some other diseases like Ebola where you're mostly in a hospital bed by the time the viral load infects other people.

Derek: Hey, so recently I got the chance to interview Bill Gates when his foundation's annual letter came out. I'll link to it in the description, and we talked about lots of things, including conspiracy theories and misinformation. But about the pandemic, I wanted to know if so many people could see this coming and the costs of prevention were relatively small, then why wasn't more done about it?

BG: Well, there are some risks like earthquakes where we see small earthquakes all the time. Or you know the history of war or fire or hurricanes, so you don't forget. These pandemics only come along so irregularly that being lulled into a sense of security where it probably won't be a problem in the next few years, why should we put money into that? You don't buy the insurance policy, basically. This one will help us understand it needs to be a priority.

Derek: I feel like humans have an issue though with fighting the last battle potentially. So if we focus on pandemics now and there isn't one, say for another hundred years, what is the next disaster? What is the one that we're not prepared for?

BG: Well, I'd point out two: One is climate change. Every year that would be a death toll even greater than we've had in this pandemic. Also, related to pandemics is something people don't like to talk about much, which is bioterrorism; that somebody who wants to cause damage could engineer a virus, and so that means the cost, the chance of running into this is more than just the naturally caused epidemics like the current one.

Derek: It feels to me like there's something similar about pandemics and, you know, climate change or like asteroid impact, which is that, you know, they're not very tangible but you could do a little bit. I don't know, it seems like humans are not very good at those sorts of problems.

BG: Well, my favorite writer, Vaclav Smil, you know wrote about all the potential kinds of disasters like, you know, the risk of an asteroid, the risk of a, you know, Yellowstone-like eruption, and in fact, he showed that pandemics were significantly the biggest thing other than a human-caused nuclear war that we needed to be more prepared for.

Derek: So what changes do we put in place to be readier for the next one, and is it possible that COVID-19 could be the last global pandemic?

BG: Well, certainly there will be more pandemics. The ways that humans interact with other species, these viruses are coming across a species barrier whether it's from bats or monkeys.

Derek: But you don't think we could increase our preparedness to such a level that it never sort of becomes this global issue?

BG: We could increase our preparedness so we never have a death toll, uh, anywhere near what we have today. You know, pandemics can be worse in terms of the fatalities. Smallpox was over 30 percent fatality. You know, so a little bit we were lucky that the fatality here is not super high, but we can nip it in the bud. It'll still get to a lot of countries, but the number of deaths, you know, uh, with the right system should be a tenth of what we've seen here.

Derek: And the systems that you want to put in place so this sort of, so you can nip it in the bud, or so what are the key elements that we didn't have that we should have going forward?

BG: I would divide it into two sections: There's the field-based activity and the R&D activity. In R&D, we need to mature mRNA so we can make it even faster and have factories all over the world, have it be cheap and thermal stable. There's a lot that can go into therapeutics including antibodies. On diagnostics, having the ability to give 10 million PCR tests a day. Then in terms of the field, we need a lot of diagnostic machines all over the world. We need a team of epidemiologists. So the investments are about equal between R&D and the field-based group and information that should be constantly flowing.

Derek: You know, I feel like there's a meta-issue that is kind of above all of these issues, which is, you know, the way that people connect with reality and figure out what's true and what's not and, you know, what information to believe. I've got to say that, you know, as I was growing up and coming into this information age, it seemed like the Internet and all these tools were going to make the correct information so much more easy to access and bring us into a more fact-based world. Instead, it doesn't look as though it's bringing us there. I wonder if you shared a similar vision for, you know, what the Internet might do for all of us, and I don't know if you have any thoughts about the current state of it. You know, how do we deal with this?

BG: Well, the Internet has done something fantastic which is if you want to learn, you know, the people who watch you are, you know, getting an opportunity to understand science and what's going on, and that just wasn't there. So for a lot of people, they're so much more informed. I mean, I have friends who ask me about these variants where I'm just stunned at how up to date they are with the latest information. So for people who want to learn facts, this is a golden age. You know, we focus on the negative part with some of these conspiracy theories and anti-factual things. And so because social media is so new, figuring out how you curb that, you know, labeling it, restrict the speed of spread of things that are titillating but false. We are missing some good ideas to, you know, not have this kind of scary phenomena that in the case of anti-vaccine things may slow down how quickly we get lots of people, uh, to take the vaccine and therefore extend the epidemic and cost us tens of thousands of lives.

Derek: It feels like you're running up against, you know, kind of that great American principle of free speech, right? I think it's a great point that you bring up that, you know, in the past the problem was kind of scarcity getting access to this sort of information, and now it's sort of a problem of too much and figuring out which is the good stuff and which is not.

BG: Well, there are certainly clear things like, you know, saying completely false things about, you know, vaccines. But there is kind of a gray area in the middle that figuring out what the rules are and who should be the one looking and interpreting those rules. Wow, we are missing that today. You know, can you get a group of experts that are weighing in on these things? You don't really want the profit motive involved, but you want, you know, expertise and capacity. And so, you know, a few years from now, I hope we're more sophisticated on what or how that line should be drawn.

Derek: You know, a while back on my second channel, I made a video called "Be Hated," which was kind of about my thoughts about pushing back against misinformation, that we should see anything that is wrong in the world and we should do our best to fight it. So you should not be liked by everyone because there are some people out there with bad ideas and you should be pushing back against them. That was essentially my thought, but since then I feel like my views have softened a little. Now I think of our pushing back against misinformation a little bit like an immune system. Obviously, it's a problem if your immune system is weak if it doesn't respond to anything, but it's also a problem if your immune system is too strong. You know, during the 1918 flu pandemic, there's a really interesting distribution of deaths where the young and old were more likely to die, obviously because they have weak immune systems, but also people in the sort of 25 to 35-year-old range because their immune systems were just so strong they were overactive, and that ended up resulting in mortality. So I feel like there's a sweet spot in terms of how much we push back against misinformation. You know, you'll never see me make a video about flat earthers because I just don't see the point. You know, making that video only kind of reconfirms their worldview, and there's not really any minds to move there, so that's kind of how I'm conceptualizing misinformation these days, a bit like we have to be a targeted immune system.

So I wanted to push Bill a bit further on this idea, and I brought up a tweet that I had seen doing the rounds on Twitter that basically said that the Oxford vaccine development, they were going to open-source that vaccine until the Bill and Melinda Gates Foundation got involved and said no you must partner exclusively with a big pharma company, AstraZeneca. And so, obviously, it seems to the people on Twitter that something nefarious was going on there, but I wanted to know from Bill what was the real story.

BG: Well, the making a safe vaccine is more complicated than, say, making a jet engine. People are very picky about vaccines; in fact, you could ruin the reputation of vaccines if you're making them in factories where the quality control at every stage is not exquisite. And you know, any mistake, you know, you can have that factory shut down literally for months at a time when its output is needed to save millions of lives. So vaccine factories are not something that you just, you know, like open-source code that you can take and, you know, mess around with. And so the limitations on how many vaccines are being made, that's based on how many great capable vaccine manufacturers there are in the world. We've made sure that the AstraZeneca's being made in these big Indian factories and there's no royalty for that, no charge at all. Now we've had to fund that, the Gates Foundation. These are companies we've been working on their factory quality for over a decade so that there was spare capacity to make inexpensive vaccines. So Oxford University is wonderful, but they're not capable of doing a phase three trial and they don't have factories. We did tell Oxford that they needed to seek somebody with expertise, and AstraZeneca came in and we didn't control that agreement, but they came in and said, hey, they want to do it on a non-profit basis, and I'm impressed with how they put their best people on it and helped out. You know, the pharma companies who didn't get involved, nobody's criticizing them. So, you know, you feel sorry for the ones that are really miraculously helping make these vaccines. These are the very good reasons that I suspect exist, but that's where I feel like social media just doesn't get the nuance, and you know, it pains me to see the world like that. And you know, even to see you, Bill, you know, be the target of some of these conspiracy theories. It seems to not bother you, but you know, it kind of bothers me as a guy who wants, you know, everyone to live in the same kind of reality. And you know, I see you out there doing great things, and I think that, you know, that should be commended as opposed to what you get. I'm not in a position to complain much; you know, I have a lot of things that, you know, make me extremely lucky, and you know, I hope these conspiracy theories go away, and I don't know what that'll mean for the future.

Derek: How do you feel about the vaccine rollout so far?

BG: Well, we, you know, we need the supply, we need the logistics, and we need the demand, and there are huge challenges in each of those. I'm hopeful that Johnson and Johnson in the next month will get approved because that's a single dose vaccine, very cheap, highly scalable. So AstraZeneca, Johnson and Johnson, and a few months later Novavax; most of the developing world, those are the vaccines that will be going to them. And so we put billions into trying to make that happen, and you know, in a few months hopefully it'll come together.