Bill Gates: COVID-19 has Set Back Global Health for Years | National Geographic

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Bill, it's so nice to talk with you about this goalkeeper's report. But I was really struck how different it was from the last time we talked about goalkeepers in 2018, and that was so much of a more positive report. You know, all of the indicators were going in the right way, and COVID really has just put the brakes on that. I think your report puts it really well; it said, "In the blink of an eye, a health crisis became an economic crisis, a food crisis, a housing crisis, a political crisis. Everything collided with everything else."

So what about all of these results? Do you think is the most important one that we... you know, where would you love to start to talk about this?

Well, as you say, in most years, the reduction in malnutrition, the reduction in childhood death, the increase in literacy rates—there's this gradual progress that human life is getting better. People are living longer, and it's amazing that this is so widespread in its negative effects. The actual direct effects of killing people in poorer countries is a very small part of the overall damage that's been done.

A big part is that their health systems, which are very fragile, have been disrupted. So vaccinations aren't taking place, malaria bed nets are not getting out, and HIV medicines are not getting out. Consequently, Africa will have dramatically more deaths from these indirect effects than from the direct effects. So the imperative is, let's bring the epidemic to an end, and that takes us to a discussion about vaccines, which is the only tool to do that.

Then, we need to make sure that we restore the services, even some ketchup for the kids who miss those vaccinations. Even if we do our best on all those things—the vaccine, the restoration, the rich country generosity—it'll take two to three years just to get back to the beginning of 2020.

Well, and it has happened also quickly. One of the things that the report talks about that I found really startling was when it came to vaccine distribution and how key this is going to be in terms of survivability. This model from Northeastern University—I was really shocked that said that 33% of the deaths will be averted if vaccines are distributed to high-income countries first, but 61% could be averted if the vaccines are distributed to all countries proportionally to their population. Can you talk about why that is?

Well, there's deaths all over, and now no one's saying that the distribution algorithm will be totally based on equity. You know, there'll be some tilt towards the countries that help fund the R&D. But we need to have some balance here—both the generosity to buy the vaccines for those countries, to increase the manufacturing capacity, because this is more units of a vaccine than the world has ever needed, and then to help fund that availability without the rich countries taking all of that capacity.

Do you think, though, that if countries, say the United States or other wealthy countries, don't take this equitable approach that we will be morally culpable for more deaths?

Well, the foundation's motto is all lives have equal value. And the foreign aid that rich countries give have saved tens of millions of lives—things like the Global Fund for HIV and GABI, which helps buy vaccines for things like diarrhea and pneumonia. And so there is some equity in the world, but the very fact that, you know, our foundation is saving a life for every thousand dollars we spend does show that we do treat lives outside the U.S. as not being as valuable as those lives.

And, you know, it's pretty extreme. This would be a double mistake because not only would you be sacrificing those lives, but as long as you let the disease exist outside the United States or anywhere in the world, it's going to come back. So you can't resume your normal activity.

Of all the health crises, this is one where the world really is in it together. Even countries that did a good job on the epidemic, like South Korea or Australia, found it difficult for there not to be reinfections. They are having to continue preventive measures where they have very few cases, with big disruption and economic costs.

So here we've got to solve it for all of humanity. And so it's both just, and even from a selfish point of view, it's the smart thing to do.

Well, I mean, the report does make that point repeatedly—that you can't solve a global problem with a national solution. But it sounds to me like you're also worried that this might not really happen; that there won't be that global solution, because, I mean, that report comes back to this point over and over again.

Well, so far the U.S., although it is exemplary in funding the R&D for the six vaccines that are the most likely to get really strong regulatory approval by early next year, has been absent in the discussion about creating the capacity and the aid money to buy those vaccines. Now, I'm hopeful. You know, Congress historically has been great on global health—very generous on things like HIV and malaria. And so the fact it's been overlooked, I hope that gets remedied very quickly, because every month that this epidemic stays out there literally costs trillions of dollars.

Yet the billions needed for the vaccine are what’s the only thing that will bring it to an end. You know, one of the figures in there that really struck me was the increase in poverty. I mean, here there had been this horrific streak of less and less poverty. I think it had gone on for about 20 years, and now all of a sudden, you know, tens of millions of more people are pushed into poverty because of what's happened here.

The report talked a little bit about, you know, women really taking the brunt of some of that. Could you talk about that?

Yeah, there's no doubt in poor countries, things are tough for everyone, but women bear the brunt of that. So if you get this reversal into poverty, it’s not equitable at all. The extra work, having the kids at home, you know, finding enough food—extreme poverty is waking up and worrying when you have enough to eat every day.

The goal by 2030—the sustainable development goal—is to bring an end to extreme poverty. The track record there, particularly in Asia, has been quite good; it has been going down a lot. The place where it's been toughest is in Africa, where you have very high population growth. You have the difficulty of climate change making the farming less predictable, so you have years where you don't get enough.

And, you know, we'd hoped that with generous aid and better seeds, Africa too would start the kind of miracles that we've seen in Asia. But this, at best, is a three or four year setback to that quest to have almost no one live in extreme poverty.

You know, there's so little good news in this report, and understandably so. But do you see any innovations that might come out of having to deal with this disease? Or do you see any, you know, anything that what are the hopeful lifelines that you could throw out there?

Well, there's no doubt that having ignored the warnings about the pandemic this time, the rich countries, including the U.S., will take the threat seriously and they'll do the kind of simulations to prepare. They'll have, you know, large-scale diagnostic capability immediately available, which the U.S. in particular was the worst on.

That will mature some of these vaccine platforms that are not only worthwhile for pandemics but will be used to make vaccines for malaria, TB, and HIV. Just like in wartime, you know, we've moved quickly and tried new things.

You know, even in terms of our lifestyle, can you use telemedicine? Can you use online education? Can you avoid some of the business travel we do? You know, our eyes have been opened up, and the software is getting a lot better.

And, you know, so it's a real acceleration there. It doesn't offset all the negative things that come out of the pandemic. But yes, the ingenuity in the pharmaceutical companies—that's why we have six vaccine candidates, several of which are extremely likely to prove safe and efficacious by early next year.

So if this pandemic could come ten years ago, you know, our internet bandwidth wouldn't have let us do our office jobs. The vaccine platforms wouldn't be as far along. So, you know, it's phenomenal we can say that within a few years—with a little bit of luck on the vaccines and some generosity, real effort to get the word out that it's safe—this pandemic will come to a close.

You know, a lot more negative would be saying, "Oh my God, this is gonna continue indefinitely." That, fortunately because of science and the pharma companies jumping in, that's not the case.

So do you think, as a last just thought, has the U.S. learned its lesson, if you will, about taking pandemics seriously and being prepared and getting ready?

That's—I mean, the problem is you get ready, and then nothing happens, nothing happens, nothing happens, and then you get unprepared. So, but do you think that this will have made that impression a lasting one?

Well, we'll go and do a post-mortem. The CDC made some mistakes at the start. Then you had things moved up to a political level without expertise, where the willingness to admit mistakes was zero. You know, the fact that we still have test results that take more than 24 hours is just a desire to say, "Oh, I solved the testing thing. You shouldn't reimburse for those delayed test results."

So we still, you know, are performing way below what we should. You know, I do think there'll be a lesson to let the professionals do their work. There'll be lots of research and development about how you can ramp up testing drugs and vaccines very quickly.

So yes, I think, unlike, you know, the title of my 2015 talk, which was "We're not ready for the next pandemic," I think three years from now, we will be ready for the next pandemic.

Well, I hope there isn't the next one, but I appreciate the optimism around that. Well, Phil, thank you so much for talking with us at National Geographic about your latest goalkeepers report.

Thank you.

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