0:00:00.001,0:00:02.806 Chris Anderson: Welcome, Bill Gates. 0:00:02.830,0:00:04.127 Bill Gates: Thank you. 0:00:04.151,0:00:06.552 CA: Alright. It's great[br]to have you here, Bill. 0:00:06.576,0:00:09.310 You know, we had a TED conversation[br]about three months ago 0:00:09.334,0:00:10.494 about this pandemic, 0:00:10.518,0:00:14.044 and back then, I think fewer than --[br]I think that was the end of March -- 0:00:14.068,0:00:16.854 back then, fewer than[br]1,000 people in the US had died 0:00:16.878,0:00:19.934 and fewer than 20,000 worldwide. 0:00:19.958,0:00:24.326 I mean, the numbers now are,[br]like, 128,000 dead in the US 0:00:24.350,0:00:27.127 and more than half a million worldwide, 0:00:27.151,0:00:28.650 in three months. 0:00:28.674,0:00:30.021 In three months. 0:00:30.045,0:00:34.942 What is your diagnosis of what is possible[br]for the rest of this year? 0:00:34.966,0:00:37.174 You look at a lot of models. 0:00:37.198,0:00:40.957 What do you think best-[br]and worst-case scenarios might be? 0:00:43.105,0:00:46.488 BG: Well, the range of scenarios,[br]sadly, is quite large, 0:00:46.512,0:00:51.124 including that, as we get into the fall, 0:00:51.148,0:00:56.488 we could have death rates[br]that rival the worst of what we had 0:00:56.512,0:00:58.499 in the April time period. 0:00:58.523,0:01:00.683 If you get a lot of young people infected, 0:01:00.707,0:01:03.839 eventually, they will infect[br]old people again, 0:01:03.863,0:01:06.842 and so you'll get into the nursing homes, 0:01:06.866,0:01:08.023 the homeless shelters, 0:01:08.047,0:01:11.723 the places where we've had[br]a lot of our deaths. 0:01:11.747,0:01:15.181 The innovation track,[br]which probably we'll touch on -- 0:01:15.205,0:01:17.653 diagnostics, therapeutics, vaccines -- 0:01:17.677,0:01:20.334 there's good progress there, 0:01:20.358,0:01:24.141 but nothing that would[br]fundamentally alter the fact 0:01:24.165,0:01:28.063 that this fall in the United States[br]could be quite bad, 0:01:28.087,0:01:32.652 and that's worse than[br]I would have expected a month ago, 0:01:32.676,0:01:35.745 the degree to which we're back[br]at high mobility, 0:01:35.769,0:01:37.210 not wearing masks, 0:01:37.234,0:01:42.127 and now the virus actually[br]has gotten into a lot of cities 0:01:42.151,0:01:47.650 that it hadn't been in before[br]in a significant way, 0:01:47.674,0:01:50.756 so it's going to be a challenge. 0:01:50.780,0:01:54.297 There's no case where we get[br]much below the current death rate, 0:01:54.321,0:01:57.574 which is about 500 deaths a day, 0:01:57.598,0:02:01.118 but there's a significant risk[br]we'd go back up 0:02:01.142,0:02:06.128 to the even 2,000 a day[br]that we had before, 0:02:06.152,0:02:09.829 because we don't have the distancing, 0:02:09.853,0:02:11.385 the behavior change, 0:02:11.409,0:02:15.733 to the degree that we had[br]in April and May. 0:02:15.757,0:02:19.242 And we know this virus[br]is somewhat seasonal, 0:02:19.266,0:02:21.571 so that the force of infection, 0:02:21.595,0:02:25.065 both through temperature, humidity,[br]more time indoors, 0:02:25.089,0:02:27.337 will be worse as we get into the fall. 0:02:28.258,0:02:30.271 CA: So there are scenarios[br]where in the US, 0:02:30.295,0:02:32.539 like, if you extrapolate[br]those numbers forward, 0:02:32.563,0:02:33.763 we end up with, what, 0:02:33.787,0:02:36.355 more than a quarter of a million[br]deaths, perchance, 0:02:36.379,0:02:39.087 even this year if we're not careful, 0:02:39.111,0:02:42.544 and worldwide, I guess the death toll[br]could, by the end of the year, 0:02:42.568,0:02:45.774 be well into the millions, with an "s." 0:02:45.798,0:02:49.114 Is there evidence that the hotter[br]temperatures of the summer 0:02:49.138,0:02:51.802 actually have been helping us? 0:02:53.004,0:02:54.913 BG: They're not absolutely sure, 0:02:54.937,0:03:01.937 but certainly, the IHME model[br]definitely wanted to use the season, 0:03:01.961,0:03:03.653 including temperature and humidity, 0:03:03.677,0:03:08.764 to try and explain[br]why May wasn't worse than it was. 0:03:08.788,0:03:14.117 And so as we came out[br]and the mobility numbers got higher, 0:03:14.141,0:03:20.242 the models expected more infections[br]and deaths to come out of that, 0:03:20.266,0:03:22.827 and the model kept wanting to say, 0:03:22.851,0:03:27.123 "But I need to use this seasonality 0:03:28.018,0:03:30.142 to match why May wasn't worse, 0:03:30.166,0:03:34.182 why June wasn't worse than it was." 0:03:34.206,0:03:39.487 And we see in the Southern Hemisphere, 0:03:39.511,0:03:41.822 you know, Brazil, 0:03:41.846,0:03:43.815 which is the opposite season, 0:03:43.839,0:03:48.093 now all of South America[br]is having a huge epidemic. 0:03:48.117,0:03:53.139 South Africa is having[br]a very fast-growing epidemic. 0:03:53.163,0:03:55.141 Fortunately, Australia and New Zealand, 0:03:55.165,0:03:57.318 the last countries[br]in the Southern Hemisphere, 0:03:57.342,0:03:59.456 are at really tiny case counts, 0:03:59.480,0:04:03.014 and so although they have[br]to keep knocking it down, 0:04:03.038,0:04:05.685 they're talking about,[br]"Oh, we have 10 cases, 0:04:05.709,0:04:09.009 that's a big deal,[br]let's go get rid of that." 0:04:09.033,0:04:14.350 So they're one of these amazing countries[br]that got the numbers so low 0:04:14.374,0:04:18.016 that test, quarantine and trace 0:04:18.040,0:04:23.085 is working to get them,[br]keep them at very near zero. 0:04:23.109,0:04:26.535 CA: Aided perhaps a bit[br]by being easier to isolate 0:04:26.559,0:04:29.602 and by less density,[br]less population density. 0:04:29.626,0:04:31.994 But nonetheless,[br]smart policies down there. 0:04:32.018,0:04:33.946 BG: Yeah, everything is so exponential 0:04:33.970,0:04:36.908 that a little bit of good work[br]goes a long way. 0:04:36.932,0:04:38.841 It's not a linear game. 0:04:38.865,0:04:43.549 You know, contact tracing, if you have[br]the number of cases we have in the US, 0:04:43.573,0:04:45.810 it's super important to do, 0:04:45.834,0:04:48.274 but it won't get you back down to zero. 0:04:48.298,0:04:49.897 It'll help you be down, 0:04:49.921,0:04:52.633 but it's too overwhelming. 0:04:53.111,0:04:56.355 CA: OK, so in May and June in the US, 0:04:56.379,0:04:59.578 the numbers were slightly better[br]than some of the models predicted, 0:04:59.602,0:05:03.293 and it's hypothesized that that might be[br]partly because of the warmer weather. 0:05:03.317,0:05:05.708 Now we're seeing, really,[br]would you describe it 0:05:05.732,0:05:10.961 as really quite alarming upticks[br]in case rates in the US? 0:05:11.711,0:05:13.071 BG: That's right, it's -- 0:05:13.603,0:05:17.579 In, say, the New York area, 0:05:17.603,0:05:20.715 the cases continue to go down somewhat, 0:05:20.739,0:05:22.896 but in other parts of the country, 0:05:22.920,0:05:26.390 primarily the South right now, 0:05:26.414,0:05:28.510 you have increases[br]that are offsetting that, 0:05:28.534,0:05:32.221 and you have testing-positive[br]rates in young people 0:05:32.245,0:05:38.505 that are actually higher than what we saw[br]even in some of the tougher areas. 0:05:38.529,0:05:42.955 And so, clearly, younger people[br]have come out of mobility 0:05:42.979,0:05:46.788 more than older people[br]have increased their mobility, 0:05:46.812,0:05:51.355 so the age structure[br]is right now very young, 0:05:51.379,0:05:54.490 but because of[br]multigenerational households, 0:05:54.514,0:05:56.807 people work in nursing care homes, 0:05:56.831,0:06:00.709 unfortunately, that will[br]work its way back, 0:06:00.733,0:06:03.188 both the time lag and the transmission, 0:06:03.212,0:06:04.853 back up into the elderly, 0:06:04.877,0:06:07.367 will start to push the death rate back up, 0:06:07.391,0:06:10.409 which, it is down -- 0:06:10.433,0:06:15.008 way down from 2,000[br]to around 500 right now. 0:06:15.653,0:06:18.467 CA: And is that partly because[br]there's a three-week lag 0:06:18.491,0:06:21.631 between case numbers and fatality numbers? 0:06:21.655,0:06:23.982 And also, perhaps, partly because 0:06:24.006,0:06:26.899 there have been[br]some effective interventions, 0:06:26.923,0:06:29.346 and we're actually seeing the possibility 0:06:29.370,0:06:32.076 that the overall fatality rate[br]is actually falling a bit 0:06:32.100,0:06:34.234 now that we've gained[br]some extra knowledge? 0:06:34.822,0:06:38.667 BG: Yeah, certainly[br]your fatality rate is always lower 0:06:38.691,0:06:40.277 when you're not overloaded. 0:06:40.301,0:06:43.445 And so Italy, when they were overloaded, 0:06:43.469,0:06:46.108 Spain, even New York at the start, 0:06:46.132,0:06:48.569 certainly China, 0:06:48.593,0:06:53.857 there you weren't even able[br]to provide the basics, 0:06:53.881,0:06:56.674 the oxygen and things. 0:06:56.698,0:07:00.267 A study that our foundation[br]funded in the UK 0:07:00.291,0:07:03.633 found the only thing[br]other than remdesivir 0:07:03.657,0:07:06.429 that is a proven therapeutic, 0:07:06.453,0:07:08.435 which is the dexamethasone, 0:07:08.459,0:07:11.159 that for serious patients, 0:07:11.183,0:07:15.213 is about a 20 percent death reduction, 0:07:15.237,0:07:20.288 and there's still quite[br]a pipeline of those things. 0:07:20.312,0:07:23.835 You know, hydroxychloroquine[br]never established positive data, 0:07:23.859,0:07:26.161 so that's pretty much done. 0:07:26.185,0:07:28.528 There's still a few trials ongoing, 0:07:28.552,0:07:31.145 but the list of things being tried, 0:07:31.169,0:07:35.545 including, eventually,[br]the monoclonal antibodies, 0:07:35.569,0:07:39.008 we will have some additional[br]tools for the fall. 0:07:39.032,0:07:42.686 And so when you talk about death rates, 0:07:42.710,0:07:46.162 the good news is,[br]some innovation we already have, 0:07:46.186,0:07:49.956 and we'll have more, even in the fall. 0:07:49.980,0:07:53.244 We should start to have[br]monoclonal antibodies, 0:07:53.268,0:07:57.850 which is the single therapeutic[br]that I'm most excited about. 0:07:57.874,0:08:01.232 CA: I'll actually ask you to tell me[br]a bit more about that in one sec, 0:08:01.256,0:08:03.707 but just putting the pieces[br]together on death rates: 0:08:03.731,0:08:05.637 so in a well-functioning health system, 0:08:05.661,0:08:09.324 so take the US when places[br]aren't overcrowded, 0:08:09.348,0:08:11.288 what do you think 0:08:11.312,0:08:14.887 the current fatality numbers are,[br]approximately, going forward, 0:08:14.911,0:08:17.001 like as a percentage of total cases? 0:08:17.025,0:08:19.568 Are we below one percent, perhaps? 0:08:20.488,0:08:23.182 BG: If you found every case, yes, 0:08:23.206,0:08:25.985 you're well below one percent. 0:08:26.009,0:08:31.066 People argue, you know, 0.4, 0.5. 0:08:31.090,0:08:34.583 By the time you bring in[br]the never symptomatics, 0:08:34.607,0:08:37.194 it probably is below 0.5, 0:08:37.218,0:08:38.741 and that's good news. 0:08:38.765,0:08:43.328 This disease could have been[br]a five-percent disease. 0:08:43.796,0:08:46.991 The transmission dynamics of this disease 0:08:47.015,0:08:54.015 are more difficult[br]than even the experts predicted. 0:08:54.039,0:08:58.811 The amount of presymptomatic[br]and never symptomatic spread 0:08:58.835,0:09:01.101 and the fact that it's not coughing, 0:09:01.125,0:09:03.669 where you would kind of notice,[br]"Hey, I'm coughing" -- 0:09:03.693,0:09:06.383 most respiratory diseases make you cough. 0:09:06.407,0:09:09.391 This one, in its early stages,[br]it's not coughing, 0:09:09.415,0:09:13.370 it's singing, laughing, talking, 0:09:13.394,0:09:16.023 actually, still, particularly[br]for the super-spreaders, 0:09:16.047,0:09:17.757 people with very high viral loads, 0:09:17.781,0:09:18.933 causes that spread, 0:09:18.957,0:09:21.893 and that's pretty novel, 0:09:21.917,0:09:25.971 and so even the experts have to say,[br]"Wow, this caught us by surprise." 0:09:25.995,0:09:27.637 The amount of asymptomatic spread 0:09:27.661,0:09:30.164 and the fact that there's not[br]a coughing element 0:09:30.188,0:09:33.339 is not a major piece like the flu or TB. 0:09:33.901,0:09:36.844 CA: Yeah, that is[br]devilish cunning by the virus. 0:09:36.868,0:09:41.564 I mean, how much is[br]that nonsymptomatic transmission 0:09:41.588,0:09:43.503 as a percentage of total transmission? 0:09:43.527,0:09:46.891 I've heard numbers it could be[br]as much as half of all transmissions 0:09:46.915,0:09:49.225 are basically presymptomatic. 0:09:49.982,0:09:52.578 BG: Yeah, if you count presymptomatics, 0:09:52.602,0:09:56.568 then most of the studies show[br]that's like at 40 percent, 0:09:57.044,0:10:00.767 and we also have never symptomatics. 0:10:00.791,0:10:04.169 The amount of virus you get[br]in your upper respiratory area 0:10:04.193,0:10:05.634 is somewhat disconnected. 0:10:05.658,0:10:08.678 Some people will have a lot here[br]and very little in their lungs, 0:10:08.702,0:10:13.729 and what you get in your lungs[br]causes the really bad symptoms -- 0:10:13.753,0:10:16.896 and other organs, but mostly the lungs -- 0:10:16.920,0:10:19.234 and so that's when you seek treatment. 0:10:19.258,0:10:21.318 And so the worst case[br]in terms of spreading 0:10:21.342,0:10:24.451 is somebody who's got a lot[br]in the upper respiratory tract 0:10:24.475,0:10:26.689 but almost none in their lungs, 0:10:26.713,0:10:29.006 so they're not care-seeking. 0:10:29.892,0:10:31.058 CA: Right. 0:10:31.082,0:10:34.024 And so if you add in the never symptomatic 0:10:34.048,0:10:36.420 to the presymptomatic, 0:10:36.444,0:10:38.691 do you get above 50 percent[br]of the transmission 0:10:38.715,0:10:40.994 is actually from nonsymptomatic people? 0:10:41.018,0:10:45.056 BG: Yeah, transmission[br]is harder to measure. 0:10:45.080,0:10:48.829 You know, we see certain[br]hotspots and things, 0:10:48.853,0:10:51.658 but that's a huge question[br]with the vaccine: 0:10:51.682,0:10:55.972 Will it, besides avoiding[br]you getting sick, 0:10:55.996,0:10:57.755 which is what the trial will test, 0:10:57.779,0:11:01.193 will it also stop you[br]from being a transmitter? 0:11:01.217,0:11:02.424 CA: So that vaccine, 0:11:02.448,0:11:05.036 it's such an important question,[br]let's come on to that. 0:11:05.060,0:11:06.244 But before we go there, 0:11:06.268,0:11:08.416 any other surprises[br]in the last couple months 0:11:08.440,0:11:10.370 that we've learned about this virus 0:11:10.394,0:11:13.909 that really impact how[br]we should respond to it? 0:11:14.846,0:11:19.612 BG: We're still not able to characterize[br]who the super-spreaders are 0:11:19.636,0:11:21.934 in terms of what that profile is, 0:11:21.958,0:11:23.365 and we may never. 0:11:23.389,0:11:25.394 That may just be quite random. 0:11:25.418,0:11:28.329 If you could identify them, 0:11:28.353,0:11:30.866 they're responsible[br]for the majority of transmission, 0:11:30.890,0:11:33.829 a few people who have[br]very high viral loads. 0:11:33.853,0:11:38.764 But sadly, we haven't figured that out. 0:11:38.788,0:11:40.090 This mode of transmission, 0:11:40.114,0:11:42.764 if you're in a room and nobody talks, 0:11:42.788,0:11:45.804 there's way less transmission. 0:11:45.828,0:11:48.826 That's partly why,[br]although planes can transmit, 0:11:48.850,0:11:53.887 it's less than you would expect[br]just in terms of time proximity measures, 0:11:53.911,0:11:57.460 because unlike, say,[br]a choir or a restaurant, 0:11:57.484,0:12:03.285 you're not exhaling in loud talking 0:12:03.309,0:12:05.897 quite as much as in other[br]indoor environments. 0:12:05.921,0:12:07.095 CA: Hmm. 0:12:07.119,0:12:10.407 What do you think about the ethics[br]of someone who would go on a plane 0:12:10.431,0:12:11.955 and refuse to wear a mask? 0:12:11.979,0:12:15.156 BG: If they own the plane,[br]that would be fine. 0:12:15.180,0:12:18.033 If there's other people on the plane, 0:12:18.057,0:12:21.091 that would be endangering[br]those other people. 0:12:21.115,0:12:22.593 CA: Early on in the pandemic, 0:12:22.617,0:12:27.787 the WHO did not advise[br]that people wear masks. 0:12:27.811,0:12:33.250 They were worried about taking them away[br]from frontline medical providers. 0:12:33.274,0:12:37.566 In retrospect, was that[br]a terrible mistake that they made? 0:12:38.000,0:12:39.541 BG: Yes. 0:12:40.420,0:12:46.226 All the experts feel bad[br]that the value of masks -- 0:12:46.250,0:12:49.271 which ties back somewhat[br]to the asymptomatics; 0:12:49.295,0:12:52.313 if people were very symptomatic, 0:12:52.337,0:12:54.839 like an Ebola, 0:12:55.498,0:12:59.570 then you know it and you isolate, 0:12:59.594,0:13:02.888 and so you don't have[br]a need for a masklike thing. 0:13:03.381,0:13:05.585 The value of masks, 0:13:05.609,0:13:09.427 the fact that the medical masks[br]was a different supply chain 0:13:09.451,0:13:12.001 than the normal masks, 0:13:12.025,0:13:14.939 the fact you could scale up[br]the normal masks so well, 0:13:14.963,0:13:18.696 the fact that it would stop[br]that presymptomatic, 0:13:18.720,0:13:20.523 never symptomatic transmission, 0:13:20.547,0:13:22.391 it's a mistake. 0:13:22.415,0:13:25.569 But it's not a conspiracy. 0:13:25.593,0:13:29.469 It's something that, we now know more. 0:13:29.493,0:13:32.125 And even now, our error bars[br]on the benefit of masks 0:13:32.149,0:13:33.942 are higher than we'd like to admit, 0:13:33.966,0:13:35.960 but it's a significant benefit. 0:13:36.798,0:13:39.301 CA: Alright, I'm going to come in[br]with some questions 0:13:39.325,0:13:40.641 from the community. 0:13:42.805,0:13:44.353 Let's pull them up there. 0:13:44.957,0:13:50.510 Jim Pitofsky, "Do you think reopening[br]efforts in the US have been premature, 0:13:50.534,0:13:55.847 and if so, how far should the US go[br]to responsibly confront this pandemic?" 0:13:57.963,0:14:01.049 BG: Well, the question[br]of how you make trade-offs 0:14:01.073,0:14:05.702 between the benefits, say,[br]of going to school 0:14:05.726,0:14:10.180 versus the risk of people getting sick[br]because they go to school, 0:14:10.204,0:14:13.137 those are very tough questions 0:14:13.161,0:14:20.029 that I don't think[br]any single person can say, 0:14:20.053,0:14:24.025 "I will tell you how to make[br]all these trade-offs." 0:14:24.375,0:14:28.380 The understanding[br]of where you have transmission, 0:14:28.404,0:14:31.323 and the fact that young people[br]do get infected 0:14:31.347,0:14:35.639 and are part of the multigenerational[br]transmission chain, 0:14:35.663,0:14:37.926 we should get that out. 0:14:37.950,0:14:40.374 If you just look at the health aspect, 0:14:40.398,0:14:43.453 we have opened up too liberally. 0:14:43.477,0:14:47.072 Now, opening up in terms of mental health 0:14:47.096,0:14:54.096 and seeking normal health things[br]like vaccines or other care, 0:14:54.120,0:14:56.465 there are benefits. 0:14:56.489,0:15:02.399 I think some of our opening up[br]has created more risk than benefit. 0:15:02.423,0:15:05.133 Opening the bars up[br]as quickly as they did, 0:15:05.157,0:15:07.712 you know, is that critical[br]for mental health? 0:15:07.736,0:15:09.404 Maybe not. 0:15:09.428,0:15:13.481 So I don't think we've been[br]as tasteful about opening up 0:15:13.505,0:15:19.228 as I'm sure, as we study it, 0:15:19.252,0:15:25.396 that we'll realize some things[br]we shouldn't have opened up as fast. 0:15:25.420,0:15:27.336 But then you have something like school, 0:15:27.360,0:15:30.072 where even sitting here today, 0:15:30.096,0:15:35.469 the exact plan, say,[br]for inner-city schools for the fall, 0:15:35.493,0:15:38.848 I wouldn't have a black-and-white view 0:15:38.872,0:15:43.665 on the relative trade-offs involved there. 0:15:44.159,0:15:50.202 There are huge benefits[br]to letting those kids go to school, 0:15:50.226,0:15:53.563 and how do you weigh the risk? 0:15:53.587,0:15:57.455 If you're in a city without many cases, 0:15:57.479,0:16:01.023 I would say probably the benefit is there. 0:16:01.047,0:16:03.499 Now that means that[br]you could get surprised. 0:16:03.523,0:16:06.645 The cases could show up,[br]and then you'd have to change that, 0:16:06.669,0:16:08.199 which is not easy. 0:16:08.223,0:16:10.774 But I think around the US, 0:16:10.798,0:16:15.599 there will be places[br]where that won't be a good trade-off. 0:16:15.623,0:16:18.225 So almost any dimension of inequity, 0:16:18.249,0:16:22.652 this disease has made worse: 0:16:22.676,0:16:27.707 job type, internet connection, 0:16:27.731,0:16:31.372 ability of your school[br]to do online learning. 0:16:31.396,0:16:33.801 White-collar workers, 0:16:33.825,0:16:35.528 people are embarrassed to admit it, 0:16:35.552,0:16:37.726 some of them are more productive 0:16:37.750,0:16:42.890 and enjoying the flexibility[br]that the at-home thing has created, 0:16:42.914,0:16:44.671 and that feels terrible 0:16:44.695,0:16:49.793 when you know lots of people[br]are suffering in many ways, 0:16:49.817,0:16:52.903 including their kids not going to school. 0:16:52.927,0:16:54.942 CA: Indeed. Let's have the next question. 0:16:54.966,0:16:56.957 [Nathalie Munyampenda] "For us in Rwanda, 0:16:56.981,0:16:59.452 early policy interventions[br]have made the difference. 0:16:59.476,0:17:03.446 At this point, what policy interventions[br]do you suggest for the US now?" 0:17:03.470,0:17:05.952 Bill, I dream of the day[br]where you are appointed 0:17:05.952,0:17:07.545 the coronavirus czar 0:17:07.545,0:17:10.251 with authority to actually[br]speak to the public. 0:17:10.275,0:17:12.281 What would you do? 0:17:13.538,0:17:18.147 BG: Well, the innovation tools 0:17:18.171,0:17:22.712 are where I and the foundation[br]probably has the most expertise. 0:17:23.174,0:17:27.165 Clearly, some of the policies[br]on opening up have been too generous, 0:17:27.189,0:17:30.450 but I think everybody 0:17:31.471,0:17:35.624 could engage in that. 0:17:36.146,0:17:37.324 We need leadership 0:17:37.348,0:17:43.123 in terms of admitting[br]that we've still got a huge problem here 0:17:43.147,0:17:47.071 and not turning that[br]into almost a political thing 0:17:47.095,0:17:51.852 of, "Oh, isn't it brilliant what we did?" 0:17:51.876,0:17:53.280 No, it's not brilliant, 0:17:53.304,0:17:57.977 but there's many people,[br]including the experts -- 0:17:58.001,0:18:00.437 there's a lot[br]they didn't understand, 0:18:00.461,0:18:04.991 and everybody wishes a week earlier[br]whatever action they took, 0:18:05.015,0:18:07.333 they'd taken that a week earlier. 0:18:08.128,0:18:09.314 The innovation tools, 0:18:09.338,0:18:15.726 that's where the foundation's work 0:18:15.750,0:18:18.988 on antibodies, vaccines, 0:18:19.012,0:18:20.848 we have deep expertise, 0:18:20.872,0:18:23.972 and it's outside of the private sector, 0:18:23.996,0:18:28.145 and so we have kind of a neutral ability[br]to work with all the governments 0:18:28.169,0:18:30.150 and the companies to pick. 0:18:30.174,0:18:32.580 Particularly when you're doing[br]break-even products, 0:18:32.604,0:18:34.698 which one should get the resources? 0:18:34.722,0:18:38.666 There's no market signal for that. 0:18:38.690,0:18:42.458 Experts have to say, "OK,[br]this antibody deserves the manufacturing. 0:18:42.482,0:18:45.098 This vaccine deserves the manufacturing," 0:18:45.122,0:18:50.091 because we have very limited[br]manufacturing for both of those things, 0:18:50.115,0:18:53.912 and it'll be cross-company,[br]which never happens in the normal case, 0:18:53.936,0:18:55.806 where one company invents it 0:18:55.830,0:18:59.777 and then you're using[br]the manufacturing plants of many companies 0:18:59.801,0:19:03.442 to get maximum scale of the best choice. 0:19:03.992,0:19:06.631 So I would be coordinating those things, 0:19:06.655,0:19:11.686 but we need a leader[br]who keeps us up to date, 0:19:11.710,0:19:14.422 is realistic 0:19:14.446,0:19:16.631 and shows us the right behavior, 0:19:16.655,0:19:18.944 as well as driving the innovation track. 0:19:20.246,0:19:22.779 CA: I mean, you have[br]to yourself be a master diplomat 0:19:22.803,0:19:24.394 in how you talk about this stuff. 0:19:24.418,0:19:26.539 So I appreciate, almost,[br]the discomfort here. 0:19:26.563,0:19:29.686 But I mean, you talk regularly[br]with Anthony Fauci, 0:19:29.710,0:19:34.801 who is a wise voice on this[br]by most people's opinion. 0:19:34.825,0:19:36.868 But to what extent is he just hamstrung? 0:19:36.892,0:19:40.210 He's not allowed to play the full role 0:19:40.234,0:19:42.592 that he could play in this circumstance. 0:19:43.171,0:19:48.582 BG: Dr. Fauci has emerged[br]where he was allowed to have some airtime, 0:19:48.606,0:19:52.614 and even though he was stating[br]things that are realistic, 0:19:52.638,0:19:54.810 his prestige has stuck. 0:19:54.834,0:19:56.652 He can speak out in that way. 0:19:56.676,0:20:02.449 Typically, the CDC would be[br]the primary voice here. 0:20:02.933,0:20:04.895 It's not absolutely necessary, 0:20:04.919,0:20:07.495 but in previous health crises, 0:20:07.519,0:20:10.383 you let the experts inside the CDC 0:20:10.407,0:20:11.774 be that voice. 0:20:11.798,0:20:13.741 They're trained to do these things, 0:20:13.765,0:20:19.810 and so it is a bit unusual here[br]how much we've had to rely on Fauci 0:20:19.834,0:20:21.645 as opposed to the CDC. 0:20:21.669,0:20:25.520 It should be Fauci,[br]who's a brilliant researcher, 0:20:25.544,0:20:28.707 so experienced, particularly in vaccines. 0:20:28.731,0:20:33.001 In some ways, he has become,[br]taking the broad advice 0:20:33.025,0:20:36.690 that's the epidemiology advice 0:20:36.714,0:20:39.365 and explaining it in the right way, 0:20:39.389,0:20:40.549 where he'll admit, 0:20:40.573,0:20:43.988 "OK, we may have a rebound here, 0:20:44.012,0:20:47.187 and this is why we need[br]to behave that way." 0:20:47.211,0:20:53.144 But it's fantastic that his voice[br]has been allowed to come through. 0:20:53.817,0:20:55.246 CA: Sometimes. 0:20:55.270,0:20:57.233 Let's have the next question. 0:21:01.150,0:21:03.802 Nina Gregory, "How are you[br]and your foundation 0:21:03.826,0:21:08.316 addressing the ethical questions about[br]which countries get the vaccine first, 0:21:08.340,0:21:10.017 assuming you find one?" 0:21:10.041,0:21:12.050 And maybe, Bill, use this as a moment 0:21:12.050,0:21:16.018 to just talk about where[br]the quest for the vaccine is 0:21:16.042,0:21:19.477 and what are just some of the key things[br]we should all be thinking about 0:21:19.501,0:21:21.293 as we track the news on this. 0:21:22.072,0:21:26.404 BG: There's three vaccines that are, 0:21:26.428,0:21:28.044 if they work, are the earliest: 0:21:28.068,0:21:34.258 the Moderna, which unfortunately,[br]won't scale very easily, 0:21:34.282,0:21:38.232 so if that works, it'll be mostly[br]a US-targeted thing; 0:21:38.984,0:21:41.558 then you have the AstraZeneca,[br]which comes from Oxford; 0:21:41.582,0:21:42.914 and the Johnson and Johnson. 0:21:42.938,0:21:44.625 Those are the three early ones. 0:21:44.649,0:21:48.149 And we have animal data 0:21:48.173,0:21:54.414 that looks potentially good[br]but not definitive, 0:21:54.438,0:21:56.550 particularly will it work in the elderly, 0:21:56.574,0:21:59.776 and we'll have human data[br]over the next several months. 0:21:59.800,0:22:05.563 Those three will be gated by[br]the safety and efficacy trial. 0:22:05.587,0:22:07.666 That is, we'll be able[br]to manufacture those, 0:22:07.690,0:22:10.277 although not as much as we want. 0:22:10.301,0:22:13.222 We'll be able to manufacture those[br]before the end of the year. 0:22:13.246,0:22:15.038 Whether the Phase 3 will succeed 0:22:15.062,0:22:18.032 and whether it'll complete[br]before the end of the year, 0:22:18.056,0:22:21.704 I wouldn't be that optimistic about. 0:22:21.728,0:22:26.320 Phase 3 is where you need[br]to really look at all the safety profile 0:22:26.344,0:22:27.510 and efficacy, 0:22:27.534,0:22:29.064 but those will get started. 0:22:29.088,0:22:33.782 And then there's four or five vaccines[br]that use different approaches 0:22:33.806,0:22:36.461 that are maybe three[br]or four months behind that: 0:22:36.485,0:22:40.846 Novavax, Sanofi, Merck. 0:22:40.870,0:22:47.115 And so we're funding factory capacity[br]for a lot of these -- 0:22:47.139,0:22:53.419 some complex negotiations[br]are taking place right now on this -- 0:22:53.443,0:22:58.736 to get factories that will be dedicated[br]to the poorer countries, 0:22:58.760,0:23:01.304 what's called low- and middle-income. 0:23:01.328,0:23:03.990 And the very scalable constructs 0:23:04.014,0:23:08.647 that include AstraZeneca[br]and Johnson and Johnson, 0:23:08.671,0:23:09.954 we'll focus on those, 0:23:09.978,0:23:11.474 the ones that are inexpensive 0:23:11.498,0:23:15.300 and you can build a single factory[br]to make 600 million doses. 0:23:15.324,0:23:19.756 So a number of the vaccine constructs 0:23:19.780,0:23:21.178 are potential. 0:23:21.202,0:23:25.218 I don't see anything[br]before the end of the year. 0:23:25.242,0:23:27.188 That's really the best case, 0:23:27.212,0:23:30.731 and it's down to a few constructs now, 0:23:30.755,0:23:35.165 which, typically, you have[br]high failure rates. 0:23:36.300,0:23:37.496 CA: Bill, is it the case 0:23:37.520,0:23:40.504 that if you and your foundation[br]weren't in the picture here 0:23:40.528,0:23:43.514 that market dynamics would likely[br]lead to a situation 0:23:43.538,0:23:47.391 where, as soon as a promising[br]vaccine candidate emerged, 0:23:47.415,0:23:50.175 the richer countries[br]would basically snap up, gobble up 0:23:50.199,0:23:52.968 all available initial supply -- 0:23:52.992,0:23:55.056 it just takes a while[br]to manufacture these, 0:23:55.080,0:23:59.036 and there would be nothing[br]for the poorer countries -- 0:23:59.060,0:24:01.561 but that what, effectively, you're doing 0:24:01.585,0:24:04.912 by giving manufacturing[br]guarantees and capability 0:24:04.936,0:24:06.837 to some of these candidates, 0:24:06.861,0:24:13.354 you're making it possible that[br]at least some of the early vaccine units 0:24:13.378,0:24:15.735 will go to poorer countries? 0:24:15.759,0:24:17.007 Is that correct? 0:24:17.031,0:24:18.897 BG: Well, it's not just us, but yes, 0:24:18.921,0:24:21.494 we're in the central role there, 0:24:21.518,0:24:28.256 along with a group we created called CEPI,[br]Coalition for Epidemic Preparedness, 0:24:28.280,0:24:32.247 and the European leaders agree with this. 0:24:32.271,0:24:35.299 Now we have the expertise[br]to look at each of the constructs 0:24:35.323,0:24:37.796 and say, "OK, where is there[br]a factory in the world 0:24:37.820,0:24:39.685 that has capacity that can build that? 0:24:39.709,0:24:42.345 Which one should we put[br]the early money into? 0:24:42.369,0:24:43.840 What should the milestones be 0:24:43.864,0:24:47.106 where we'll shift the money[br]over to a different one?" 0:24:47.130,0:24:51.309 Because the kind of private sector people 0:24:51.333,0:24:53.971 who really understand that stuff, 0:24:53.995,0:24:55.729 some of them work for us, 0:24:55.753,0:24:59.669 and we're a trusted party on these things, 0:24:59.693,0:25:05.033 we get to coordinate a lot of it,[br]particularly that manufacturing piece. 0:25:05.374,0:25:10.477 Usually, you'd expect the US[br]to think of this as a global problem 0:25:10.501,0:25:11.669 and be involved. 0:25:11.693,0:25:17.709 So far, no activity[br]on that front has taken place. 0:25:17.733,0:25:22.086 I am talking to people in the Congress[br]and the Administration 0:25:22.110,0:25:25.472 about when the next[br]relief bill comes along 0:25:25.496,0:25:30.269 that maybe one percent of that[br]could go for the tools 0:25:30.293,0:25:32.223 to help the entire world. 0:25:32.247,0:25:35.117 And so it's possible, 0:25:35.141,0:25:36.972 but it's unfortunate, 0:25:36.996,0:25:40.196 and the vacuum here, 0:25:40.220,0:25:41.688 the world is not that used to, 0:25:41.712,0:25:46.209 and a lot of people are stepping in,[br]including our foundation, 0:25:46.233,0:25:48.739 to try and have a strategy, 0:25:48.763,0:25:50.866 including for the poorer countries, 0:25:50.890,0:25:56.972 who will suffer a high percentage[br]of the deaths and negative effects, 0:25:56.996,0:26:00.229 including their health systems[br]being overwhelmed. 0:26:00.253,0:26:02.834 Most of the deaths will be[br]in developing countries, 0:26:02.858,0:26:06.574 despite the huge deaths we've seen[br]in Europe and the US. 0:26:07.193,0:26:09.456 CA: I mean, I wish[br]I could be a fly on the wall 0:26:09.480,0:26:11.769 and hearing you and Melinda[br]talk about this, 0:26:11.793,0:26:17.258 because of all of the ethical ...[br]"crimes," let's say, 0:26:17.282,0:26:21.106 executed by leaders[br]who should know better, 0:26:21.130,0:26:25.410 I mean, it's one thing[br]to not model mask-wearing, 0:26:25.434,0:26:31.655 but to not play a role[br]in helping the world 0:26:31.679,0:26:33.510 when faced with a common enemy, 0:26:33.534,0:26:35.510 respond as one humanity, 0:26:35.534,0:26:36.760 and instead ... 0:26:38.040,0:26:42.817 you know, catalyze a really unseemly[br]scramble between nations 0:26:42.841,0:26:45.300 to fight for vaccines, for example. 0:26:45.324,0:26:51.179 That just seems -- surely, history[br]is going to judge that harshly. 0:26:51.203,0:26:54.322 That is just sickening. 0:26:54.798,0:26:56.796 Isn't it? Am I missing something? 0:26:56.820,0:27:02.177 BG: Well, it's not quite[br]as black-and-white as that. 0:27:02.201,0:27:04.833 The US has put more money out 0:27:04.857,0:27:08.290 to fund the basic research[br]on these vaccines 0:27:08.314,0:27:10.958 than any country by far, 0:27:10.982,0:27:13.661 and that research is not restricted. 0:27:13.685,0:27:17.314 There's not, like, some royalty[br]that says, "Hey, if you take our money, 0:27:17.338,0:27:19.410 you have to pay the US a royalty." 0:27:19.434,0:27:22.359 They do, to the degree they fund research, 0:27:22.383,0:27:23.567 it's for everybody. 0:27:23.591,0:27:26.277 To the degree they fund factories,[br]it's just for the US. 0:27:26.301,0:27:30.802 The thing that makes this tough is that[br]in every other global health problem, 0:27:30.826,0:27:33.913 the US totally leads smallpox eradication, 0:27:33.937,0:27:38.769 the US is totally the leader[br]on polio eradication, 0:27:38.793,0:27:44.891 with key partners -- CDC, WHO,[br]Rotary, UNICEF, our foundation. 0:27:44.915,0:27:48.074 So the world -- and on HIV, 0:27:48.098,0:27:52.868 under President Bush's leadership,[br]but it was very bipartisan, 0:27:52.892,0:27:55.885 this thing called PEPFAR was unbelievable. 0:27:55.909,0:27:58.618 That has saved tens of millions of lives. 0:27:58.642,0:28:02.914 And so it's that the world[br]always expected the US 0:28:02.938,0:28:04.941 to at least be at the head of the table, 0:28:04.965,0:28:10.697 financially, strategy, OK, how do you[br]get these factories for the world, 0:28:10.721,0:28:14.700 even if it's just to avoid the infection[br]coming back to the US 0:28:14.724,0:28:16.596 or to have the global economy working, 0:28:16.620,0:28:18.610 which is good for US jobs 0:28:18.634,0:28:21.966 to have demand outside the US. 0:28:21.990,0:28:23.870 And so the world is kind of -- 0:28:23.894,0:28:27.076 you know, there's all this uncertainty[br]about which thing will work, 0:28:27.100,0:28:31.013 and there's this,[br]"OK, who's in charge here?" 0:28:31.037,0:28:35.491 And so the worst thing,[br]the withdrawal from WHO, 0:28:35.515,0:28:42.288 that is a difficulty[br]that hopefully will get remedied 0:28:42.312,0:28:43.895 at some point, 0:28:43.919,0:28:46.920 because we need that coordination 0:28:46.944,0:28:48.455 through WHO. 0:28:49.488,0:28:51.866 CA: Let's take another question. 0:28:55.661,0:28:58.837 Ali Kashani, "Are there any[br]particularly successful models 0:28:58.861,0:29:01.873 of handling the pandemic[br]that you have seen around the world?" 0:29:03.540,0:29:08.028 BG: Well, it's fascinating that,[br]besides early action, 0:29:08.052,0:29:11.654 there are definitely things where[br]you take people who have tested positive 0:29:11.678,0:29:15.058 and you monitor their pulse ox, 0:29:15.082,0:29:18.243 which is the oxygen saturation[br]level in their blood, 0:29:18.267,0:29:19.863 which is a very cheap detector, 0:29:19.887,0:29:23.325 and then you know to get them[br]to the hospitals fairly early. 0:29:23.349,0:29:30.244 Weirdly, patients don't know[br]things are about to get severe. 0:29:30.268,0:29:34.531 It's an interesting physiological reason[br]that I won't get into. 0:29:34.555,0:29:39.577 And so Germany has[br]quite a low case fatality rate 0:29:39.601,0:29:42.547 that they've done through[br]that type of monitoring. 0:29:42.571,0:29:45.530 And then, of course,[br]once you get into facilities, 0:29:45.554,0:29:50.697 we've learned that the ventilator,[br]actually, although extremely well-meaning, 0:29:50.721,0:29:55.067 was actually overused[br]and used in the wrong mode 0:29:55.091,0:29:56.335 in those early days. 0:29:56.359,0:30:02.917 So the health -- the doctors[br]are way smarter about treatment today. 0:30:02.941,0:30:05.293 Most of that, I would say, is global. 0:30:05.317,0:30:07.587 Using this pulse ox as an early indicator, 0:30:07.611,0:30:09.291 that'll probably catch on broadly, 0:30:09.315,0:30:11.942 but Germany was a pioneer there. 0:30:11.966,0:30:18.072 And now, of course, dexamethasone --[br]fortunately, it's cheap, it's oral, 0:30:18.096,0:30:19.752 we can ramp up manufacture. 0:30:19.776,0:30:22.727 That'll go global as well. 0:30:25.061,0:30:28.850 CA: Bill, I want to ask you[br]something about 0:30:28.874,0:30:32.029 what it's been like for you personally[br]through this whole process. 0:30:32.053,0:30:38.070 Because, weirdly, even though[br]your passion and good intent on this topic 0:30:38.094,0:30:43.704 seems completely bloody obvious to anyone[br]who has spent a moment with you, 0:30:43.728,0:30:47.771 there are these crazy conspiracy theories[br]out there about you. 0:30:47.795,0:30:50.669 I just checked in[br]with a company called Zignal 0:30:50.693,0:30:53.082 that monitors social media spaces. 0:30:53.106,0:30:57.285 They say that, to date,[br]I think on Facebook alone, 0:30:57.309,0:31:01.483 more than four million posts[br]have taken place 0:31:01.507,0:31:06.709 that associate you with some kind[br]of conspiracy theory around the virus. 0:31:07.133,0:31:13.094 I read that there was a poll[br]that more than 40 percent of Republicans 0:31:13.118,0:31:16.925 believe that the vaccine[br]that you would roll out 0:31:16.949,0:31:21.945 would somehow plant a microchip[br]in people to track their location. 0:31:21.969,0:31:26.471 I mean, I can't even believe[br]that poll number. 0:31:27.376,0:31:30.449 And then some people[br]are taking this seriously enough, 0:31:30.473,0:31:35.148 and some of them have even been[br]recirculated on "Fox News" and so forth, 0:31:35.172,0:31:37.429 some people are taking this[br]seriously enough 0:31:37.453,0:31:41.706 to make really quite horrible[br]threats and so forth. 0:31:41.730,0:31:45.504 You seem to do a good job[br]sort of shrugging this off, 0:31:45.528,0:31:48.942 but really, like, who else[br]has ever been in this position? 0:31:48.966,0:31:51.071 How are you managing this? 0:31:51.095,0:31:54.082 What on earth world are we in 0:31:54.106,0:31:56.478 that this kind of misinformation[br]can be out there? 0:31:56.502,0:31:58.253 What can we do to help correct it? 0:31:59.856,0:32:03.101 BG: I'm not sure. 0:32:04.539,0:32:06.931 And it's a new thing 0:32:08.380,0:32:11.403 that there's conspiracy theories. 0:32:11.427,0:32:13.917 I mean, Microsoft had[br]its share of controversy, 0:32:13.941,0:32:16.874 but at least that related[br]to the real world, you know? 0:32:16.898,0:32:20.535 Did Windows crash more than it should? 0:32:20.559,0:32:22.399 We definitely had antitrust problems. 0:32:22.423,0:32:25.302 But at least I knew what that was. 0:32:25.326,0:32:27.242 When this emerged, I have to say, 0:32:27.266,0:32:31.443 my instinct was to joke about it. 0:32:31.467,0:32:33.853 People have said[br]that's really inappropriate, 0:32:33.877,0:32:36.654 because this is a very serious thing. 0:32:37.270,0:32:42.135 It is going to make people[br]less willing to take a vaccine. 0:32:42.159,0:32:45.112 And, of course, once we have that vaccine, 0:32:45.136,0:32:46.908 it'll be like masks, 0:32:46.932,0:32:49.593 where getting lots of people, 0:32:49.617,0:32:52.966 particularly when it's[br]a transmission-blocking vaccine, 0:32:52.990,0:32:55.573 there's this huge community benefit 0:32:55.597,0:33:00.911 to widespread adoption of that vaccine. 0:33:00.935,0:33:04.218 So I am caught a little bit, 0:33:04.242,0:33:06.700 unsure of what to say or do, 0:33:06.724,0:33:10.184 because the conspiracy piece[br]is a new thing for me, 0:33:11.287,0:33:14.853 and what do you say 0:33:14.877,0:33:19.380 that doesn't give credence to the thing? 0:33:19.404,0:33:24.455 The fact that a "Fox News"[br]commentator, Laura Ingraham, 0:33:24.479,0:33:26.941 was saying this stuff[br]about me microchipping people, 0:33:26.965,0:33:30.666 that survey isn't that surprising[br]because that's what they heard 0:33:30.690,0:33:32.885 on the TV. 0:33:33.418,0:33:35.403 It's wild. 0:33:35.427,0:33:38.720 And people are clearly seeking[br]simpler explanations 0:33:38.744,0:33:41.712 than going and studying virology. 0:33:43.379,0:33:45.102 CA: I mean, 0:33:45.126,0:33:46.551 TED is nonpolitical, 0:33:46.575,0:33:49.312 but we believe in the truth. 0:33:49.336,0:33:52.058 I would say this: 0:33:52.082,0:33:56.174 Laura Ingraham, you owe Bill Gates[br]an apology and a retraction. 0:33:56.198,0:33:57.366 You do. 0:33:57.390,0:33:58.948 And anyone who's watching this 0:33:58.972,0:34:03.762 who thinks for a minute that this man[br]is involved in some kind of conspiracy, 0:34:03.786,0:34:05.121 you want your head examined. 0:34:05.145,0:34:06.383 You are crazy. 0:34:06.407,0:34:08.996 Enough of us know Bill over many years 0:34:09.020,0:34:12.780 and have seen the passion[br]and engagement in this to know 0:34:12.804,0:34:14.368 that you are crazy. 0:34:14.392,0:34:15.564 So get over it, 0:34:15.588,0:34:19.293 and let's look at the actual problem[br]of solving this pandemic. 0:34:19.317,0:34:20.777 Honestly. 0:34:20.801,0:34:22.956 If anyone in the chat here[br]has a suggestion, 0:34:22.980,0:34:25.575 a positive suggestion for how you can, 0:34:25.599,0:34:27.450 how do you get rid of conspiracies, 0:34:27.474,0:34:29.278 because they feed on each other. 0:34:29.302,0:34:33.191 Now, "Oh, well I would say that,[br]because I'm part of the conspiracy," 0:34:33.215,0:34:34.405 or whatever. 0:34:34.429,0:34:37.282 Like, how do we get back to a world 0:34:39.080,0:34:40.753 where information can be trusted? 0:34:40.777,0:34:42.675 We have to do better on it. 0:34:42.699,0:34:45.493 Are there any other questions[br]out there from the community? 0:34:50.912,0:34:52.425 Aria Bendix from New York City: 0:34:52.449,0:34:55.831 "What are your personal recommendations[br]for those who want to reduce 0:34:55.855,0:34:59.160 their risk of infection[br]amid an uptick in cases?" 0:35:00.369,0:35:03.144 BG: Well, it's great if you have a job 0:35:03.168,0:35:10.176 that you can stay at your house[br]and do it through digital meetings, 0:35:10.200,0:35:14.491 and even some of your social activities, 0:35:14.515,0:35:18.274 you know, I do video calls[br]with lots of friends. 0:35:18.298,0:35:21.315 I have friends in Europe that,[br]who knows when I'll see them, 0:35:21.339,0:35:26.192 but we schedule regular calls to talk. 0:35:26.586,0:35:31.519 If you stay fairly isolated, 0:35:31.543,0:35:35.060 you don't run much risk, 0:35:35.084,0:35:40.938 and it's when you're getting together[br]with lots of other people, 0:35:40.962,0:35:42.776 either through work or socialization, 0:35:42.800,0:35:45.623 that drives that risk, 0:35:45.647,0:35:51.763 and particularly in these communities[br]where you have increased cases, 0:35:51.787,0:35:54.464 even though it's not going to be mandated, 0:35:54.488,0:35:58.530 hopefully, the mobility numbers[br]will show people responding 0:35:58.554,0:36:05.097 and minimizing those kind of[br]out-of-the-house contacts. 0:36:05.121,0:36:07.133 CA: Bill, I wonder if I could just ask you 0:36:07.157,0:36:08.936 just a little bit about philanthropy. 0:36:08.960,0:36:12.326 Obviously, your foundation[br]has played a huge role in this, 0:36:12.350,0:36:15.759 but philanthropy more generally. 0:36:15.783,0:36:19.210 You know, you've started[br]this Giving Pledge movement, 0:36:19.234,0:36:21.929 recruited all these billionaires 0:36:21.953,0:36:27.014 who have pledged to give away[br]half their net worth 0:36:27.038,0:36:29.342 before or after their death. 0:36:29.366,0:36:30.701 But it's really hard to do. 0:36:30.725,0:36:33.042 It's really hard to give away[br]that much money. 0:36:33.066,0:36:34.252 You yourself, I think, 0:36:34.276,0:36:36.291 since The Giving Pledge was started -- 0:36:36.315,0:36:39.635 what? 10 years ago or something,[br]I'm not sure when -- 0:36:39.659,0:36:43.077 but your own net worth, I think,[br]has doubled since that period 0:36:43.101,0:36:46.579 despite being the world's[br]leading philanthropist. 0:36:46.981,0:36:52.464 Is it just fundamentally hard[br]to give away money effectively 0:36:52.488,0:36:54.944 to make the world better? 0:36:54.968,0:36:58.995 Or should the world's donors, 0:36:59.019,0:37:01.221 and especially the world's[br]really rich donors, 0:37:01.245,0:37:03.466 start to almost commit to a schedule, 0:37:03.490,0:37:07.272 like, "Here's a percentage[br]of my net worth each year 0:37:07.296,0:37:08.664 that, as I get older, 0:37:08.688,0:37:10.425 maybe that goes up. 0:37:10.449,0:37:12.847 If I'm to take this seriously, 0:37:12.871,0:37:15.517 I have to give away -- somehow,[br]I've got to find a way 0:37:15.541,0:37:16.917 of doing that effectively." 0:37:16.941,0:37:19.320 Is that an unfair and crazy question? 0:37:19.344,0:37:22.733 BG: Well, it'd be great to up the rate, 0:37:22.757,0:37:28.150 and our goal, both as the Gates Foundation[br]or through The Giving Pledge, 0:37:28.174,0:37:31.507 is to help people find causes[br]they connect to. 0:37:31.531,0:37:34.447 People give through passion. 0:37:34.471,0:37:36.416 Yes, numbers are important, 0:37:36.440,0:37:39.123 but there's so many causes out there. 0:37:39.147,0:37:42.494 The way you're going to pick[br]is you see somebody who's sick, 0:37:42.518,0:37:45.520 you see somebody who's not[br]getting social services. 0:37:45.544,0:37:48.407 You see something[br]that helps reduce racism. 0:37:48.431,0:37:51.549 And you're very passionate,[br]and so you give to that. 0:37:51.573,0:37:52.774 And, of course, 0:37:52.798,0:37:54.898 some philanthropic gifts won't work out. 0:37:54.922,0:38:00.480 We do need to up the ambition level[br]of philanthropists. 0:38:00.504,0:38:02.087 Now, collaborative philanthropy 0:38:02.111,0:38:06.179 that you're helping to facilitate[br]through Audacious, 0:38:06.203,0:38:09.812 there's four or five other groups[br]that are getting philanthropists together, 0:38:09.836,0:38:11.031 that is fantastic, 0:38:11.055,0:38:14.207 because then they learn from each other, 0:38:14.231,0:38:16.379 they get confidence from each other, 0:38:16.403,0:38:20.969 they feel like, "Hey, I put in x,[br]and the four other people put money in, 0:38:20.993,0:38:24.377 so I'm getting more impact," 0:38:24.401,0:38:28.828 and hopefully, it can be made fun for them[br]even when they find out, 0:38:28.852,0:38:31.280 OK, that particular gift[br]didn't work out that well, 0:38:31.304,0:38:34.182 but let's keep going. 0:38:34.206,0:38:36.202 So philanthropy, yes, 0:38:36.226,0:38:38.897 I would like to see the rate go up, 0:38:38.921,0:38:42.002 and people who do get going, 0:38:42.026,0:38:43.216 it is fun, 0:38:43.240,0:38:45.391 it's fulfilling, 0:38:45.415,0:38:49.523 you pick which of the family members[br]are partnered in doing it. 0:38:49.547,0:38:52.786 In my case, Melinda and I[br]love doing this stuff together, 0:38:52.810,0:38:53.977 learning together. 0:38:54.001,0:38:58.816 Some families, it will even[br]involve the kids in the activities. 0:38:58.840,0:39:00.579 Sometimes the kids are pushing. 0:39:00.603,0:39:03.426 When you have lots of money, 0:39:03.450,0:39:06.883 you still think of a million dollars[br]as a lot of money, 0:39:06.907,0:39:08.769 but if you have billions, 0:39:08.793,0:39:10.925 you should be giving hundreds of millions. 0:39:10.949,0:39:15.221 So it's kind of charming that,[br]in terms of your personal expenditure, 0:39:15.245,0:39:17.264 you stay at the level you were at before. 0:39:17.288,0:39:19.974 That's societally quite appropriate. 0:39:19.998,0:39:23.171 But on your giving, you need to scale up 0:39:23.195,0:39:28.755 or else it will be your will, 0:39:28.779,0:39:33.008 and you won't get to shape it[br]and enjoy it quite that same way. 0:39:33.032,0:39:34.253 And so without -- 0:39:34.277,0:39:36.055 we don't want to mandate it, 0:39:36.079,0:39:40.919 but yes, both you and I[br]want to inspire philanthropists 0:39:40.943,0:39:44.482 to see that passion,[br]to see those opportunities 0:39:44.506,0:39:47.855 significantly faster than in the past, 0:39:47.879,0:39:52.750 because whether it's race or disease,[br]or all the other social ills, 0:39:52.774,0:39:57.280 the innovation of what philanthropy[br]can go to and do quickly 0:39:57.304,0:40:00.545 that, if it works, government[br]can come in behind it and scale it up, 0:40:00.569,0:40:02.753 God knows we need solutions, 0:40:02.777,0:40:06.112 we need that kind of hope and progress 0:40:06.136,0:40:10.522 that expectations are high 0:40:10.546,0:40:13.290 that will solve very tough problems. 0:40:13.956,0:40:17.518 CA: I mean, most philanthropists,[br]even the best of them, 0:40:17.542,0:40:21.810 find it hard to give away more than about[br]a percent of their net worth every year, 0:40:21.834,0:40:25.872 and yet the world's richest[br]often have access 0:40:25.896,0:40:27.558 to great investment opportunities. 0:40:27.582,0:40:31.488 Many of them are gaining wealth[br]at seven to 10 percent plus per year. 0:40:31.512,0:40:33.737 Isn't it the case that[br]to have a real chance 0:40:33.761,0:40:35.487 of giving away half your fortune, 0:40:35.511,0:40:39.581 at some point you have to plan[br]to give away five, six, seven, eight, 0:40:39.605,0:40:42.085 10 percent of your net worth annually? 0:40:42.109,0:40:46.968 And that is, isn't that the logic[br]of what should be happening? 0:40:46.992,0:40:49.383 BG: Yeah, there are people[br]like Chuck Feeney, 0:40:49.407,0:40:56.407 who set a good example[br]and gave away all of his money. 0:40:56.431,0:41:01.831 Even Melinda and I are talking about,[br]should we up the rate that we give at? 0:41:01.855,0:41:05.887 As you say, we've been very lucky[br]on the investment side 0:41:05.911,0:41:07.309 through a variety of things. 0:41:07.333,0:41:11.669 Tech fortunes in general have done well, 0:41:11.693,0:41:13.564 even this year, 0:41:13.588,0:41:18.918 which is one of those great contrasts 0:41:18.942,0:41:21.391 in what's going on in the world. 0:41:21.415,0:41:26.092 And I do think there's an expectation[br]that we should speed up, 0:41:26.116,0:41:29.006 and there's a reason to speed up, 0:41:29.030,0:41:32.686 and government is going[br]to miss a lot of needs. 0:41:32.710,0:41:35.622 Yes, there's tons of government[br]money out there, 0:41:35.646,0:41:37.358 but helping it be spent well, 0:41:37.382,0:41:40.726 helping find places it's not stepping up, 0:41:40.750,0:41:45.572 and if people are willing to give[br]to the developing world, 0:41:45.596,0:41:47.044 they don't have governments 0:41:47.068,0:41:51.687 that can print checks[br]for 15 percent of GDP, 0:41:51.711,0:41:55.880 and so the suffering there broadly,[br]just the economic stuff alone, 0:41:55.904,0:41:58.409 put aside the pandemic, 0:41:58.433,0:41:59.770 is tragic. 0:41:59.794,0:42:02.680 It's about a five-year setback 0:42:02.704,0:42:05.308 in terms of these countries[br]moving forward, 0:42:05.332,0:42:09.665 and in a few cases, it's tough enough[br]that the very stability of the country 0:42:09.689,0:42:11.467 is in question. 0:42:12.249,0:42:13.408 CA: Well, Bill, 0:42:13.432,0:42:18.885 I'm in awe of what[br]you and Melinda have done. 0:42:18.909,0:42:22.365 You walk this narrow path 0:42:22.389,0:42:26.887 of trying to juggle[br]so many different things, 0:42:26.911,0:42:32.694 and the amount of time that you dedicate[br]to the betterment of the world at large, 0:42:32.718,0:42:34.422 and definitely the amount of money 0:42:34.446,0:42:36.520 and the amount[br]of passion you put into it -- 0:42:36.544,0:42:37.952 I mean, it's pretty awesome, 0:42:37.976,0:42:42.337 and I'm really grateful to you[br]for spending this time with us now. 0:42:42.361,0:42:43.996 Thank you so much, 0:42:44.020,0:42:45.760 and honestly, the rest of this year, 0:42:45.784,0:42:48.901 your skills and resources[br]are going to be needed more than ever, 0:42:48.925,0:42:50.101 so good luck. 0:42:50.669,0:42:51.833 BG: Well, thanks. 0:42:51.857,0:42:54.645 It's fun work and I'm optimistic,[br]so thanks, Chris.