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