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How the pandemic will shape the near future

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    Chris Anderson: Welcome, Bill Gates.
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    Bill Gates: Thank you.
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    CA: Alright. It's great
    to have you here, Bill.
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    You know, we had a TED conversation
    about three months ago
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    about this pandemic,
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    and back then, I think fewer than --
    I think that was the end of March --
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    back then, fewer than
    1,000 people in the US had died
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    and fewer than 20,000 worldwide.
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    I mean, the numbers now are,
    like, 128,000 dead in the US
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    and more than half a million worldwide,
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    in three months.
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    In three months.
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    What is your diagnosis of what is possible
    for the rest of this year?
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    You look at a lot of models.
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    What do you think best-
    and worst-case scenarios might be?
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    BG: Well, the range of scenarios,
    sadly, is quite large,
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    including that, as we get into the fall,
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    we could have death rates
    that rival the worst of what we had
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    in the April time period.
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    If you get a lot of young people infected,
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    eventually, they will infect
    old people again,
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    and so you'll get into the nursing homes,
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    the homeless shelters,
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    the places where we've had
    a lot of our deaths.
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    The innovation track,
    which probably we'll touch on --
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    diagnostics, therapeutics, vaccines --
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    there's good progress there,
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    but nothing that would
    fundamentally alter the fact
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    that this fall in the United States
    could be quite bad,
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    and that's worse than
    I would have expected a month ago,
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    the degree to which we're back
    at high mobility,
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    not wearing masks,
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    and now the virus actually
    has gotten into a lot of cities
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    that it hadn't been in before
    in a significant way,
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    so it's going to be a challenge.
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    There's no case where we get
    much below the current death rate,
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    which is about 500 deaths a day,
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    but there's a significant risk
    we'd go back up
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    to the even 2,000 a day
    that we had before,
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    because we don't have the distancing,
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    the behavior change,
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    to the degree that we had
    in April and May.
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    And we know this virus
    is somewhat seasonal,
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    so that the force of infection,
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    both through temperature, humidity,
    more time indoors,
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    will be worse as we get into the fall.
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    CA: So there are scenarios
    where in the US,
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    like, if you extrapolate
    those numbers forward,
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    we end up with, what,
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    more than a quarter of a million
    deaths, perchance,
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    even this year if we're not careful,
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    and worldwide, I guess the death toll
    could, by the end of the year,
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    be well into the millions, with an "s."
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    Is there evidence that the hotter
    temperatures of the summer
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    actually have been helping us?
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    BG: They're not absolutely sure,
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    but certainly, the IHME model
    definitely wanted to use the season,
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    including temperature and humidity,
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    to try and explain
    why May wasn't worse than it was.
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    And so as we came out
    and the mobility numbers got higher,
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    the models expected more infections
    and deaths to come out of that,
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    and the model kept wanting to say,
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    "But I need to use this seasonality
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    to match why May wasn't worse,
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    why June wasn't worse than it was."
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    And we see in the Southern Hemisphere,
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    you know, Brazil,
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    which is the opposite season,
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    now all of South America
    is having a huge epidemic.
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    South Africa is having
    a very fast-growing epidemic.
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    Fortunately, Australia and New Zealand,
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    the last countries
    in the Southern Hemisphere,
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    are at really tiny case counts,
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    and so although they have
    to keep knocking it down,
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    they're talking about,
    "Oh, we have 10 cases,
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    that's a big deal,
    let's go get rid of that."
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    So they're one of these amazing countries
    that got the numbers so low
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    that test, quarantine and trace
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    is working to get them,
    keep them at very near zero.
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    CA: Aided perhaps a bit
    by being easier to isolate
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    and by less density,
    less population density.
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    But nonetheless,
    smart policies down there.
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    BG: Yeah, everything is so exponential
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    that a little bit of good work
    goes a long way.
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    It's not a linear game.
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    You know, contact tracing, if you have
    the number of cases we have in the US,
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    it's super important to do,
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    but it won't get you back down to zero.
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    It'll help you be down,
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    but it's too overwhelming.
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    CA: OK, so in May and June in the US,
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    the numbers were slightly better
    than some of the models predicted,
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    and it's hypothesized that that might be
    partly because of the warmer weather.
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    Now we're seeing, really,
    would you describe it
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    as really quite alarming upticks
    in case rates in the US?
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    BG: That's right, it's --
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    In, say, the New York area,
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    the cases continue to go down somewhat,
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    but in other parts of the country,
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    primarily the South right now,
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    you have increases
    that are offsetting that,
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    and you have testing-positive
    rates in young people
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    that are actually higher than what we saw
    even in some of the tougher areas.
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    And so, clearly, younger people
    have come out of mobility
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    more than older people
    have increased their mobility,
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    so the age structure
    is right now very young,
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    but because of
    multigenerational households,
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    people work in nursing care homes,
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    unfortunately, that will
    work its way back,
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    both the time lag and the transmission,
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    back up into the elderly,
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    will start to push the death rate back up,
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    which, it is down --
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    way down from 2,000
    to around 500 right now.
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    CA: And is that partly because
    there's a three-week lag
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    between case numbers and fatality numbers?
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    And also, perhaps, partly because
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    there have been
    some effective interventions,
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    and we're actually seeing the possibility
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    that the overall fatality rate
    is actually falling a bit
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    now that we've gained
    some extra knowledge?
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    BG: Yeah, certainly
    your fatality rate is always lower
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    when you're not overloaded.
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    And so Italy, when they were overloaded,
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    Spain, even New York at the start,
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    certainly China,
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    there you weren't even able
    to provide the basics,
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    the oxygen and things.
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    A study that our foundation
    funded in the UK
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    found the only thing
    other than remdesivir
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    that is a proven therapeutic,
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    which is the dexamethasone,
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    that for serious patients,
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    is about a 20 percent death reduction,
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    and there's still quite
    a pipeline of those things.
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    You know, hydroxychloroquine
    never established positive data,
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    so that's pretty much done.
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    There's still a few trials ongoing,
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    but the list of things being tried,
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    including, eventually,
    the monoclonal antibodies,
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    we will have some additional
    tools for the fall.
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    And so when you talk about death rates,
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    the good news is,
    some innovation we already have,
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    and we'll have more, even in the fall.
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    We should start to have
    monoclonal antibodies,
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    which is the single therapeutic
    that I'm most excited about.
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    CA: I'll actually ask you to tell me
    a bit more about that in one sec,
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    but just putting the pieces
    together on death rates:
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    so in a well-functioning health system,
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    so take the US when places
    aren't overcrowded,
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    what do you think
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    the current fatality numbers are,
    approximately, going forward,
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    like as a percentage of total cases?
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    Are we below one percent, perhaps?
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    BG: If you found every case, yes,
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    you're well below one percent.
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    People argue, you know, 0.4, 0.5.
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    By the time you bring in
    the never symptomatics,
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    it probably is below 0.5,
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    and that's good news.
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    This disease could have been
    a five-percent disease.
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    The transmission dynamics of this disease
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    are more difficult
    than even the experts predicted.
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    The amount of presymptomatic
    and never symptomatic spread
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    and the fact that it's not coughing,
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    where you would kind of notice,
    "Hey, I'm coughing" --
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    most respiratory diseases make you cough.
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    This one, in its early stages,
    it's not coughing,
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    it's singing, laughing, talking,
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    actually, still, particularly
    for the super-spreaders,
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    people with very high viral loads,
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    causes that spread,
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    and that's pretty novel,
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    and so even the experts have to say,
    "Wow, this caught us by surprise."
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    The amount of asymptomatic spread
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    and the fact that there's not
    a coughing element
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    is not a major piece like the flu or TB.
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    CA: Yeah, that is
    devilish cunning by the virus.
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    I mean, how much is
    that nonsymptomatic transmission
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    as a percentage of total transmission?
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    I've heard numbers it could be
    as much as half of all transmissions
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    are basically presymptomatic.
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    BG: Yeah, if you count presymptomatics,
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    then most of the studies show
    that's like at 40 percent,
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    and we also have never symptomatics.
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    The amount of virus you get
    in your upper respiratory area
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    is somewhat disconnected.
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    Some people will have a lot here
    and very little in their lungs,
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    and what you get in your lungs
    causes the really bad symptoms --
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    and other organs, but mostly the lungs --
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    and so that's when you seek treatment.
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    And so the worst case
    in terms of spreading
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    is somebody who's got a lot
    in the upper respiratory tract
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    but almost none in their lungs,
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    so they're not care-seeking.
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    CA: Right.
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    And so if you add in the never symptomatic
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    to the presymptomatic,
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    do you get above 50 percent
    of the transmission
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    is actually from nonsymptomatic people?
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    BG: Yeah, transmission
    is harder to measure.
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    You know, we see certain
    hotspots and things,
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    but that's a huge question
    with the vaccine:
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    Will it, besides avoiding
    you getting sick,
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    which is what the trial will test,
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    will it also stop you
    from being a transmitter?
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    CA: So that vaccine,
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    it's such an important question,
    let's come on to that.
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    But before we go there,
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    any other surprises
    in the last couple months
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    that we've learned about this virus
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    that really impact how
    we should respond to it?
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    BG: We're still not able to characterize
    who the super-spreaders are
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    in terms of what that profile is,
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    and we may never.
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    That may just be quite random.
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    If you could identify them,
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    they're responsible
    for the majority of transmission,
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    a few people who have
    very high viral loads.
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    But sadly, we haven't figured that out.
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    This mode of transmission,
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    if you're in a room and nobody talks,
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    there's way less transmission.
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    That's partly why,
    although planes can transmit,
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    it's less than you would expect
    just in terms of time proximity measures,
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    because unlike, say,
    a choir or a restaurant,
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    you're not exhaling in loud talking
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    quite as much as in other
    indoor environments.
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    CA: Hmm.
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    What do you think about the ethics
    of someone who would go on a plane
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    and refuse to wear a mask?
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    BG: If they own the plane,
    that would be fine.
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    If there's other people on the plane,
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    that would be endangering
    those other people.
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    CA: Early on in the pandemic,
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    the WHO did not advise
    that people wear masks.
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    They were worried about taking them away
    from frontline medical providers.
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    In retrospect, was that
    a terrible mistake that they made?
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    BG: Yes.
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    All the experts feel bad
    that the value of masks --
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    which ties back somewhat
    to the asymptomatics;
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    if people were very symptomatic,
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    like an Ebola,
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    then you know it and you isolate,
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    and so you don't have
    a need for a masklike thing.
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    The value of masks,
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    the fact that the medical masks
    was a different supply chain
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    than the normal masks,
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    the fact you could scale up
    the normal masks so well,
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    the fact that it would stop
    that presymptomatic,
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    never symptomatic transmission,
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    it's a mistake.
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    But it's not a conspiracy.
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    It's something that, we now know more.
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    And even now, our error bars
    on the benefit of masks
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    are higher than we'd like to admit,
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    but it's a significant benefit.
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    CA: Alright, I'm going to come in
    with some questions
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    from the community.
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    Let's pull them up there.
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    Jim Pitofsky, "Do you think reopening
    efforts in the US have been premature,
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    and if so, how far should the US go
    to responsibly confront this pandemic?"
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    BG: Well, the question
    of how you make trade-offs
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    between the benefits, say,
    of going to school
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    versus the risk of people getting sick
    because they go to school,
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    those are very tough questions
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    that I don't think
    any single person can say,
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    "I will tell you how to make
    all these trade-offs."
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    The understanding
    of where you have transmission,
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    and the fact that young people
    do get infected
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    and are part of the multigenerational
    transmission chain,
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    we should get that out.
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    If you just look at the health aspect,
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    we have opened up too liberally.
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    Now, opening up in terms of mental health
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    and seeking normal health things
    like vaccines or other care,
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    there are benefits.
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    I think some of our opening up
    has created more risk than benefit.
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    Opening the bars up
    as quickly as they did,
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    you know, is that critical
    for mental health?
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    Maybe not.
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    So I don't think we've been
    as tasteful about opening up
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    as I'm sure, as we study it,
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    that we'll realize some things
    we shouldn't have opened up as fast.
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    But then you have something like school,
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    where even sitting here today,
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    the exact plan, say,
    for inner-city schools for the fall,
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    I wouldn't have a black-and-white view
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    on the relative trade-offs involved there.
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    There are huge benefits
    to letting those kids go to school,
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    and how do you weigh the risk?
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    If you're in a city without many cases,
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    I would say probably the benefit is there.
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    Now that means that
    you could get surprised.
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    The cases could show up,
    and then you'd have to change that,
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    which is not easy.
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    But I think around the US,
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    there will be places
    where that won't be a good trade-off.
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    So almost any dimension of inequity,
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    this disease has made worse:
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    job type, internet connection,
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    ability of your school
    to do online learning.
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    White-collar workers,
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    people are embarrassed to admit it,
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    some of them are more productive
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    and enjoying the flexibility
    that the at-home thing has created,
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    and that feels terrible
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    when you know lots of people
    are suffering in many ways,
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    including their kids not going to school.
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    CA: Indeed. Let's have the next question.
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    [Nathalie Munyampenda] "For us in Rwanda,
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    early policy interventions
    have made the difference.
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    At this point, what policy interventions
    do you suggest for the US now?"
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    Bill, I dream of the day
    where you are appointed
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    the coronavirus czar
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    with authority to actually
    speak to the public.
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    What would you do?
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    BG: Well, the innovation tools
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    are where I and the foundation
    probably has the most expertise.
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    Clearly, some of the policies
    on opening up have been too generous,
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    but I think everybody
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    could engage in that.
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    We need leadership
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    in terms of admitting
    that we've still got a huge problem here
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    and not turning that
    into almost a political thing
  • 17:47 - 17:52
    of, "Oh, isn't it brilliant what we did?"
  • 17:52 - 17:53
    No, it's not brilliant,
  • 17:53 - 17:58
    but there's many people,
    including the experts --
  • 17:58 - 18:00
    there's a lot
    they didn't understand,
  • 18:00 - 18:05
    and everybody wishes a week earlier
    whatever action they took,
  • 18:05 - 18:07
    they'd taken that a week earlier.
  • 18:08 - 18:09
    The innovation tools,
  • 18:09 - 18:16
    that's where the foundation's work
  • 18:16 - 18:19
    on antibodies, vaccines,
  • 18:19 - 18:21
    we have deep expertise,
  • 18:21 - 18:24
    and it's outside of the private sector,
  • 18:24 - 18:28
    and so we have kind of a neutral ability
    to work with all the governments
  • 18:28 - 18:30
    and the companies to pick.
  • 18:30 - 18:33
    Particularly when you're doing
    break-even products,
  • 18:33 - 18:35
    which one should get the resources?
  • 18:35 - 18:39
    There's no market signal for that.
  • 18:39 - 18:42
    Experts have to say, "OK,
    this antibody deserves the manufacturing.
  • 18:42 - 18:45
    This vaccine deserves the manufacturing,"
  • 18:45 - 18:50
    because we have very limited
    manufacturing for both of those things,
  • 18:50 - 18:54
    and it'll be cross-company,
    which never happens in the normal case,
  • 18:54 - 18:56
    where one company invents it
  • 18:56 - 19:00
    and then you're using
    the manufacturing plants of many companies
  • 19:00 - 19:03
    to get maximum scale of the best choice.
  • 19:04 - 19:07
    So I would be coordinating those things,
  • 19:07 - 19:12
    but we need a leader
    who keeps us up to date,
  • 19:12 - 19:14
    is realistic
  • 19:14 - 19:17
    and shows us the right behavior,
  • 19:17 - 19:19
    as well as driving the innovation track.
  • 19:20 - 19:23
    CA: I mean, you have
    to yourself be a master diplomat
  • 19:23 - 19:24
    in how you talk about this stuff.
  • 19:24 - 19:27
    So I appreciate, almost,
    the discomfort here.
  • 19:27 - 19:30
    But I mean, you talk regularly
    with Anthony Fauci,
  • 19:30 - 19:35
    who is a wise voice on this
    by most people's opinion.
  • 19:35 - 19:37
    But to what extent is he just hamstrung?
  • 19:37 - 19:40
    He's not allowed to play the full role
  • 19:40 - 19:43
    that he could play in this circumstance.
  • 19:43 - 19:49
    BG: Dr. Fauci has emerged
    where he was allowed to have some airtime,
  • 19:49 - 19:53
    and even though he was stating
    things that are realistic,
  • 19:53 - 19:55
    his prestige has stuck.
  • 19:55 - 19:57
    He can speak out in that way.
  • 19:57 - 20:02
    Typically, the CDC would be
    the primary voice here.
  • 20:03 - 20:05
    It's not absolutely necessary,
  • 20:05 - 20:07
    but in previous health crises,
  • 20:08 - 20:10
    you let the experts inside the CDC
  • 20:10 - 20:12
    be that voice.
  • 20:12 - 20:14
    They're trained to do these things,
  • 20:14 - 20:20
    and so it is a bit unusual here
    how much we've had to rely on Fauci
  • 20:20 - 20:22
    as opposed to the CDC.
  • 20:22 - 20:26
    It should be Fauci,
    who's a brilliant researcher,
  • 20:26 - 20:29
    so experienced, particularly in vaccines.
  • 20:29 - 20:33
    In some ways, he has become,
    taking the broad advice
  • 20:33 - 20:37
    that's the epidemiology advice
  • 20:37 - 20:39
    and explaining it in the right way,
  • 20:39 - 20:41
    where he'll admit,
  • 20:41 - 20:44
    "OK, we may have a rebound here,
  • 20:44 - 20:47
    and this is why we need
    to behave that way."
  • 20:47 - 20:53
    But it's fantastic that his voice
    has been allowed to come through.
  • 20:54 - 20:55
    CA: Sometimes.
  • 20:55 - 20:57
    Let's have the next question.
  • 21:01 - 21:04
    Nina Gregory, "How are you
    and your foundation
  • 21:04 - 21:08
    addressing the ethical questions about
    which countries get the vaccine first,
  • 21:08 - 21:10
    assuming you find one?"
  • 21:10 - 21:12
    And maybe, Bill, use this as a moment
  • 21:12 - 21:16
    to just talk about where
    the quest for the vaccine is
  • 21:16 - 21:19
    and what are just some of the key things
    we should all be thinking about
  • 21:20 - 21:21
    as we track the news on this.
  • 21:22 - 21:26
    BG: There's three vaccines that are,
  • 21:26 - 21:28
    if they work, are the earliest:
  • 21:28 - 21:34
    the Moderna, which unfortunately,
    won't scale very easily,
  • 21:34 - 21:38
    so if that works, it'll be mostly
    a US-targeted thing;
  • 21:39 - 21:42
    then you have the AstraZeneca,
    which comes from Oxford;
  • 21:42 - 21:43
    and the Johnson and Johnson.
  • 21:43 - 21:45
    Those are the three early ones.
  • 21:45 - 21:48
    And we have animal data
  • 21:48 - 21:54
    that looks potentially good
    but not definitive,
  • 21:54 - 21:57
    particularly will it work in the elderly,
  • 21:57 - 22:00
    and we'll have human data
    over the next several months.
  • 22:00 - 22:06
    Those three will be gated by
    the safety and efficacy trial.
  • 22:06 - 22:08
    That is, we'll be able
    to manufacture those,
  • 22:08 - 22:10
    although not as much as we want.
  • 22:10 - 22:13
    We'll be able to manufacture those
    before the end of the year.
  • 22:13 - 22:15
    Whether the Phase 3 will succeed
  • 22:15 - 22:18
    and whether it'll complete
    before the end of the year,
  • 22:18 - 22:22
    I wouldn't be that optimistic about.
  • 22:22 - 22:26
    Phase 3 is where you need
    to really look at all the safety profile
  • 22:26 - 22:28
    and efficacy,
  • 22:28 - 22:29
    but those will get started.
  • 22:29 - 22:34
    And then there's four or five vaccines
    that use different approaches
  • 22:34 - 22:36
    that are maybe three
    or four months behind that:
  • 22:36 - 22:41
    Novavax, Sanofi, Merck.
  • 22:41 - 22:47
    And so we're funding factory capacity
    for a lot of these --
  • 22:47 - 22:53
    some complex negotiations
    are taking place right now on this --
  • 22:53 - 22:59
    to get factories that will be dedicated
    to the poorer countries,
  • 22:59 - 23:01
    what's called low- and middle-income.
  • 23:01 - 23:04
    And the very scalable constructs
  • 23:04 - 23:09
    that include AstraZeneca
    and Johnson and Johnson,
  • 23:09 - 23:10
    we'll focus on those,
  • 23:10 - 23:11
    the ones that are inexpensive
  • 23:11 - 23:15
    and you can build a single factory
    to make 600 million doses.
  • 23:15 - 23:20
    So a number of the vaccine constructs
  • 23:20 - 23:21
    are potential.
  • 23:21 - 23:25
    I don't see anything
    before the end of the year.
  • 23:25 - 23:27
    That's really the best case,
  • 23:27 - 23:31
    and it's down to a few constructs now,
  • 23:31 - 23:35
    which, typically, you have
    high failure rates.
  • 23:36 - 23:37
    CA: Bill, is it the case
  • 23:38 - 23:41
    that if you and your foundation
    weren't in the picture here
  • 23:41 - 23:44
    that market dynamics would likely
    lead to a situation
  • 23:44 - 23:47
    where, as soon as a promising
    vaccine candidate emerged,
  • 23:47 - 23:50
    the richer countries
    would basically snap up, gobble up
  • 23:50 - 23:53
    all available initial supply --
  • 23:53 - 23:55
    it just takes a while
    to manufacture these,
  • 23:55 - 23:59
    and there would be nothing
    for the poorer countries --
  • 23:59 - 24:02
    but that what, effectively, you're doing
  • 24:02 - 24:05
    by giving manufacturing
    guarantees and capability
  • 24:05 - 24:07
    to some of these candidates,
  • 24:07 - 24:13
    you're making it possible that
    at least some of the early vaccine units
  • 24:13 - 24:16
    will go to poorer countries?
  • 24:16 - 24:17
    Is that correct?
  • 24:17 - 24:19
    BG: Well, it's not just us, but yes,
  • 24:19 - 24:21
    we're in the central role there,
  • 24:22 - 24:28
    along with a group we created called CEPI,
    Coalition for Epidemic Preparedness,
  • 24:28 - 24:32
    and the European leaders agree with this.
  • 24:32 - 24:35
    Now we have the expertise
    to look at each of the constructs
  • 24:35 - 24:38
    and say, "OK, where is there
    a factory in the world
  • 24:38 - 24:40
    that has capacity that can build that?
  • 24:40 - 24:42
    Which one should we put
    the early money into?
  • 24:42 - 24:44
    What should the milestones be
  • 24:44 - 24:47
    where we'll shift the money
    over to a different one?"
  • 24:47 - 24:51
    Because the kind of private sector people
  • 24:51 - 24:54
    who really understand that stuff,
  • 24:54 - 24:56
    some of them work for us,
  • 24:56 - 25:00
    and we're a trusted party on these things,
  • 25:00 - 25:05
    we get to coordinate a lot of it,
    particularly that manufacturing piece.
  • 25:05 - 25:10
    Usually, you'd expect the US
    to think of this as a global problem
  • 25:11 - 25:12
    and be involved.
  • 25:12 - 25:18
    So far, no activity
    on that front has taken place.
  • 25:18 - 25:22
    I am talking to people in the Congress
    and the Administration
  • 25:22 - 25:25
    about when the next
    relief bill comes along
  • 25:25 - 25:30
    that maybe one percent of that
    could go for the tools
  • 25:30 - 25:32
    to help the entire world.
  • 25:32 - 25:35
    And so it's possible,
  • 25:35 - 25:37
    but it's unfortunate,
  • 25:37 - 25:40
    and the vacuum here,
  • 25:40 - 25:42
    the world is not that used to,
  • 25:42 - 25:46
    and a lot of people are stepping in,
    including our foundation,
  • 25:46 - 25:49
    to try and have a strategy,
  • 25:49 - 25:51
    including for the poorer countries,
  • 25:51 - 25:57
    who will suffer a high percentage
    of the deaths and negative effects,
  • 25:57 - 26:00
    including their health systems
    being overwhelmed.
  • 26:00 - 26:03
    Most of the deaths will be
    in developing countries,
  • 26:03 - 26:07
    despite the huge deaths we've seen
    in Europe and the US.
  • 26:07 - 26:09
    CA: I mean, I wish
    I could be a fly on the wall
  • 26:09 - 26:12
    and hearing you and Melinda
    talk about this,
  • 26:12 - 26:17
    because of all of the ethical ...
    "crimes," let's say,
  • 26:17 - 26:21
    executed by leaders
    who should know better,
  • 26:21 - 26:25
    I mean, it's one thing
    to not model mask-wearing,
  • 26:25 - 26:32
    but to not play a role
    in helping the world
  • 26:32 - 26:34
    when faced with a common enemy,
  • 26:34 - 26:36
    respond as one humanity,
  • 26:36 - 26:37
    and instead ...
  • 26:38 - 26:43
    you know, catalyze a really unseemly
    scramble between nations
  • 26:43 - 26:45
    to fight for vaccines, for example.
  • 26:45 - 26:51
    That just seems -- surely, history
    is going to judge that harshly.
  • 26:51 - 26:54
    That is just sickening.
  • 26:55 - 26:57
    Isn't it? Am I missing something?
  • 26:57 - 27:02
    BG: Well, it's not quite
    as black-and-white as that.
  • 27:02 - 27:05
    The US has put more money out
  • 27:05 - 27:08
    to fund the basic research
    on these vaccines
  • 27:08 - 27:11
    than any country by far,
  • 27:11 - 27:14
    and that research is not restricted.
  • 27:14 - 27:17
    There's not, like, some royalty
    that says, "Hey, if you take our money,
  • 27:17 - 27:19
    you have to pay the US a royalty."
  • 27:19 - 27:22
    They do, to the degree they fund research,
  • 27:22 - 27:24
    it's for everybody.
  • 27:24 - 27:26
    To the degree they fund factories,
    it's just for the US.
  • 27:26 - 27:31
    The thing that makes this tough is that
    in every other global health problem,
  • 27:31 - 27:34
    the US totally leads smallpox eradication,
  • 27:34 - 27:39
    the US is totally the leader
    on polio eradication,
  • 27:39 - 27:45
    with key partners -- CDC, WHO,
    Rotary, UNICEF, our foundation.
  • 27:45 - 27:48
    So the world -- and on HIV,
  • 27:48 - 27:53
    under President Bush's leadership,
    but it was very bipartisan,
  • 27:53 - 27:56
    this thing called PEPFAR was unbelievable.
  • 27:56 - 27:59
    That has saved tens of millions of lives.
  • 27:59 - 28:03
    And so it's that the world
    always expected the US
  • 28:03 - 28:05
    to at least be at the head of the table,
  • 28:05 - 28:11
    financially, strategy, OK, how do you
    get these factories for the world,
  • 28:11 - 28:15
    even if it's just to avoid the infection
    coming back to the US
  • 28:15 - 28:17
    or to have the global economy working,
  • 28:17 - 28:19
    which is good for US jobs
  • 28:19 - 28:22
    to have demand outside the US.
  • 28:22 - 28:24
    And so the world is kind of --
  • 28:24 - 28:27
    you know, there's all this uncertainty
    about which thing will work,
  • 28:27 - 28:31
    and there's this,
    "OK, who's in charge here?"
  • 28:31 - 28:35
    And so the worst thing,
    the withdrawal from WHO,
  • 28:36 - 28:42
    that is a difficulty
    that hopefully will get remedied
  • 28:42 - 28:44
    at some point,
  • 28:44 - 28:47
    because we need that coordination
  • 28:47 - 28:48
    through WHO.
  • 28:49 - 28:52
    CA: Let's take another question.
  • 28:56 - 28:59
    Ali Kashani, "Are there any
    particularly successful models
  • 28:59 - 29:02
    of handling the pandemic
    that you have seen around the world?"
  • 29:04 - 29:08
    BG: Well, it's fascinating that,
    besides early action,
  • 29:08 - 29:12
    there are definitely things where
    you take people who have tested positive
  • 29:12 - 29:15
    and you monitor their pulse ox,
  • 29:15 - 29:18
    which is the oxygen saturation
    level in their blood,
  • 29:18 - 29:20
    which is a very cheap detector,
  • 29:20 - 29:23
    and then you know to get them
    to the hospitals fairly early.
  • 29:23 - 29:30
    Weirdly, patients don't know
    things are about to get severe.
  • 29:30 - 29:35
    It's an interesting physiological reason
    that I won't get into.
  • 29:35 - 29:40
    And so Germany has
    quite a low case fatality rate
  • 29:40 - 29:43
    that they've done through
    that type of monitoring.
  • 29:43 - 29:46
    And then, of course,
    once you get into facilities,
  • 29:46 - 29:51
    we've learned that the ventilator,
    actually, although extremely well-meaning,
  • 29:51 - 29:55
    was actually overused
    and used in the wrong mode
  • 29:55 - 29:56
    in those early days.
  • 29:56 - 30:03
    So the health -- the doctors
    are way smarter about treatment today.
  • 30:03 - 30:05
    Most of that, I would say, is global.
  • 30:05 - 30:08
    Using this pulse ox as an early indicator,
  • 30:08 - 30:09
    that'll probably catch on broadly,
  • 30:09 - 30:12
    but Germany was a pioneer there.
  • 30:12 - 30:18
    And now, of course, dexamethasone --
    fortunately, it's cheap, it's oral,
  • 30:18 - 30:20
    we can ramp up manufacture.
  • 30:20 - 30:23
    That'll go global as well.
  • 30:25 - 30:29
    CA: Bill, I want to ask you
    something about
  • 30:29 - 30:32
    what it's been like for you personally
    through this whole process.
  • 30:32 - 30:38
    Because, weirdly, even though
    your passion and good intent on this topic
  • 30:38 - 30:44
    seems completely bloody obvious to anyone
    who has spent a moment with you,
  • 30:44 - 30:48
    there are these crazy conspiracy theories
    out there about you.
  • 30:48 - 30:51
    I just checked in
    with a company called Zignal
  • 30:51 - 30:53
    that monitors social media spaces.
  • 30:53 - 30:57
    They say that, to date,
    I think on Facebook alone,
  • 30:57 - 31:01
    more than four million posts
    have taken place
  • 31:02 - 31:07
    that associate you with some kind
    of conspiracy theory around the virus.
  • 31:07 - 31:13
    I read that there was a poll
    that more than 40 percent of Republicans
  • 31:13 - 31:17
    believe that the vaccine
    that you would roll out
  • 31:17 - 31:22
    would somehow plant a microchip
    in people to track their location.
  • 31:22 - 31:26
    I mean, I can't even believe
    that poll number.
  • 31:27 - 31:30
    And then some people
    are taking this seriously enough,
  • 31:30 - 31:35
    and some of them have even been
    recirculated on "Fox News" and so forth,
  • 31:35 - 31:37
    some people are taking this
    seriously enough
  • 31:37 - 31:42
    to make really quite horrible
    threats and so forth.
  • 31:42 - 31:46
    You seem to do a good job
    sort of shrugging this off,
  • 31:46 - 31:49
    but really, like, who else
    has ever been in this position?
  • 31:49 - 31:51
    How are you managing this?
  • 31:51 - 31:54
    What on earth world are we in
  • 31:54 - 31:56
    that this kind of misinformation
    can be out there?
  • 31:57 - 31:58
    What can we do to help correct it?
  • 32:00 - 32:03
    BG: I'm not sure.
  • 32:05 - 32:07
    And it's a new thing
  • 32:08 - 32:11
    that there's conspiracy theories.
  • 32:11 - 32:14
    I mean, Microsoft had
    its share of controversy,
  • 32:14 - 32:17
    but at least that related
    to the real world, you know?
  • 32:17 - 32:21
    Did Windows crash more than it should?
  • 32:21 - 32:22
    We definitely had antitrust problems.
  • 32:22 - 32:25
    But at least I knew what that was.
  • 32:25 - 32:27
    When this emerged, I have to say,
  • 32:27 - 32:31
    my instinct was to joke about it.
  • 32:31 - 32:34
    People have said
    that's really inappropriate,
  • 32:34 - 32:37
    because this is a very serious thing.
  • 32:37 - 32:42
    It is going to make people
    less willing to take a vaccine.
  • 32:42 - 32:45
    And, of course, once we have that vaccine,
  • 32:45 - 32:47
    it'll be like masks,
  • 32:47 - 32:50
    where getting lots of people,
  • 32:50 - 32:53
    particularly when it's
    a transmission-blocking vaccine,
  • 32:53 - 32:56
    there's this huge community benefit
  • 32:56 - 33:01
    to widespread adoption of that vaccine.
  • 33:01 - 33:04
    So I am caught a little bit,
  • 33:04 - 33:07
    unsure of what to say or do,
  • 33:07 - 33:10
    because the conspiracy piece
    is a new thing for me,
  • 33:11 - 33:15
    and what do you say
  • 33:15 - 33:19
    that doesn't give credence to the thing?
  • 33:19 - 33:24
    The fact that a "Fox News"
    commentator, Laura Ingraham,
  • 33:24 - 33:27
    was saying this stuff
    about me microchipping people,
  • 33:27 - 33:31
    that survey isn't that surprising
    because that's what they heard
  • 33:31 - 33:33
    on the TV.
  • 33:33 - 33:35
    It's wild.
  • 33:35 - 33:39
    And people are clearly seeking
    simpler explanations
  • 33:39 - 33:42
    than going and studying virology.
  • 33:43 - 33:45
    CA: I mean,
  • 33:45 - 33:47
    TED is nonpolitical,
  • 33:47 - 33:49
    but we believe in the truth.
  • 33:49 - 33:52
    I would say this:
  • 33:52 - 33:56
    Laura Ingraham, you owe Bill Gates
    an apology and a retraction.
  • 33:56 - 33:57
    You do.
  • 33:57 - 33:59
    And anyone who's watching this
  • 33:59 - 34:04
    who thinks for a minute that this man
    is involved in some kind of conspiracy,
  • 34:04 - 34:05
    you want your head examined.
  • 34:05 - 34:06
    You are crazy.
  • 34:06 - 34:09
    Enough of us know Bill over many years
  • 34:09 - 34:13
    and have seen the passion
    and engagement in this to know
  • 34:13 - 34:14
    that you are crazy.
  • 34:14 - 34:16
    So get over it,
  • 34:16 - 34:19
    and let's look at the actual problem
    of solving this pandemic.
  • 34:19 - 34:21
    Honestly.
  • 34:21 - 34:23
    If anyone in the chat here
    has a suggestion,
  • 34:23 - 34:26
    a positive suggestion for how you can,
  • 34:26 - 34:27
    how do you get rid of conspiracies,
  • 34:27 - 34:29
    because they feed on each other.
  • 34:29 - 34:33
    Now, "Oh, well I would say that,
    because I'm part of the conspiracy,"
  • 34:33 - 34:34
    or whatever.
  • 34:34 - 34:37
    Like, how do we get back to a world
  • 34:39 - 34:41
    where information can be trusted?
  • 34:41 - 34:43
    We have to do better on it.
  • 34:43 - 34:45
    Are there any other questions
    out there from the community?
  • 34:51 - 34:52
    Aria Bendix from New York City:
  • 34:52 - 34:56
    "What are your personal recommendations
    for those who want to reduce
  • 34:56 - 34:59
    their risk of infection
    amid an uptick in cases?"
  • 35:00 - 35:03
    BG: Well, it's great if you have a job
  • 35:03 - 35:10
    that you can stay at your house
    and do it through digital meetings,
  • 35:10 - 35:14
    and even some of your social activities,
  • 35:15 - 35:18
    you know, I do video calls
    with lots of friends.
  • 35:18 - 35:21
    I have friends in Europe that,
    who knows when I'll see them,
  • 35:21 - 35:26
    but we schedule regular calls to talk.
  • 35:27 - 35:32
    If you stay fairly isolated,
  • 35:32 - 35:35
    you don't run much risk,
  • 35:35 - 35:41
    and it's when you're getting together
    with lots of other people,
  • 35:41 - 35:43
    either through work or socialization,
  • 35:43 - 35:46
    that drives that risk,
  • 35:46 - 35:52
    and particularly in these communities
    where you have increased cases,
  • 35:52 - 35:54
    even though it's not going to be mandated,
  • 35:54 - 35:59
    hopefully, the mobility numbers
    will show people responding
  • 35:59 - 36:05
    and minimizing those kind of
    out-of-the-house contacts.
  • 36:05 - 36:07
    CA: Bill, I wonder if I could just ask you
  • 36:07 - 36:09
    just a little bit about philanthropy.
  • 36:09 - 36:12
    Obviously, your foundation
    has played a huge role in this,
  • 36:12 - 36:16
    but philanthropy more generally.
  • 36:16 - 36:19
    You know, you've started
    this Giving Pledge movement,
  • 36:19 - 36:22
    recruited all these billionaires
  • 36:22 - 36:27
    who have pledged to give away
    half their net worth
  • 36:27 - 36:29
    before or after their death.
  • 36:29 - 36:31
    But it's really hard to do.
  • 36:31 - 36:33
    It's really hard to give away
    that much money.
  • 36:33 - 36:34
    You yourself, I think,
  • 36:34 - 36:36
    since The Giving Pledge was started --
  • 36:36 - 36:40
    what? 10 years ago or something,
    I'm not sure when --
  • 36:40 - 36:43
    but your own net worth, I think,
    has doubled since that period
  • 36:43 - 36:47
    despite being the world's
    leading philanthropist.
  • 36:47 - 36:52
    Is it just fundamentally hard
    to give away money effectively
  • 36:52 - 36:55
    to make the world better?
  • 36:55 - 36:59
    Or should the world's donors,
  • 36:59 - 37:01
    and especially the world's
    really rich donors,
  • 37:01 - 37:03
    start to almost commit to a schedule,
  • 37:03 - 37:07
    like, "Here's a percentage
    of my net worth each year
  • 37:07 - 37:09
    that, as I get older,
  • 37:09 - 37:10
    maybe that goes up.
  • 37:10 - 37:13
    If I'm to take this seriously,
  • 37:13 - 37:16
    I have to give away -- somehow,
    I've got to find a way
  • 37:16 - 37:17
    of doing that effectively."
  • 37:17 - 37:19
    Is that an unfair and crazy question?
  • 37:19 - 37:23
    BG: Well, it'd be great to up the rate,
  • 37:23 - 37:28
    and our goal, both as the Gates Foundation
    or through The Giving Pledge,
  • 37:28 - 37:32
    is to help people find causes
    they connect to.
  • 37:32 - 37:34
    People give through passion.
  • 37:34 - 37:36
    Yes, numbers are important,
  • 37:36 - 37:39
    but there's so many causes out there.
  • 37:39 - 37:42
    The way you're going to pick
    is you see somebody who's sick,
  • 37:43 - 37:46
    you see somebody who's not
    getting social services.
  • 37:46 - 37:48
    You see something
    that helps reduce racism.
  • 37:48 - 37:52
    And you're very passionate,
    and so you give to that.
  • 37:52 - 37:53
    And, of course,
  • 37:53 - 37:55
    some philanthropic gifts won't work out.
  • 37:55 - 38:00
    We do need to up the ambition level
    of philanthropists.
  • 38:01 - 38:02
    Now, collaborative philanthropy
  • 38:02 - 38:06
    that you're helping to facilitate
    through Audacious,
  • 38:06 - 38:10
    there's four or five other groups
    that are getting philanthropists together,
  • 38:10 - 38:11
    that is fantastic,
  • 38:11 - 38:14
    because then they learn from each other,
  • 38:14 - 38:16
    they get confidence from each other,
  • 38:16 - 38:21
    they feel like, "Hey, I put in x,
    and the four other people put money in,
  • 38:21 - 38:24
    so I'm getting more impact,"
  • 38:24 - 38:29
    and hopefully, it can be made fun for them
    even when they find out,
  • 38:29 - 38:31
    OK, that particular gift
    didn't work out that well,
  • 38:31 - 38:34
    but let's keep going.
  • 38:34 - 38:36
    So philanthropy, yes,
  • 38:36 - 38:39
    I would like to see the rate go up,
  • 38:39 - 38:42
    and people who do get going,
  • 38:42 - 38:43
    it is fun,
  • 38:43 - 38:45
    it's fulfilling,
  • 38:45 - 38:50
    you pick which of the family members
    are partnered in doing it.
  • 38:50 - 38:53
    In my case, Melinda and I
    love doing this stuff together,
  • 38:53 - 38:54
    learning together.
  • 38:54 - 38:59
    Some families, it will even
    involve the kids in the activities.
  • 38:59 - 39:01
    Sometimes the kids are pushing.
  • 39:01 - 39:03
    When you have lots of money,
  • 39:03 - 39:07
    you still think of a million dollars
    as a lot of money,
  • 39:07 - 39:09
    but if you have billions,
  • 39:09 - 39:11
    you should be giving hundreds of millions.
  • 39:11 - 39:15
    So it's kind of charming that,
    in terms of your personal expenditure,
  • 39:15 - 39:17
    you stay at the level you were at before.
  • 39:17 - 39:20
    That's societally quite appropriate.
  • 39:20 - 39:23
    But on your giving, you need to scale up
  • 39:23 - 39:29
    or else it will be your will,
  • 39:29 - 39:33
    and you won't get to shape it
    and enjoy it quite that same way.
  • 39:33 - 39:34
    And so without --
  • 39:34 - 39:36
    we don't want to mandate it,
  • 39:36 - 39:41
    but yes, both you and I
    want to inspire philanthropists
  • 39:41 - 39:44
    to see that passion,
    to see those opportunities
  • 39:45 - 39:48
    significantly faster than in the past,
  • 39:48 - 39:53
    because whether it's race or disease,
    or all the other social ills,
  • 39:53 - 39:57
    the innovation of what philanthropy
    can go to and do quickly
  • 39:57 - 40:01
    that, if it works, government
    can come in behind it and scale it up,
  • 40:01 - 40:03
    God knows we need solutions,
  • 40:03 - 40:06
    we need that kind of hope and progress
  • 40:06 - 40:11
    that expectations are high
  • 40:11 - 40:13
    that will solve very tough problems.
  • 40:14 - 40:18
    CA: I mean, most philanthropists,
    even the best of them,
  • 40:18 - 40:22
    find it hard to give away more than about
    a percent of their net worth every year,
  • 40:22 - 40:26
    and yet the world's richest
    often have access
  • 40:26 - 40:28
    to great investment opportunities.
  • 40:28 - 40:31
    Many of them are gaining wealth
    at seven to 10 percent plus per year.
  • 40:32 - 40:34
    Isn't it the case that
    to have a real chance
  • 40:34 - 40:35
    of giving away half your fortune,
  • 40:36 - 40:40
    at some point you have to plan
    to give away five, six, seven, eight,
  • 40:40 - 40:42
    10 percent of your net worth annually?
  • 40:42 - 40:47
    And that is, isn't that the logic
    of what should be happening?
  • 40:47 - 40:49
    BG: Yeah, there are people
    like Chuck Feeney,
  • 40:49 - 40:56
    who set a good example
    and gave away all of his money.
  • 40:56 - 41:02
    Even Melinda and I are talking about,
    should we up the rate that we give at?
  • 41:02 - 41:06
    As you say, we've been very lucky
    on the investment side
  • 41:06 - 41:07
    through a variety of things.
  • 41:07 - 41:12
    Tech fortunes in general have done well,
  • 41:12 - 41:14
    even this year,
  • 41:14 - 41:19
    which is one of those great contrasts
  • 41:19 - 41:21
    in what's going on in the world.
  • 41:21 - 41:26
    And I do think there's an expectation
    that we should speed up,
  • 41:26 - 41:29
    and there's a reason to speed up,
  • 41:29 - 41:33
    and government is going
    to miss a lot of needs.
  • 41:33 - 41:36
    Yes, there's tons of government
    money out there,
  • 41:36 - 41:37
    but helping it be spent well,
  • 41:37 - 41:41
    helping find places it's not stepping up,
  • 41:41 - 41:46
    and if people are willing to give
    to the developing world,
  • 41:46 - 41:47
    they don't have governments
  • 41:47 - 41:52
    that can print checks
    for 15 percent of GDP,
  • 41:52 - 41:56
    and so the suffering there broadly,
    just the economic stuff alone,
  • 41:56 - 41:58
    put aside the pandemic,
  • 41:58 - 42:00
    is tragic.
  • 42:00 - 42:03
    It's about a five-year setback
  • 42:03 - 42:05
    in terms of these countries
    moving forward,
  • 42:05 - 42:10
    and in a few cases, it's tough enough
    that the very stability of the country
  • 42:10 - 42:11
    is in question.
  • 42:12 - 42:13
    CA: Well, Bill,
  • 42:13 - 42:19
    I'm in awe of what
    you and Melinda have done.
  • 42:19 - 42:22
    You walk this narrow path
  • 42:22 - 42:27
    of trying to juggle
    so many different things,
  • 42:27 - 42:33
    and the amount of time that you dedicate
    to the betterment of the world at large,
  • 42:33 - 42:34
    and definitely the amount of money
  • 42:34 - 42:37
    and the amount
    of passion you put into it --
  • 42:37 - 42:38
    I mean, it's pretty awesome,
  • 42:38 - 42:42
    and I'm really grateful to you
    for spending this time with us now.
  • 42:42 - 42:44
    Thank you so much,
  • 42:44 - 42:46
    and honestly, the rest of this year,
  • 42:46 - 42:49
    your skills and resources
    are going to be needed more than ever,
  • 42:49 - 42:50
    so good luck.
  • 42:51 - 42:52
    BG: Well, thanks.
  • 42:52 - 42:55
    It's fun work and I'm optimistic,
    so thanks, Chris.
Title:
How the pandemic will shape the near future
Speaker:
Bill Gates
Description:

Bill Gates talks best (and worst) case scenarios for the coronavirus pandemic in the months ahead, explaining the challenges of reducing virus transmission, providing an update on promising vaccine candidates, offering his thoughts on reopening and even taking a moment to address conspiracy theories circulating about himself. Stay tuned for his critical call to fellow philanthropists to ramp up their action, ambition and awareness to create a better world for all. (This virtual conversation, hosted by head of TED Chris Anderson, was recorded June 29, 2020.)

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Video Language:
English
Team:
TED
Project:
TEDTalks
Duration:
43:07

English subtitles

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