How the pandemic will shape the near future

Chris Anderson: Welcome, Bill Gates.

Bill Gates: Thank you.

CA: Alright. It's great
to have you here, Bill.

You know, we had a TED conversation
about three months ago

about this pandemic,

and back then, I think fewer than --
I think that was the end of March --

back then, fewer than
1,000 people in the US had died,

and fewer than 20,000 worldwide.

I mean, the numbers now are,
like, 128,000 dead in the US

and more than half a million worldwide,

in three months.

In three months.

What is your diagnosis of what is possible
for the rest of this year?

You look at a lot of models.

What do you think best-
and worst-case scenarios might be?

BG: Well, the range of scenarios,
sadly, is quite large,

including that, as we get into the fall,

we could have death rates
that rival the worst of what we had

in the April time period.

If you get a lot of young people infected,

eventually, they will infect
old people again,

and so you'll get into the nursing homes,

the homeless shelters,

the places where we've had
a lot of our deaths.

The innovation track,
which probably we'll touch on --

diagnostics, therapeutics, vaccines --

there's good progress there,

but nothing that would
fundamentally alter the fact

that this fall in the United States
could be quite bad,

and that's worse than
I would have expected a month ago,

the degree to which we're back
at high mobility,

not wearing masks,

and now the virus actually
has gotten into a lot of cities

that it hadn't been in before
in a significant way,

so it's going to be a challenge.

There's no case where we get
much below the current death rate,

which is about 500 deaths a day,

but there's a significant risk
we'd go back up

to the even 2,000 a day
that we had before,

because we don't have the distancing,

the behavior change,

to the degree that we had
in April and May.

And we know this virus
is somewhat seasonal,

so that the force of infection,

both through temperature, humidity,
more time indoors,

will be worse as we get into the fall.

CA: So there are scenarios
where in the US,

like, if you extrapolate
those numbers forward,

we end up with, what,

more than a quarter of a million
deaths, perchance,

even this year if we're not careful,

and worldwide, I guess the death toll
could, by the end of the year,

be well into the millions, with an "s."

Is there evidence that the hotter
temperatures of the summer

actually have been helping us?

BG: They're not absolutely sure,

but certainly, the IHME model
definitely wanted to use the season,

including temperature and humidity,

to try and explain
why May wasn't worse than it was.

And so as we came out
and the mobility numbers got higher,

the models expected more infections
and deaths to come out of that,

and the model kept wanting to say,

"But I need to use this seasonality

to match why May wasn't worse,

why June wasn't worse than it was."

And we see in the Southern Hemisphere,

you know, Brazil,

which is the opposite season,

now all of South America
is having a huge epidemic.

South Africa is having
a very fast-growing epidemic.

Fortunately, Australia and New Zealand,

the last countries
in the Southern Hemisphere,

are at really tiny case counts,

and so although they have
to keep knocking it down,

they're talking about,
"Oh, we have 10 cases,

that's a big deal,
let's go get rid of that."

So they're one of these amazing countries
that got the numbers so low

that test, quarantine and trace

is working to get them,
keep them at very near zero.

CA: Aided perhaps a bit
by being easier to isolate

and by less density,
less population density.

But nonetheless,
smart policies down there.

BG: Yeah, everything is so exponential

that a little bit of good work
goes a long way.

It's not a linear game.

You know, contact tracing, if you have
the number of cases we have in the US,

it's super important to do,

but it won't get you back down to zero.

It'll help you be down,

but it's too overwhelming.

CA: OK, so in May and June in the US,

the numbers were slightly better
than some of the models predicted,

and it's hypothesized that that might be
partly because of the warmer weather.

Now we're seeing, really,
would you describe it

as really quite alarming upticks
in case rates in the US?

BG: That's right, it's --

In, say, the New York area,

the cases continue to go down somewhat,

but in other parts of the country,

primarily the South right now,

you have increases
that are offsetting that,

and you have testing-positive
rates in young people

that are actually higher than what we saw
even in some of the tougher areas.

And so, clearly, younger people
have come out of mobility

more than older people
have increased their mobility,

so the age structure
is right now very young,

but because of
multigenerational households,

people work in nursing care homes,

unfortunately, that will
work its way back,

both the time lag and the transmission,

back up into the elderly,

will start to push the death rate back up,

which, it is down --

way down from 2,000
to around 500 right now.

CA: And is that partly because
there's a three-week lag

between case numbers and fatality numbers?

And also, perhaps, partly because

there have been
some effective interventions,

and we're actually seeing the possibility

that the overall fatality rate
is actually falling a bit

now that we've gained
some extra knowledge?

BG: Yeah, certainly
your fatality rate is always lower

when you're not overloaded.

And so Italy, when they were overloaded,

Spain, even New York at the start,

certainly China,

there you weren't even able
to provide the basics,

the oxygen and things.

A study that our foundation
funded in the UK

found the only thing
other than remdesivir

that is a proven therapeutic,

which is the dexamethasone,

that for serious patients

is about a 20 percent death reduction,

and there's still quite
a pipeline of those things.

You know, hydroxychloroquine
never established positive data,

so that's pretty much done.

There's still a few trials ongoing,

but the list of things being tried,

including, eventually,
the monoclonal antibodies,

we will have some additional
tools for the fall.

And so when you talk about death rates,

the good news is,
some innovation we already have,

and we'll have more, even in the fall.

We should start to have
monoclonal antibodies,

which is the single therapeutic
that I'm most excited about.

CA: I'll actually ask you to tell me
a bit more about that in one sec,

but just putting the pieces
together on death rates:

so in a well-functioning health system,

so take the US when places
aren't overcrowded,

what do you think

the current fatality numbers are,
approximately, going forward,

like as a percentage of total cases?

Are we below one percent, perhaps?

BG: If you found every case, yes,

you're well below one percent.

People argue, you know, 0.4, 0.5.

By the time you bring in
the never symptomatics,

it probably is below 0.5,

and that's good news.

This disease could have been
a five-percent disease.

The transmission dynamics of this disease

are more difficult
than even the experts predicted.

The amount of presymptomatic
and never symptomatic spread

and the fact that it's not coughing,

where you would kind of notice,
"Hey, I'm coughing" --

most respiratory diseases make you cough.

This one, in its early stages,
it's not coughing,

it's singing, laughing, talking,

actually, still, particularly
for the super-spreaders,

people with very high viral loads,

causes that spread,

and that's pretty novel,

and so even the experts have to say,
"Wow, this caught us by surprise."

The amount of asymptomatic spread

and the fact that there's not
a coughing element

is not a major piece like the flu or TB.

CA: Yeah, that is
devilish cunning by the virus.

I mean, how much is
that nonsymptomatic transmission

as a percentage of total transmission?

I've heard numbers it could be
as much as half of all transmissions

are basically presymptomatic.

BG: Yeah, if you count presymptomatics,

then most of the studies show
that's like at 40 percent,

and we also have never symptomatics.

The amount of virus you get
in your upper respiratory area

is somewhat disconnected.

Some people will have a lot here
and very little in their lungs,

and what you get in your lungs
causes the really bad symptoms --

and other organs, but mostly the lungs --

and so that's when you seek treatment.

And so the worst case
in terms of spreading

is somebody who's got a lot
in the upper respiratory tract

but almost none in their lungs,

so they're not care-seeking.

CA: Right.

And so if you add in the never symptomatic

to the presymptomatic,

do you get above 50 percent
of the transmission

is actually from nonsymptomatic people?

BG: Yeah, transmission
is harder to measure.

You know, we see certain
hotspots and things,

but that's a huge question
with the vaccine:

Will it, besides avoiding
you getting sick,

which is what the trial will test,

will it also stop you
from being a transmitter?

CA: So that vaccine,

it's such an important question,
let's come on to that.

But before we go there,

any other surprises
in the last couple months

that we've learned about this virus

that really impact how
we should respond to it?

BG: We're still not able to characterize
who the super-spreaders are

in terms of what that profile is,

and we may never.

That may just be quite random.

If you could identify them,

they're responsible
for the majority of transmission,

a few people who have
very high viral loads.

But sadly, we haven't figured that out.

This mode of transmission,

if you're in a room and nobody talks,

there's way less transmission.

That's partly why,
although planes can transmit,

it's less than you would expect
just in terms of time proximity measures,

because unlike, say,
a choir or a restaurant,

you're not exhaling in loud talking

quite as much as in other
indoor environments.

CA: Hmm.

What do you think about the ethics
of someone who would go on a plane

and refuse to wear a mask?

BG: If they own the plane,
that would be fine.

If there's other people on the plane,

that would be endangering
those other people.

CA: Early on in the pandemic,

the WHO did not advise
that people wear masks.

They were worried about taking them away
from frontline medical providers.

In retrospect, was that
a terrible mistake that they made?

BG: Yes.

All the experts feel bad
that the value of masks --

which ties back somewhat
to the asymptomatics;

if people were very symptomatic,

like an Ebola,

then you know it and you isolate,

and so you don't have
a need for a masklike thing.

The value of masks,

the fact that the medical masks
was a different supply chain

than the normal masks,

the fact you could scale up
the normal masks so well,

the fact that it would stop
that presymptomatic,

never symptomatic transmission,

it's a mistake.

But it's not a conspiracy.

It's something that, we now know more.

And even now, our error bars
on the benefit of masks

are higher than we'd like to admit,

but it's a significant benefit.

CA: Alright, I'm going to come in
with some questions

from the community.

Let's pull them up there.

Jim Pitofsky: "Do you think reopening
efforts in the US have been premature,

and if so, how far should the US go
to responsibly confront this pandemic?"

BG: Well, the question
of how you make trade-offs

between the benefits, say,
of going to school

versus the risk of people getting sick
because they go to school,

those are very tough questions

that I don't think
any single person can say,

"I will tell you how to make
all these trade-offs."

The understanding
of where you have transmission,

and the fact that young people
do get infected

and are part of the multigenerational
transmission chain,

we should get that out.

If you just look at the health aspect,

we have opened up too liberally.

Now, opening up in terms of mental health

and seeking normal health things
like vaccines or other care,

there are benefits.

I think some of our opening up
has created more risk than benefit.

Opening the bars up
as quickly as they did,

you know, is that critical
for mental health?

Maybe not.

So I don't think we've been
as tasteful about opening up

as I'm sure, as we study it,

that we'll realize some things
we shouldn't have opened up as fast.

But then you have something like school,

where even sitting here today,

the exact plan, say,
for inner-city schools for the fall,

I wouldn't have a black-and-white view

on the relative trade-offs involved there.

There are huge benefits
to letting those kids go to school,

and how do you weigh the risk?

If you're in a city without many cases,

I would say probably the benefit is there.

Now that means that
you could get surprised.

The cases could show up,
and then you'd have to change that,

which is not easy.

But I think around the US,

there will be places
where that won't be a good trade-off.

So almost any dimension of inequity,

this disease has made worse:

job type, internet connection,

ability of your school
to do online learning.

White-collar workers,

people are embarrassed to admit it,

some of them are more productive

and enjoying the flexibility
that the at-home thing has created,

and that feels terrible

when you know lots of people
are suffering in many ways,

including their kids not going to school.

CA: Indeed. Let's have the next question.

[Nathalie Munyampenda] "For us in Rwanda,

early policy interventions
have made the difference.

At this point, what policy interventions
do you suggest for the US now?"

Bill, I dream of the day
where you are appointed

the coronavirus czar

with authority to actually
speak to the public.

What would you do?

BG: Well, the innovation tools

are where I and the foundation
probably has the most expertise.

Clearly, some of the policies
on opening up have been too generous,

but I think everybody

could engage in that.

We need leadership

in terms of admitting
that we've still got a huge problem here

and not turning that
into almost a political thing

of, "Oh, isn't it brilliant what we did?"

No, it's not brilliant,

but there's many people,
including the experts,

where there's a lot
they didn't understand,

and everybody wishes a week earlier
whatever action they took,

they'd taken that a week earlier.

The innovation tools,

that's where the foundation's work

on antibodies, vaccines,

we have deep expertise,

and it's outside of the private sector,

and so we have kind of a neutral ability
to work with all the governments

and the companies to pick.

Particularly when you're doing
break-even products,

which one should get the resources?

There's no market signal for that.

Experts have to say, "OK,
this antibody deserves the manufacturing.

This vaccine deserves the manufacturing,"

because we have very limited
manufacturing for both of those things,

and it'll be cross-company,
which never happens in the normal case,

where one company invents it

and then you're using
the manufacturing plants of many companies

to get maximum scale of the best choice.

So I would be coordinating those things,

but we need a leader
who keeps us up to date,

is realistic,

and shows us the right behavior,

as well as driving the innovation track.

CA: I mean, you have
to yourself be a master diplomat

in how you talk about this stuff.

So I appreciate, almost,
the discomfort here.

But I mean, you talk regularly
with Anthony Fauci,

who is a wise voice on this
by most people's opinion.

But to what extent is he just hamstrung?

He's not allowed to play the full role

that he could play in this circumstance.

BG: Dr. Fauci has emerged
where he was allowed to have some airtime,

and even though he was stating
things that are realistic,

his prestige has stuck.

He can speak out in that way.

Typically, the CDC would be
the primary voice here.

It's not absolutely necessary,

but in previous health crises,

you let the experts inside the CDC

be that voice.

They're trained to do these things,

and so it is a bit unusual here
how much we've had to rely on Fauci

as opposed to the CDC.

It should be Fauci,
who's a brilliant researcher,

so experienced, particularly in vaccines.

In some ways, he has become,
taking the broad advice

that's the epidemiology advice

and explaining it in the right way,

where he'll admit,

"OK, we may have a rebound here,

and this is why we need
to behave that way."

But it's fantastic that his voice
has been allowed to come through.

CA: ... sometimes.

Let's have the next question.

Nina Gregory: "How are you
and your foundation

addressing the ethical questions about
which countries get the vaccine first,

assuming you find one?"

And maybe, Bill, use this as a moment

to just talk about where
the quest for the vaccine is

and what are just some of the key things
we should all be thinking about

as we track the news on this.

BG: There's three vaccines that are,

if they work, are the earliest:

the Moderna, which unfortunately,
won't scale very easily,

so if that works, it'll be mostly
a US-targeted thing;

then you have the AstraZeneca,
which comes from Oxford;

and the Johnson & Johnson.

Those are the three early ones.

And we have animal data

that looks potentially good
but not definitive,

particularly will it work in the elderly,

and we'll have human data
over the next several months.

Those three will be gated by
the safety and efficacy trial.

That is, we'll be able
to manufacture those,

although not as much as we want.

We'll be able to manufacture those
before the end of the year.

Whether the Phase 3 will succeed

and whether it'll complete
before the end of the year,

I wouldn't be that optimistic about.

Phase 3 is where you need
to really look at all the safety profile

and efficacy,

but those will get started.

And then there's four or five vaccines
that use different approaches

that are maybe three
or four months behind that:

Novavax, Sanofi, Merck.

And so we're funding factory capacity
for a lot of these --

some complex negotiations
are taking place right now on this --

to get factories that will be dedicated
to the poorer countries,

what's called low- and middle-income.

And the very scalable constructs

that include AstraZeneca
and Johnson & Johnson,

we'll focus on those,

the ones that are inexpensive

and you can build a single factory
to make 600 million doses.

So a number of the vaccine constructs

are potential.

I don't see anything
before the end of the year.

That's really the best case,

and it's down to a few constructs now,

which, typically, you have
high failure rates.

CA: Bill, is it the case

that if you and your foundation
weren't in the picture here

that market dynamics would likely
lead to a situation

where, as soon as a promising
vaccine candidate emerged,

the richer countries
would basically snap up, gobble up

all available initial supply --

it just takes a while
to manufacture these,

and there would be nothing
for the poorer countries --

but that what, effectively, you're doing

by giving manufacturing
guarantees and capability

to some of these candidates,

you're making it possible that
at least some of the early vaccine units

will go to poorer countries?

Is that correct?

BG: Well, it's not just us, but yes,

we're in the central role there,

along with a group we created called CEPI,
Coalition for Epidemic Preparedness,

and the European leaders agree with this.

Now we have the expertise
to look at each of the constructs

and say, "OK, where is there
a factory in the world

that has capacity that can build that?

Which one should we put
the early money into?

What should the milestones be

where we'll shift the money
over to a different one?"

Because the kind of private sector people

who really understand that stuff,

some of them work for us,

and we're a trusted party on these things,

we get to coordinate a lot of it,
particularly that manufacturing piece.

Usually, you'd expect the US
to think of this as a global problem

and be involved.

So far, no activity
on that front has taken place.

I am talking to people in the Congress
and the Administration

about when the next
relief bill comes along

that maybe one percent of that
could go for the tools

to help the entire world.

And so it's possible,

but it's unfortunate,

and the vacuum here,

the world is not that used to,

and a lot of people are stepping in,
including our foundation,

to try and have a strategy,

including for the poorer countries,

who will suffer a high percentage
of the deaths and negative effects,

including their health systems
being overwhelmed.

Most of the deaths will be
in developing countries,

despite the huge deaths we've seen
in Europe and the US.

CA: I mean, I wish
I could be a fly on the wall

and hearing you and Melinda
talk about this,

because of all of the ethical ...
"crimes," let's say,

executed by leaders
who should know better,

I mean, it's one thing
to not model mask-wearing,

but to not play a role
in helping the world

when faced with a common enemy,

respond as one humanity,

and instead ...

you know, catalyze a really unseemly
scramble between nations

to fight for vaccines, for example.

That just seems -- surely, history
is going to judge that harshly.

That is just sickening.

Isn't it? Am I missing something?

BG: Well, it's not quite
as black-and-white as that.

The US has put more money out

to fund the basic research
on these vaccines

than any country by far,

and that research is not restricted.

There's not, like, some royalty
that says, "Hey, if you take our money,

you have to pay the US a royalty."

They do, to the degree they fund research,

it's for everybody.

To the degree they fund factories,
it's just for the US.

The thing that makes this tough is that
in every other global health problem,

the US totally leads smallpox eradication,

the US is totally the leader
on polio eradication,

with key partners -- CDC, WHO,
Rotary, UNICEF, our foundation.

So the world -- and on HIV,

under President Bush's leadership,
but it was very bipartisan,

this thing called PEPFAR was unbelievable.

That has saved tens of millions of lives.

And so it's that the world
always expected the US

to at least be at the head of the table,

financially, strategy, OK, how do you
get these factories for the world,

even if it's just to avoid the infection
coming back to the US

or to have the global economy working,

which is good for US jobs

to have demand outside the US.

And so the world is kind of --

you know, there's all this uncertainty
about which thing will work,

and there's this,
"OK, who's in charge here?"

And so the worst thing,
the withdrawal from WHO,

that is a difficulty
that hopefully will get remedied

at some point,

because we need that coordination

through WHO.

CA: Let's take another question.

Ali Kashani: "Are there any
particularly successful models

of handling the pandemic
that you have seen around the world?"

BG: Well, it's fascinating that,
besides early action,

there are definitely things where
you take people who have tested positive

and you monitor their pulse ox,

which is the oxygen saturation
level in their blood,

which is a very cheap detector,

and then you know to get them
to the hospitals fairly early.

Weirdly, patients don't know
things are about to get severe.

It's an interesting physiological reason
that I won't get into.

And so Germany has
quite a low case fatality rate

that they've done through
that type of monitoring.

And then, of course,
once you get into facilities,

we've learned that the ventilator,
actually, although extremely well-meaning,

was actually overused
and used in the wrong mode

in those early days.

So the health -- the doctors
are way smarter about treatment today.

Most of that, I would say, is global.

Using this pulse ox as an early indicator,

that'll probably catch on broadly,

but Germany was a pioneer there.

And now, of course, dexamethasone --
fortunately, it's cheap, it's oral,

we can ramp up manufacture.

That'll go global as well.

CA: Bill, I want to ask you
something about

what it's been like for you personally
through this whole process.

Because, weirdly, even though
your passion and good intent on this topic

seems completely bloody obvious to anyone
who has spent a moment with you,

there are these crazy conspiracy theories
out there about you.

I just checked in
with a company called Zignal

that monitors social media spaces.

They say that, to date,
I think on Facebook alone,

more than four million posts
have taken place

that associate you with some kind
of conspiracy theory around the virus.

I read that there was a poll
that more than 40 percent of Republicans

believe that the vaccine
that you would roll out

would somehow plant a microchip
in people to track their location.

I mean, I can't even believe
that poll number.

And then some people
are taking this seriously enough,

and some of them have even been
recirculated on "Fox News" and so forth,

some people are taking this
seriously enough

to make really quite horrible
threats and so forth.

You seem to do a good job
sort of shrugging this off,

but really, like, who else
has ever been in this position?

How are you managing this?

What on earth world are we in

that this kind of misinformation
can be out there?

What can we do to help correct it?

BG: I'm not sure.

And it's a new thing

that there's conspiracy theories.

I mean, Microsoft had
its share of controversy,

but at least that related
to the real world, you know?

Did Windows crash more than it should?

We definitely had antitrust problems.

But at least I knew what that was.

When this emerged, I have to say,

my instinct was to joke about it.

People have said
that's really inappropriate,

because this is a very serious thing.

It is going to make people
less willing to take a vaccine.

And, of course, once we have that vaccine,

it'll be like masks,

where getting lots of people,

particularly when it's
a transmission-blocking vaccine,

there's this huge community benefit

to widespread adoption of that vaccine.

So I am caught a little bit,

unsure of what to say or do,

because the conspiracy piece
is a new thing for me,

and what do you say

that doesn't give credence to the thing?

The fact that a "Fox News"
commentator, Laura Ingraham,

was saying this stuff
about me microchipping people,

that survey isn't that surprising
because that's what they heard

on the TV.

It's wild.

And people are clearly seeking
simpler explanations

than going and studying virology.

CA: I mean,

TED is nonpolitical,

but we believe in the truth.

I would say this:

Laura Ingraham, you owe Bill Gates
an apology and a retraction.

You do.

And anyone who's watching this

who thinks for a minute that this man
is involved in some kind of conspiracy,

you want your head examined.

You are crazy.

Enough of us know Bill over many years

and have seen the passion
and engagement in this to know

that you are crazy.

So get over it,

and let's look at the actual problem
of solving this pandemic.

Honestly.

If anyone in the chat here
has a suggestion,

a positive suggestion for how you can,

how do you get rid of conspiracies,

because they feed on each other.

Now, oh, well I would say that,
because I'm part of the conspiracy,

or whatever.

Like, how do we get back to a world

where information can be trusted?

We have to do better on it.

Are there any other questions
out there from the community?

Aria Bendix from New York City:

"What are your personal recommendations
for those who want to reduce

their risk of infection
amid an uptick in cases?"

BG: Well, it's great if you have a job

that you can stay at your house
and do it through digital meetings,

and even some of your social activities,

you know, I do video calls
with lots of friends.

I have friends in Europe that,
who knows when I'll see them,

but we schedule regular calls to talk.

If you stay fairly isolated,

you don't run much risk,

and it's when you're getting together
with lots of other people,

either through work or socialization,

that drives that risk,

and particularly in these communities
where you have increased cases,

even though it's not going to be mandated,

hopefully, the mobility numbers
will show people responding

and minimizing those kind of
out-of-the-house contacts.

CA: Bill, I wonder if I could just ask you

just a little bit about philanthropy.

Obviously, your foundation
has played a huge role in this,

but philanthropy more generally.

You know, you've started
this Giving Pledge movement,

recruited all these billionaires

who have pledged to give away
half their net worth

before or after their death.

But it's really hard to do.

It's really hard to give away
that much money.

You yourself, I think,

since The Giving Pledge was started --

what? 10 years ago or something,
I'm not sure when --

but your own net worth, I think,
has doubled since that period

despite being the world's
leading philanthropist.

Is it just fundamentally hard
to give away money effectively

to make the world better?

Or should the world's donors,

and especially the world's
really rich donors,

start to almost commit to a schedule,

like, "Here's a percentage
of my net worth each year

that, as I get older,

maybe that goes up.

If I'm to take this seriously,

I have to give away -- somehow,
I've got to find a way

of doing that effectively."

Is that an unfair and crazy question?

BG: Well, it'd be great to up the rate,

and our goal, both as the Gates Foundation
or through The Giving Pledge,

is to help people find causes
they connect to.

People give through passion.

Yes, numbers are important,

but there's so many causes out there.

The way you're going to pick
is you see somebody who's sick,

you see somebody who's not
getting social services.

You see something
that helps reduce racism.

And you're very passionate,
and so you give to that.

And, of course,

some philanthropic gifts won't work out.

We do need to up the ambition level
of philanthropists.

Now, collaborative philanthropy

that you're helping to facilitate
through Audacious,

there's four or five other groups
that are getting philanthropists together,

that is fantastic,

because then they learn from each other,

they get confidence from each other,

they feel like, "Hey, I put in x,
and the four other people put money in,

so I'm getting more impact,"

and hopefully, it can be made fun for them
even when they find out,

OK, that particular gift
didn't work out that well,

but let's keep going.

So philanthropy, yes,

I would like to see the rate go up,

and people who do get going,

it is fun,

it's fulfilling,

you pick which of the family members
are partnered in doing it.

In my case, Melinda and I
love doing this stuff together,

learning together.

Some families, it will even
involve the kids in the activities.

Sometimes the kids are pushing.

When you have lots of money,

you still think of a million dollars
as a lot of money,

but if you have billions,

you should be giving hundreds of millions.

So it's kind of charming that,
in terms of your personal expenditure,

you stay at the level you were at before.

That's societally quite appropriate.

But on your giving, you need to scale up

or else it will be your will,

and you won't get to shape it
and enjoy it quite that same way.

And so without --

we don't want to mandate it,

but yes, both you and I
want to inspire philanthropists

to see that passion,
to see those opportunities

significantly faster than in the past,

because whether it's race or disease,
or all the other social ills,

the innovation of what philanthropy
can go to and do quickly

that, if it works, government
can come in behind it and scale it up,

God knows we need solutions,

we need that kind of hope and progress

that expectations are high

that will solve very tough problems.

CA: I mean, most philanthropists,
even the best of them,

find it hard to give away more than about
a percent of their net worth every year,

and yet the world's richest
often have access

to great investment opportunities.

Many of them are gaining wealth
at seven to 10 percent plus per year.

Isn't it the case that
to have a real chance

of giving away half your fortune,

at some point you have to plan
to give away five, six, seven, eight,

10 percent of your net worth annually?

And that is, isn't that the logic
of what should be happening?

BG: Yeah, there are people
like Chuck Feeney,

who set a good example
and gave away all of his money.

Even Melinda and I are talking about,
should we up the rate that we give at?

As you say, we've been very lucky
on the investment side

through a variety of things.

Tech fortunes in general have done well,

even this year,

which is one of those great contrasts

in what's going on in the world.

And I do think there's an expectation
that we should speed up,

and there's a reason to speed up,

and government is going
to miss a lot of needs.

Yes, there's tons of government
money out there,

but helping it be spent well,

helping find places it's not stepping up,

and if people are willing to give
to the developing world,

they don't have governments

that can print checks
for 15 percent of GDP,

and so the suffering there broadly,
just the economic stuff alone,

put aside the pandemic,

is tragic.

It's about a five-year setback

in terms of these countries
moving forward,

and in a few cases, it's tough enough
that the very stability of the country

is in question.

CA: Well, Bill,

I'm in awe of what
you and Melinda have done.

You walk this narrow path

of trying to juggle
so many different things,

and the amount of time that you dedicate
to the betterment of the world at large,

and definitely the amount of money

and the amount
of passion you put into it --

I mean, it's pretty awesome,

and I'm really grateful to you
for spending this time with us now.

Thank you so much,

and honestly, the rest of this year,

your skills and resources
are going to be needed more than ever,

so good luck.

BG: Well, thanks.

It's fun work and I'm optimistic,
so thanks, Chris.