How the pandemic will shape the near future
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0:00 - 0:03Chris Anderson: Welcome, Bill Gates.
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0:03 - 0:04Bill Gates: Thank you.
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0:04 - 0:07CA: Alright. It's great
to have you here, Bill. -
0:07 - 0:09You know, we had a TED conversation
about three months ago -
0:09 - 0:10about this pandemic,
-
0:11 - 0:14and back then, I think fewer than --
I think that was the end of March -- -
0:14 - 0:17back then, fewer than
1,000 people in the US had died -
0:17 - 0:20and fewer than 20,000 worldwide.
-
0:20 - 0:24I mean, the numbers now are,
like, 128,000 dead in the US -
0:24 - 0:27and more than half a million worldwide,
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0:27 - 0:29in three months.
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0:29 - 0:30In three months.
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0:30 - 0:35What is your diagnosis of what is possible
for the rest of this year? -
0:35 - 0:37You look at a lot of models.
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0:37 - 0:41What do you think best-
and worst-case scenarios might be? -
0:43 - 0:46BG: Well, the range of scenarios,
sadly, is quite large, -
0:47 - 0:51including that, as we get into the fall,
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0:51 - 0:56we could have death rates
that rival the worst of what we had -
0:57 - 0:58in the April time period.
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0:59 - 1:01If you get a lot of young people infected,
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1:01 - 1:04eventually, they will infect
old people again, -
1:04 - 1:07and so you'll get into the nursing homes,
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1:07 - 1:08the homeless shelters,
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1:08 - 1:12the places where we've had
a lot of our deaths. -
1:12 - 1:15The innovation track,
which probably we'll touch on -- -
1:15 - 1:18diagnostics, therapeutics, vaccines --
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1:18 - 1:20there's good progress there,
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1:20 - 1:24but nothing that would
fundamentally alter the fact -
1:24 - 1:28that this fall in the United States
could be quite bad, -
1:28 - 1:33and that's worse than
I would have expected a month ago, -
1:33 - 1:36the degree to which we're back
at high mobility, -
1:36 - 1:37not wearing masks,
-
1:37 - 1:42and now the virus actually
has gotten into a lot of cities -
1:42 - 1:48that it hadn't been in before
in a significant way, -
1:48 - 1:51so it's going to be a challenge.
-
1:51 - 1:54There's no case where we get
much below the current death rate, -
1:54 - 1:58which is about 500 deaths a day,
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1:58 - 2:01but there's a significant risk
we'd go back up -
2:01 - 2:06to the even 2,000 a day
that we had before, -
2:06 - 2:10because we don't have the distancing,
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2:10 - 2:11the behavior change,
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2:11 - 2:16to the degree that we had
in April and May. -
2:16 - 2:19And we know this virus
is somewhat seasonal, -
2:19 - 2:22so that the force of infection,
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2:22 - 2:25both through temperature, humidity,
more time indoors, -
2:25 - 2:27will be worse as we get into the fall.
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2:28 - 2:30CA: So there are scenarios
where in the US, -
2:30 - 2:33like, if you extrapolate
those numbers forward, -
2:33 - 2:34we end up with, what,
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2:34 - 2:36more than a quarter of a million
deaths, perchance, -
2:36 - 2:39even this year if we're not careful,
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2:39 - 2:43and worldwide, I guess the death toll
could, by the end of the year, -
2:43 - 2:46be well into the millions, with an "s."
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2:46 - 2:49Is there evidence that the hotter
temperatures of the summer -
2:49 - 2:52actually have been helping us?
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2:53 - 2:55BG: They're not absolutely sure,
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2:55 - 3:02but certainly, the IHME model
definitely wanted to use the season, -
3:02 - 3:04including temperature and humidity,
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3:04 - 3:09to try and explain
why May wasn't worse than it was. -
3:09 - 3:14And so as we came out
and the mobility numbers got higher, -
3:14 - 3:20the models expected more infections
and deaths to come out of that, -
3:20 - 3:23and the model kept wanting to say,
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3:23 - 3:27"But I need to use this seasonality
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3:28 - 3:30to match why May wasn't worse,
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3:30 - 3:34why June wasn't worse than it was."
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3:34 - 3:39And we see in the Southern Hemisphere,
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3:40 - 3:42you know, Brazil,
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3:42 - 3:44which is the opposite season,
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3:44 - 3:48now all of South America
is having a huge epidemic. -
3:48 - 3:53South Africa is having
a very fast-growing epidemic. -
3:53 - 3:55Fortunately, Australia and New Zealand,
-
3:55 - 3:57the last countries
in the Southern Hemisphere, -
3:57 - 3:59are at really tiny case counts,
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3:59 - 4:03and so although they have
to keep knocking it down, -
4:03 - 4:06they're talking about,
"Oh, we have 10 cases, -
4:06 - 4:09that's a big deal,
let's go get rid of that." -
4:09 - 4:14So they're one of these amazing countries
that got the numbers so low -
4:14 - 4:18that test, quarantine and trace
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4:18 - 4:23is working to get them,
keep them at very near zero. -
4:23 - 4:27CA: Aided perhaps a bit
by being easier to isolate -
4:27 - 4:30and by less density,
less population density. -
4:30 - 4:32But nonetheless,
smart policies down there. -
4:32 - 4:34BG: Yeah, everything is so exponential
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4:34 - 4:37that a little bit of good work
goes a long way. -
4:37 - 4:39It's not a linear game.
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4:39 - 4:44You know, contact tracing, if you have
the number of cases we have in the US, -
4:44 - 4:46it's super important to do,
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4:46 - 4:48but it won't get you back down to zero.
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4:48 - 4:50It'll help you be down,
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4:50 - 4:53but it's too overwhelming.
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4:53 - 4:56CA: OK, so in May and June in the US,
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4:56 - 5:00the numbers were slightly better
than some of the models predicted, -
5:00 - 5:03and it's hypothesized that that might be
partly because of the warmer weather. -
5:03 - 5:06Now we're seeing, really,
would you describe it -
5:06 - 5:11as really quite alarming upticks
in case rates in the US? -
5:12 - 5:13BG: That's right, it's --
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5:14 - 5:18In, say, the New York area,
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5:18 - 5:21the cases continue to go down somewhat,
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5:21 - 5:23but in other parts of the country,
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5:23 - 5:26primarily the South right now,
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5:26 - 5:29you have increases
that are offsetting that, -
5:29 - 5:32and you have testing-positive
rates in young people -
5:32 - 5:39that are actually higher than what we saw
even in some of the tougher areas. -
5:39 - 5:43And so, clearly, younger people
have come out of mobility -
5:43 - 5:47more than older people
have increased their mobility, -
5:47 - 5:51so the age structure
is right now very young, -
5:51 - 5:54but because of
multigenerational households, -
5:55 - 5:57people work in nursing care homes,
-
5:57 - 6:01unfortunately, that will
work its way back, -
6:01 - 6:03both the time lag and the transmission,
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6:03 - 6:05back up into the elderly,
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6:05 - 6:07will start to push the death rate back up,
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6:07 - 6:10which, it is down --
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6:10 - 6:15way down from 2,000
to around 500 right now. -
6:16 - 6:18CA: And is that partly because
there's a three-week lag -
6:18 - 6:22between case numbers and fatality numbers?
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6:22 - 6:24And also, perhaps, partly because
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6:24 - 6:27there have been
some effective interventions, -
6:27 - 6:29and we're actually seeing the possibility
-
6:29 - 6:32that the overall fatality rate
is actually falling a bit -
6:32 - 6:34now that we've gained
some extra knowledge? -
6:35 - 6:39BG: Yeah, certainly
your fatality rate is always lower -
6:39 - 6:40when you're not overloaded.
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6:40 - 6:43And so Italy, when they were overloaded,
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6:43 - 6:46Spain, even New York at the start,
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6:46 - 6:49certainly China,
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6:49 - 6:54there you weren't even able
to provide the basics, -
6:54 - 6:57the oxygen and things.
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6:57 - 7:00A study that our foundation
funded in the UK -
7:00 - 7:04found the only thing
other than remdesivir -
7:04 - 7:06that is a proven therapeutic,
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7:06 - 7:08which is the dexamethasone,
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7:08 - 7:11that for serious patients,
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7:11 - 7:15is about a 20 percent death reduction,
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7:15 - 7:20and there's still quite
a pipeline of those things. -
7:20 - 7:24You know, hydroxychloroquine
never established positive data, -
7:24 - 7:26so that's pretty much done.
-
7:26 - 7:29There's still a few trials ongoing,
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7:29 - 7:31but the list of things being tried,
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7:31 - 7:36including, eventually,
the monoclonal antibodies, -
7:36 - 7:39we will have some additional
tools for the fall. -
7:39 - 7:43And so when you talk about death rates,
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7:43 - 7:46the good news is,
some innovation we already have, -
7:46 - 7:50and we'll have more, even in the fall.
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7:50 - 7:53We should start to have
monoclonal antibodies, -
7:53 - 7:58which is the single therapeutic
that I'm most excited about. -
7:58 - 8:01CA: I'll actually ask you to tell me
a bit more about that in one sec, -
8:01 - 8:04but just putting the pieces
together on death rates: -
8:04 - 8:06so in a well-functioning health system,
-
8:06 - 8:09so take the US when places
aren't overcrowded, -
8:09 - 8:11what do you think
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8:11 - 8:15the current fatality numbers are,
approximately, going forward, -
8:15 - 8:17like as a percentage of total cases?
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8:17 - 8:20Are we below one percent, perhaps?
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8:20 - 8:23BG: If you found every case, yes,
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8:23 - 8:26you're well below one percent.
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8:26 - 8:31People argue, you know, 0.4, 0.5.
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8:31 - 8:35By the time you bring in
the never symptomatics, -
8:35 - 8:37it probably is below 0.5,
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8:37 - 8:39and that's good news.
-
8:39 - 8:43This disease could have been
a five-percent disease. -
8:44 - 8:47The transmission dynamics of this disease
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8:47 - 8:54are more difficult
than even the experts predicted. -
8:54 - 8:59The amount of presymptomatic
and never symptomatic spread -
8:59 - 9:01and the fact that it's not coughing,
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9:01 - 9:04where you would kind of notice,
"Hey, I'm coughing" -- -
9:04 - 9:06most respiratory diseases make you cough.
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9:06 - 9:09This one, in its early stages,
it's not coughing, -
9:09 - 9:13it's singing, laughing, talking,
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9:13 - 9:16actually, still, particularly
for the super-spreaders, -
9:16 - 9:18people with very high viral loads,
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9:18 - 9:19causes that spread,
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9:19 - 9:22and that's pretty novel,
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9:22 - 9:26and so even the experts have to say,
"Wow, this caught us by surprise." -
9:26 - 9:28The amount of asymptomatic spread
-
9:28 - 9:30and the fact that there's not
a coughing element -
9:30 - 9:33is not a major piece like the flu or TB.
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9:34 - 9:37CA: Yeah, that is
devilish cunning by the virus. -
9:37 - 9:42I mean, how much is
that nonsymptomatic transmission -
9:42 - 9:44as a percentage of total transmission?
-
9:44 - 9:47I've heard numbers it could be
as much as half of all transmissions -
9:47 - 9:49are basically presymptomatic.
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9:50 - 9:53BG: Yeah, if you count presymptomatics,
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9:53 - 9:57then most of the studies show
that's like at 40 percent, -
9:57 - 10:01and we also have never symptomatics.
-
10:01 - 10:04The amount of virus you get
in your upper respiratory area -
10:04 - 10:06is somewhat disconnected.
-
10:06 - 10:09Some people will have a lot here
and very little in their lungs, -
10:09 - 10:14and what you get in your lungs
causes the really bad symptoms -- -
10:14 - 10:17and other organs, but mostly the lungs --
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10:17 - 10:19and so that's when you seek treatment.
-
10:19 - 10:21And so the worst case
in terms of spreading -
10:21 - 10:24is somebody who's got a lot
in the upper respiratory tract -
10:24 - 10:27but almost none in their lungs,
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10:27 - 10:29so they're not care-seeking.
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10:30 - 10:31CA: Right.
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10:31 - 10:34And so if you add in the never symptomatic
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10:34 - 10:36to the presymptomatic,
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10:36 - 10:39do you get above 50 percent
of the transmission -
10:39 - 10:41is actually from nonsymptomatic people?
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10:41 - 10:45BG: Yeah, transmission
is harder to measure. -
10:45 - 10:49You know, we see certain
hotspots and things, -
10:49 - 10:52but that's a huge question
with the vaccine: -
10:52 - 10:56Will it, besides avoiding
you getting sick, -
10:56 - 10:58which is what the trial will test,
-
10:58 - 11:01will it also stop you
from being a transmitter? -
11:01 - 11:02CA: So that vaccine,
-
11:02 - 11:05it's such an important question,
let's come on to that. -
11:05 - 11:06But before we go there,
-
11:06 - 11:08any other surprises
in the last couple months -
11:08 - 11:10that we've learned about this virus
-
11:10 - 11:14that really impact how
we should respond to it? -
11:15 - 11:20BG: We're still not able to characterize
who the super-spreaders are -
11:20 - 11:22in terms of what that profile is,
-
11:22 - 11:23and we may never.
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11:23 - 11:25That may just be quite random.
-
11:25 - 11:28If you could identify them,
-
11:28 - 11:31they're responsible
for the majority of transmission, -
11:31 - 11:34a few people who have
very high viral loads. -
11:34 - 11:39But sadly, we haven't figured that out.
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11:39 - 11:40This mode of transmission,
-
11:40 - 11:43if you're in a room and nobody talks,
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11:43 - 11:46there's way less transmission.
-
11:46 - 11:49That's partly why,
although planes can transmit, -
11:49 - 11:54it's less than you would expect
just in terms of time proximity measures, -
11:54 - 11:57because unlike, say,
a choir or a restaurant, -
11:57 - 12:03you're not exhaling in loud talking
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12:03 - 12:06quite as much as in other
indoor environments. -
12:06 - 12:07CA: Hmm.
-
12:07 - 12:10What do you think about the ethics
of someone who would go on a plane -
12:10 - 12:12and refuse to wear a mask?
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12:12 - 12:15BG: If they own the plane,
that would be fine. -
12:15 - 12:18If there's other people on the plane,
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12:18 - 12:21that would be endangering
those other people. -
12:21 - 12:23CA: Early on in the pandemic,
-
12:23 - 12:28the WHO did not advise
that people wear masks. -
12:28 - 12:33They were worried about taking them away
from frontline medical providers. -
12:33 - 12:38In retrospect, was that
a terrible mistake that they made? -
12:38 - 12:40BG: Yes.
-
12:40 - 12:46All the experts feel bad
that the value of masks -- -
12:46 - 12:49which ties back somewhat
to the asymptomatics; -
12:49 - 12:52if people were very symptomatic,
-
12:52 - 12:55like an Ebola,
-
12:55 - 13:00then you know it and you isolate,
-
13:00 - 13:03and so you don't have
a need for a masklike thing. -
13:03 - 13:06The value of masks,
-
13:06 - 13:09the fact that the medical masks
was a different supply chain -
13:09 - 13:12than the normal masks,
-
13:12 - 13:15the fact you could scale up
the normal masks so well, -
13:15 - 13:19the fact that it would stop
that presymptomatic, -
13:19 - 13:21never symptomatic transmission,
-
13:21 - 13:22it's a mistake.
-
13:22 - 13:26But it's not a conspiracy.
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13:26 - 13:29It's something that, we now know more.
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13:29 - 13:32And even now, our error bars
on the benefit of masks -
13:32 - 13:34are higher than we'd like to admit,
-
13:34 - 13:36but it's a significant benefit.
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13:37 - 13:39CA: Alright, I'm going to come in
with some questions -
13:39 - 13:41from the community.
-
13:43 - 13:44Let's pull them up there.
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13:45 - 13:51Jim Pitofsky, "Do you think reopening
efforts in the US have been premature, -
13:51 - 13:56and if so, how far should the US go
to responsibly confront this pandemic?" -
13:58 - 14:01BG: Well, the question
of how you make trade-offs -
14:01 - 14:06between the benefits, say,
of going to school -
14:06 - 14:10versus the risk of people getting sick
because they go to school, -
14:10 - 14:13those are very tough questions
-
14:13 - 14:20that I don't think
any single person can say, -
14:20 - 14:24"I will tell you how to make
all these trade-offs." -
14:24 - 14:28The understanding
of where you have transmission, -
14:28 - 14:31and the fact that young people
do get infected -
14:31 - 14:36and are part of the multigenerational
transmission chain, -
14:36 - 14:38we should get that out.
-
14:38 - 14:40If you just look at the health aspect,
-
14:40 - 14:43we have opened up too liberally.
-
14:43 - 14:47Now, opening up in terms of mental health
-
14:47 - 14:54and seeking normal health things
like vaccines or other care, -
14:54 - 14:56there are benefits.
-
14:56 - 15:02I think some of our opening up
has created more risk than benefit. -
15:02 - 15:05Opening the bars up
as quickly as they did, -
15:05 - 15:08you know, is that critical
for mental health? -
15:08 - 15:09Maybe not.
-
15:09 - 15:13So I don't think we've been
as tasteful about opening up -
15:14 - 15:19as I'm sure, as we study it,
-
15:19 - 15:25that we'll realize some things
we shouldn't have opened up as fast. -
15:25 - 15:27But then you have something like school,
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15:27 - 15:30where even sitting here today,
-
15:30 - 15:35the exact plan, say,
for inner-city schools for the fall, -
15:35 - 15:39I wouldn't have a black-and-white view
-
15:39 - 15:44on the relative trade-offs involved there.
-
15:44 - 15:50There are huge benefits
to letting those kids go to school, -
15:50 - 15:54and how do you weigh the risk?
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15:54 - 15:57If you're in a city without many cases,
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15:57 - 16:01I would say probably the benefit is there.
-
16:01 - 16:03Now that means that
you could get surprised. -
16:04 - 16:07The cases could show up,
and then you'd have to change that, -
16:07 - 16:08which is not easy.
-
16:08 - 16:11But I think around the US,
-
16:11 - 16:16there will be places
where that won't be a good trade-off. -
16:16 - 16:18So almost any dimension of inequity,
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16:18 - 16:23this disease has made worse:
-
16:23 - 16:28job type, internet connection,
-
16:28 - 16:31ability of your school
to do online learning. -
16:31 - 16:34White-collar workers,
-
16:34 - 16:36people are embarrassed to admit it,
-
16:36 - 16:38some of them are more productive
-
16:38 - 16:43and enjoying the flexibility
that the at-home thing has created, -
16:43 - 16:45and that feels terrible
-
16:45 - 16:50when you know lots of people
are suffering in many ways, -
16:50 - 16:53including their kids not going to school.
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16:53 - 16:55CA: Indeed. Let's have the next question.
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16:55 - 16:57[Nathalie Munyampenda] "For us in Rwanda,
-
16:57 - 16:59early policy interventions
have made the difference. -
16:59 - 17:03At this point, what policy interventions
do you suggest for the US now?" -
17:03 - 17:06Bill, I dream of the day
where you are appointed -
17:06 - 17:08the coronavirus czar
-
17:08 - 17:10with authority to actually
speak to the public. -
17:10 - 17:12What would you do?
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17:14 - 17:18BG: Well, the innovation tools
-
17:18 - 17:23are where I and the foundation
probably has the most expertise. -
17:23 - 17:27Clearly, some of the policies
on opening up have been too generous, -
17:27 - 17:30but I think everybody
-
17:31 - 17:36could engage in that.
-
17:36 - 17:37We need leadership
-
17:37 - 17:43in terms of admitting
that we've still got a huge problem here -
17:43 - 17:47and not turning that
into almost a political thing -
17:47 - 17:52of, "Oh, isn't it brilliant what we did?"
-
17:52 - 17:53No, it's not brilliant,
-
17:53 - 17:58but there's many people,
including the experts -- -
17:58 - 18:00there's a lot
they didn't understand, -
18:00 - 18:05and everybody wishes a week earlier
whatever action they took, -
18:05 - 18:07they'd taken that a week earlier.
-
18:08 - 18:09The innovation tools,
-
18:09 - 18:16that's where the foundation's work
-
18:16 - 18:19on antibodies, vaccines,
-
18:19 - 18:21we have deep expertise,
-
18:21 - 18:24and it's outside of the private sector,
-
18:24 - 18:28and so we have kind of a neutral ability
to work with all the governments -
18:28 - 18:30and the companies to pick.
-
18:30 - 18:33Particularly when you're doing
break-even products, -
18:33 - 18:35which one should get the resources?
-
18:35 - 18:39There's no market signal for that.
-
18:39 - 18:42Experts have to say, "OK,
this antibody deserves the manufacturing. -
18:42 - 18:45This vaccine deserves the manufacturing,"
-
18:45 - 18:50because we have very limited
manufacturing for both of those things, -
18:50 - 18:54and it'll be cross-company,
which never happens in the normal case, -
18:54 - 18:56where one company invents it
-
18:56 - 19:00and then you're using
the manufacturing plants of many companies -
19:00 - 19:03to get maximum scale of the best choice.
-
19:04 - 19:07So I would be coordinating those things,
-
19:07 - 19:12but we need a leader
who keeps us up to date, -
19:12 - 19:14is realistic
-
19:14 - 19:17and shows us the right behavior,
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19:17 - 19:19as well as driving the innovation track.
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19:20 - 19:23CA: I mean, you have
to yourself be a master diplomat -
19:23 - 19:24in how you talk about this stuff.
-
19:24 - 19:27So I appreciate, almost,
the discomfort here. -
19:27 - 19:30But I mean, you talk regularly
with Anthony Fauci, -
19:30 - 19:35who is a wise voice on this
by most people's opinion. -
19:35 - 19:37But to what extent is he just hamstrung?
-
19:37 - 19:40He's not allowed to play the full role
-
19:40 - 19:43that he could play in this circumstance.
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19:43 - 19:49BG: Dr. Fauci has emerged
where he was allowed to have some airtime, -
19:49 - 19:53and even though he was stating
things that are realistic, -
19:53 - 19:55his prestige has stuck.
-
19:55 - 19:57He can speak out in that way.
-
19:57 - 20:02Typically, the CDC would be
the primary voice here. -
20:03 - 20:05It's not absolutely necessary,
-
20:05 - 20:07but in previous health crises,
-
20:08 - 20:10you let the experts inside the CDC
-
20:10 - 20:12be that voice.
-
20:12 - 20:14They're trained to do these things,
-
20:14 - 20:20and so it is a bit unusual here
how much we've had to rely on Fauci -
20:20 - 20:22as opposed to the CDC.
-
20:22 - 20:26It should be Fauci,
who's a brilliant researcher, -
20:26 - 20:29so experienced, particularly in vaccines.
-
20:29 - 20:33In some ways, he has become,
taking the broad advice -
20:33 - 20:37that's the epidemiology advice
-
20:37 - 20:39and explaining it in the right way,
-
20:39 - 20:41where he'll admit,
-
20:41 - 20:44"OK, we may have a rebound here,
-
20:44 - 20:47and this is why we need
to behave that way." -
20:47 - 20:53But it's fantastic that his voice
has been allowed to come through. -
20:54 - 20:55CA: Sometimes.
-
20:55 - 20:57Let's have the next question.
-
21:01 - 21:04Nina Gregory, "How are you
and your foundation -
21:04 - 21:08addressing the ethical questions about
which countries get the vaccine first, -
21:08 - 21:10assuming you find one?"
-
21:10 - 21:12And maybe, Bill, use this as a moment
-
21:12 - 21:16to just talk about where
the quest for the vaccine is -
21:16 - 21:19and what are just some of the key things
we should all be thinking about -
21:20 - 21:21as we track the news on this.
-
21:22 - 21:26BG: There's three vaccines that are,
-
21:26 - 21:28if they work, are the earliest:
-
21:28 - 21:34the Moderna, which unfortunately,
won't scale very easily, -
21:34 - 21:38so if that works, it'll be mostly
a US-targeted thing; -
21:39 - 21:42then you have the AstraZeneca,
which comes from Oxford; -
21:42 - 21:43and the Johnson and Johnson.
-
21:43 - 21:45Those are the three early ones.
-
21:45 - 21:48And we have animal data
-
21:48 - 21:54that looks potentially good
but not definitive, -
21:54 - 21:57particularly will it work in the elderly,
-
21:57 - 22:00and we'll have human data
over the next several months. -
22:00 - 22:06Those three will be gated by
the safety and efficacy trial. -
22:06 - 22:08That is, we'll be able
to manufacture those, -
22:08 - 22:10although not as much as we want.
-
22:10 - 22:13We'll be able to manufacture those
before the end of the year. -
22:13 - 22:15Whether the Phase 3 will succeed
-
22:15 - 22:18and whether it'll complete
before the end of the year, -
22:18 - 22:22I wouldn't be that optimistic about.
-
22:22 - 22:26Phase 3 is where you need
to really look at all the safety profile -
22:26 - 22:28and efficacy,
-
22:28 - 22:29but those will get started.
-
22:29 - 22:34And then there's four or five vaccines
that use different approaches -
22:34 - 22:36that are maybe three
or four months behind that: -
22:36 - 22:41Novavax, Sanofi, Merck.
-
22:41 - 22:47And so we're funding factory capacity
for a lot of these -- -
22:47 - 22:53some complex negotiations
are taking place right now on this -- -
22:53 - 22:59to get factories that will be dedicated
to the poorer countries, -
22:59 - 23:01what's called low- and middle-income.
-
23:01 - 23:04And the very scalable constructs
-
23:04 - 23:09that include AstraZeneca
and Johnson and Johnson, -
23:09 - 23:10we'll focus on those,
-
23:10 - 23:11the ones that are inexpensive
-
23:11 - 23:15and you can build a single factory
to make 600 million doses. -
23:15 - 23:20So a number of the vaccine constructs
-
23:20 - 23:21are potential.
-
23:21 - 23:25I don't see anything
before the end of the year. -
23:25 - 23:27That's really the best case,
-
23:27 - 23:31and it's down to a few constructs now,
-
23:31 - 23:35which, typically, you have
high failure rates. -
23:36 - 23:37CA: Bill, is it the case
-
23:38 - 23:41that if you and your foundation
weren't in the picture here -
23:41 - 23:44that market dynamics would likely
lead to a situation -
23:44 - 23:47where, as soon as a promising
vaccine candidate emerged, -
23:47 - 23:50the richer countries
would basically snap up, gobble up -
23:50 - 23:53all available initial supply --
-
23:53 - 23:55it just takes a while
to manufacture these, -
23:55 - 23:59and there would be nothing
for the poorer countries -- -
23:59 - 24:02but that what, effectively, you're doing
-
24:02 - 24:05by giving manufacturing
guarantees and capability -
24:05 - 24:07to some of these candidates,
-
24:07 - 24:13you're making it possible that
at least some of the early vaccine units -
24:13 - 24:16will go to poorer countries?
-
24:16 - 24:17Is that correct?
-
24:17 - 24:19BG: Well, it's not just us, but yes,
-
24:19 - 24:21we're in the central role there,
-
24:22 - 24:28along with a group we created called CEPI,
Coalition for Epidemic Preparedness, -
24:28 - 24:32and the European leaders agree with this.
-
24:32 - 24:35Now we have the expertise
to look at each of the constructs -
24:35 - 24:38and say, "OK, where is there
a factory in the world -
24:38 - 24:40that has capacity that can build that?
-
24:40 - 24:42Which one should we put
the early money into? -
24:42 - 24:44What should the milestones be
-
24:44 - 24:47where we'll shift the money
over to a different one?" -
24:47 - 24:51Because the kind of private sector people
-
24:51 - 24:54who really understand that stuff,
-
24:54 - 24:56some of them work for us,
-
24:56 - 25:00and we're a trusted party on these things,
-
25:00 - 25:05we get to coordinate a lot of it,
particularly that manufacturing piece. -
25:05 - 25:10Usually, you'd expect the US
to think of this as a global problem -
25:11 - 25:12and be involved.
-
25:12 - 25:18So far, no activity
on that front has taken place. -
25:18 - 25:22I am talking to people in the Congress
and the Administration -
25:22 - 25:25about when the next
relief bill comes along -
25:25 - 25:30that maybe one percent of that
could go for the tools -
25:30 - 25:32to help the entire world.
-
25:32 - 25:35And so it's possible,
-
25:35 - 25:37but it's unfortunate,
-
25:37 - 25:40and the vacuum here,
-
25:40 - 25:42the world is not that used to,
-
25:42 - 25:46and a lot of people are stepping in,
including our foundation, -
25:46 - 25:49to try and have a strategy,
-
25:49 - 25:51including for the poorer countries,
-
25:51 - 25:57who will suffer a high percentage
of the deaths and negative effects, -
25:57 - 26:00including their health systems
being overwhelmed. -
26:00 - 26:03Most of the deaths will be
in developing countries, -
26:03 - 26:07despite the huge deaths we've seen
in Europe and the US. -
26:07 - 26:09CA: I mean, I wish
I could be a fly on the wall -
26:09 - 26:12and hearing you and Melinda
talk about this, -
26:12 - 26:17because of all of the ethical ...
"crimes," let's say, -
26:17 - 26:21executed by leaders
who should know better, -
26:21 - 26:25I mean, it's one thing
to not model mask-wearing, -
26:25 - 26:32but to not play a role
in helping the world -
26:32 - 26:34when faced with a common enemy,
-
26:34 - 26:36respond as one humanity,
-
26:36 - 26:37and instead ...
-
26:38 - 26:43you know, catalyze a really unseemly
scramble between nations -
26:43 - 26:45to fight for vaccines, for example.
-
26:45 - 26:51That just seems -- surely, history
is going to judge that harshly. -
26:51 - 26:54That is just sickening.
-
26:55 - 26:57Isn't it? Am I missing something?
-
26:57 - 27:02BG: Well, it's not quite
as black-and-white as that. -
27:02 - 27:05The US has put more money out
-
27:05 - 27:08to fund the basic research
on these vaccines -
27:08 - 27:11than any country by far,
-
27:11 - 27:14and that research is not restricted.
-
27:14 - 27:17There's not, like, some royalty
that says, "Hey, if you take our money, -
27:17 - 27:19you have to pay the US a royalty."
-
27:19 - 27:22They do, to the degree they fund research,
-
27:22 - 27:24it's for everybody.
-
27:24 - 27:26To the degree they fund factories,
it's just for the US. -
27:26 - 27:31The thing that makes this tough is that
in every other global health problem, -
27:31 - 27:34the US totally leads smallpox eradication,
-
27:34 - 27:39the US is totally the leader
on polio eradication, -
27:39 - 27:45with key partners -- CDC, WHO,
Rotary, UNICEF, our foundation. -
27:45 - 27:48So the world -- and on HIV,
-
27:48 - 27:53under President Bush's leadership,
but it was very bipartisan, -
27:53 - 27:56this thing called PEPFAR was unbelievable.
-
27:56 - 27:59That has saved tens of millions of lives.
-
27:59 - 28:03And so it's that the world
always expected the US -
28:03 - 28:05to at least be at the head of the table,
-
28:05 - 28:11financially, strategy, OK, how do you
get these factories for the world, -
28:11 - 28:15even if it's just to avoid the infection
coming back to the US -
28:15 - 28:17or to have the global economy working,
-
28:17 - 28:19which is good for US jobs
-
28:19 - 28:22to have demand outside the US.
-
28:22 - 28:24And so the world is kind of --
-
28:24 - 28:27you know, there's all this uncertainty
about which thing will work, -
28:27 - 28:31and there's this,
"OK, who's in charge here?" -
28:31 - 28:35And so the worst thing,
the withdrawal from WHO, -
28:36 - 28:42that is a difficulty
that hopefully will get remedied -
28:42 - 28:44at some point,
-
28:44 - 28:47because we need that coordination
-
28:47 - 28:48through WHO.
-
28:49 - 28:52CA: Let's take another question.
-
28:56 - 28:59Ali Kashani, "Are there any
particularly successful models -
28:59 - 29:02of handling the pandemic
that you have seen around the world?" -
29:04 - 29:08BG: Well, it's fascinating that,
besides early action, -
29:08 - 29:12there are definitely things where
you take people who have tested positive -
29:12 - 29:15and you monitor their pulse ox,
-
29:15 - 29:18which is the oxygen saturation
level in their blood, -
29:18 - 29:20which is a very cheap detector,
-
29:20 - 29:23and then you know to get them
to the hospitals fairly early. -
29:23 - 29:30Weirdly, patients don't know
things are about to get severe. -
29:30 - 29:35It's an interesting physiological reason
that I won't get into. -
29:35 - 29:40And so Germany has
quite a low case fatality rate -
29:40 - 29:43that they've done through
that type of monitoring. -
29:43 - 29:46And then, of course,
once you get into facilities, -
29:46 - 29:51we've learned that the ventilator,
actually, although extremely well-meaning, -
29:51 - 29:55was actually overused
and used in the wrong mode -
29:55 - 29:56in those early days.
-
29:56 - 30:03So the health -- the doctors
are way smarter about treatment today. -
30:03 - 30:05Most of that, I would say, is global.
-
30:05 - 30:08Using this pulse ox as an early indicator,
-
30:08 - 30:09that'll probably catch on broadly,
-
30:09 - 30:12but Germany was a pioneer there.
-
30:12 - 30:18And now, of course, dexamethasone --
fortunately, it's cheap, it's oral, -
30:18 - 30:20we can ramp up manufacture.
-
30:20 - 30:23That'll go global as well.
-
30:25 - 30:29CA: Bill, I want to ask you
something about -
30:29 - 30:32what it's been like for you personally
through this whole process. -
30:32 - 30:38Because, weirdly, even though
your passion and good intent on this topic -
30:38 - 30:44seems completely bloody obvious to anyone
who has spent a moment with you, -
30:44 - 30:48there are these crazy conspiracy theories
out there about you. -
30:48 - 30:51I just checked in
with a company called Zignal -
30:51 - 30:53that monitors social media spaces.
-
30:53 - 30:57They say that, to date,
I think on Facebook alone, -
30:57 - 31:01more than four million posts
have taken place -
31:02 - 31:07that associate you with some kind
of conspiracy theory around the virus. -
31:07 - 31:13I read that there was a poll
that more than 40 percent of Republicans -
31:13 - 31:17believe that the vaccine
that you would roll out -
31:17 - 31:22would somehow plant a microchip
in people to track their location. -
31:22 - 31:26I mean, I can't even believe
that poll number. -
31:27 - 31:30And then some people
are taking this seriously enough, -
31:30 - 31:35and some of them have even been
recirculated on "Fox News" and so forth, -
31:35 - 31:37some people are taking this
seriously enough -
31:37 - 31:42to make really quite horrible
threats and so forth. -
31:42 - 31:46You seem to do a good job
sort of shrugging this off, -
31:46 - 31:49but really, like, who else
has ever been in this position? -
31:49 - 31:51How are you managing this?
-
31:51 - 31:54What on earth world are we in
-
31:54 - 31:56that this kind of misinformation
can be out there? -
31:57 - 31:58What can we do to help correct it?
-
32:00 - 32:03BG: I'm not sure.
-
32:05 - 32:07And it's a new thing
-
32:08 - 32:11that there's conspiracy theories.
-
32:11 - 32:14I mean, Microsoft had
its share of controversy, -
32:14 - 32:17but at least that related
to the real world, you know? -
32:17 - 32:21Did Windows crash more than it should?
-
32:21 - 32:22We definitely had antitrust problems.
-
32:22 - 32:25But at least I knew what that was.
-
32:25 - 32:27When this emerged, I have to say,
-
32:27 - 32:31my instinct was to joke about it.
-
32:31 - 32:34People have said
that's really inappropriate, -
32:34 - 32:37because this is a very serious thing.
-
32:37 - 32:42It is going to make people
less willing to take a vaccine. -
32:42 - 32:45And, of course, once we have that vaccine,
-
32:45 - 32:47it'll be like masks,
-
32:47 - 32:50where getting lots of people,
-
32:50 - 32:53particularly when it's
a transmission-blocking vaccine, -
32:53 - 32:56there's this huge community benefit
-
32:56 - 33:01to widespread adoption of that vaccine.
-
33:01 - 33:04So I am caught a little bit,
-
33:04 - 33:07unsure of what to say or do,
-
33:07 - 33:10because the conspiracy piece
is a new thing for me, -
33:11 - 33:15and what do you say
-
33:15 - 33:19that doesn't give credence to the thing?
-
33:19 - 33:24The fact that a "Fox News"
commentator, Laura Ingraham, -
33:24 - 33:27was saying this stuff
about me microchipping people, -
33:27 - 33:31that survey isn't that surprising
because that's what they heard -
33:31 - 33:33on the TV.
-
33:33 - 33:35It's wild.
-
33:35 - 33:39And people are clearly seeking
simpler explanations -
33:39 - 33:42than going and studying virology.
-
33:43 - 33:45CA: I mean,
-
33:45 - 33:47TED is nonpolitical,
-
33:47 - 33:49but we believe in the truth.
-
33:49 - 33:52I would say this:
-
33:52 - 33:56Laura Ingraham, you owe Bill Gates
an apology and a retraction. -
33:56 - 33:57You do.
-
33:57 - 33:59And anyone who's watching this
-
33:59 - 34:04who thinks for a minute that this man
is involved in some kind of conspiracy, -
34:04 - 34:05you want your head examined.
-
34:05 - 34:06You are crazy.
-
34:06 - 34:09Enough of us know Bill over many years
-
34:09 - 34:13and have seen the passion
and engagement in this to know -
34:13 - 34:14that you are crazy.
-
34:14 - 34:16So get over it,
-
34:16 - 34:19and let's look at the actual problem
of solving this pandemic. -
34:19 - 34:21Honestly.
-
34:21 - 34:23If anyone in the chat here
has a suggestion, -
34:23 - 34:26a positive suggestion for how you can,
-
34:26 - 34:27how do you get rid of conspiracies,
-
34:27 - 34:29because they feed on each other.
-
34:29 - 34:33Now, "Oh, well I would say that,
because I'm part of the conspiracy," -
34:33 - 34:34or whatever.
-
34:34 - 34:37Like, how do we get back to a world
-
34:39 - 34:41where information can be trusted?
-
34:41 - 34:43We have to do better on it.
-
34:43 - 34:45Are there any other questions
out there from the community? -
34:51 - 34:52Aria Bendix from New York City:
-
34:52 - 34:56"What are your personal recommendations
for those who want to reduce -
34:56 - 34:59their risk of infection
amid an uptick in cases?" -
35:00 - 35:03BG: Well, it's great if you have a job
-
35:03 - 35:10that you can stay at your house
and do it through digital meetings, -
35:10 - 35:14and even some of your social activities,
-
35:15 - 35:18you know, I do video calls
with lots of friends. -
35:18 - 35:21I have friends in Europe that,
who knows when I'll see them, -
35:21 - 35:26but we schedule regular calls to talk.
-
35:27 - 35:32If you stay fairly isolated,
-
35:32 - 35:35you don't run much risk,
-
35:35 - 35:41and it's when you're getting together
with lots of other people, -
35:41 - 35:43either through work or socialization,
-
35:43 - 35:46that drives that risk,
-
35:46 - 35:52and particularly in these communities
where you have increased cases, -
35:52 - 35:54even though it's not going to be mandated,
-
35:54 - 35:59hopefully, the mobility numbers
will show people responding -
35:59 - 36:05and minimizing those kind of
out-of-the-house contacts. -
36:05 - 36:07CA: Bill, I wonder if I could just ask you
-
36:07 - 36:09just a little bit about philanthropy.
-
36:09 - 36:12Obviously, your foundation
has played a huge role in this, -
36:12 - 36:16but philanthropy more generally.
-
36:16 - 36:19You know, you've started
this Giving Pledge movement, -
36:19 - 36:22recruited all these billionaires
-
36:22 - 36:27who have pledged to give away
half their net worth -
36:27 - 36:29before or after their death.
-
36:29 - 36:31But it's really hard to do.
-
36:31 - 36:33It's really hard to give away
that much money. -
36:33 - 36:34You yourself, I think,
-
36:34 - 36:36since The Giving Pledge was started --
-
36:36 - 36:40what? 10 years ago or something,
I'm not sure when -- -
36:40 - 36:43but your own net worth, I think,
has doubled since that period -
36:43 - 36:47despite being the world's
leading philanthropist. -
36:47 - 36:52Is it just fundamentally hard
to give away money effectively -
36:52 - 36:55to make the world better?
-
36:55 - 36:59Or should the world's donors,
-
36:59 - 37:01and especially the world's
really rich donors, -
37:01 - 37:03start to almost commit to a schedule,
-
37:03 - 37:07like, "Here's a percentage
of my net worth each year -
37:07 - 37:09that, as I get older,
-
37:09 - 37:10maybe that goes up.
-
37:10 - 37:13If I'm to take this seriously,
-
37:13 - 37:16I have to give away -- somehow,
I've got to find a way -
37:16 - 37:17of doing that effectively."
-
37:17 - 37:19Is that an unfair and crazy question?
-
37:19 - 37:23BG: Well, it'd be great to up the rate,
-
37:23 - 37:28and our goal, both as the Gates Foundation
or through The Giving Pledge, -
37:28 - 37:32is to help people find causes
they connect to. -
37:32 - 37:34People give through passion.
-
37:34 - 37:36Yes, numbers are important,
-
37:36 - 37:39but there's so many causes out there.
-
37:39 - 37:42The way you're going to pick
is you see somebody who's sick, -
37:43 - 37:46you see somebody who's not
getting social services. -
37:46 - 37:48You see something
that helps reduce racism. -
37:48 - 37:52And you're very passionate,
and so you give to that. -
37:52 - 37:53And, of course,
-
37:53 - 37:55some philanthropic gifts won't work out.
-
37:55 - 38:00We do need to up the ambition level
of philanthropists. -
38:01 - 38:02Now, collaborative philanthropy
-
38:02 - 38:06that you're helping to facilitate
through Audacious, -
38:06 - 38:10there's four or five other groups
that are getting philanthropists together, -
38:10 - 38:11that is fantastic,
-
38:11 - 38:14because then they learn from each other,
-
38:14 - 38:16they get confidence from each other,
-
38:16 - 38:21they feel like, "Hey, I put in x,
and the four other people put money in, -
38:21 - 38:24so I'm getting more impact,"
-
38:24 - 38:29and hopefully, it can be made fun for them
even when they find out, -
38:29 - 38:31OK, that particular gift
didn't work out that well, -
38:31 - 38:34but let's keep going.
-
38:34 - 38:36So philanthropy, yes,
-
38:36 - 38:39I would like to see the rate go up,
-
38:39 - 38:42and people who do get going,
-
38:42 - 38:43it is fun,
-
38:43 - 38:45it's fulfilling,
-
38:45 - 38:50you pick which of the family members
are partnered in doing it. -
38:50 - 38:53In my case, Melinda and I
love doing this stuff together, -
38:53 - 38:54learning together.
-
38:54 - 38:59Some families, it will even
involve the kids in the activities. -
38:59 - 39:01Sometimes the kids are pushing.
-
39:01 - 39:03When you have lots of money,
-
39:03 - 39:07you still think of a million dollars
as a lot of money, -
39:07 - 39:09but if you have billions,
-
39:09 - 39:11you should be giving hundreds of millions.
-
39:11 - 39:15So it's kind of charming that,
in terms of your personal expenditure, -
39:15 - 39:17you stay at the level you were at before.
-
39:17 - 39:20That's societally quite appropriate.
-
39:20 - 39:23But on your giving, you need to scale up
-
39:23 - 39:29or else it will be your will,
-
39:29 - 39:33and you won't get to shape it
and enjoy it quite that same way. -
39:33 - 39:34And so without --
-
39:34 - 39:36we don't want to mandate it,
-
39:36 - 39:41but yes, both you and I
want to inspire philanthropists -
39:41 - 39:44to see that passion,
to see those opportunities -
39:45 - 39:48significantly faster than in the past,
-
39:48 - 39:53because whether it's race or disease,
or all the other social ills, -
39:53 - 39:57the innovation of what philanthropy
can go to and do quickly -
39:57 - 40:01that, if it works, government
can come in behind it and scale it up, -
40:01 - 40:03God knows we need solutions,
-
40:03 - 40:06we need that kind of hope and progress
-
40:06 - 40:11that expectations are high
-
40:11 - 40:13that will solve very tough problems.
-
40:14 - 40:18CA: I mean, most philanthropists,
even the best of them, -
40:18 - 40:22find it hard to give away more than about
a percent of their net worth every year, -
40:22 - 40:26and yet the world's richest
often have access -
40:26 - 40:28to great investment opportunities.
-
40:28 - 40:31Many of them are gaining wealth
at seven to 10 percent plus per year. -
40:32 - 40:34Isn't it the case that
to have a real chance -
40:34 - 40:35of giving away half your fortune,
-
40:36 - 40:40at some point you have to plan
to give away five, six, seven, eight, -
40:40 - 40:4210 percent of your net worth annually?
-
40:42 - 40:47And that is, isn't that the logic
of what should be happening? -
40:47 - 40:49BG: Yeah, there are people
like Chuck Feeney, -
40:49 - 40:56who set a good example
and gave away all of his money. -
40:56 - 41:02Even Melinda and I are talking about,
should we up the rate that we give at? -
41:02 - 41:06As you say, we've been very lucky
on the investment side -
41:06 - 41:07through a variety of things.
-
41:07 - 41:12Tech fortunes in general have done well,
-
41:12 - 41:14even this year,
-
41:14 - 41:19which is one of those great contrasts
-
41:19 - 41:21in what's going on in the world.
-
41:21 - 41:26And I do think there's an expectation
that we should speed up, -
41:26 - 41:29and there's a reason to speed up,
-
41:29 - 41:33and government is going
to miss a lot of needs. -
41:33 - 41:36Yes, there's tons of government
money out there, -
41:36 - 41:37but helping it be spent well,
-
41:37 - 41:41helping find places it's not stepping up,
-
41:41 - 41:46and if people are willing to give
to the developing world, -
41:46 - 41:47they don't have governments
-
41:47 - 41:52that can print checks
for 15 percent of GDP, -
41:52 - 41:56and so the suffering there broadly,
just the economic stuff alone, -
41:56 - 41:58put aside the pandemic,
-
41:58 - 42:00is tragic.
-
42:00 - 42:03It's about a five-year setback
-
42:03 - 42:05in terms of these countries
moving forward, -
42:05 - 42:10and in a few cases, it's tough enough
that the very stability of the country -
42:10 - 42:11is in question.
-
42:12 - 42:13CA: Well, Bill,
-
42:13 - 42:19I'm in awe of what
you and Melinda have done. -
42:19 - 42:22You walk this narrow path
-
42:22 - 42:27of trying to juggle
so many different things, -
42:27 - 42:33and the amount of time that you dedicate
to the betterment of the world at large, -
42:33 - 42:34and definitely the amount of money
-
42:34 - 42:37and the amount
of passion you put into it -- -
42:37 - 42:38I mean, it's pretty awesome,
-
42:38 - 42:42and I'm really grateful to you
for spending this time with us now. -
42:42 - 42:44Thank you so much,
-
42:44 - 42:46and honestly, the rest of this year,
-
42:46 - 42:49your skills and resources
are going to be needed more than ever, -
42:49 - 42:50so good luck.
-
42:51 - 42:52BG: Well, thanks.
-
42:52 - 42:55It'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.)
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 43:07
Erin Gregory approved English subtitles for How the pandemic will shape the near future | ||
Erin Gregory edited English subtitles for How the pandemic will shape the near future | ||
Erin Gregory edited English subtitles for How the pandemic will shape the near future | ||
Camille Martínez accepted English subtitles for How the pandemic will shape the near future | ||
Camille Martínez edited English subtitles for How the pandemic will shape the near future | ||
Camille Martínez edited English subtitles for How the pandemic will shape the near future | ||
Joseph Geni edited English subtitles for How the pandemic will shape the near future | ||
Joseph Geni edited English subtitles for How the pandemic will shape the near future |