WEBVTT 00:00:01.079 --> 00:00:03.291 Chris Anderson. Welcome, Bill Gates. NOTE Paragraph 00:00:03.291 --> 00:00:04.688 Bill Gates: Thank you. NOTE Paragraph 00:00:04.688 --> 00:00:06.419 CA: All right. It's great to have you here, Bill. 00:00:06.419 --> 00:00:08.917 You know, we had a TED conversation 00:00:08.917 --> 00:00:10.764 about three months ago about this pandemic, 00:00:10.764 --> 00:00:12.805 and back then I think fewer than -- 00:00:12.805 --> 00:00:13.821 I think that was the end of March -- 00:00:13.821 --> 00:00:16.733 back then, fewer than a thousand people in the US had died, 00:00:16.733 --> 00:00:19.515 and fewer than 20,000 worldwide. 00:00:19.841 --> 00:00:24.824 I mean, the numbers now are, like, 128,000 dead in the US 00:00:24.824 --> 00:00:27.151 and more than half a million worldwide. 00:00:27.151 --> 00:00:28.864 in three months. 00:00:28.864 --> 00:00:30.045 In three months. 00:00:30.045 --> 00:00:35.087 What is your diagnosis of what is possible for the rest of this year? 00:00:35.263 --> 00:00:37.198 You look at a lot of models. 00:00:37.198 --> 00:00:40.957 What do you think best and worst case scenarios might be? NOTE Paragraph 00:00:43.336 --> 00:00:45.782 BG: Well, the range of scenarios, sadly, 00:00:45.782 --> 00:00:48.260 is quite large, including that, 00:00:48.260 --> 00:00:51.337 as we get into the fall, 00:00:51.337 --> 00:00:53.486 we could have death rates 00:00:53.486 --> 00:00:57.759 that rival the worst of what we had in the April time period. 00:00:58.716 --> 00:01:01.062 If you get a lot of young people infected, 00:01:01.062 --> 00:01:04.217 eventually they will infect old people again, 00:01:04.217 --> 00:01:06.678 and so you'll get into the nursing homes, 99:59:59.999 --> 99:59:59.999 the homeless shelters, 99:59:59.999 --> 99:59:59.999 the places where we've had a lot of our deaths. 99:59:59.999 --> 99:59:59.999 The innovation track, which probably we will touch on -- 99:59:59.999 --> 99:59:59.999 diagnostics, therapeutics, vaccines -- 99:59:59.999 --> 99:59:59.999 there's good progress there, 99:59:59.999 --> 99:59:59.999 but nothing that would fundamentally alter the fact 99:59:59.999 --> 99:59:59.999 that this fall in the United States could be quite bad, 99:59:59.999 --> 99:59:59.999 and that's worse than I would have expected a month ago, 99:59:59.999 --> 99:59:59.999 the degree to which we're back at high mobility, 99:59:59.999 --> 99:59:59.999 not wearing masks, 99:59:59.999 --> 99:59:59.999 and now the virus actually has gotten into a lot of cities 99:59:59.999 --> 99:59:59.999 that it hadn't been in before 99:59:59.999 --> 99:59:59.999 in a significant way, 99:59:59.999 --> 99:59:59.999 so it's going to be a challenge. 99:59:59.999 --> 99:59:59.999 There's no case where we get much below the current death rate, 99:59:59.999 --> 99:59:59.999 which is about 500 deaths a day, 99:59:59.999 --> 99:59:59.999 but there's a significant risk we'd go back up 99:59:59.999 --> 99:59:59.999 to the even 2,000 a day that we had before, 99:59:59.999 --> 99:59:59.999 because we don't have the distancing, 99:59:59.999 --> 99:59:59.999 the behavior change, 99:59:59.999 --> 99:59:59.999 to the degree that we had in April and May, 99:59:59.999 --> 99:59:59.999 and we know this virus is somewhat seasonal, 99:59:59.999 --> 99:59:59.999 so that the force of infection, 99:59:59.999 --> 99:59:59.999 both through temperature, humidity, more time indoors, 99:59:59.999 --> 99:59:59.999 will be worse as we get into the fall. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: So there are scenarios where in the US, 99:59:59.999 --> 99:59:59.999 like, if you extrapolate those numbers forward, 99:59:59.999 --> 99:59:59.999 we end up with, what, 99:59:59.999 --> 99:59:59.999 more than a quarter of a million deaths, 99:59:59.999 --> 99:59:59.999 perchance, even this year if we're not careful, 99:59:59.999 --> 99:59:59.999 and worldwide I guess the death toll could by the end of the year 99:59:59.999 --> 99:59:59.999 be well into the millions, with an s. 99:59:59.999 --> 99:59:59.999 Is there evidence that the hotter temperatures of the summer 99:59:59.999 --> 99:59:59.999 actually have been helping us? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: They're not absolutely sure, 99:59:59.999 --> 99:59:59.999 but certainly the ?? model definitely wanted to use the season, 99:59:59.999 --> 99:59:59.999 including temperature and humidity, 99:59:59.999 --> 99:59:59.999 to try and explain why May wasn't worse than it was. 99:59:59.999 --> 99:59:59.999 And so as we came out and the mobility numbers got higher, 99:59:59.999 --> 99:59:59.999 the models expected more infections and deaths to come out of that, 99:59:59.999 --> 99:59:59.999 and the model kept wanting to say, 99:59:59.999 --> 99:59:59.999 "But I need to use this seasonality 99:59:59.999 --> 99:59:59.999 to match why May wasn't worse, 99:59:59.999 --> 99:59:59.999 why June wasn't worse than it was." 99:59:59.999 --> 99:59:59.999 And we see in the Southern Hemisphere, 99:59:59.999 --> 99:59:59.999 you know, Brazil, 99:59:59.999 --> 99:59:59.999 which is the opposite season, 99:59:59.999 --> 99:59:59.999 all of South America is having a huge epidemic. 99:59:59.999 --> 99:59:59.999 South Africa is having a very fast-growing epidemic. 99:59:59.999 --> 99:59:59.999 Fortunately, Australia and New Zealand, 99:59:59.999 --> 99:59:59.999 the last countries in the Southern Hemisphere, 99:59:59.999 --> 99:59:59.999 are at really tiny case counts, 99:59:59.999 --> 99:59:59.999 and so although they have to keep knocking it down, 99:59:59.999 --> 99:59:59.999 they're talking about, oh, we have 10 cases, 99:59:59.999 --> 99:59:59.999 that's a big deal, let's go get rid of that. 99:59:59.999 --> 99:59:59.999 So they're one of these amazing countries 99:59:59.999 --> 99:59:59.999 that got the numbers so low 99:59:59.999 --> 99:59:59.999 that test, quarantine and trace 99:59:59.999 --> 99:59:59.999 is working to get them, 99:59:59.999 --> 99:59:59.999 keep them at very near zero. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Aided perhaps a bit by being easier to isolate 99:59:59.999 --> 99:59:59.999 and by less density, less population density, 99:59:59.999 --> 99:59:59.999 but nonetheless smart policies down there. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yeah. Everything is so exponential that a little bit of good work 99:59:59.999 --> 99:59:59.999 goes a long ways. 99:59:59.999 --> 99:59:59.999 It's not a linear game. 99:59:59.999 --> 99:59:59.999 Contact tracing, if you have the number of cases we have in the US, 99:59:59.999 --> 99:59:59.999 it's super-important to do, 99:59:59.999 --> 99:59:59.999 but it won't get you back down to zero. 99:59:59.999 --> 99:59:59.999 It'll help you be down, 99:59:59.999 --> 99:59:59.999 but it's too overwhelming. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: OK, so in May and June in the US, 99:59:59.999 --> 99:59:59.999 the numbers were actually slightly better than some of the models predicted, 99:59:59.999 --> 99:59:59.999 and it's hypothesized that that might be partly because of the warmer weather. 99:59:59.999 --> 99:59:59.999 Now we're seeing, really, would you describe it 99:59:59.999 --> 99:59:59.999 as really quite alarming upticks in case rates in the US? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: That's right. 99:59:59.999 --> 99:59:59.999 In, say, the New York area, 99:59:59.999 --> 99:59:59.999 the cases continue to go down somewhat, 99:59:59.999 --> 99:59:59.999 but in other parts of the country, 99:59:59.999 --> 99:59:59.999 primarily the South right now, 99:59:59.999 --> 99:59:59.999 you have increases that are offsetting that, 99:59:59.999 --> 99:59:59.999 and you have testing positive rates in young people 99:59:59.999 --> 99:59:59.999 that are actually higher 99:59:59.999 --> 99:59:59.999 than what we saw even in some of the tougher areas, 99:59:59.999 --> 99:59:59.999 and so clearly younger people have come out of mobility 99:59:59.999 --> 99:59:59.999 more than older people have increased their mobility, 99:59:59.999 --> 99:59:59.999 so the age structure 99:59:59.999 --> 99:59:59.999 is right now very young, but because of multigenerational households, 99:59:59.999 --> 99:59:59.999 people work in nursing care homes, 99:59:59.999 --> 99:59:59.999 unfortunately that will work its way back, 99:59:59.999 --> 99:59:59.999 both the time lag and the transmission back up into the elderly, 99:59:59.999 --> 99:59:59.999 will start to push the death rate back up, 99:59:59.999 --> 99:59:59.999 which it is down, 99:59:59.999 --> 99:59:59.999 way down from 2,000 to around 500 right now. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: And is that partly because there's a three-week lag 99:59:59.999 --> 99:59:59.999 between case numbers and fatality numbers? 99:59:59.999 --> 99:59:59.999 And also, perhaps, partly because 99:59:59.999 --> 99:59:59.999 there have been some effective interventions 99:59:59.999 --> 99:59:59.999 and we're actually seeing the possibility 99:59:59.999 --> 99:59:59.999 that the overall fatality rate is actually falling a bit 99:59:59.999 --> 99:59:59.999 now that we've gained some extra knowledge? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yeah, certainly your fatality rate is always lower 99:59:59.999 --> 99:59:59.999 when you're not overloaded, 99:59:59.999 --> 99:59:59.999 and so Italy when they were overloaded, 99:59:59.999 --> 99:59:59.999 Spain, even New York at the start, 99:59:59.999 --> 99:59:59.999 certainly China, 99:59:59.999 --> 99:59:59.999 there you weren't even able to provide the basics, 99:59:59.999 --> 99:59:59.999 the oxygen and things. 99:59:59.999 --> 99:59:59.999 A study that our foundation funded in the UK 99:59:59.999 --> 99:59:59.999 found the only thing other than remdesivir 99:59:59.999 --> 99:59:59.999 that is a proven therapeutic, 99:59:59.999 --> 99:59:59.999 which is the dexamethasone, 99:59:59.999 --> 99:59:59.999 that for serious patients 99:59:59.999 --> 99:59:59.999 is about a 20 percent death reduction, 99:59:59.999 --> 99:59:59.999 and there's still quite a pipeline of those things. 99:59:59.999 --> 99:59:59.999 You know, hydroxychloroquine never established positive data, 99:59:59.999 --> 99:59:59.999 so that's pretty much done. 99:59:59.999 --> 99:59:59.999 There's still a few trials ongoing, 99:59:59.999 --> 99:59:59.999 but the list of things being tried, 99:59:59.999 --> 99:59:59.999 including eventually ?? antibodies, 99:59:59.999 --> 99:59:59.999 we will have some additional tools for the fall. 99:59:59.999 --> 99:59:59.999 And so when you talk about death rates, 99:59:59.999 --> 99:59:59.999 the good news is some innovation we already have 99:59:59.999 --> 99:59:59.999 and we will have more 99:59:59.999 --> 99:59:59.999 even in the fall. 99:59:59.999 --> 99:59:59.999 We should start to have monoclonal antibodies, 99:59:59.999 --> 99:59:59.999 which is the single therapeutic that I'm most excited about. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: I'll actually ask you to tell me a bit more about that in one sec, 99:59:59.999 --> 99:59:59.999 but just putting the pieces together on death rates: 99:59:59.999 --> 99:59:59.999 so in a well-functioning health system, 99:59:59.999 --> 99:59:59.999 so take the US when places aren't overcrowded, 99:59:59.999 --> 99:59:59.999 what do you think 99:59:59.999 --> 99:59:59.999 the current fatality numbers are approximately going forward, 99:59:59.999 --> 99:59:59.999 like as a percentage of total cases? 99:59:59.999 --> 99:59:59.999 Are we below one percent, perhaps? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: If you found every case, yes, 99:59:59.999 --> 99:59:59.999 you're well below one percent. 99:59:59.999 --> 99:59:59.999 People argue, you know, 0.4, 0.5. 99:59:59.999 --> 99:59:59.999 By the time you bring in the never symptomatics, 99:59:59.999 --> 99:59:59.999 it probably is below 0.5, 99:59:59.999 --> 99:59:59.999 and that's good news. 99:59:59.999 --> 99:59:59.999 This disease could have been a five percent disease. 99:59:59.999 --> 99:59:59.999 The transmission dynamics of this disease 99:59:59.999 --> 99:59:59.999 are more difficult than even the experts predicted. 99:59:59.999 --> 99:59:59.999 The amount of pre-symptomatic and never symptomatic spread, 99:59:59.999 --> 99:59:59.999 and the fact that it's not coughing, 99:59:59.999 --> 99:59:59.999 where you would kind of notice, hey, I'm coughing. 99:59:59.999 --> 99:59:59.999 Most respiratory diseases make you cough. 99:59:59.999 --> 99:59:59.999 This one, in its early stages, it's not coughing, 99:59:59.999 --> 99:59:59.999 it's singing, laughing, talking, 99:59:59.999 --> 99:59:59.999 actually still particularly for the super-spreaders, 99:59:59.999 --> 99:59:59.999 people with very high viral loads, 99:59:59.999 --> 99:59:59.999 causes that spread, 99:59:59.999 --> 99:59:59.999 and that's pretty novel, 99:59:59.999 --> 99:59:59.999 and so even experts have to say, wow, this caught us by surprise. 99:59:59.999 --> 99:59:59.999 The amount of asymptomatic spread 99:59:59.999 --> 99:59:59.999 and the fact that there's not a coughing element 99:59:59.999 --> 99:59:59.999 is not a major piece like the flu or TB. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Yeah, that is devilish cunning 99:59:59.999 --> 99:59:59.999 by the virus. 99:59:59.999 --> 99:59:59.999 I mean, how much is that non-symptomatic transmission 99:59:59.999 --> 99:59:59.999 as a percentage of total transmission? 99:59:59.999 --> 99:59:59.999 I've heard numbers it could be as much as half of all transmissions 99:59:59.999 --> 99:59:59.999 are basically pre-symptomatic. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yeah, if you count pre-symptomatics, 99:59:59.999 --> 99:59:59.999 then most of the studies show that's like at 40 percent, 99:59:59.999 --> 99:59:59.999 and we also have never symptomatics. 99:59:59.999 --> 99:59:59.999 The amount of virus you get in your upper respiratory area 99:59:59.999 --> 99:59:59.999 is somewhat disconnected. 99:59:59.999 --> 99:59:59.999 Some people will have a lot here and very little in their lungs, 99:59:59.999 --> 99:59:59.999 and what you get in your lungs 99:59:59.999 --> 99:59:59.999 causes the really bad symptoms, 99:59:59.999 --> 99:59:59.999 and other organs, 99:59:59.999 --> 99:59:59.999 but mostly the lungs, 99:59:59.999 --> 99:59:59.999 and so that's when you seek treatment. 99:59:59.999 --> 99:59:59.999 And so the worst case in terms of spreading 99:59:59.999 --> 99:59:59.999 is somebody who's got a lot in the upper respiratory tract 99:59:59.999 --> 99:59:59.999 but almost none in their lungs, 99:59:59.999 --> 99:59:59.999 so they're not care-seeking. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Right. 99:59:59.999 --> 99:59:59.999 And so if you add in the never symptomatic 99:59:59.999 --> 99:59:59.999 to the pre-symptomatic, 99:59:59.999 --> 99:59:59.999 do you get above 50 percent of the transmission 99:59:59.999 --> 99:59:59.999 is actually from non-symptomatic people? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yeah, transmission is harder to measure. 99:59:59.999 --> 99:59:59.999 You know, we see certain hotspots and things, 99:59:59.999 --> 99:59:59.999 but that's a huge question with the vaccine: 99:59:59.999 --> 99:59:59.999 will it, besides avoiding you getting sick, 99:59:59.999 --> 99:59:59.999 which is what the trial will test, 99:59:59.999 --> 99:59:59.999 will it also stop you from being a transmitter? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: So that vaccine, 99:59:59.999 --> 99:59:59.999 it's such an important question, let's come on to that, 99:59:59.999 --> 99:59:59.999 but before we go there, 99:59:59.999 --> 99:59:59.999 any other surprises in the last couple months 99:59:59.999 --> 99:59:59.999 that we've learned about this virus 99:59:59.999 --> 99:59:59.999 that really impact how we should respond to it? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: We're still not able to characterize who the super-spreaders are 99:59:59.999 --> 99:59:59.999 in terms of what that profile is, 99:59:59.999 --> 99:59:59.999 and we may never. 99:59:59.999 --> 99:59:59.999 That may just be quite random. 99:59:59.999 --> 99:59:59.999 If you could identify them, 99:59:59.999 --> 99:59:59.999 they're responsible for the majority of transmission, 99:59:59.999 --> 99:59:59.999 a few people who have very high viral loads. 99:59:59.999 --> 99:59:59.999 But sadly, we haven't figured that out. 99:59:59.999 --> 99:59:59.999 This mode of transmission, 99:59:59.999 --> 99:59:59.999 if you're in a room and nobody talks, 99:59:59.999 --> 99:59:59.999 there's way less transmission. 99:59:59.999 --> 99:59:59.999 That's partly why, although planes can transmit, 99:59:59.999 --> 99:59:59.999 it's less than you would expect just in terms of time proximity measures, 99:59:59.999 --> 99:59:59.999 because unlike, say, a choir or a restaurant, 99:59:59.999 --> 99:59:59.999 you're not exhaling in loud talking 99:59:59.999 --> 99:59:59.999 quite as much as in other indoor environments. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: What do you think about the ethics of someone who would go on a plane 99:59:59.999 --> 99:59:59.999 and refuse to wear a mask? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: If they own the plane, that would be fine. 99:59:59.999 --> 99:59:59.999 If there's other people on the plane, 99:59:59.999 --> 99:59:59.999 that would be endangering those other people. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Early on in the pandemic, 99:59:59.999 --> 99:59:59.999 the WHO did not advise that people wear masks. 99:59:59.999 --> 99:59:59.999 They were worried about taking them away from frontline medical providers. 99:59:59.999 --> 99:59:59.999 In retrospect, was that a terrible mistake that they made? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yes. 99:59:59.999 --> 99:59:59.999 All the experts feel bad 99:59:59.999 --> 99:59:59.999 that the value of masks, 99:59:59.999 --> 99:59:59.999 which ties back somewhat to the asymptomatics, 99:59:59.999 --> 99:59:59.999 if people were very symptomatic, 99:59:59.999 --> 99:59:59.999 like in Ebola, 99:59:59.999 --> 99:59:59.999 then you know it and you isolate, 99:59:59.999 --> 99:59:59.999 and so you don't have a need for a mask-like thing. 99:59:59.999 --> 99:59:59.999 The value of masks, 99:59:59.999 --> 99:59:59.999 the fact that the medical masks was a different supply chain 99:59:59.999 --> 99:59:59.999 than the normal masks, 99:59:59.999 --> 99:59:59.999 the fact you could scale up the normal masks so well, 99:59:59.999 --> 99:59:59.999 the fact that it would stop that pre-symptomatic, 99:59:59.999 --> 99:59:59.999 never symptomatic transmission, 99:59:59.999 --> 99:59:59.999 it's a mistake, 99:59:59.999 --> 99:59:59.999 but it's not a conspiracy, 99:59:59.999 --> 99:59:59.999 it's something that we now know more. 99:59:59.999 --> 99:59:59.999 And even now, our error bars on the benefit of masks 99:59:59.999 --> 99:59:59.999 are higher than we'd like to admit, 99:59:59.999 --> 99:59:59.999 but it's a significant benefit. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: All right, I'm going to come in with some questions 99:59:59.999 --> 99:59:59.999 from the community. 99:59:59.999 --> 99:59:59.999 Let's pull them up there. 99:59:59.999 --> 99:59:59.999 Jim Pitofsky: "Do you think reopening efforts in the US have been premature, 99:59:59.999 --> 99:59:59.999 and if so how far should the US go to responsibly confront this pandemic?" NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, the question of how you make tradeoffs 99:59:59.999 --> 99:59:59.999 between the benefits, say, of going to school 99:59:59.999 --> 99:59:59.999 versus the risk of people getting sick because they go to school, 99:59:59.999 --> 99:59:59.999 those are very tough questions 99:59:59.999 --> 99:59:59.999 that I don't think any single person 99:59:59.999 --> 99:59:59.999 can say, "I will tell you how to make all these tradeoffs." 99:59:59.999 --> 99:59:59.999 The understanding of where you have transmission, 99:59:59.999 --> 99:59:59.999 and the fact that young people do get infected 99:59:59.999 --> 99:59:59.999 and are part of the multi-generational transmission chain, 99:59:59.999 --> 99:59:59.999 we should get that out. 99:59:59.999 --> 99:59:59.999 If you just look at the health aspect, 99:59:59.999 --> 99:59:59.999 we have opened up too liberally. 99:59:59.999 --> 99:59:59.999 Now, opening up in terms of mental health 99:59:59.999 --> 99:59:59.999 and seeking normal health things 99:59:59.999 --> 99:59:59.999 like vaccines and other care, 99:59:59.999 --> 99:59:59.999 there are benefits. 99:59:59.999 --> 99:59:59.999 I think some of our opening up 99:59:59.999 --> 99:59:59.999 has created more risk than benefit. 99:59:59.999 --> 99:59:59.999 Opening the bars up as quickly as they did, 99:59:59.999 --> 99:59:59.999 is that critical for mental health? 99:59:59.999 --> 99:59:59.999 Maybe not. 99:59:59.999 --> 99:59:59.999 So I don't think we've been as tasteful about opening up 99:59:59.999 --> 99:59:59.999 as I'm sure, as we study it, 99:59:59.999 --> 99:59:59.999 that we'll realize some things we shouldn't have opened up as fast, 99:59:59.999 --> 99:59:59.999 but then you have something like school, 99:59:59.999 --> 99:59:59.999 where even sitting here today, 99:59:59.999 --> 99:59:59.999 the exact plan, say, for inner city schools for the fall, 99:59:59.999 --> 99:59:59.999 I wouldn't have a black-and-white view 99:59:59.999 --> 99:59:59.999 on the relative tradeoffs involved there. 99:59:59.999 --> 99:59:59.999 There are huge benefits 99:59:59.999 --> 99:59:59.999 to letting those kids go to school, 99:59:59.999 --> 99:59:59.999 and how do you weigh the risk? 99:59:59.999 --> 99:59:59.999 If you're in a city 99:59:59.999 --> 99:59:59.999 without many cases, 99:59:59.999 --> 99:59:59.999 I would say probably the benefit is there. 99:59:59.999 --> 99:59:59.999 Now that means that you could get surprised. 99:59:59.999 --> 99:59:59.999 The cases could show up, and then you'd have to change that, 99:59:59.999 --> 99:59:59.999 which is not easy. 99:59:59.999 --> 99:59:59.999 But I think around the US there will be places 99:59:59.999 --> 99:59:59.999 where that won't be a good tradeoff. 99:59:59.999 --> 99:59:59.999 So almost any dimension and inequity, 99:59:59.999 --> 99:59:59.999 this disease has made worse: 99:59:59.999 --> 99:59:59.999 job type, internet connection, 99:59:59.999 --> 99:59:59.999 ability of your school to do online learning. 99:59:59.999 --> 99:59:59.999 White collar workers, 99:59:59.999 --> 99:59:59.999 people are embarrassed to admit it, 99:59:59.999 --> 99:59:59.999 some of them are more productive 99:59:59.999 --> 99:59:59.999 and enjoying the flexibility that the at-home thing has created, 99:59:59.999 --> 99:59:59.999 and that feels terrible 99:59:59.999 --> 99:59:59.999 when you know lots of people are suffering in many ways, 99:59:59.999 --> 99:59:59.999 including their kids not going to school. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Indeed. Let's have the next question. 99:59:59.999 --> 99:59:59.999 "For us in Rwanda, 99:59:59.999 --> 99:59:59.999 early policy interventions have made the difference. 99:59:59.999 --> 99:59:59.999 At this point, what policy interventions do you suggest for the US now?" 99:59:59.999 --> 99:59:59.999 Bill, I dream of the day where you are appointed 99:59:59.999 --> 99:59:59.999 the coronavirus czar 99:59:59.999 --> 99:59:59.999 with authority to actually speak to the public. 99:59:59.999 --> 99:59:59.999 What would you do? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: The innovation tools 99:59:59.999 --> 99:59:59.999 are where I and the foundation probably has the most expertise. 99:59:59.999 --> 99:59:59.999 Clearly some of the policies on opening up have been too generous, 99:59:59.999 --> 99:59:59.999 but I think everybody 99:59:59.999 --> 99:59:59.999 could engage in that. 99:59:59.999 --> 99:59:59.999 We need leadership 99:59:59.999 --> 99:59:59.999 in terms of admitting 99:59:59.999 --> 99:59:59.999 that we've still got a huge problem here, 99:59:59.999 --> 99:59:59.999 and not turning that into almost a political thing 99:59:59.999 --> 99:59:59.999 of, oh, isn't it brilliant what we did. 99:59:59.999 --> 99:59:59.999 No, it's not brilliant, 99:59:59.999 --> 99:59:59.999 but there's many people, 99:59:59.999 --> 99:59:59.999 including the experts, 99:59:59.999 --> 99:59:59.999 where there's a lot they didn't understand, 99:59:59.999 --> 99:59:59.999 and everybody wishes a week earlier whatever action they took, 99:59:59.999 --> 99:59:59.999 they'd taken that a week earlier. 99:59:59.999 --> 99:59:59.999 The innovation tools, 99:59:59.999 --> 99:59:59.999 that's where the foundation's work 99:59:59.999 --> 99:59:59.999 on antibodies, vaccines, 99:59:59.999 --> 99:59:59.999 we have deep expertise, 99:59:59.999 --> 99:59:59.999 and it's outside of the private sector, 99:59:59.999 --> 99:59:59.999 and so we have kind of a neutral ability to work with all the governments 99:59:59.999 --> 99:59:59.999 and the companies to pick. 99:59:59.999 --> 99:59:59.999 Particularly when you're doing break-even products, 99:59:59.999 --> 99:59:59.999 which one should get the resources. 99:59:59.999 --> 99:59:59.999 There's no market signal for that. 99:59:59.999 --> 99:59:59.999 Experts have to say, OK, this antibody deserves the manufacturing. 99:59:59.999 --> 99:59:59.999 This vaccine deserves the manufacturing. 99:59:59.999 --> 99:59:59.999 Because, we have very limited manufacturing for both of those things, 99:59:59.999 --> 99:59:59.999 and it'll be cross-company, 99:59:59.999 --> 99:59:59.999 which never happens in the normal case, 99:59:59.999 --> 99:59:59.999 where one company invents it 99:59:59.999 --> 99:59:59.999 and then you're using the manufacturing plants 99:59:59.999 --> 99:59:59.999 of many companies 99:59:59.999 --> 99:59:59.999 to get maximum scale of the best choice. 99:59:59.999 --> 99:59:59.999 So I would be coordinating those things, 99:59:59.999 --> 99:59:59.999 but we need a leader who keeps us up to date, 99:59:59.999 --> 99:59:59.999 is realistic, 99:59:59.999 --> 99:59:59.999 and shows us the right behavior, 99:59:59.999 --> 99:59:59.999 as well as driving the innovation track. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: I mean, you have to yourself be a master diplomat 99:59:59.999 --> 99:59:59.999 in how you talk about this stuff. 99:59:59.999 --> 99:59:59.999 So I appreciate, almost, the discomfort here, 99:59:59.999 --> 99:59:59.999 but you talk regularly with Anthony Fauci, 99:59:59.999 --> 99:59:59.999 who is a wise voice on this by most people's opinion. 99:59:59.999 --> 99:59:59.999 But to what extent is he just hamstrung? 99:59:59.999 --> 99:59:59.999 He's not allowed to play the full role 99:59:59.999 --> 99:59:59.999 that he could play in the circumstance. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Dr. Fauci has emerged, 99:59:59.999 --> 99:59:59.999 where he was allowed to have some airtime, 99:59:59.999 --> 99:59:59.999 and even though he was stating things that are realistic, 99:59:59.999 --> 99:59:59.999 his prestige has stuck. 99:59:59.999 --> 99:59:59.999 He can speak out in that way. 99:59:59.999 --> 99:59:59.999 Typically, the CDC would be the primary voice here. 99:59:59.999 --> 99:59:59.999 It's not absolutely necessary, 99:59:59.999 --> 99:59:59.999 but in previous health crises, 99:59:59.999 --> 99:59:59.999 you let the experts inside the CDC 99:59:59.999 --> 99:59:59.999 be that voice. 99:59:59.999 --> 99:59:59.999 They're trained to do these things, 99:59:59.999 --> 99:59:59.999 and so it is a bit unusual here 99:59:59.999 --> 99:59:59.999 how much we've had to rely on Fauci 99:59:59.999 --> 99:59:59.999 as opposed to the CDC. 99:59:59.999 --> 99:59:59.999 It should be Fauci, who is a brilliant researcher, 99:59:59.999 --> 99:59:59.999 so experienced, particularly in vaccines, 99:59:59.999 --> 99:59:59.999 in some ways he has become, taking the broad advice 99:59:59.999 --> 99:59:59.999 that is the epidemiology advice 99:59:59.999 --> 99:59:59.999 and explaining it in the right way, 99:59:59.999 --> 99:59:59.999 where he'll admit, 99:59:59.999 --> 99:59:59.999 "OK, we may have a rebound here, 99:59:59.999 --> 99:59:59.999 and this is why we need to behave that way." 99:59:59.999 --> 99:59:59.999 But it's fantastic that his voice has been allowed to come through. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Sometimes. 99:59:59.999 --> 99:59:59.999 Let's have the next question. 99:59:59.999 --> 99:59:59.999 Nina Gregory: "How are you and your foundation 99:59:59.999 --> 99:59:59.999 addressing the ethical questions about which countries 99:59:59.999 --> 99:59:59.999 get the vaccine first, 99:59:59.999 --> 99:59:59.999 assuming you find one?" 99:59:59.999 --> 99:59:59.999 And maybe, Bill, use this as a moment 99:59:59.999 --> 99:59:59.999 to just talk about where the quest for the vaccine is 99:59:59.999 --> 99:59:59.999 and what are just some of the key things we should all be thinking about 99:59:59.999 --> 99:59:59.999 as we track the news on this. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: There's three vaccines that are, 99:59:59.999 --> 99:59:59.999 if they work, are the earliest: 99:59:59.999 --> 99:59:59.999 the Moderna, which unfortunately won't scale very easily, 99:59:59.999 --> 99:59:59.999 so if that works, it'll be mostly a US-targeted thing; 99:59:59.999 --> 99:59:59.999 then you have the AstraZeneca, which comes from Oxford; 99:59:59.999 --> 99:59:59.999 and the Johnson & Johnson. 99:59:59.999 --> 99:59:59.999 Those are the three early ones, 99:59:59.999 --> 99:59:59.999 and we have animal data 99:59:59.999 --> 99:59:59.999 that looks potentially good, 99:59:59.999 --> 99:59:59.999 but not definitive, 99:59:59.999 --> 99:59:59.999 particularly will it work in the elderly, 99:59:59.999 --> 99:59:59.999 and we'll have human data over the next several months. 99:59:59.999 --> 99:59:59.999 Those three will be gated by the safety and efficacy trial. 99:59:59.999 --> 99:59:59.999 That is, we'll be able to manufacture those, 99:59:59.999 --> 99:59:59.999 although not as much as we want. 99:59:59.999 --> 99:59:59.999 We'll be able to manufacture those before the end of the year. 99:59:59.999 --> 99:59:59.999 Whether the Phase 3 will succeed, 99:59:59.999 --> 99:59:59.999 and whether it'll complete before the end of the year, 99:59:59.999 --> 99:59:59.999 I wouldn't be that optimistic about. 99:59:59.999 --> 99:59:59.999 Phase 3 is where you need to really look at all the safety profile 99:59:59.999 --> 99:59:59.999 and efficacy, 99:59:59.999 --> 99:59:59.999 but those will get started. 99:59:59.999 --> 99:59:59.999 And then there's four or five vaccines 99:59:59.999 --> 99:59:59.999 that use different approaches 99:59:59.999 --> 99:59:59.999 that are maybe three or four months behind that: 99:59:59.999 --> 99:59:59.999 Novavax, Sanofi, Merck. 99:59:59.999 --> 99:59:59.999 And so we're funding factory capacity for a lot of these -- 99:59:59.999 --> 99:59:59.999 some complex negotiations are taking place right now on this -- 99:59:59.999 --> 99:59:59.999 to get factories that will be dedicated to the poorer countries, 99:59:59.999 --> 99:59:59.999 what's called low- and middle-income. 99:59:59.999 --> 99:59:59.999 And the very scalable constructs 99:59:59.999 --> 99:59:59.999 that include AstraZeneca and Johnson & Johnson, 99:59:59.999 --> 99:59:59.999 we'll focus on those, 99:59:59.999 --> 99:59:59.999 the ones that are inexpensive 99:59:59.999 --> 99:59:59.999 and you can build a single factory to make 600 million doses. 99:59:59.999 --> 99:59:59.999 So a number of the vaccine constructs 99:59:59.999 --> 99:59:59.999 are potential. 99:59:59.999 --> 99:59:59.999 I don't see anything before the end of the year. 99:59:59.999 --> 99:59:59.999 That's really the best case, 99:59:59.999 --> 99:59:59.999 and it's down to a few constructs now, 99:59:59.999 --> 99:59:59.999 which typically you have high failure rates. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Bill, is the case 99:59:59.999 --> 99:59:59.999 that you and your foundation weren't in the picture here 99:59:59.999 --> 99:59:59.999 that market dynamics would likely lead to a situation 99:59:59.999 --> 99:59:59.999 where as soon as a promising vaccine candidate emerged, 99:59:59.999 --> 99:59:59.999 the richer countries would basically snap up, 99:59:59.999 --> 99:59:59.999 gobble up all available initial supply -- 99:59:59.999 --> 99:59:59.999 it just takes a while to manufacture these -- 99:59:59.999 --> 99:59:59.999 and there would be nothing for the poorer countries, 99:59:59.999 --> 99:59:59.999 but that what effectively you're doing, 99:59:59.999 --> 99:59:59.999 by giving manufacturing guarantees 99:59:59.999 --> 99:59:59.999 and capability to some of these candidates, 99:59:59.999 --> 99:59:59.999 you're making it possible that at least some of the early vaccine units 99:59:59.999 --> 99:59:59.999 will go to poorer countries? 99:59:59.999 --> 99:59:59.999 Is that correct? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, it's not just us, but yes, 99:59:59.999 --> 99:59:59.999 we're in the central role there 99:59:59.999 --> 99:59:59.999 along with a group we created called CEPI, 99:59:59.999 --> 99:59:59.999 Coalition for Epidemic Preparedness, 99:59:59.999 --> 99:59:59.999 and the European leaders agree with this. 99:59:59.999 --> 99:59:59.999 Now we have the expertise to look at each of the constructs 99:59:59.999 --> 99:59:59.999 and say, OK, where is there a factory in the world 99:59:59.999 --> 99:59:59.999 that has capacity that can build that? 99:59:59.999 --> 99:59:59.999 Which one should we put the early money into? 99:59:59.999 --> 99:59:59.999 What should the milestones be 99:59:59.999 --> 99:59:59.999 where we'll shift the money over to a different one? 99:59:59.999 --> 99:59:59.999 Because the kind of private sector people 99:59:59.999 --> 99:59:59.999 who really understand that stuff, 99:59:59.999 --> 99:59:59.999 some of them work for us, 99:59:59.999 --> 99:59:59.999 and we're a trusted party on these things, 99:59:59.999 --> 99:59:59.999 we get to coordinate a lot, particularly the manufacturing piece. 99:59:59.999 --> 99:59:59.999 Usually, you'd expect the US 99:59:59.999 --> 99:59:59.999 to think of this as a global problem and be involved. 99:59:59.999 --> 99:59:59.999 So far, no activity on that front has taken place. 99:59:59.999 --> 99:59:59.999 I am talking to people in the Congress and the Administration 99:59:59.999 --> 99:59:59.999 about when the next relief bill comes along 99:59:59.999 --> 99:59:59.999 that maybe one percent of that 99:59:59.999 --> 99:59:59.999 could go for the tools 99:59:59.999 --> 99:59:59.999 to help the entire world. 99:59:59.999 --> 99:59:59.999 And so it's possible, 99:59:59.999 --> 99:59:59.999 but it's unfortunate, 99:59:59.999 --> 99:59:59.999 and the vacuum here 99:59:59.999 --> 99:59:59.999 the world is not that used to 99:59:59.999 --> 99:59:59.999 and a lot of people are stepping in, 99:59:59.999 --> 99:59:59.999 including our foundation, 99:59:59.999 --> 99:59:59.999 to try and have a strategy, 99:59:59.999 --> 99:59:59.999 including for the poorer countries 99:59:59.999 --> 99:59:59.999 who will suffer a high percentage of the deaths and negative effects, 99:59:59.999 --> 99:59:59.999 including their health systems being overwhelmed. 99:59:59.999 --> 99:59:59.999 Most of the deaths will be in developing countries, 99:59:59.999 --> 99:59:59.999 despite the huge deaths we've seen in Europe and the US. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: I mean, I wish I could be a fly on the wall and hearing 99:59:59.999 --> 99:59:59.999 you and Melinda talk about this, 99:59:59.999 --> 99:59:59.999 because of all of the ethical crimes, let's say, 99:59:59.999 --> 99:59:59.999 executed by leaders who should know better, 99:59:59.999 --> 99:59:59.999 I mean, it's one thing to not model mask-wearing, 99:59:59.999 --> 99:59:59.999 but to not play a role 99:59:59.999 --> 99:59:59.999 in helping the world when faced with a common enemy, 99:59:59.999 --> 99:59:59.999 respond as one humanity 99:59:59.999 --> 99:59:59.999 and instead catalyze a really unseemly scramble between nations 99:59:59.999 --> 99:59:59.999 to fight for vaccines, for example. 99:59:59.999 --> 99:59:59.999 That just seems that surely history is going to judge that harshly. 99:59:59.999 --> 99:59:59.999 That is just sickening. 99:59:59.999 --> 99:59:59.999 Isn't it? Am I missing something? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, it's not quite as black and white as that. 99:59:59.999 --> 99:59:59.999 The US has put more money out 99:59:59.999 --> 99:59:59.999 to fund the basic research on these vaccines 99:59:59.999 --> 99:59:59.999 than any country by far, 99:59:59.999 --> 99:59:59.999 and that research is not restricted. 99:59:59.999 --> 99:59:59.999 There's not, like, some royalty that says, "Hey, if you take our money, 99:59:59.999 --> 99:59:59.999 you have to pay the US a royalty." 99:59:59.999 --> 99:59:59.999 They do, to the degree they fund research, 99:59:59.999 --> 99:59:59.999 it's for everybody. 99:59:59.999 --> 99:59:59.999 To the degree they fund factories, it's just for the US. 99:59:59.999 --> 99:59:59.999 The thing that makes this tough is that in every other global health problem, 99:59:59.999 --> 99:59:59.999 the US totally leads smallpox eradication, 99:59:59.999 --> 99:59:59.999 the US is totally the leader on polio eradication 99:59:59.999 --> 99:59:59.999 with key partners -- CDC, WHO, Rotary, UNICEF, our foundation. 99:59:59.999 --> 99:59:59.999 So the world, and on HIV, 99:59:59.999 --> 99:59:59.999 what under President Bush's leadership, but it was very bipartisan, 99:59:59.999 --> 99:59:59.999 this thing called PEPFAR was unbelievable. 99:59:59.999 --> 99:59:59.999 That has saved tens of millions of lives. 99:59:59.999 --> 99:59:59.999 And so it's that the world always expected the US 99:59:59.999 --> 99:59:59.999 to at least be at the head of the table, 99:59:59.999 --> 99:59:59.999 financially, strategy, OK, how do you get these factories for the world, 99:59:59.999 --> 99:59:59.999 even if it's just to avoid the infection coming back to the US 99:59:59.999 --> 99:59:59.999 or to have the global economy working, 99:59:59.999 --> 99:59:59.999 which is good for US jobs 99:59:59.999 --> 99:59:59.999 to have demand outside the US. 99:59:59.999 --> 99:59:59.999 And so the world is kind of, there's all this uncertainty 99:59:59.999 --> 99:59:59.999 about which thing will work, 99:59:59.999 --> 99:59:59.999 and there's, OK, who is in charge here? 99:59:59.999 --> 99:59:59.999 And so the worst thing, 99:59:59.999 --> 99:59:59.999 the withdrawal from WHO, 99:59:59.999 --> 99:59:59.999 that is a difficulty 99:59:59.999 --> 99:59:59.999 that hopefully will get remedied at some point, 99:59:59.999 --> 99:59:59.999 because we need that coordination 99:59:59.999 --> 99:59:59.999 through WHO. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Let's take another question. 99:59:59.999 --> 99:59:59.999 Ali Kashani: "Are there any particularly successful models 99:59:59.999 --> 99:59:59.999 of handling the pandemic that you have seen around the world?" NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, it's fascinating that, besides early action, 99:59:59.999 --> 99:59:59.999 there are definitely things where you take people who have tested positive 99:59:59.999 --> 99:59:59.999 and you monitor their ??, 99:59:59.999 --> 99:59:59.999 which is a oxygen saturation level in their blood, 99:59:59.999 --> 99:59:59.999 which is a very cheap detector, 99:59:59.999 --> 99:59:59.999 and then you know to get them to the hospitals fairly early. 99:59:59.999 --> 99:59:59.999 Weirdly, patients don't know things are about to get severe. 99:59:59.999 --> 99:59:59.999 It's an interesting physiological reason but I won't get into. 99:59:59.999 --> 99:59:59.999 And so Germany has a quite a low case fatality rate 99:59:59.999 --> 99:59:59.999 that they've done through that type of monitoring. 99:59:59.999 --> 99:59:59.999 And then, of course, once you get into facilities, 99:59:59.999 --> 99:59:59.999 we've learned that the ventilator actually, although extremely well-meaning, 99:59:59.999 --> 99:59:59.999 was actually overused and used in the wrong mode 99:59:59.999 --> 99:59:59.999 in those early days. 99:59:59.999 --> 99:59:59.999 So the health, the doctors 99:59:59.999 --> 99:59:59.999 are way smarter about treatment today. 99:59:59.999 --> 99:59:59.999 Most of that I would say is global. 99:59:59.999 --> 99:59:59.999 Using this ?? as an early indicator, 99:59:59.999 --> 99:59:59.999 that'll probably catch on broadly, 99:59:59.999 --> 99:59:59.999 but Germany was a pioneer there. 99:59:59.999 --> 99:59:59.999 And now, of course, dexamethasone, 99:59:59.999 --> 99:59:59.999 fortunately, it's cheap, it's oral, 99:59:59.999 --> 99:59:59.999 we can ramp up manufacture. 99:59:59.999 --> 99:59:59.999 That'll go global as well. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Bill, I want to ask you 99:59:59.999 --> 99:59:59.999 something about 99:59:59.999 --> 99:59:59.999 what it's been like for you personally through this whole process. 99:59:59.999 --> 99:59:59.999 Because, weirdly, even though your passion and good intent on this topic 99:59:59.999 --> 99:59:59.999 seems completely bloody obvious to anyone who has spent a moment with you, 99:59:59.999 --> 99:59:59.999 there are these crazy conspiracy theories out there about you. 99:59:59.999 --> 99:59:59.999 I just checked in with a company called Zignal 99:59:59.999 --> 99:59:59.999 that monitors social media spaces. 99:59:59.999 --> 99:59:59.999 They say that, to date, I think on Facebook alone, 99:59:59.999 --> 99:59:59.999 more than four million posts have taken place 99:59:59.999 --> 99:59:59.999 that associate you with some kind of conspiracy theory around the virus. 99:59:59.999 --> 99:59:59.999 I read that there was a poll that more than 40 percent of Republicans 99:59:59.999 --> 99:59:59.999 believe that the vaccine that you would roll out 99:59:59.999 --> 99:59:59.999 would somehow plant a microchip in people to track their location. 99:59:59.999 --> 99:59:59.999 I mean, I can't even believe that poll number. 99:59:59.999 --> 99:59:59.999 And then some people are taking this seriously enough, 99:59:59.999 --> 99:59:59.999 and some of them have even been recirculated on Fox News and so forth, 99:59:59.999 --> 99:59:59.999 some people are taking this seriously enough 99:59:59.999 --> 99:59:59.999 to make really quite horrible threats and so forth. 99:59:59.999 --> 99:59:59.999 You seem to do a good job sort of shrugging this off, 99:59:59.999 --> 99:59:59.999 but really, like, who else has ever been in this position? 99:59:59.999 --> 99:59:59.999 How are you managing this? 99:59:59.999 --> 99:59:59.999 What on earth world are we in 99:59:59.999 --> 99:59:59.999 that this kind of misinformation can be out there? 99:59:59.999 --> 99:59:59.999 What can we do to help correct it? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: I'm not sure, 99:59:59.999 --> 99:59:59.999 and it's a new thing 99:59:59.999 --> 99:59:59.999 that there's conspiracy theories. 99:59:59.999 --> 99:59:59.999 I mean, Microsoft had its share of controversy, 99:59:59.999 --> 99:59:59.999 but at least that related to the real world, you know? 99:59:59.999 --> 99:59:59.999 Did Windows crash more than it should? 99:59:59.999 --> 99:59:59.999 We definitely had anti-trust problems. 99:59:59.999 --> 99:59:59.999 But at least I knew what that was. 99:59:59.999 --> 99:59:59.999 When this emerged, I have to say, 99:59:59.999 --> 99:59:59.999 my instinct was to joke about it. 99:59:59.999 --> 99:59:59.999 People have said that's really inappropriate, 99:59:59.999 --> 99:59:59.999 because this is a very serious thing. 99:59:59.999 --> 99:59:59.999 It is going to make people less willing to take a vaccine. 99:59:59.999 --> 99:59:59.999 And, of course, once we have that vaccine, 99:59:59.999 --> 99:59:59.999 it'll be like masks, 99:59:59.999 --> 99:59:59.999 where getting lots of people, 99:59:59.999 --> 99:59:59.999 particularly when it's a transmission-blocking vaccine, 99:59:59.999 --> 99:59:59.999 there's this huge community benefit 99:59:59.999 --> 99:59:59.999 to widespread adoption of that vaccine. 99:59:59.999 --> 99:59:59.999 So I am caught a little bit, 99:59:59.999 --> 99:59:59.999 unsure of what to say or do, 99:59:59.999 --> 99:59:59.999 because the conspiracy piece is a new thing for me, 99:59:59.999 --> 99:59:59.999 and what do you say 99:59:59.999 --> 99:59:59.999 that doesn't give credence to the thing? 99:59:59.999 --> 99:59:59.999 The fact that a Fox News commentator, 99:59:59.999 --> 99:59:59.999 Laura Ingraham, was saying this stuff about me microchipping people, 99:59:59.999 --> 99:59:59.999 that survey isn't that surprising because that's what they heard 99:59:59.999 --> 99:59:59.999 on the TV. 99:59:59.999 --> 99:59:59.999 It's wild. 99:59:59.999 --> 99:59:59.999 And people are clearly seeking simpler explanations 99:59:59.999 --> 99:59:59.999 than going and studying virology. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: I mean, 99:59:59.999 --> 99:59:59.999 TED is nonpolitical, 99:59:59.999 --> 99:59:59.999 but we believe in the truth. 99:59:59.999 --> 99:59:59.999 I would say this. 99:59:59.999 --> 99:59:59.999 Laura Ingraham, you owe Bill Gates an apology and a retraction. 99:59:59.999 --> 99:59:59.999 You do. 99:59:59.999 --> 99:59:59.999 And anyone who is watching this 99:59:59.999 --> 99:59:59.999 who thinks for a minute 99:59:59.999 --> 99:59:59.999 that this man is involved in some kind of conspiracy, 99:59:59.999 --> 99:59:59.999 you want your head examined. 99:59:59.999 --> 99:59:59.999 You are crazy. 99:59:59.999 --> 99:59:59.999 Enough of us know Bill over many years 99:59:59.999 --> 99:59:59.999 and have seen the passion and engagement in this to know 99:59:59.999 --> 99:59:59.999 that you are crazy. 99:59:59.999 --> 99:59:59.999 So get over it, 99:59:59.999 --> 99:59:59.999 and let's look at the actual problem of solving this pandemic. 99:59:59.999 --> 99:59:59.999 Honestly. 99:59:59.999 --> 99:59:59.999 If anyone in the chat here has a suggestion, 99:59:59.999 --> 99:59:59.999 a positive suggestion for how you can, 99:59:59.999 --> 99:59:59.999 how do you get rid of conspiracies, because they feed on each other. 99:59:59.999 --> 99:59:59.999 Now, oh, well I would say that, because I'm part of the conspiracy, 99:59:59.999 --> 99:59:59.999 or whatever. 99:59:59.999 --> 99:59:59.999 Like, how do we get back to a world where information can be trusted? 99:59:59.999 --> 99:59:59.999 We have to do better on it. 99:59:59.999 --> 99:59:59.999 Are there any other questions out there from the community? 99:59:59.999 --> 99:59:59.999 Aria Bendix from New York City: 99:59:59.999 --> 99:59:59.999 "What are your personal recommendations for those who want to reduce 99:59:59.999 --> 99:59:59.999 their risk of infection amid an uptick in cases?" NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, it's great if you have a job 99:59:59.999 --> 99:59:59.999 that you can stay at your house 99:59:59.999 --> 99:59:59.999 and do it through digital meetings, 99:59:59.999 --> 99:59:59.999 and even some of your social activities, 99:59:59.999 --> 99:59:59.999 you know, I do video calls with lots of friends. 99:59:59.999 --> 99:59:59.999 I have friends in Europe that who knows when I'll see them 99:59:59.999 --> 99:59:59.999 but we schedule regular calls to talk. 99:59:59.999 --> 99:59:59.999 If you stay fairly isolated, 99:59:59.999 --> 99:59:59.999 you don't run much risk, 99:59:59.999 --> 99:59:59.999 and it's when you're getting together with lots of other people, 99:59:59.999 --> 99:59:59.999 either through work or socialization, 99:59:59.999 --> 99:59:59.999 that drives that risk, 99:59:59.999 --> 99:59:59.999 and particularly in these communities where you have increased cases, 99:59:59.999 --> 99:59:59.999 even though it's not going to be mandated, 99:59:59.999 --> 99:59:59.999 hopefully the mobility numbers will show people responding 99:59:59.999 --> 99:59:59.999 and minimizing those kind of out of the house contacts. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Bill, I wonder if I could just ask you 99:59:59.999 --> 99:59:59.999 just a little bit about philanthropy. 99:59:59.999 --> 99:59:59.999 Obviously your foundation has played a huge role in this, 99:59:59.999 --> 99:59:59.999 but philanthropy more generally. 99:59:59.999 --> 99:59:59.999 You know, you've started this giving pledge movement, 99:59:59.999 --> 99:59:59.999 recruited all these billionaires 99:59:59.999 --> 99:59:59.999 who have pledged to give away half their net worth 99:59:59.999 --> 99:59:59.999 before or after their death. 99:59:59.999 --> 99:59:59.999 But it's really hard to do. 99:59:59.999 --> 99:59:59.999 It's really hard to give away that much money. 99:59:59.999 --> 99:59:59.999 You yourself, I think, 99:59:59.999 --> 99:59:59.999 since the giving pledge was started, 99:59:59.999 --> 99:59:59.999 what, 10 years ago or something, I'm not sure when, 99:59:59.999 --> 99:59:59.999 but your own net worth I think has doubled since that period 99:59:59.999 --> 99:59:59.999 despite being the world's leading philanthropist. 99:59:59.999 --> 99:59:59.999 Is it just fundamentally hard 99:59:59.999 --> 99:59:59.999 to give away money effectively to make the world better? 99:59:59.999 --> 99:59:59.999 Or should the world's donors, 99:59:59.999 --> 99:59:59.999 and especially the world's really rich donors, 99:59:59.999 --> 99:59:59.999 start to almost commit to a schedule, 99:59:59.999 --> 99:59:59.999 like, here's a percentage of my net worth each year 99:59:59.999 --> 99:59:59.999 that as I get older, 99:59:59.999 --> 99:59:59.999 maybe that goes up. 99:59:59.999 --> 99:59:59.999 If I'm to take this seriously, 99:59:59.999 --> 99:59:59.999 I have to give away, somehow, I've got to find a way 99:59:59.999 --> 99:59:59.999 of doing that effectively. 99:59:59.999 --> 99:59:59.999 Is that an unfair and crazy question? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, it'd be great to up the rate, 99:59:59.999 --> 99:59:59.999 and our goal, both as the Gates Foundation or through the giving pledge, 99:59:59.999 --> 99:59:59.999 is to help people find causes they connect to. 99:59:59.999 --> 99:59:59.999 People give through passion. 99:59:59.999 --> 99:59:59.999 Yes, numbers are important, 99:59:59.999 --> 99:59:59.999 but there's so many causes out there. 99:59:59.999 --> 99:59:59.999 The way you're going to pick is you see somebody who is sick, 99:59:59.999 --> 99:59:59.999 you see somebody who is not getting social services. 99:59:59.999 --> 99:59:59.999 You see something that helps reduce racism. 99:59:59.999 --> 99:59:59.999 And you're very passionate, and so you give to that. 99:59:59.999 --> 99:59:59.999 And, of course, 99:59:59.999 --> 99:59:59.999 some philanthropic gifts won't work out. 99:59:59.999 --> 99:59:59.999 We do need to up the ambition level 99:59:59.999 --> 99:59:59.999 of philanthropists. 99:59:59.999 --> 99:59:59.999 Now, collaborative philanthropy 99:59:59.999 --> 99:59:59.999 that you're helping to facilitate through Audacious, 99:59:59.999 --> 99:59:59.999 there's four or five other groups that are getting philanthropists together, 99:59:59.999 --> 99:59:59.999 that is fantastic, 99:59:59.999 --> 99:59:59.999 because then they learn from each other, 99:59:59.999 --> 99:59:59.999 they get confidence from each other, 99:59:59.999 --> 99:59:59.999 they feel like, hey, I put in x 99:59:59.999 --> 99:59:59.999 and the four other people put money in, 99:59:59.999 --> 99:59:59.999 so I'm getting more impact, 99:59:59.999 --> 99:59:59.999 and hopefully it can be made for them 99:59:59.999 --> 99:59:59.999 even when they find out, 99:59:59.999 --> 99:59:59.999 OK, that particular gift didn't work out that well, 99:59:59.999 --> 99:59:59.999 but let's keep going. 99:59:59.999 --> 99:59:59.999 So philanthropy, yes, 99:59:59.999 --> 99:59:59.999 I would like to see the rate go up, 99:59:59.999 --> 99:59:59.999 and people who do get going, 99:59:59.999 --> 99:59:59.999 it is fun, 99:59:59.999 --> 99:59:59.999 it's fulfilling, 99:59:59.999 --> 99:59:59.999 you pick which of the family members are partnered in doing it. 99:59:59.999 --> 99:59:59.999 In my case, Melinda and I love doing this stuff together, 99:59:59.999 --> 99:59:59.999 learning together. 99:59:59.999 --> 99:59:59.999 Some families, it will even involve the kids in the activities. 99:59:59.999 --> 99:59:59.999 Sometimes the kids are pushing. 99:59:59.999 --> 99:59:59.999 When you have lots of money, 99:59:59.999 --> 99:59:59.999 you still think of million dollars as a lot of money, 99:59:59.999 --> 99:59:59.999 but if you have billions, 99:59:59.999 --> 99:59:59.999 you should be giving hundreds of millions. 99:59:59.999 --> 99:59:59.999 So it's kind of charming that, in terms of your personal expenditure, 99:59:59.999 --> 99:59:59.999 you stay at the level you were at before. 99:59:59.999 --> 99:59:59.999 That's societally quite appropriate. 99:59:59.999 --> 99:59:59.999 But on your giving, you need to scale up 99:59:59.999 --> 99:59:59.999 or else it will be your will, 99:59:59.999 --> 99:59:59.999 and you won't get to shape it and enjoy it quite that same way. 99:59:59.999 --> 99:59:59.999 And so without, 99:59:59.999 --> 99:59:59.999 we don't want to mandate it, 99:59:59.999 --> 99:59:59.999 but yes, both you and I want to inspire philanthropists 99:59:59.999 --> 99:59:59.999 to see that passion, 99:59:59.999 --> 99:59:59.999 to see those opportunities, 99:59:59.999 --> 99:59:59.999 significantly faster than in the past, 99:59:59.999 --> 99:59:59.999 because whether it's race or disease 99:59:59.999 --> 99:59:59.999 or all the other social ills, 99:59:59.999 --> 99:59:59.999 the innovation of what philanthropy can go to and do quickly 99:59:59.999 --> 99:59:59.999 that, if it works, government can come in behind it and scale it up, 99:59:59.999 --> 99:59:59.999 God knows we need solutions, 99:59:59.999 --> 99:59:59.999 we need that kind of hope and progress 99:59:59.999 --> 99:59:59.999 that expectations are high 99:59:59.999 --> 99:59:59.999 that will solve very tough problems. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: I mean, most philanthropists, 99:59:59.999 --> 99:59:59.999 even the best of them, 99:59:59.999 --> 99:59:59.999 find it hard to give away more than about a percent of their net worth every year, 99:59:59.999 --> 99:59:59.999 and yet the world's richest often have access 99:59:59.999 --> 99:59:59.999 to great investment opportunities. 99:59:59.999 --> 99:59:59.999 Many of them are gaining wealth at seven to 10 percent plus per year. 99:59:59.999 --> 99:59:59.999 Isn't it the case that to have a real chance 99:59:59.999 --> 99:59:59.999 of giving away half your fortune, 99:59:59.999 --> 99:59:59.999 at some point you have to plan to give away five, six, seven, eight, 99:59:59.999 --> 99:59:59.999 10 percent of your net worth annually? 99:59:59.999 --> 99:59:59.999 And that is, isn't that the logic of what should be happening? NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Yeah, there are people like Chuck Feeney, 99:59:59.999 --> 99:59:59.999 who set a good example 99:59:59.999 --> 99:59:59.999 and gave away all of his money. 99:59:59.999 --> 99:59:59.999 Even Melinda and I are talking about, 99:59:59.999 --> 99:59:59.999 should we up the rate that we give at? 99:59:59.999 --> 99:59:59.999 As you say, we've been very lucky on the investment side 99:59:59.999 --> 99:59:59.999 through a variety of things. 99:59:59.999 --> 99:59:59.999 Tech fortunes in general have done well, 99:59:59.999 --> 99:59:59.999 even this year, 99:59:59.999 --> 99:59:59.999 which is one of those great contrasts 99:59:59.999 --> 99:59:59.999 in what's going on in the world. 99:59:59.999 --> 99:59:59.999 And I do think there's an expectation 99:59:59.999 --> 99:59:59.999 that we should speed up, 99:59:59.999 --> 99:59:59.999 and there's a reason to speed up, 99:59:59.999 --> 99:59:59.999 and government is going to miss a lot of needs. 99:59:59.999 --> 99:59:59.999 Yes, there's tons of government money out there, 99:59:59.999 --> 99:59:59.999 but helping it be spent well, 99:59:59.999 --> 99:59:59.999 helping find places it's not stepping up, 99:59:59.999 --> 99:59:59.999 and if people are willing to give to the developing world, 99:59:59.999 --> 99:59:59.999 they don't have governments 99:59:59.999 --> 99:59:59.999 that can print checks for 15 percent of GDP, 99:59:59.999 --> 99:59:59.999 and so the suffering there broadly, just the economic stuff alone, 99:59:59.999 --> 99:59:59.999 put aside the pandemic, 99:59:59.999 --> 99:59:59.999 is tragic. 99:59:59.999 --> 99:59:59.999 It's about a five year setback 99:59:59.999 --> 99:59:59.999 in terms of these countries moving forward, 99:59:59.999 --> 99:59:59.999 and in a few cases it's tough enough that the very stability of the country 99:59:59.999 --> 99:59:59.999 is in question. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 CA: Well, Bill, 99:59:59.999 --> 99:59:59.999 I'm in awe of what you and Melinda have done. 99:59:59.999 --> 99:59:59.999 You walk this narrow path 99:59:59.999 --> 99:59:59.999 of trying to juggle so many different things, 99:59:59.999 --> 99:59:59.999 and the amount of time that you dedicate to the betterment of the world at large, 99:59:59.999 --> 99:59:59.999 and definitely the amount of money 99:59:59.999 --> 99:59:59.999 and the amount of passion you put into it, 99:59:59.999 --> 99:59:59.999 I mean, it's pretty awesome, 99:59:59.999 --> 99:59:59.999 and I'm really grateful to you for spending this time with us now. 99:59:59.999 --> 99:59:59.999 Thank you so much, 99:59:59.999 --> 99:59:59.999 and honestly the rest of this year 99:59:59.999 --> 99:59:59.999 your skills and resources are going to be needed more than ever, 99:59:59.999 --> 99:59:59.999 so good luck. NOTE Paragraph 99:59:59.999 --> 99:59:59.999 BG: Well, thanks. 99:59:59.999 --> 99:59:59.999 It's fun work and I'm optimistic, 99:59:59.999 --> 99:59:59.999 so thanks, Chris.