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, 00:01:06.906 --> 00:01:08.287 the homeless shelters, 00:01:08.287 --> 00:01:11.546 the places where we've had a lot of our deaths. 00:01:11.827 --> 00:01:15.456 The innovation track, which probably we will touch on -- 00:01:15.456 --> 00:01:17.927 diagnostics, therapeutics, vaccines -- 00:01:17.927 --> 00:01:20.639 there's good progress there, 00:01:20.639 --> 00:01:24.364 but nothing that would fundamentally alter the fact 00:01:24.364 --> 00:01:27.943 that this fall in the United States could be quite bad, 00:01:28.222 --> 00:01:32.810 and that's worse than I would have expected a month ago, 00:01:32.810 --> 00:01:36.052 the degree to which we're back at high mobility, 00:01:36.052 --> 00:01:37.516 not wearing masks, 00:01:37.516 --> 00:01:42.421 and now the virus actually has gotten into a lot of cities 00:01:42.421 --> 00:01:45.612 that it hadn't been in before 00:01:45.612 --> 00:01:47.325 in a significant way, 00:01:47.325 --> 00:01:50.635 so it's going to be a challenge. 00:01:50.899 --> 00:01:54.424 There's no case where we get much below the current death rate, 00:01:54.424 --> 00:01:56.925 which is about 500 deaths a day, 00:01:57.236 --> 00:02:00.127 but there's a significant risk we'd go back up 00:02:00.127 --> 00:02:06.744 to the even 2,000 a day that we had before, 00:02:06.744 --> 00:02:10.120 because we don't have the distancing, 00:02:10.120 --> 00:02:11.684 the behavior change, 00:02:11.684 --> 00:02:15.441 to the degree that we had in April and May, 00:02:15.988 --> 00:02:19.496 and we know this virus is somewhat seasonal, 00:02:19.496 --> 00:02:21.824 so that the force of infection, 00:02:21.824 --> 00:02:25.185 both through temperature, humidity, more time indoors, 00:02:25.185 --> 00:02:27.433 will be worse as we get into the fall. NOTE Paragraph 00:02:28.258 --> 00:02:30.405 CA: So there are scenarios where in the US, 00:02:30.405 --> 00:02:32.897 like, if you extrapolate those numbers forward, 00:02:32.897 --> 00:02:34.227 we end up with, what, 00:02:34.227 --> 00:02:36.339 more than a quarter of a million deaths, 00:02:36.339 --> 00:02:39.215 perchance, even this year if we're not careful, 00:02:39.215 --> 00:02:43.338 and worldwide I guess the death toll could by the end of the year 00:02:43.338 --> 00:02:46.048 be well into the millions, with an s. 00:02:46.048 --> 00:02:49.407 Is there evidence that the hotter temperatures of the summer 00:02:49.407 --> 00:02:51.802 actually have been helping us? NOTE Paragraph 00:02:52.584 --> 00:02:54.695 BG: They're not absolutely sure, 00:02:54.695 --> 00:03:01.062 but certainly the ?? model definitely wanted to use the season, 00:03:01.062 --> 00:03:03.872 including temperature and humidity, 00:03:03.872 --> 00:03:07.715 to try and explain why May wasn't worse than it was. 00:03:08.995 --> 00:03:14.347 And so as we came out and the mobility numbers got higher, 00:03:14.347 --> 00:03:20.516 the models expected more infections and deaths to come out of that, 00:03:20.516 --> 00:03:23.026 and the model kept wanting to say, 00:03:23.026 --> 00:03:26.815 "But I need to use this seasonality 00:03:28.098 --> 00:03:31.290 to match why May wasn't worse, 00:03:31.290 --> 00:03:34.184 why June wasn't worse than it was." 00:03:34.184 --> 00:03:39.174 And we see in the Southern Hemisphere, 00:03:39.174 --> 00:03:41.846 you know, Brazil, 00:03:41.846 --> 00:03:44.274 which is the opposite season, 00:03:44.274 --> 00:03:48.434 all of South America is having a huge epidemic. 00:03:48.434 --> 00:03:53.452 South Africa is having a very fast-growing epidemic. 00:03:53.452 --> 00:03:57.743 Fortunately, Australia and New Zealand, 00:03:57.743 --> 00:04:00.174 the last countries in the Southern Hemisphere, 00:04:00.174 --> 00:04:01.217 are at really tiny case counts, 00:04:01.217 --> 00:04:03.015 and so although they have to keep knocking it down, 00:04:03.015 --> 00:04:06.373 they're talking about, oh, we have 10 cases, 00:04:06.373 --> 00:04:09.422 that's a big deal, let's go get rid of that. 00:04:09.422 --> 00:04:12.771 So they're one of these amazing countries 00:04:12.771 --> 00:04:14.618 that got the numbers so low 00:04:14.618 --> 00:04:17.960 that test, quarantine and trace 00:04:17.960 --> 00:04:20.370 is working to get them, 00:04:20.370 --> 00:04:23.381 keep them at very near zero. NOTE Paragraph 00:04:23.579 --> 00:04:26.721 CA: Aided perhaps a bit by being easier to isolate 00:04:26.721 --> 00:04:29.882 and by less density, less population density, 00:04:29.882 --> 00:04:32.273 but nonetheless smart policies down there. NOTE Paragraph 00:04:32.273 --> 00:04:35.892 BG: Yeah. Everything is so exponential that a little bit of good work 00:04:35.892 --> 00:04:37.211 goes a long ways. 00:04:37.211 --> 00:04:38.842 It's not a linear game. 00:04:38.842 --> 00:04:43.729 Contact tracing, if you have the number of cases we have in the US, 00:04:43.895 --> 00:04:46.040 it's super-important to do, 00:04:46.040 --> 00:04:48.421 but it won't get you back down to zero. 00:04:48.602 --> 00:04:50.198 It'll help you be down, 00:04:50.198 --> 00:04:52.840 but it's too overwhelming. NOTE Paragraph 00:04:53.190 --> 00:04:56.581 CA: OK, so in May and June in the US, 00:04:56.581 --> 00:04:59.691 the numbers were actually slightly better than some of the models predicted, 00:04:59.691 --> 00:05:02.660 and it's hypothesized that that might be partly because of the warmer weather. 00:05:02.660 --> 00:05:05.825 Now we're seeing, really, would you describe it 00:05:05.825 --> 00:05:10.615 as really quite alarming upticks in case rates in the US? NOTE Paragraph 00:05:11.878 --> 00:05:13.441 BG: That's right. 00:05:13.441 --> 00:05:17.547 In, say, the New York area, 00:05:17.547 --> 00:05:20.773 the cases continue to go down somewhat, 00:05:20.773 --> 00:05:22.984 but in other parts of the country, 00:05:22.984 --> 00:05:25.894 primarily the South right now, 00:05:26.259 --> 00:05:28.638 you have increases that are offsetting that, 00:05:28.638 --> 00:05:32.245 and you have testing positive rates in young people 00:05:32.245 --> 00:05:34.414 that are actually higher 00:05:34.414 --> 00:05:38.130 than what we saw even in some of the tougher areas, 00:05:38.746 --> 00:05:42.803 and so clearly younger people have come out of mobility 00:05:42.803 --> 00:05:46.825 more than older people have increased their mobility, 00:05:47.058 --> 00:05:48.605 so the age structure 00:05:48.605 --> 00:05:54.915 is right now very young, but because of multigenerational households, 00:05:54.915 --> 00:05:57.284 people work in nursing care homes, 00:05:57.284 --> 00:06:00.476 unfortunately that will work its way back, 00:06:00.476 --> 00:06:04.919 both the time lag and the transmission back up into the elderly, 00:06:04.919 --> 00:06:07.742 will start to push the death rate back up, 00:06:07.742 --> 00:06:09.538 which it is down, 00:06:09.538 --> 00:06:15.008 way down from 2,000 to around 500 right now. NOTE Paragraph 00:06:15.924 --> 00:06:18.666 CA: And is that partly because there's a three-week lag 00:06:18.666 --> 00:06:21.309 between case numbers and fatality numbers? 00:06:21.655 --> 00:06:24.218 And also, perhaps, partly because 00:06:24.218 --> 00:06:27.178 there have been some effective interventions 00:06:27.178 --> 00:06:29.657 and we're actually seeing the possibility 00:06:29.657 --> 00:06:32.516 that the overall fatality rate is actually falling a bit 00:06:32.516 --> 00:06:35.108 now that we've gained some extra knowledge? NOTE Paragraph 00:06:35.108 --> 00:06:39.515 BG: Yeah, certainly your fatality rate is always lower 00:06:39.515 --> 00:06:41.094 when you're not overloaded, 00:06:41.094 --> 00:06:43.588 and so Italy when they were overloaded, 00:06:43.588 --> 00:06:46.265 Spain, even New York at the start, 00:06:46.548 --> 00:06:47.877 certainly China, 00:06:47.877 --> 00:06:53.098 there you weren't even able to provide the basics, 00:06:54.080 --> 00:06:56.822 the oxygen and things. 00:06:57.055 --> 00:07:00.447 A study that our foundation funded in the UK 00:07:00.447 --> 00:07:03.410 found the only thing other than remdesivir 00:07:03.410 --> 00:07:06.549 that is a proven therapeutic, 00:07:06.549 --> 00:07:08.645 which is the dexamethasone, 00:07:08.645 --> 00:07:11.401 that for serious patients 00:07:11.401 --> 00:07:14.416 is about a 20 percent death reduction, 00:07:15.460 --> 00:07:18.786 and there's still quite a pipeline of those things. 00:07:19.567 --> 00:07:23.990 You know, hydroxychloroquine never established positive data, 00:07:23.990 --> 00:07:26.185 so that's pretty much done. 00:07:26.185 --> 00:07:28.629 There's still a few trials ongoing, 00:07:28.629 --> 00:07:31.006 but the list of things being tried, 00:07:31.456 --> 00:07:34.980 including eventually monoclonal antibodies, 00:07:34.980 --> 00:07:39.032 we will have some additional tools for the fall. 00:07:39.032 --> 00:07:42.259 And so when you talk about death rates, 00:07:42.259 --> 00:07:45.965 the good news is some innovation we already have 00:07:45.965 --> 00:07:48.044 and we will have more 00:07:48.044 --> 00:07:50.072 even in the fall. 00:07:50.271 --> 00:07:53.364 We should start to have monoclonal antibodies, 00:07:53.364 --> 00:07:57.588 which is the single therapeutic that I'm most excited about. NOTE Paragraph 00:07:58.136 --> 00:08:01.112 CA: I'll actually ask you to tell me a bit more about that in one sec, 00:08:01.112 --> 00:08:03.464 but just putting the pieces together on death rates: 00:08:03.464 --> 00:08:05.435 so in a well-functioning health system, 00:08:05.435 --> 00:08:08.555 so take the US when places aren't overcrowded, 00:08:08.555 --> 00:08:10.351 what do you think 00:08:10.351 --> 00:08:15.105 the current fatality numbers are approximately going forward, 00:08:15.321 --> 00:08:17.217 like as a percentage of total cases? 00:08:17.217 --> 00:08:19.811 Are we below one percent, perhaps? NOTE Paragraph 00:08:20.176 --> 00:08:23.402 BG: If you found every case, yes, 00:08:23.402 --> 00:08:26.245 you're well below one percent. 00:08:26.245 --> 00:08:29.970 People argue, you know, 0.4, 0.5. 00:08:29.970 --> 00:08:34.176 By the time you bring in the never symptomatics, 00:08:34.408 --> 00:08:37.035 it probably is below 0.5, 00:08:37.218 --> 00:08:38.831 and that's good news. 00:08:38.981 --> 00:08:42.456 This disease could have been a five percent disease. 00:08:42.971 --> 00:08:47.077 The transmission dynamics of this disease 00:08:47.077 --> 00:08:52.498 are more difficult than even the experts predicted. 00:08:53.447 --> 00:08:58.035 The amount of pre-symptomatic and never symptomatic spread, 00:08:59.049 --> 00:09:01.277 and the fact that it's not coughing, 00:09:01.277 --> 00:09:03.787 where you would kind of notice, hey, I'm coughing. 00:09:03.787 --> 00:09:06.630 Most respiratory diseases make you cough. 00:09:06.630 --> 00:09:09.590 This one, in its early stages, it's not coughing, 00:09:09.790 --> 00:09:12.998 it's singing, laughing, talking, 00:09:13.530 --> 00:09:16.307 actually still particularly for the super-spreaders, 00:09:16.307 --> 00:09:18.352 people with very high viral loads, 00:09:18.352 --> 00:09:19.865 causes that spread, 00:09:19.865 --> 00:09:22.176 and that's pretty novel, 00:09:22.393 --> 00:09:26.215 and so even experts have to say, wow, this caught us by surprise. 00:09:26.215 --> 00:09:28.096 The amount of asymptomatic spread 00:09:28.096 --> 00:09:30.772 and the fact that there's not a coughing element 00:09:30.772 --> 00:09:33.631 is not a major piece like the flu or TB. NOTE Paragraph 00:09:34.147 --> 00:09:36.158 CA: Yeah, that is devilish cunning 00:09:36.158 --> 00:09:37.189 by the virus. 00:09:37.189 --> 00:09:41.446 I mean, how much is that non-symptomatic transmission 00:09:41.696 --> 00:09:43.773 as a percentage of total transmission? 00:09:43.773 --> 00:09:47.131 I've heard numbers it could be as much as half of all transmissions 00:09:47.131 --> 00:09:49.060 are basically pre-symptomatic. NOTE Paragraph 00:09:49.060 --> 00:09:52.602 BG: Yeah, if you count pre-symptomatics, 00:09:52.602 --> 00:09:55.794 then most of the studies show that's like at 40 percent, 00:09:56.076 --> 00:10:00.317 and we also have never symptomatics. 00:10:01.198 --> 00:10:04.376 The amount of virus you get in your upper respiratory area 00:10:04.376 --> 00:10:06.003 is somewhat disconnected. 00:10:06.003 --> 00:10:08.795 Some people will have a lot here and very little in their lungs, 00:10:08.795 --> 00:10:11.256 and what you get in your lungs 00:10:11.256 --> 00:10:14.151 causes the really bad symptoms, 00:10:14.151 --> 00:10:15.888 and other organs, 00:10:15.888 --> 00:10:17.369 but mostly the lungs, 00:10:17.369 --> 00:10:19.417 and so that's when you seek treatment. 00:10:19.417 --> 00:10:22.010 And so the worst case in terms of spreading 00:10:22.010 --> 00:10:25.086 is somebody who's got a lot in the upper respiratory tract 00:10:25.086 --> 00:10:26.949 but almost none in their lungs, 00:10:26.949 --> 00:10:29.227 so they're not care-seeking. NOTE Paragraph 00:10:30.009 --> 00:10:30.923 CA: Right. 00:10:30.923 --> 00:10:34.048 And so if you add in the never symptomatic 00:10:34.048 --> 00:10:36.675 to the pre-symptomatic, 00:10:36.675 --> 00:10:38.803 do you get above 50 percent of the transmission 00:10:38.803 --> 00:10:40.998 is actually from non-symptomatic people? NOTE Paragraph 00:10:41.231 --> 00:10:45.088 BG: Yeah, transmission is harder to measure. 00:10:45.320 --> 00:10:48.444 You know, we see certain hotspots and things, 00:10:48.444 --> 00:10:51.937 but that's a huge question with the vaccine: 00:10:51.937 --> 00:10:56.340 will it, besides avoiding you getting sick, 00:10:56.340 --> 00:10:58.319 which is what the trial will test, 00:10:58.319 --> 00:11:01.162 will it also stop you from being a transmitter? NOTE Paragraph 00:11:01.428 --> 00:11:02.825 CA: So that vaccine, 00:11:02.825 --> 00:11:05.252 it's such an important question, let's come on to that, 00:11:05.252 --> 00:11:06.201 but before we go there, 00:11:06.201 --> 00:11:08.078 any other surprises in the last couple months 00:11:08.078 --> 00:11:10.257 that we've learned about this virus 00:11:10.257 --> 00:11:13.500 that really impact how we should respond to it? NOTE Paragraph 00:11:14.846 --> 00:11:19.767 BG: We're still not able to characterize who the super-spreaders are 00:11:19.767 --> 00:11:22.195 in terms of what that profile is, 00:11:22.195 --> 00:11:23.625 and we may never. 00:11:23.625 --> 00:11:25.537 That may just be quite random. 00:11:25.537 --> 00:11:27.531 If you could identify them, 00:11:27.531 --> 00:11:30.491 they're responsible for the majority of transmission, 00:11:30.890 --> 00:11:33.553 a few people who have very high viral loads. 00:11:33.553 --> 00:11:38.987 But sadly, we haven't figured that out. 00:11:38.987 --> 00:11:40.650 This mode of transmission, 00:11:40.650 --> 00:11:43.011 if you're in a room and nobody talks, 00:11:43.011 --> 00:11:45.140 there's way less transmission. 00:11:45.140 --> 00:11:48.714 That's partly why, although planes can transmit, 00:11:48.946 --> 00:11:53.768 it's less than you would expect just in terms of time proximity measures, 00:11:53.768 --> 00:11:57.708 because unlike, say, a choir or a restaurant, 00:11:57.708 --> 00:12:03.473 you're not exhaling in loud talking 00:12:03.473 --> 00:12:06.136 quite as much as in other indoor environments. NOTE Paragraph 00:12:06.318 --> 00:12:10.374 CA: What do you think about the ethics of someone who would go on a plane 00:12:10.374 --> 00:12:12.219 and refuse to wear a mask? NOTE Paragraph 00:12:12.219 --> 00:12:15.496 BG: If they own the plane, that would be fine. 00:12:15.496 --> 00:12:18.172 If there's other people on the plane, 00:12:18.172 --> 00:12:21.564 that would be endangering those other people. NOTE Paragraph 00:12:21.564 --> 00:12:23.367 CA: Early on in the pandemic, 00:12:23.367 --> 00:12:27.915 the WHO did not advise that people wear masks. 00:12:28.147 --> 00:12:33.352 They were worried about taking them away from frontline medical providers. 00:12:33.616 --> 00:12:36.826 In retrospect, was that a terrible mistake that they made? NOTE Paragraph 00:12:36.826 --> 00:12:38.367 BG: Yes. 00:12:38.788 --> 00:12:41.606 All the experts feel bad 00:12:41.797 --> 00:12:46.470 that the value of masks, 00:12:46.470 --> 00:12:49.228 which ties back somewhat to the asymptomatics, 00:12:49.228 --> 00:12:52.554 if people were very symptomatic, 00:12:52.554 --> 00:12:54.201 like an Ebola, 00:12:54.201 --> 00:12:59.831 then you know it and you isolate, 00:12:59.831 --> 00:13:02.922 and so you don't have a need for a mask-like thing. 00:13:03.604 --> 00:13:05.831 The value of masks, 00:13:05.831 --> 00:13:09.144 the fact that the medical masks was a different supply chain 00:13:09.144 --> 00:13:12.067 than the normal masks, 00:13:12.266 --> 00:13:15.159 the fact you could scale up the normal masks so well, 00:13:15.159 --> 00:13:19.390 the fact that it would stop that pre-symptomatic, 00:13:19.390 --> 00:13:21.211 never symptomatic transmission, 00:13:21.211 --> 00:13:22.508 it's a mistake, 00:13:22.508 --> 00:13:25.085 but it's not a conspiracy, 00:13:25.318 --> 00:13:29.192 it's something that we now know more. 00:13:29.632 --> 00:13:32.484 And even now, our error bars on the benefit of masks 00:13:32.484 --> 00:13:34.263 are higher than we'd like to admit, 00:13:34.263 --> 00:13:36.257 but it's a significant benefit. NOTE Paragraph 00:13:37.005 --> 00:13:39.318 CA: All right, I'm going to come in with some questions 00:13:39.318 --> 00:13:41.180 from the community. 00:13:43.091 --> 00:13:44.969 Let's pull them up there. 00:13:45.219 --> 00:13:50.557 Jim Pitofsky: "Do you think reopening efforts in the US have been premature, 00:13:50.773 --> 00:13:55.478 and if so how far should the US go to responsibly confront this pandemic?" NOTE Paragraph 00:13:58.187 --> 00:14:00.815 BG: Well, the question of how you make tradeoffs 00:14:00.815 --> 00:14:05.130 between the benefits, say, of going to school 00:14:05.130 --> 00:14:09.494 versus the risk of people getting sick because they go to school, 00:14:10.292 --> 00:14:13.351 those are very tough questions 00:14:13.351 --> 00:14:16.892 that I don't think any single person 00:14:17.258 --> 00:14:23.411 can say, "I will tell you how to make all these tradeoffs." 00:14:24.590 --> 00:14:28.165 The understanding of where you have transmission, 00:14:28.165 --> 00:14:31.157 and the fact that young people do get infected 00:14:31.381 --> 00:14:35.164 and are part of the multi-generational transmission chain, 00:14:35.763 --> 00:14:37.395 we should get that out. 00:14:37.395 --> 00:14:40.734 If you just look at the health aspect, 00:14:40.734 --> 00:14:43.477 we have opened up too liberally. 00:14:43.477 --> 00:14:46.570 Now, opening up in terms of mental health 00:14:46.570 --> 00:14:50.510 and seeking normal health things 00:14:50.510 --> 00:14:53.389 like vaccines and other care, 00:14:54.152 --> 00:14:56.148 there are benefits. 00:14:56.695 --> 00:14:59.040 I think some of our opening up 00:14:59.040 --> 00:15:01.551 has created more risk than benefit. 00:15:01.551 --> 00:15:04.560 Opening the bars up as quickly as they did, 00:15:05.458 --> 00:15:07.951 is that critical for mental health? 00:15:07.951 --> 00:15:09.565 Maybe not. 00:15:10.014 --> 00:15:13.604 So I don't think we've been as tasteful about opening up 00:15:13.604 --> 00:15:18.808 as I'm sure, as we study it, 00:15:18.808 --> 00:15:24.827 that we'll realize some things we shouldn't have opened up as fast, 00:15:25.343 --> 00:15:27.588 but then you have something like school, 00:15:27.588 --> 00:15:30.348 where even sitting here today, 00:15:30.348 --> 00:15:34.454 the exact plan, say, for inner city schools for the fall, 00:15:35.800 --> 00:15:39.131 I wouldn't have a black-and-white view 00:15:39.131 --> 00:15:42.185 on the relative tradeoffs involved there. 00:15:44.414 --> 00:15:46.241 There are huge benefits 00:15:46.241 --> 00:15:49.751 to letting those kids go to school, 00:15:50.465 --> 00:15:53.342 and how do you weigh the risk? 00:15:53.342 --> 00:15:55.171 If you're in a city 00:15:55.171 --> 00:15:57.430 without many cases, 00:15:57.680 --> 00:16:01.022 I would say probably the benefit is there. 00:16:01.372 --> 00:16:04.248 Now that means that you could get surprised. 00:16:04.248 --> 00:16:07.025 The cases could show up, and then you'd have to change that, 00:16:07.025 --> 00:16:08.721 which is not easy. 00:16:08.721 --> 00:16:12.080 But I think around the US there will be places 00:16:12.080 --> 00:16:15.676 where that won't be a good tradeoff. 00:16:15.676 --> 00:16:18.140 So almost any dimension and inequity, 00:16:18.140 --> 00:16:23.157 this disease has made worse: 00:16:23.197 --> 00:16:27.382 job type, internet connection, 00:16:27.382 --> 00:16:30.521 ability of your school to do online learning. 00:16:31.452 --> 00:16:33.215 White collar workers, 00:16:33.215 --> 00:16:35.377 people are embarrassed to admit it, 00:16:35.377 --> 00:16:37.820 some of them are more productive 00:16:37.820 --> 00:16:42.627 and enjoying the flexibility that the at-home thing has created, 00:16:43.074 --> 00:16:44.854 and that feels terrible 00:16:44.854 --> 00:16:49.824 when you know lots of people are suffering in many ways, 00:16:50.057 --> 00:16:52.867 including their kids not going to school. NOTE Paragraph 00:16:53.166 --> 00:16:55.312 CA: Indeed. Let's have the next question. 00:16:55.312 --> 00:16:56.675 "For us in Rwanda, 00:16:56.675 --> 00:16:59.252 early policy interventions have made the difference. 00:16:59.252 --> 00:17:03.359 At this point, what policy interventions do you suggest for the US now?" 00:17:03.708 --> 00:17:06.218 Bill, I dream of the day where you are appointed 00:17:06.218 --> 00:17:07.598 the coronavirus czar 00:17:07.598 --> 00:17:10.274 with authority to actually speak to the public. 00:17:10.274 --> 00:17:12.553 What would you do? NOTE Paragraph 00:17:13.170 --> 00:17:17.441 BG: The innovation tools 00:17:17.441 --> 00:17:22.213 are where I and the foundation probably has the most expertise. 00:17:23.444 --> 00:17:27.317 Clearly some of the policies on opening up have been too generous, 00:17:27.317 --> 00:17:30.309 but I think everybody 00:17:30.309 --> 00:17:35.435 could engage in that. 00:17:35.496 --> 00:17:37.773 We need leadership 00:17:37.773 --> 00:17:39.833 in terms of admitting 00:17:39.833 --> 00:17:43.441 that we've still got a huge problem here, 00:17:43.441 --> 00:17:47.231 and not turning that into almost a political thing 00:17:47.231 --> 00:17:51.771 of, oh, isn't it brilliant what we did. 00:17:52.123 --> 00:17:53.550 No, it's not brilliant, 00:17:53.550 --> 00:17:56.459 but there's many people, 00:17:56.459 --> 00:17:57.955 including the experts, 00:17:57.955 --> 00:18:00.732 where there's a lot they didn't understand, 00:18:00.732 --> 00:18:05.205 and everybody wishes a week earlier whatever action they took, 00:18:05.205 --> 00:18:07.266 they'd taken that a week earlier. 00:18:07.266 --> 00:18:09.743 The innovation tools, 00:18:09.743 --> 00:18:13.070 that's where the foundation's work 00:18:13.418 --> 00:18:18.323 on antibodies, vaccines, 00:18:18.323 --> 00:18:21.233 we have deep expertise, 00:18:21.233 --> 00:18:24.258 and it's outside of the private sector, 00:18:24.258 --> 00:18:28.431 and so we have kind of a neutral ability to work with all the governments 00:18:28.431 --> 00:18:30.926 and the companies to pick. 00:18:30.926 --> 00:18:32.987 Particularly when you're doing break-even products, 00:18:32.987 --> 00:18:34.965 which one should get the resources. 00:18:34.965 --> 00:18:37.129 There's no market signal for that. 00:18:37.379 --> 00:18:42.617 Experts have to say, OK, this antibody deserves the manufacturing. 00:18:42.617 --> 00:18:45.473 This vaccine deserves the manufacturing. 00:18:45.473 --> 00:18:50.445 Because, we have very limited manufacturing for both of those things, 00:18:50.644 --> 00:18:54.484 and it'll be cross-company, 00:18:54.484 --> 00:18:55.120 which never happens in the normal case, 00:18:55.120 --> 00:18:56.148 where one company invents it 00:18:56.148 --> 00:18:59.057 and then you're using the manufacturing plants 00:18:59.057 --> 00:19:01.335 of many companies 00:19:01.335 --> 00:19:04.278 to get maximum scale of the best choice. 00:19:04.278 --> 00:19:06.838 So I would be coordinating those things, 00:19:06.838 --> 00:19:12.009 but we need a leader who keeps us up to date, 00:19:12.009 --> 00:19:13.972 is realistic, 00:19:13.972 --> 00:19:16.963 and shows us the right behavior, 00:19:16.963 --> 00:19:19.424 as well as driving the innovation track. NOTE Paragraph 00:19:19.435 --> 00:19:20.538 CA: I mean, you have to yourself be a master diplomat 00:19:20.538 --> 00:19:24.147 in how you talk about this stuff. 00:19:24.147 --> 00:19:26.524 So I appreciate, almost, the discomfort here, 00:19:26.524 --> 00:19:29.001 but you talk regularly with Anthony Fauci, 00:19:29.001 --> 00:19:35.103 who is a wise voice on this by most people's opinion. 00:19:35.103 --> 00:19:37.298 But to what extent is he just hamstrung? 00:19:37.298 --> 00:19:40.440 He's not allowed to play the full role 00:19:40.440 --> 00:19:43.017 that he could play in the circumstance. NOTE Paragraph 00:19:43.017 --> 00:19:45.045 BG: Dr. Fauci has emerged, 00:19:45.045 --> 00:19:48.902 where he was allowed to have some airtime, 00:19:48.902 --> 00:19:53.242 and even though he was stating things that are realistic, 00:19:53.242 --> 00:19:55.171 his prestige has stuck. 00:19:55.171 --> 00:19:57.049 He can speak out in that way. 00:19:57.049 --> 00:20:01.373 Typically, the CDC would be the primary voice here. 00:20:02.071 --> 00:20:05.637 It's not absolutely necessary, 00:20:05.637 --> 00:20:07.199 but in previous health crises, 00:20:07.199 --> 00:20:10.477 you let the experts inside the CDC 00:20:10.477 --> 00:20:12.056 be that voice. 00:20:12.272 --> 00:20:14.168 They're trained to do these things, 00:20:14.168 --> 00:20:16.896 and so it is a bit unusual here 00:20:16.896 --> 00:20:20.171 how much we've had to rely on Fauci 00:20:20.171 --> 00:20:22.165 as opposed to the CDC. 00:20:22.165 --> 00:20:25.823 It should be Fauci, who is a brilliant researcher, 00:20:25.823 --> 00:20:28.943 so experienced, particularly in vaccines, 00:20:28.943 --> 00:20:32.656 in some ways he has become, taking the broad advice 00:20:32.656 --> 00:20:36.481 that is the epidemiology advice 00:20:36.481 --> 00:20:39.806 and explaining it in the right way, 00:20:39.806 --> 00:20:41.419 where he'll admit, 00:20:41.419 --> 00:20:44.012 "OK, we may have a rebound here, 00:20:44.012 --> 00:20:47.920 and this is why we need to behave that way." 00:20:47.920 --> 00:20:53.459 But it's fantastic that his voice has been allowed to come through. NOTE Paragraph 00:20:54.087 --> 00:20:55.633 CA: Sometimes. 00:20:55.633 --> 00:20:57.596 Let's have the next question. 00:21:00.447 --> 00:21:03.564 Nina Gregory: "How are you and your foundation 00:21:03.564 --> 00:21:07.372 addressing the ethical questions about which countries 00:21:07.372 --> 00:21:08.736 get the vaccine first, 00:21:08.736 --> 00:21:10.531 assuming you find one?" 00:21:10.531 --> 00:21:12.528 And maybe, Bill, use this as a moment 00:21:12.528 --> 00:21:16.192 to just talk about where the quest for the vaccine is 00:21:16.192 --> 00:21:19.892 and what are just some of the key things we should all be thinking about 00:21:19.892 --> 00:21:21.687 as we track the news on this. NOTE Paragraph 00:21:22.072 --> 00:21:26.742 BG: There's three vaccines that are, 00:21:26.742 --> 00:21:28.604 if they work, are the earliest: 00:21:28.604 --> 00:21:34.257 the Moderna, which unfortunately won't scale very easily, 00:21:34.573 --> 00:21:38.547 so if that works, it'll be mostly a US-targeted thing; 00:21:38.547 --> 00:21:42.270 then you have the AstraZeneca, which comes from Oxford; 00:21:42.270 --> 00:21:43.954 and the Johnson & Johnson. 00:21:43.954 --> 00:21:45.646 Those are the three early ones, 00:21:45.646 --> 00:21:48.173 and we have animal data 00:21:48.173 --> 00:21:51.549 that looks potentially good, 00:21:51.549 --> 00:21:53.642 but not definitive, 00:21:54.258 --> 00:21:56.802 particularly will it work in the elderly, 00:21:56.802 --> 00:22:00.027 and we'll have human data over the next several months. 00:22:00.027 --> 00:22:05.912 Those three will be gated by the safety and efficacy trial. 00:22:05.912 --> 00:22:08.109 That is, we'll be able to manufacture those, 00:22:08.109 --> 00:22:10.635 although not as much as we want. 00:22:10.635 --> 00:22:13.179 We'll be able to manufacture those before the end of the year. 00:22:13.179 --> 00:22:15.340 Whether the Phase 3 will succeed, 00:22:15.340 --> 00:22:17.851 and whether it'll complete before the end of the year, 00:22:17.851 --> 00:22:22.058 I wouldn't be that optimistic about. 00:22:22.058 --> 00:22:26.047 Phase 3 is where you need to really look at all the safety profile 00:22:26.047 --> 00:22:27.811 and efficacy, 00:22:27.811 --> 00:22:29.722 but those will get started. 00:22:29.722 --> 00:22:32.315 And then there's four or five vaccines 00:22:32.315 --> 00:22:34.094 that use different approaches 00:22:34.094 --> 00:22:36.756 that are maybe three or four months behind that: 00:22:36.756 --> 00:22:40.463 Novavax, Sanofi, Merck. 00:22:41.077 --> 00:22:47.595 And so we're funding factory capacity for a lot of these -- 00:22:47.595 --> 00:22:53.680 some complex negotiations are taking place right now on this -- 00:22:53.680 --> 00:22:58.402 to get factories that will be dedicated to the poorer countries, 00:22:58.951 --> 00:23:01.827 what's called low- and middle-income. 00:23:01.827 --> 00:23:04.221 And the very scalable constructs 00:23:04.221 --> 00:23:08.877 that include AstraZeneca and Johnson & Johnson, 00:23:08.877 --> 00:23:10.552 we'll focus on those, 00:23:10.552 --> 00:23:12.333 the ones that are inexpensive 00:23:12.333 --> 00:23:15.674 and you can build a single factory to make 600 million doses. 00:23:15.674 --> 00:23:20.129 So a number of the vaccine constructs 00:23:20.129 --> 00:23:21.162 are potential. 00:23:21.162 --> 00:23:25.549 I don't see anything before the end of the year. 00:23:25.549 --> 00:23:27.483 That's really the best case, 00:23:27.483 --> 00:23:31.069 and it's down to a few constructs now, 00:23:31.069 --> 00:23:35.479 which typically you have high failure rates. NOTE Paragraph 00:23:36.539 --> 00:23:37.902 CA: Bill, is the case 00:23:37.902 --> 00:23:40.861 that you and your foundation weren't in the picture here 00:23:40.861 --> 00:23:44.354 that market dynamics would likely lead to a situation 00:23:44.354 --> 00:23:47.695 where as soon as a promising vaccine candidate emerged, 00:23:47.695 --> 00:23:50.123 the richer countries would basically snap up, 00:23:50.123 --> 00:23:53.582 gobble up all available initial supply -- 00:23:53.582 --> 00:23:55.410 it just takes a while to manufacture these -- 00:23:55.410 --> 00:23:59.317 and there would be nothing for the poorer countries, 00:23:59.317 --> 00:24:01.794 but that what effectively you're doing, 00:24:01.794 --> 00:24:03.989 by giving manufacturing guarantees 00:24:03.989 --> 00:24:07.248 and capability to some of these candidates, 00:24:07.248 --> 00:24:13.184 you're making it possible that at least some of the early vaccine units 00:24:13.600 --> 00:24:15.911 will go to poorer countries? 00:24:15.911 --> 00:24:17.257 Is that correct? NOTE Paragraph 00:24:17.257 --> 00:24:19.186 BG: Well, it's not just us, but yes, 00:24:19.186 --> 00:24:21.313 we're in the central role there 00:24:21.313 --> 00:24:24.856 along with a group we created called CEPI, 00:24:24.856 --> 00:24:27.914 Coalition for Epidemic Preparedness, 00:24:27.931 --> 00:24:32.087 and the European leaders agree with this. 00:24:32.087 --> 00:24:35.485 Now we have the expertise to look at each of the constructs 00:24:35.485 --> 00:24:37.929 and say, OK, where is there a factory in the world 00:24:37.929 --> 00:24:39.674 that has capacity that can build that? 00:24:39.674 --> 00:24:42.702 Which one should we put the early money into? 00:24:42.702 --> 00:24:45.078 What should the milestones be 00:24:45.078 --> 00:24:47.821 where we'll shift the money over to a different one? 00:24:47.821 --> 00:24:51.580 Because the kind of private sector people 00:24:51.580 --> 00:24:53.707 who really understand that stuff, 00:24:53.707 --> 00:24:55.753 some of them work for us, 00:24:55.753 --> 00:24:59.693 and we're a trusted party on these things, 00:24:59.693 --> 00:25:04.315 we get to coordinate a lot, particularly that manufacturing piece. 00:25:04.631 --> 00:25:07.328 Usually, you'd expect the US 00:25:07.328 --> 00:25:11.281 to think of this as a global problem and be involved. 00:25:11.464 --> 00:25:18.115 So far, no activity on that front has taken place. 00:25:18.115 --> 00:25:22.305 I am talking to people in the Congress and the Administration 00:25:22.305 --> 00:25:25.124 about when the next relief bill comes along 00:25:25.415 --> 00:25:28.025 that maybe one percent of that 00:25:28.025 --> 00:25:30.419 could go for the tools 00:25:30.419 --> 00:25:32.467 to help the entire world. 00:25:32.467 --> 00:25:34.958 And so it's possible, 00:25:35.141 --> 00:25:37.287 but it's unfortunate, 00:25:37.287 --> 00:25:40.411 and the vacuum here 00:25:40.411 --> 00:25:42.240 the world is not that used to 00:25:42.240 --> 00:25:44.734 and a lot of people are stepping in, 00:25:44.734 --> 00:25:46.397 including our foundation, 00:25:46.397 --> 00:25:48.991 to try and have a strategy, 00:25:48.991 --> 00:25:50.986 including for the poorer countries 00:25:50.986 --> 00:25:57.004 who will suffer a high percentage of the deaths and negative effects, 00:25:57.305 --> 00:26:00.346 including their health systems being overwhelmed. 00:26:00.346 --> 00:26:03.368 Most of the deaths will be in developing countries, 00:26:03.368 --> 00:26:06.927 despite the huge deaths we've seen in Europe and the US. NOTE Paragraph 00:26:07.408 --> 00:26:10.619 CA: I mean, I wish I could be a fly on the wall and hearing 00:26:10.619 --> 00:26:12.313 you and Melinda talk about this, 00:26:12.313 --> 00:26:17.068 because of all of the ethical crimes, let's say, 00:26:17.068 --> 00:26:20.428 executed by leaders who should know better, 00:26:21.424 --> 00:26:25.689 I mean, it's one thing to not model mask-wearing, 00:26:25.689 --> 00:26:29.372 but to not play a role 00:26:29.372 --> 00:26:32.913 in helping the world when faced with a common enemy, 00:26:32.913 --> 00:26:35.873 respond as one humanity 00:26:35.873 --> 00:26:42.792 and instead catalyze a really unseemly scramble between nations 00:26:42.961 --> 00:26:45.585 to fight for vaccines, for example. 00:26:45.585 --> 00:26:51.421 That just seems that surely history is going to judge that harshly. 00:26:51.421 --> 00:26:54.149 That is just sickening. 00:26:54.149 --> 00:26:56.741 Isn't it? Am I missing something? NOTE Paragraph 00:26:56.741 --> 00:27:03.125 BG: Well, it's not quite as black and white as that. 00:27:03.125 --> 00:27:05.070 The US has put more money out 00:27:05.070 --> 00:27:08.545 to fund the basic research on these vaccines 00:27:08.545 --> 00:27:11.104 than any country by far, 00:27:11.104 --> 00:27:13.982 and that research is not restricted. 00:27:13.982 --> 00:27:17.672 There's not, like, some royalty that says, "Hey, if you take our money, 00:27:17.672 --> 00:27:19.751 you have to pay the US a royalty." 00:27:19.751 --> 00:27:22.527 They do, to the degree they fund research, 00:27:22.527 --> 00:27:23.791 it's for everybody. 00:27:23.791 --> 00:27:26.584 To the degree they fund factories, it's just for the US. 00:27:26.584 --> 00:27:31.173 The thing that makes this tough is that in every other global health problem, 00:27:31.173 --> 00:27:34.182 the US totally leads smallpox eradication, 00:27:34.182 --> 00:27:38.888 the US is totally the leader on polio eradication 00:27:38.888 --> 00:27:45.155 with key partners -- CDC, WHO, Rotary, UNICEF, our foundation. 00:27:45.155 --> 00:27:47.616 So the world, and on HIV, 00:27:47.616 --> 00:27:52.904 what under President Bush's leadership, but it was very bipartisan, 00:27:53.153 --> 00:27:56.611 this thing called PEPFAR was unbelievable. 00:27:56.611 --> 00:27:59.138 That has saved tens of millions of lives. 00:27:59.138 --> 00:28:03.186 And so it's that the world always expected the US 00:28:03.186 --> 00:28:04.990 to at least be at the head of the table, 00:28:04.990 --> 00:28:10.428 financially, strategy, OK, how do you get these factories for the world, 00:28:10.428 --> 00:28:14.941 even if it's just to avoid the infection coming back to the US 00:28:14.941 --> 00:28:17.105 or to have the global economy working, 00:28:17.105 --> 00:28:18.818 which is good for US jobs 00:28:18.818 --> 00:28:21.844 to have demand outside the US. 00:28:22.043 --> 00:28:25.755 And so the world is kind of, there's all this uncertainty 00:28:25.755 --> 00:28:27.447 about which thing will work, 00:28:27.447 --> 00:28:30.605 and there's, OK, who is in charge here? 00:28:30.605 --> 00:28:33.698 And so the worst thing, 00:28:33.698 --> 00:28:35.761 the withdrawal from WHO, 00:28:35.761 --> 00:28:37.997 that is a difficulty 00:28:37.997 --> 00:28:43.657 that hopefully will get remedied at some point, 00:28:43.657 --> 00:28:47.158 because we need that coordination 00:28:47.158 --> 00:28:49.520 through WHO. NOTE Paragraph 00:28:49.719 --> 00:28:53.515 CA: Let's take another question. 00:28:55.025 --> 00:28:58.861 Ali Kashani: "Are there any particularly successful models 00:28:58.861 --> 00:29:02.702 of handling the pandemic that you have seen around the world?" NOTE Paragraph 00:29:03.771 --> 00:29:08.172 BG: Well, it's fascinating that, besides early action, 00:29:08.172 --> 00:29:11.665 there are definitely things where you take people who have tested positive 00:29:11.665 --> 00:29:14.324 and you monitor their ??, 00:29:14.324 --> 00:29:18.267 which is a oxygen saturation level in their blood, 00:29:18.267 --> 00:29:20.176 which is a very cheap detector, 00:29:20.176 --> 00:29:23.302 and then you know to get them to the hospitals fairly early. 00:29:23.302 --> 00:29:27.763 Weirdly, patients don't know things are about to get severe. 00:29:28.092 --> 00:29:34.991 It's an interesting physiological reason that I won't get into. 00:29:34.991 --> 00:29:39.981 And so Germany has a quite a low case fatality rate 00:29:39.981 --> 00:29:42.658 that they've done through that type of monitoring. 00:29:42.856 --> 00:29:45.783 And then, of course, once you get into facilities, 00:29:45.783 --> 00:29:50.870 we've learned that the ventilator actually, although extremely well-meaning, 00:29:50.870 --> 00:29:54.147 was actually overused and used in the wrong mode 00:29:54.147 --> 00:29:56.025 in those early days. 00:29:56.226 --> 00:29:59.258 So the health, the doctors 00:29:59.258 --> 00:30:02.792 are way smarter about treatment today. 00:30:03.024 --> 00:30:05.054 Most of that I would say is global. 00:30:05.054 --> 00:30:07.813 Using this ?? as an early indicator, 00:30:07.813 --> 00:30:09.807 that'll probably catch on broadly, 00:30:09.807 --> 00:30:12.152 but Germany was a pioneer there. 00:30:12.320 --> 00:30:14.812 And now, of course, dexamethasone, 00:30:14.812 --> 00:30:18.388 fortunately, it's cheap, it's oral, 00:30:18.388 --> 00:30:20.215 we can ramp up manufacture. 00:30:20.215 --> 00:30:22.727 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.