1 00:00:00,001 --> 00:00:02,806 Chris Anderson: Welcome, Bill Gates. 2 00:00:02,830 --> 00:00:04,127 Bill Gates: Thank you. 3 00:00:04,151 --> 00:00:06,552 CA: Alright. It's great to have you here, Bill. 4 00:00:06,576 --> 00:00:09,310 You know, we had a TED conversation about three months ago 5 00:00:09,334 --> 00:00:10,494 about this pandemic, 6 00:00:10,518 --> 00:00:14,044 and back then, I think fewer than -- I think that was the end of March -- 7 00:00:14,068 --> 00:00:16,854 back then, fewer than 1,000 people in the US had died 8 00:00:16,878 --> 00:00:19,934 and fewer than 20,000 worldwide. 9 00:00:19,958 --> 00:00:24,326 I mean, the numbers now are, like, 128,000 dead in the US 10 00:00:24,350 --> 00:00:27,127 and more than half a million worldwide, 11 00:00:27,151 --> 00:00:28,650 in three months. 12 00:00:28,674 --> 00:00:30,021 In three months. 13 00:00:30,045 --> 00:00:34,942 What is your diagnosis of what is possible for the rest of this year? 14 00:00:34,966 --> 00:00:37,174 You look at a lot of models. 15 00:00:37,198 --> 00:00:40,957 What do you think best- and worst-case scenarios might be? 16 00:00:43,105 --> 00:00:46,488 BG: Well, the range of scenarios, sadly, is quite large, 17 00:00:46,512 --> 00:00:51,124 including that, as we get into the fall, 18 00:00:51,148 --> 00:00:56,488 we could have death rates that rival the worst of what we had 19 00:00:56,512 --> 00:00:58,499 in the April time period. 20 00:00:58,523 --> 00:01:00,683 If you get a lot of young people infected, 21 00:01:00,707 --> 00:01:03,839 eventually, they will infect old people again, 22 00:01:03,863 --> 00:01:06,842 and so you'll get into the nursing homes, 23 00:01:06,866 --> 00:01:08,023 the homeless shelters, 24 00:01:08,047 --> 00:01:11,723 the places where we've had a lot of our deaths. 25 00:01:11,747 --> 00:01:15,181 The innovation track, which probably we'll touch on -- 26 00:01:15,205 --> 00:01:17,653 diagnostics, therapeutics, vaccines -- 27 00:01:17,677 --> 00:01:20,334 there's good progress there, 28 00:01:20,358 --> 00:01:24,141 but nothing that would fundamentally alter the fact 29 00:01:24,165 --> 00:01:28,063 that this fall in the United States could be quite bad, 30 00:01:28,087 --> 00:01:32,652 and that's worse than I would have expected a month ago, 31 00:01:32,676 --> 00:01:35,745 the degree to which we're back at high mobility, 32 00:01:35,769 --> 00:01:37,210 not wearing masks, 33 00:01:37,234 --> 00:01:42,127 and now the virus actually has gotten into a lot of cities 34 00:01:42,151 --> 00:01:47,650 that it hadn't been in before in a significant way, 35 00:01:47,674 --> 00:01:50,756 so it's going to be a challenge. 36 00:01:50,780 --> 00:01:54,297 There's no case where we get much below the current death rate, 37 00:01:54,321 --> 00:01:57,574 which is about 500 deaths a day, 38 00:01:57,598 --> 00:02:01,118 but there's a significant risk we'd go back up 39 00:02:01,142 --> 00:02:06,128 to the even 2,000 a day that we had before, 40 00:02:06,152 --> 00:02:09,829 because we don't have the distancing, 41 00:02:09,853 --> 00:02:11,385 the behavior change, 42 00:02:11,409 --> 00:02:15,733 to the degree that we had in April and May. 43 00:02:15,757 --> 00:02:19,242 And we know this virus is somewhat seasonal, 44 00:02:19,266 --> 00:02:21,571 so that the force of infection, 45 00:02:21,595 --> 00:02:25,065 both through temperature, humidity, more time indoors, 46 00:02:25,089 --> 00:02:27,337 will be worse as we get into the fall. 47 00:02:28,258 --> 00:02:30,271 CA: So there are scenarios where in the US, 48 00:02:30,295 --> 00:02:32,539 like, if you extrapolate those numbers forward, 49 00:02:32,563 --> 00:02:33,763 we end up with, what, 50 00:02:33,787 --> 00:02:36,355 more than a quarter of a million deaths, perchance, 51 00:02:36,379 --> 00:02:39,087 even this year if we're not careful, 52 00:02:39,111 --> 00:02:42,544 and worldwide, I guess the death toll could, by the end of the year, 53 00:02:42,568 --> 00:02:45,774 be well into the millions, with an "s." 54 00:02:45,798 --> 00:02:49,114 Is there evidence that the hotter temperatures of the summer 55 00:02:49,138 --> 00:02:51,802 actually have been helping us? 56 00:02:53,004 --> 00:02:54,913 BG: They're not absolutely sure, 57 00:02:54,937 --> 00:03:01,937 but certainly, the IHME model definitely wanted to use the season, 58 00:03:01,961 --> 00:03:03,653 including temperature and humidity, 59 00:03:03,677 --> 00:03:08,764 to try and explain why May wasn't worse than it was. 60 00:03:08,788 --> 00:03:14,117 And so as we came out and the mobility numbers got higher, 61 00:03:14,141 --> 00:03:20,242 the models expected more infections and deaths to come out of that, 62 00:03:20,266 --> 00:03:22,827 and the model kept wanting to say, 63 00:03:22,851 --> 00:03:27,123 "But I need to use this seasonality 64 00:03:28,018 --> 00:03:30,142 to match why May wasn't worse, 65 00:03:30,166 --> 00:03:34,182 why June wasn't worse than it was." 66 00:03:34,206 --> 00:03:39,487 And we see in the Southern Hemisphere, 67 00:03:39,511 --> 00:03:41,822 you know, Brazil, 68 00:03:41,846 --> 00:03:43,815 which is the opposite season, 69 00:03:43,839 --> 00:03:48,093 now all of South America is having a huge epidemic. 70 00:03:48,117 --> 00:03:53,139 South Africa is having a very fast-growing epidemic. 71 00:03:53,163 --> 00:03:55,141 Fortunately, Australia and New Zealand, 72 00:03:55,165 --> 00:03:57,318 the last countries in the Southern Hemisphere, 73 00:03:57,342 --> 00:03:59,456 are at really tiny case counts, 74 00:03:59,480 --> 00:04:03,014 and so although they have to keep knocking it down, 75 00:04:03,038 --> 00:04:05,685 they're talking about, "Oh, we have 10 cases, 76 00:04:05,709 --> 00:04:09,009 that's a big deal, let's go get rid of that." 77 00:04:09,033 --> 00:04:14,350 So they're one of these amazing countries that got the numbers so low 78 00:04:14,374 --> 00:04:18,016 that test, quarantine and trace 79 00:04:18,040 --> 00:04:23,085 is working to get them, keep them at very near zero. 80 00:04:23,109 --> 00:04:26,535 CA: Aided perhaps a bit by being easier to isolate 81 00:04:26,559 --> 00:04:29,602 and by less density, less population density. 82 00:04:29,626 --> 00:04:31,994 But nonetheless, smart policies down there. 83 00:04:32,018 --> 00:04:33,946 BG: Yeah, everything is so exponential 84 00:04:33,970 --> 00:04:36,908 that a little bit of good work goes a long way. 85 00:04:36,932 --> 00:04:38,841 It's not a linear game. 86 00:04:38,865 --> 00:04:43,549 You know, contact tracing, if you have the number of cases we have in the US, 87 00:04:43,573 --> 00:04:45,810 it's super important to do, 88 00:04:45,834 --> 00:04:48,274 but it won't get you back down to zero. 89 00:04:48,298 --> 00:04:49,897 It'll help you be down, 90 00:04:49,921 --> 00:04:52,633 but it's too overwhelming. 91 00:04:53,111 --> 00:04:56,355 CA: OK, so in May and June in the US, 92 00:04:56,379 --> 00:04:59,578 the numbers were slightly better than some of the models predicted, 93 00:04:59,602 --> 00:05:03,293 and it's hypothesized that that might be partly because of the warmer weather. 94 00:05:03,317 --> 00:05:05,708 Now we're seeing, really, would you describe it 95 00:05:05,732 --> 00:05:10,961 as really quite alarming upticks in case rates in the US? 96 00:05:11,711 --> 00:05:13,071 BG: That's right, it's -- 97 00:05:13,603 --> 00:05:17,579 In, say, the New York area, 98 00:05:17,603 --> 00:05:20,715 the cases continue to go down somewhat, 99 00:05:20,739 --> 00:05:22,896 but in other parts of the country, 100 00:05:22,920 --> 00:05:26,390 primarily the South right now, 101 00:05:26,414 --> 00:05:28,510 you have increases that are offsetting that, 102 00:05:28,534 --> 00:05:32,221 and you have testing-positive rates in young people 103 00:05:32,245 --> 00:05:38,505 that are actually higher than what we saw even in some of the tougher areas. 104 00:05:38,529 --> 00:05:42,955 And so, clearly, younger people have come out of mobility 105 00:05:42,979 --> 00:05:46,788 more than older people have increased their mobility, 106 00:05:46,812 --> 00:05:51,355 so the age structure is right now very young, 107 00:05:51,379 --> 00:05:54,490 but because of multigenerational households, 108 00:05:54,514 --> 00:05:56,807 people work in nursing care homes, 109 00:05:56,831 --> 00:06:00,709 unfortunately, that will work its way back, 110 00:06:00,733 --> 00:06:03,188 both the time lag and the transmission, 111 00:06:03,212 --> 00:06:04,853 back up into the elderly, 112 00:06:04,877 --> 00:06:07,367 will start to push the death rate back up, 113 00:06:07,391 --> 00:06:10,409 which, it is down -- 114 00:06:10,433 --> 00:06:15,008 way down from 2,000 to around 500 right now. 115 00:06:15,653 --> 00:06:18,467 CA: And is that partly because there's a three-week lag 116 00:06:18,491 --> 00:06:21,631 between case numbers and fatality numbers? 117 00:06:21,655 --> 00:06:23,982 And also, perhaps, partly because 118 00:06:24,006 --> 00:06:26,899 there have been some effective interventions, 119 00:06:26,923 --> 00:06:29,346 and we're actually seeing the possibility 120 00:06:29,370 --> 00:06:32,076 that the overall fatality rate is actually falling a bit 121 00:06:32,100 --> 00:06:34,234 now that we've gained some extra knowledge? 122 00:06:34,822 --> 00:06:38,667 BG: Yeah, certainly your fatality rate is always lower 123 00:06:38,691 --> 00:06:40,277 when you're not overloaded. 124 00:06:40,301 --> 00:06:43,445 And so Italy, when they were overloaded, 125 00:06:43,469 --> 00:06:46,108 Spain, even New York at the start, 126 00:06:46,132 --> 00:06:48,569 certainly China, 127 00:06:48,593 --> 00:06:53,857 there you weren't even able to provide the basics, 128 00:06:53,881 --> 00:06:56,674 the oxygen and things. 129 00:06:56,698 --> 00:07:00,267 A study that our foundation funded in the UK 130 00:07:00,291 --> 00:07:03,633 found the only thing other than remdesivir 131 00:07:03,657 --> 00:07:06,429 that is a proven therapeutic, 132 00:07:06,453 --> 00:07:08,435 which is the dexamethasone, 133 00:07:08,459 --> 00:07:11,159 that for serious patients, 134 00:07:11,183 --> 00:07:15,213 is about a 20 percent death reduction, 135 00:07:15,237 --> 00:07:20,288 and there's still quite a pipeline of those things. 136 00:07:20,312 --> 00:07:23,835 You know, hydroxychloroquine never established positive data, 137 00:07:23,859 --> 00:07:26,161 so that's pretty much done. 138 00:07:26,185 --> 00:07:28,528 There's still a few trials ongoing, 139 00:07:28,552 --> 00:07:31,145 but the list of things being tried, 140 00:07:31,169 --> 00:07:35,545 including, eventually, the monoclonal antibodies, 141 00:07:35,569 --> 00:07:39,008 we will have some additional tools for the fall. 142 00:07:39,032 --> 00:07:42,686 And so when you talk about death rates, 143 00:07:42,710 --> 00:07:46,162 the good news is, some innovation we already have, 144 00:07:46,186 --> 00:07:49,956 and we'll have more, even in the fall. 145 00:07:49,980 --> 00:07:53,244 We should start to have monoclonal antibodies, 146 00:07:53,268 --> 00:07:57,850 which is the single therapeutic that I'm most excited about. 147 00:07:57,874 --> 00:08:01,232 CA: I'll actually ask you to tell me a bit more about that in one sec, 148 00:08:01,256 --> 00:08:03,707 but just putting the pieces together on death rates: 149 00:08:03,731 --> 00:08:05,637 so in a well-functioning health system, 150 00:08:05,661 --> 00:08:09,324 so take the US when places aren't overcrowded, 151 00:08:09,348 --> 00:08:11,288 what do you think 152 00:08:11,312 --> 00:08:14,887 the current fatality numbers are, approximately, going forward, 153 00:08:14,911 --> 00:08:17,001 like as a percentage of total cases? 154 00:08:17,025 --> 00:08:19,568 Are we below one percent, perhaps? 155 00:08:20,488 --> 00:08:23,182 BG: If you found every case, yes, 156 00:08:23,206 --> 00:08:25,985 you're well below one percent. 157 00:08:26,009 --> 00:08:31,066 People argue, you know, 0.4, 0.5. 158 00:08:31,090 --> 00:08:34,583 By the time you bring in the never symptomatics, 159 00:08:34,607 --> 00:08:37,194 it probably is below 0.5, 160 00:08:37,218 --> 00:08:38,741 and that's good news. 161 00:08:38,765 --> 00:08:43,328 This disease could have been a five-percent disease. 162 00:08:43,796 --> 00:08:46,991 The transmission dynamics of this disease 163 00:08:47,015 --> 00:08:54,015 are more difficult than even the experts predicted. 164 00:08:54,039 --> 00:08:58,811 The amount of presymptomatic and never symptomatic spread 165 00:08:58,835 --> 00:09:01,101 and the fact that it's not coughing, 166 00:09:01,125 --> 00:09:03,669 where you would kind of notice, "Hey, I'm coughing" -- 167 00:09:03,693 --> 00:09:06,383 most respiratory diseases make you cough. 168 00:09:06,407 --> 00:09:09,391 This one, in its early stages, it's not coughing, 169 00:09:09,415 --> 00:09:13,370 it's singing, laughing, talking, 170 00:09:13,394 --> 00:09:16,023 actually, still, particularly for the super-spreaders, 171 00:09:16,047 --> 00:09:17,757 people with very high viral loads, 172 00:09:17,781 --> 00:09:18,933 causes that spread, 173 00:09:18,957 --> 00:09:21,893 and that's pretty novel, 174 00:09:21,917 --> 00:09:25,971 and so even the experts have to say, "Wow, this caught us by surprise." 175 00:09:25,995 --> 00:09:27,637 The amount of asymptomatic spread 176 00:09:27,661 --> 00:09:30,164 and the fact that there's not a coughing element 177 00:09:30,188 --> 00:09:33,339 is not a major piece like the flu or TB. 178 00:09:33,901 --> 00:09:36,844 CA: Yeah, that is devilish cunning by the virus. 179 00:09:36,868 --> 00:09:41,564 I mean, how much is that nonsymptomatic transmission 180 00:09:41,588 --> 00:09:43,503 as a percentage of total transmission? 181 00:09:43,527 --> 00:09:46,891 I've heard numbers it could be as much as half of all transmissions 182 00:09:46,915 --> 00:09:49,225 are basically presymptomatic. 183 00:09:49,982 --> 00:09:52,578 BG: Yeah, if you count presymptomatics, 184 00:09:52,602 --> 00:09:56,568 then most of the studies show that's like at 40 percent, 185 00:09:57,044 --> 00:10:00,767 and we also have never symptomatics. 186 00:10:00,791 --> 00:10:04,169 The amount of virus you get in your upper respiratory area 187 00:10:04,193 --> 00:10:05,634 is somewhat disconnected. 188 00:10:05,658 --> 00:10:08,678 Some people will have a lot here and very little in their lungs, 189 00:10:08,702 --> 00:10:13,729 and what you get in your lungs causes the really bad symptoms -- 190 00:10:13,753 --> 00:10:16,896 and other organs, but mostly the lungs -- 191 00:10:16,920 --> 00:10:19,234 and so that's when you seek treatment. 192 00:10:19,258 --> 00:10:21,318 And so the worst case in terms of spreading 193 00:10:21,342 --> 00:10:24,451 is somebody who's got a lot in the upper respiratory tract 194 00:10:24,475 --> 00:10:26,689 but almost none in their lungs, 195 00:10:26,713 --> 00:10:29,006 so they're not care-seeking. 196 00:10:29,892 --> 00:10:31,058 CA: Right. 197 00:10:31,082 --> 00:10:34,024 And so if you add in the never symptomatic 198 00:10:34,048 --> 00:10:36,420 to the presymptomatic, 199 00:10:36,444 --> 00:10:38,691 do you get above 50 percent of the transmission 200 00:10:38,715 --> 00:10:40,994 is actually from nonsymptomatic people? 201 00:10:41,018 --> 00:10:45,056 BG: Yeah, transmission is harder to measure. 202 00:10:45,080 --> 00:10:48,829 You know, we see certain hotspots and things, 203 00:10:48,853 --> 00:10:51,658 but that's a huge question with the vaccine: 204 00:10:51,682 --> 00:10:55,972 Will it, besides avoiding you getting sick, 205 00:10:55,996 --> 00:10:57,755 which is what the trial will test, 206 00:10:57,779 --> 00:11:01,193 will it also stop you from being a transmitter? 207 00:11:01,217 --> 00:11:02,424 CA: So that vaccine, 208 00:11:02,448 --> 00:11:05,036 it's such an important question, let's come on to that. 209 00:11:05,060 --> 00:11:06,244 But before we go there, 210 00:11:06,268 --> 00:11:08,416 any other surprises in the last couple months 211 00:11:08,440 --> 00:11:10,370 that we've learned about this virus 212 00:11:10,394 --> 00:11:13,909 that really impact how we should respond to it? 213 00:11:14,846 --> 00:11:19,612 BG: We're still not able to characterize who the super-spreaders are 214 00:11:19,636 --> 00:11:21,934 in terms of what that profile is, 215 00:11:21,958 --> 00:11:23,365 and we may never. 216 00:11:23,389 --> 00:11:25,394 That may just be quite random. 217 00:11:25,418 --> 00:11:28,329 If you could identify them, 218 00:11:28,353 --> 00:11:30,866 they're responsible for the majority of transmission, 219 00:11:30,890 --> 00:11:33,829 a few people who have very high viral loads. 220 00:11:33,853 --> 00:11:38,764 But sadly, we haven't figured that out. 221 00:11:38,788 --> 00:11:40,090 This mode of transmission, 222 00:11:40,114 --> 00:11:42,764 if you're in a room and nobody talks, 223 00:11:42,788 --> 00:11:45,804 there's way less transmission. 224 00:11:45,828 --> 00:11:48,826 That's partly why, although planes can transmit, 225 00:11:48,850 --> 00:11:53,887 it's less than you would expect just in terms of time proximity measures, 226 00:11:53,911 --> 00:11:57,460 because unlike, say, a choir or a restaurant, 227 00:11:57,484 --> 00:12:03,285 you're not exhaling in loud talking 228 00:12:03,309 --> 00:12:05,897 quite as much as in other indoor environments. 229 00:12:05,921 --> 00:12:07,095 CA: Hmm. 230 00:12:07,119 --> 00:12:10,407 What do you think about the ethics of someone who would go on a plane 231 00:12:10,431 --> 00:12:11,955 and refuse to wear a mask? 232 00:12:11,979 --> 00:12:15,156 BG: If they own the plane, that would be fine. 233 00:12:15,180 --> 00:12:18,033 If there's other people on the plane, 234 00:12:18,057 --> 00:12:21,091 that would be endangering those other people. 235 00:12:21,115 --> 00:12:22,593 CA: Early on in the pandemic, 236 00:12:22,617 --> 00:12:27,787 the WHO did not advise that people wear masks. 237 00:12:27,811 --> 00:12:33,250 They were worried about taking them away from frontline medical providers. 238 00:12:33,274 --> 00:12:37,566 In retrospect, was that a terrible mistake that they made? 239 00:12:38,000 --> 00:12:39,541 BG: Yes. 240 00:12:40,420 --> 00:12:46,226 All the experts feel bad that the value of masks -- 241 00:12:46,250 --> 00:12:49,271 which ties back somewhat to the asymptomatics; 242 00:12:49,295 --> 00:12:52,313 if people were very symptomatic, 243 00:12:52,337 --> 00:12:54,839 like an Ebola, 244 00:12:55,498 --> 00:12:59,570 then you know it and you isolate, 245 00:12:59,594 --> 00:13:02,888 and so you don't have a need for a masklike thing. 246 00:13:03,381 --> 00:13:05,585 The value of masks, 247 00:13:05,609 --> 00:13:09,427 the fact that the medical masks was a different supply chain 248 00:13:09,451 --> 00:13:12,001 than the normal masks, 249 00:13:12,025 --> 00:13:14,939 the fact you could scale up the normal masks so well, 250 00:13:14,963 --> 00:13:18,696 the fact that it would stop that presymptomatic, 251 00:13:18,720 --> 00:13:20,523 never symptomatic transmission, 252 00:13:20,547 --> 00:13:22,391 it's a mistake. 253 00:13:22,415 --> 00:13:25,569 But it's not a conspiracy. 254 00:13:25,593 --> 00:13:29,469 It's something that, we now know more. 255 00:13:29,493 --> 00:13:32,125 And even now, our error bars on the benefit of masks 256 00:13:32,149 --> 00:13:33,942 are higher than we'd like to admit, 257 00:13:33,966 --> 00:13:35,960 but it's a significant benefit. 258 00:13:36,798 --> 00:13:39,301 CA: Alright, I'm going to come in with some questions 259 00:13:39,325 --> 00:13:40,641 from the community. 260 00:13:42,805 --> 00:13:44,353 Let's pull them up there. 261 00:13:44,957 --> 00:13:50,510 Jim Pitofsky, "Do you think reopening efforts in the US have been premature, 262 00:13:50,534 --> 00:13:55,847 and if so, how far should the US go to responsibly confront this pandemic?" 263 00:13:57,963 --> 00:14:01,049 BG: Well, the question of how you make trade-offs 264 00:14:01,073 --> 00:14:05,702 between the benefits, say, of going to school 265 00:14:05,726 --> 00:14:10,180 versus the risk of people getting sick because they go to school, 266 00:14:10,204 --> 00:14:13,137 those are very tough questions 267 00:14:13,161 --> 00:14:20,029 that I don't think any single person can say, 268 00:14:20,053 --> 00:14:24,025 "I will tell you how to make all these trade-offs." 269 00:14:24,375 --> 00:14:28,380 The understanding of where you have transmission, 270 00:14:28,404 --> 00:14:31,323 and the fact that young people do get infected 271 00:14:31,347 --> 00:14:35,639 and are part of the multigenerational transmission chain, 272 00:14:35,663 --> 00:14:37,926 we should get that out. 273 00:14:37,950 --> 00:14:40,374 If you just look at the health aspect, 274 00:14:40,398 --> 00:14:43,453 we have opened up too liberally. 275 00:14:43,477 --> 00:14:47,072 Now, opening up in terms of mental health 276 00:14:47,096 --> 00:14:54,096 and seeking normal health things like vaccines or other care, 277 00:14:54,120 --> 00:14:56,465 there are benefits. 278 00:14:56,489 --> 00:15:02,399 I think some of our opening up has created more risk than benefit. 279 00:15:02,423 --> 00:15:05,133 Opening the bars up as quickly as they did, 280 00:15:05,157 --> 00:15:07,712 you know, is that critical for mental health? 281 00:15:07,736 --> 00:15:09,404 Maybe not. 282 00:15:09,428 --> 00:15:13,481 So I don't think we've been as tasteful about opening up 283 00:15:13,505 --> 00:15:19,228 as I'm sure, as we study it, 284 00:15:19,252 --> 00:15:25,396 that we'll realize some things we shouldn't have opened up as fast. 285 00:15:25,420 --> 00:15:27,336 But then you have something like school, 286 00:15:27,360 --> 00:15:30,072 where even sitting here today, 287 00:15:30,096 --> 00:15:35,469 the exact plan, say, for inner-city schools for the fall, 288 00:15:35,493 --> 00:15:38,848 I wouldn't have a black-and-white view 289 00:15:38,872 --> 00:15:43,665 on the relative trade-offs involved there. 290 00:15:44,159 --> 00:15:50,202 There are huge benefits to letting those kids go to school, 291 00:15:50,226 --> 00:15:53,563 and how do you weigh the risk? 292 00:15:53,587 --> 00:15:57,455 If you're in a city without many cases, 293 00:15:57,479 --> 00:16:01,023 I would say probably the benefit is there. 294 00:16:01,047 --> 00:16:03,499 Now that means that you could get surprised. 295 00:16:03,523 --> 00:16:06,645 The cases could show up, and then you'd have to change that, 296 00:16:06,669 --> 00:16:08,199 which is not easy. 297 00:16:08,223 --> 00:16:10,774 But I think around the US, 298 00:16:10,798 --> 00:16:15,599 there will be places where that won't be a good trade-off. 299 00:16:15,623 --> 00:16:18,225 So almost any dimension of inequity, 300 00:16:18,249 --> 00:16:22,652 this disease has made worse: 301 00:16:22,676 --> 00:16:27,707 job type, internet connection, 302 00:16:27,731 --> 00:16:31,372 ability of your school to do online learning. 303 00:16:31,396 --> 00:16:33,801 White-collar workers, 304 00:16:33,825 --> 00:16:35,528 people are embarrassed to admit it, 305 00:16:35,552 --> 00:16:37,726 some of them are more productive 306 00:16:37,750 --> 00:16:42,890 and enjoying the flexibility that the at-home thing has created, 307 00:16:42,914 --> 00:16:44,671 and that feels terrible 308 00:16:44,695 --> 00:16:49,793 when you know lots of people are suffering in many ways, 309 00:16:49,817 --> 00:16:52,903 including their kids not going to school. 310 00:16:52,927 --> 00:16:54,942 CA: Indeed. Let's have the next question. 311 00:16:54,966 --> 00:16:56,957 [Nathalie Munyampenda] "For us in Rwanda, 312 00:16:56,981 --> 00:16:59,452 early policy interventions have made the difference. 313 00:16:59,476 --> 00:17:03,446 At this point, what policy interventions do you suggest for the US now?" 314 00:17:03,470 --> 00:17:05,952 Bill, I dream of the day where you are appointed 315 00:17:05,952 --> 00:17:07,545 the coronavirus czar 316 00:17:07,545 --> 00:17:10,251 with authority to actually speak to the public. 317 00:17:10,275 --> 00:17:12,281 What would you do? 318 00:17:13,538 --> 00:17:18,147 BG: Well, the innovation tools 319 00:17:18,171 --> 00:17:22,712 are where I and the foundation probably has the most expertise. 320 00:17:23,174 --> 00:17:27,165 Clearly, some of the policies on opening up have been too generous, 321 00:17:27,189 --> 00:17:30,450 but I think everybody 322 00:17:31,471 --> 00:17:35,624 could engage in that. 323 00:17:36,146 --> 00:17:37,324 We need leadership 324 00:17:37,348 --> 00:17:43,123 in terms of admitting that we've still got a huge problem here 325 00:17:43,147 --> 00:17:47,071 and not turning that into almost a political thing 326 00:17:47,095 --> 00:17:51,852 of, "Oh, isn't it brilliant what we did?" 327 00:17:51,876 --> 00:17:53,280 No, it's not brilliant, 328 00:17:53,304 --> 00:17:57,977 but there's many people, including the experts -- 329 00:17:58,001 --> 00:18:00,437 there's a lot they didn't understand, 330 00:18:00,461 --> 00:18:04,991 and everybody wishes a week earlier whatever action they took, 331 00:18:05,015 --> 00:18:07,333 they'd taken that a week earlier. 332 00:18:08,128 --> 00:18:09,314 The innovation tools, 333 00:18:09,338 --> 00:18:15,726 that's where the foundation's work 334 00:18:15,750 --> 00:18:18,988 on antibodies, vaccines, 335 00:18:19,012 --> 00:18:20,848 we have deep expertise, 336 00:18:20,872 --> 00:18:23,972 and it's outside of the private sector, 337 00:18:23,996 --> 00:18:28,145 and so we have kind of a neutral ability to work with all the governments 338 00:18:28,169 --> 00:18:30,150 and the companies to pick. 339 00:18:30,174 --> 00:18:32,580 Particularly when you're doing break-even products, 340 00:18:32,604 --> 00:18:34,698 which one should get the resources? 341 00:18:34,722 --> 00:18:38,666 There's no market signal for that. 342 00:18:38,690 --> 00:18:42,458 Experts have to say, "OK, this antibody deserves the manufacturing. 343 00:18:42,482 --> 00:18:45,098 This vaccine deserves the manufacturing," 344 00:18:45,122 --> 00:18:50,091 because we have very limited manufacturing for both of those things, 345 00:18:50,115 --> 00:18:53,912 and it'll be cross-company, which never happens in the normal case, 346 00:18:53,936 --> 00:18:55,806 where one company invents it 347 00:18:55,830 --> 00:18:59,777 and then you're using the manufacturing plants of many companies 348 00:18:59,801 --> 00:19:03,442 to get maximum scale of the best choice. 349 00:19:03,992 --> 00:19:06,631 So I would be coordinating those things, 350 00:19:06,655 --> 00:19:11,686 but we need a leader who keeps us up to date, 351 00:19:11,710 --> 00:19:14,422 is realistic 352 00:19:14,446 --> 00:19:16,631 and shows us the right behavior, 353 00:19:16,655 --> 00:19:18,944 as well as driving the innovation track. 354 00:19:20,246 --> 00:19:22,779 CA: I mean, you have to yourself be a master diplomat 355 00:19:22,803 --> 00:19:24,394 in how you talk about this stuff. 356 00:19:24,418 --> 00:19:26,539 So I appreciate, almost, the discomfort here. 357 00:19:26,563 --> 00:19:29,686 But I mean, you talk regularly with Anthony Fauci, 358 00:19:29,710 --> 00:19:34,801 who is a wise voice on this by most people's opinion. 359 00:19:34,825 --> 00:19:36,868 But to what extent is he just hamstrung? 360 00:19:36,892 --> 00:19:40,210 He's not allowed to play the full role 361 00:19:40,234 --> 00:19:42,592 that he could play in this circumstance. 362 00:19:43,171 --> 00:19:48,582 BG: Dr. Fauci has emerged where he was allowed to have some airtime, 363 00:19:48,606 --> 00:19:52,614 and even though he was stating things that are realistic, 364 00:19:52,638 --> 00:19:54,810 his prestige has stuck. 365 00:19:54,834 --> 00:19:56,652 He can speak out in that way. 366 00:19:56,676 --> 00:20:02,449 Typically, the CDC would be the primary voice here. 367 00:20:02,933 --> 00:20:04,895 It's not absolutely necessary, 368 00:20:04,919 --> 00:20:07,495 but in previous health crises, 369 00:20:07,519 --> 00:20:10,383 you let the experts inside the CDC 370 00:20:10,407 --> 00:20:11,774 be that voice. 371 00:20:11,798 --> 00:20:13,741 They're trained to do these things, 372 00:20:13,765 --> 00:20:19,810 and so it is a bit unusual here how much we've had to rely on Fauci 373 00:20:19,834 --> 00:20:21,645 as opposed to the CDC. 374 00:20:21,669 --> 00:20:25,520 It should be Fauci, who's a brilliant researcher, 375 00:20:25,544 --> 00:20:28,707 so experienced, particularly in vaccines. 376 00:20:28,731 --> 00:20:33,001 In some ways, he has become, taking the broad advice 377 00:20:33,025 --> 00:20:36,690 that's the epidemiology advice 378 00:20:36,714 --> 00:20:39,365 and explaining it in the right way, 379 00:20:39,389 --> 00:20:40,549 where he'll admit, 380 00:20:40,573 --> 00:20:43,988 "OK, we may have a rebound here, 381 00:20:44,012 --> 00:20:47,187 and this is why we need to behave that way." 382 00:20:47,211 --> 00:20:53,144 But it's fantastic that his voice has been allowed to come through. 383 00:20:53,817 --> 00:20:55,246 CA: Sometimes. 384 00:20:55,270 --> 00:20:57,233 Let's have the next question. 385 00:21:01,150 --> 00:21:03,802 Nina Gregory, "How are you and your foundation 386 00:21:03,826 --> 00:21:08,316 addressing the ethical questions about which countries get the vaccine first, 387 00:21:08,340 --> 00:21:10,017 assuming you find one?" 388 00:21:10,041 --> 00:21:12,050 And maybe, Bill, use this as a moment 389 00:21:12,050 --> 00:21:16,018 to just talk about where the quest for the vaccine is 390 00:21:16,042 --> 00:21:19,477 and what are just some of the key things we should all be thinking about 391 00:21:19,501 --> 00:21:21,293 as we track the news on this. 392 00:21:22,072 --> 00:21:26,404 BG: There's three vaccines that are, 393 00:21:26,428 --> 00:21:28,044 if they work, are the earliest: 394 00:21:28,068 --> 00:21:34,258 the Moderna, which unfortunately, won't scale very easily, 395 00:21:34,282 --> 00:21:38,232 so if that works, it'll be mostly a US-targeted thing; 396 00:21:38,984 --> 00:21:41,558 then you have the AstraZeneca, which comes from Oxford; 397 00:21:41,582 --> 00:21:42,914 and the Johnson and Johnson. 398 00:21:42,938 --> 00:21:44,625 Those are the three early ones. 399 00:21:44,649 --> 00:21:48,149 And we have animal data 400 00:21:48,173 --> 00:21:54,414 that looks potentially good but not definitive, 401 00:21:54,438 --> 00:21:56,550 particularly will it work in the elderly, 402 00:21:56,574 --> 00:21:59,776 and we'll have human data over the next several months. 403 00:21:59,800 --> 00:22:05,563 Those three will be gated by the safety and efficacy trial. 404 00:22:05,587 --> 00:22:07,666 That is, we'll be able to manufacture those, 405 00:22:07,690 --> 00:22:10,277 although not as much as we want. 406 00:22:10,301 --> 00:22:13,222 We'll be able to manufacture those before the end of the year. 407 00:22:13,246 --> 00:22:15,038 Whether the Phase 3 will succeed 408 00:22:15,062 --> 00:22:18,032 and whether it'll complete before the end of the year, 409 00:22:18,056 --> 00:22:21,704 I wouldn't be that optimistic about. 410 00:22:21,728 --> 00:22:26,320 Phase 3 is where you need to really look at all the safety profile 411 00:22:26,344 --> 00:22:27,510 and efficacy, 412 00:22:27,534 --> 00:22:29,064 but those will get started. 413 00:22:29,088 --> 00:22:33,782 And then there's four or five vaccines that use different approaches 414 00:22:33,806 --> 00:22:36,461 that are maybe three or four months behind that: 415 00:22:36,485 --> 00:22:40,846 Novavax, Sanofi, Merck. 416 00:22:40,870 --> 00:22:47,115 And so we're funding factory capacity for a lot of these -- 417 00:22:47,139 --> 00:22:53,419 some complex negotiations are taking place right now on this -- 418 00:22:53,443 --> 00:22:58,736 to get factories that will be dedicated to the poorer countries, 419 00:22:58,760 --> 00:23:01,304 what's called low- and middle-income. 420 00:23:01,328 --> 00:23:03,990 And the very scalable constructs 421 00:23:04,014 --> 00:23:08,647 that include AstraZeneca and Johnson and Johnson, 422 00:23:08,671 --> 00:23:09,954 we'll focus on those, 423 00:23:09,978 --> 00:23:11,474 the ones that are inexpensive 424 00:23:11,498 --> 00:23:15,300 and you can build a single factory to make 600 million doses. 425 00:23:15,324 --> 00:23:19,756 So a number of the vaccine constructs 426 00:23:19,780 --> 00:23:21,178 are potential. 427 00:23:21,202 --> 00:23:25,218 I don't see anything before the end of the year. 428 00:23:25,242 --> 00:23:27,188 That's really the best case, 429 00:23:27,212 --> 00:23:30,731 and it's down to a few constructs now, 430 00:23:30,755 --> 00:23:35,165 which, typically, you have high failure rates. 431 00:23:36,300 --> 00:23:37,496 CA: Bill, is it the case 432 00:23:37,520 --> 00:23:40,504 that if you and your foundation weren't in the picture here 433 00:23:40,528 --> 00:23:43,514 that market dynamics would likely lead to a situation 434 00:23:43,538 --> 00:23:47,391 where, as soon as a promising vaccine candidate emerged, 435 00:23:47,415 --> 00:23:50,175 the richer countries would basically snap up, gobble up 436 00:23:50,199 --> 00:23:52,968 all available initial supply -- 437 00:23:52,992 --> 00:23:55,056 it just takes a while to manufacture these, 438 00:23:55,080 --> 00:23:59,036 and there would be nothing for the poorer countries -- 439 00:23:59,060 --> 00:24:01,561 but that what, effectively, you're doing 440 00:24:01,585 --> 00:24:04,912 by giving manufacturing guarantees and capability 441 00:24:04,936 --> 00:24:06,837 to some of these candidates, 442 00:24:06,861 --> 00:24:13,354 you're making it possible that at least some of the early vaccine units 443 00:24:13,378 --> 00:24:15,735 will go to poorer countries? 444 00:24:15,759 --> 00:24:17,007 Is that correct? 445 00:24:17,031 --> 00:24:18,897 BG: Well, it's not just us, but yes, 446 00:24:18,921 --> 00:24:21,494 we're in the central role there, 447 00:24:21,518 --> 00:24:28,256 along with a group we created called CEPI, Coalition for Epidemic Preparedness, 448 00:24:28,280 --> 00:24:32,247 and the European leaders agree with this. 449 00:24:32,271 --> 00:24:35,299 Now we have the expertise to look at each of the constructs 450 00:24:35,323 --> 00:24:37,796 and say, "OK, where is there a factory in the world 451 00:24:37,820 --> 00:24:39,685 that has capacity that can build that? 452 00:24:39,709 --> 00:24:42,345 Which one should we put the early money into? 453 00:24:42,369 --> 00:24:43,840 What should the milestones be 454 00:24:43,864 --> 00:24:47,106 where we'll shift the money over to a different one?" 455 00:24:47,130 --> 00:24:51,309 Because the kind of private sector people 456 00:24:51,333 --> 00:24:53,971 who really understand that stuff, 457 00:24:53,995 --> 00:24:55,729 some of them work for us, 458 00:24:55,753 --> 00:24:59,669 and we're a trusted party on these things, 459 00:24:59,693 --> 00:25:05,033 we get to coordinate a lot of it, particularly that manufacturing piece. 460 00:25:05,374 --> 00:25:10,477 Usually, you'd expect the US to think of this as a global problem 461 00:25:10,501 --> 00:25:11,669 and be involved. 462 00:25:11,693 --> 00:25:17,709 So far, no activity on that front has taken place. 463 00:25:17,733 --> 00:25:22,086 I am talking to people in the Congress and the Administration 464 00:25:22,110 --> 00:25:25,472 about when the next relief bill comes along 465 00:25:25,496 --> 00:25:30,269 that maybe one percent of that could go for the tools 466 00:25:30,293 --> 00:25:32,223 to help the entire world. 467 00:25:32,247 --> 00:25:35,117 And so it's possible, 468 00:25:35,141 --> 00:25:36,972 but it's unfortunate, 469 00:25:36,996 --> 00:25:40,196 and the vacuum here, 470 00:25:40,220 --> 00:25:41,688 the world is not that used to, 471 00:25:41,712 --> 00:25:46,209 and a lot of people are stepping in, including our foundation, 472 00:25:46,233 --> 00:25:48,739 to try and have a strategy, 473 00:25:48,763 --> 00:25:50,866 including for the poorer countries, 474 00:25:50,890 --> 00:25:56,972 who will suffer a high percentage of the deaths and negative effects, 475 00:25:56,996 --> 00:26:00,229 including their health systems being overwhelmed. 476 00:26:00,253 --> 00:26:02,834 Most of the deaths will be in developing countries, 477 00:26:02,858 --> 00:26:06,574 despite the huge deaths we've seen in Europe and the US. 478 00:26:07,193 --> 00:26:09,456 CA: I mean, I wish I could be a fly on the wall 479 00:26:09,480 --> 00:26:11,769 and hearing you and Melinda talk about this, 480 00:26:11,793 --> 00:26:17,258 because of all of the ethical ... "crimes," let's say, 481 00:26:17,282 --> 00:26:21,106 executed by leaders who should know better, 482 00:26:21,130 --> 00:26:25,410 I mean, it's one thing to not model mask-wearing, 483 00:26:25,434 --> 00:26:31,655 but to not play a role in helping the world 484 00:26:31,679 --> 00:26:33,510 when faced with a common enemy, 485 00:26:33,534 --> 00:26:35,510 respond as one humanity, 486 00:26:35,534 --> 00:26:36,760 and instead ... 487 00:26:38,040 --> 00:26:42,817 you know, catalyze a really unseemly scramble between nations 488 00:26:42,841 --> 00:26:45,300 to fight for vaccines, for example. 489 00:26:45,324 --> 00:26:51,179 That just seems -- surely, history is going to judge that harshly. 490 00:26:51,203 --> 00:26:54,322 That is just sickening. 491 00:26:54,798 --> 00:26:56,796 Isn't it? Am I missing something? 492 00:26:56,820 --> 00:27:02,177 BG: Well, it's not quite as black-and-white as that. 493 00:27:02,201 --> 00:27:04,833 The US has put more money out 494 00:27:04,857 --> 00:27:08,290 to fund the basic research on these vaccines 495 00:27:08,314 --> 00:27:10,958 than any country by far, 496 00:27:10,982 --> 00:27:13,661 and that research is not restricted. 497 00:27:13,685 --> 00:27:17,314 There's not, like, some royalty that says, "Hey, if you take our money, 498 00:27:17,338 --> 00:27:19,410 you have to pay the US a royalty." 499 00:27:19,434 --> 00:27:22,359 They do, to the degree they fund research, 500 00:27:22,383 --> 00:27:23,567 it's for everybody. 501 00:27:23,591 --> 00:27:26,277 To the degree they fund factories, it's just for the US. 502 00:27:26,301 --> 00:27:30,802 The thing that makes this tough is that in every other global health problem, 503 00:27:30,826 --> 00:27:33,913 the US totally leads smallpox eradication, 504 00:27:33,937 --> 00:27:38,769 the US is totally the leader on polio eradication, 505 00:27:38,793 --> 00:27:44,891 with key partners -- CDC, WHO, Rotary, UNICEF, our foundation. 506 00:27:44,915 --> 00:27:48,074 So the world -- and on HIV, 507 00:27:48,098 --> 00:27:52,868 under President Bush's leadership, but it was very bipartisan, 508 00:27:52,892 --> 00:27:55,885 this thing called PEPFAR was unbelievable. 509 00:27:55,909 --> 00:27:58,618 That has saved tens of millions of lives. 510 00:27:58,642 --> 00:28:02,914 And so it's that the world always expected the US 511 00:28:02,938 --> 00:28:04,941 to at least be at the head of the table, 512 00:28:04,965 --> 00:28:10,697 financially, strategy, OK, how do you get these factories for the world, 513 00:28:10,721 --> 00:28:14,700 even if it's just to avoid the infection coming back to the US 514 00:28:14,724 --> 00:28:16,596 or to have the global economy working, 515 00:28:16,620 --> 00:28:18,610 which is good for US jobs 516 00:28:18,634 --> 00:28:21,966 to have demand outside the US. 517 00:28:21,990 --> 00:28:23,870 And so the world is kind of -- 518 00:28:23,894 --> 00:28:27,076 you know, there's all this uncertainty about which thing will work, 519 00:28:27,100 --> 00:28:31,013 and there's this, "OK, who's in charge here?" 520 00:28:31,037 --> 00:28:35,491 And so the worst thing, the withdrawal from WHO, 521 00:28:35,515 --> 00:28:42,288 that is a difficulty that hopefully will get remedied 522 00:28:42,312 --> 00:28:43,895 at some point, 523 00:28:43,919 --> 00:28:46,920 because we need that coordination 524 00:28:46,944 --> 00:28:48,455 through WHO. 525 00:28:49,488 --> 00:28:51,866 CA: Let's take another question. 526 00:28:55,661 --> 00:28:58,837 Ali Kashani, "Are there any particularly successful models 527 00:28:58,861 --> 00:29:01,873 of handling the pandemic that you have seen around the world?" 528 00:29:03,540 --> 00:29:08,028 BG: Well, it's fascinating that, besides early action, 529 00:29:08,052 --> 00:29:11,654 there are definitely things where you take people who have tested positive 530 00:29:11,678 --> 00:29:15,058 and you monitor their pulse ox, 531 00:29:15,082 --> 00:29:18,243 which is the oxygen saturation level in their blood, 532 00:29:18,267 --> 00:29:19,863 which is a very cheap detector, 533 00:29:19,887 --> 00:29:23,325 and then you know to get them to the hospitals fairly early. 534 00:29:23,349 --> 00:29:30,244 Weirdly, patients don't know things are about to get severe. 535 00:29:30,268 --> 00:29:34,531 It's an interesting physiological reason that I won't get into. 536 00:29:34,555 --> 00:29:39,577 And so Germany has quite a low case fatality rate 537 00:29:39,601 --> 00:29:42,547 that they've done through that type of monitoring. 538 00:29:42,571 --> 00:29:45,530 And then, of course, once you get into facilities, 539 00:29:45,554 --> 00:29:50,697 we've learned that the ventilator, actually, although extremely well-meaning, 540 00:29:50,721 --> 00:29:55,067 was actually overused and used in the wrong mode 541 00:29:55,091 --> 00:29:56,335 in those early days. 542 00:29:56,359 --> 00:30:02,917 So the health -- the doctors are way smarter about treatment today. 543 00:30:02,941 --> 00:30:05,293 Most of that, I would say, is global. 544 00:30:05,317 --> 00:30:07,587 Using this pulse ox as an early indicator, 545 00:30:07,611 --> 00:30:09,291 that'll probably catch on broadly, 546 00:30:09,315 --> 00:30:11,942 but Germany was a pioneer there. 547 00:30:11,966 --> 00:30:18,072 And now, of course, dexamethasone -- fortunately, it's cheap, it's oral, 548 00:30:18,096 --> 00:30:19,752 we can ramp up manufacture. 549 00:30:19,776 --> 00:30:22,727 That'll go global as well. 550 00:30:25,061 --> 00:30:28,850 CA: Bill, I want to ask you something about 551 00:30:28,874 --> 00:30:32,029 what it's been like for you personally through this whole process. 552 00:30:32,053 --> 00:30:38,070 Because, weirdly, even though your passion and good intent on this topic 553 00:30:38,094 --> 00:30:43,704 seems completely bloody obvious to anyone who has spent a moment with you, 554 00:30:43,728 --> 00:30:47,771 there are these crazy conspiracy theories out there about you. 555 00:30:47,795 --> 00:30:50,669 I just checked in with a company called Zignal 556 00:30:50,693 --> 00:30:53,082 that monitors social media spaces. 557 00:30:53,106 --> 00:30:57,285 They say that, to date, I think on Facebook alone, 558 00:30:57,309 --> 00:31:01,483 more than four million posts have taken place 559 00:31:01,507 --> 00:31:06,709 that associate you with some kind of conspiracy theory around the virus. 560 00:31:07,133 --> 00:31:13,094 I read that there was a poll that more than 40 percent of Republicans 561 00:31:13,118 --> 00:31:16,925 believe that the vaccine that you would roll out 562 00:31:16,949 --> 00:31:21,945 would somehow plant a microchip in people to track their location. 563 00:31:21,969 --> 00:31:26,471 I mean, I can't even believe that poll number. 564 00:31:27,376 --> 00:31:30,449 And then some people are taking this seriously enough, 565 00:31:30,473 --> 00:31:35,148 and some of them have even been recirculated on "Fox News" and so forth, 566 00:31:35,172 --> 00:31:37,429 some people are taking this seriously enough 567 00:31:37,453 --> 00:31:41,706 to make really quite horrible threats and so forth. 568 00:31:41,730 --> 00:31:45,504 You seem to do a good job sort of shrugging this off, 569 00:31:45,528 --> 00:31:48,942 but really, like, who else has ever been in this position? 570 00:31:48,966 --> 00:31:51,071 How are you managing this? 571 00:31:51,095 --> 00:31:54,082 What on earth world are we in 572 00:31:54,106 --> 00:31:56,478 that this kind of misinformation can be out there? 573 00:31:56,502 --> 00:31:58,253 What can we do to help correct it? 574 00:31:59,856 --> 00:32:03,101 BG: I'm not sure. 575 00:32:04,539 --> 00:32:06,931 And it's a new thing 576 00:32:08,380 --> 00:32:11,403 that there's conspiracy theories. 577 00:32:11,427 --> 00:32:13,917 I mean, Microsoft had its share of controversy, 578 00:32:13,941 --> 00:32:16,874 but at least that related to the real world, you know? 579 00:32:16,898 --> 00:32:20,535 Did Windows crash more than it should? 580 00:32:20,559 --> 00:32:22,399 We definitely had antitrust problems. 581 00:32:22,423 --> 00:32:25,302 But at least I knew what that was. 582 00:32:25,326 --> 00:32:27,242 When this emerged, I have to say, 583 00:32:27,266 --> 00:32:31,443 my instinct was to joke about it. 584 00:32:31,467 --> 00:32:33,853 People have said that's really inappropriate, 585 00:32:33,877 --> 00:32:36,654 because this is a very serious thing. 586 00:32:37,270 --> 00:32:42,135 It is going to make people less willing to take a vaccine. 587 00:32:42,159 --> 00:32:45,112 And, of course, once we have that vaccine, 588 00:32:45,136 --> 00:32:46,908 it'll be like masks, 589 00:32:46,932 --> 00:32:49,593 where getting lots of people, 590 00:32:49,617 --> 00:32:52,966 particularly when it's a transmission-blocking vaccine, 591 00:32:52,990 --> 00:32:55,573 there's this huge community benefit 592 00:32:55,597 --> 00:33:00,911 to widespread adoption of that vaccine. 593 00:33:00,935 --> 00:33:04,218 So I am caught a little bit, 594 00:33:04,242 --> 00:33:06,700 unsure of what to say or do, 595 00:33:06,724 --> 00:33:10,184 because the conspiracy piece is a new thing for me, 596 00:33:11,287 --> 00:33:14,853 and what do you say 597 00:33:14,877 --> 00:33:19,380 that doesn't give credence to the thing? 598 00:33:19,404 --> 00:33:24,455 The fact that a "Fox News" commentator, Laura Ingraham, 599 00:33:24,479 --> 00:33:26,941 was saying this stuff about me microchipping people, 600 00:33:26,965 --> 00:33:30,666 that survey isn't that surprising because that's what they heard 601 00:33:30,690 --> 00:33:32,885 on the TV. 602 00:33:33,418 --> 00:33:35,403 It's wild. 603 00:33:35,427 --> 00:33:38,720 And people are clearly seeking simpler explanations 604 00:33:38,744 --> 00:33:41,712 than going and studying virology. 605 00:33:43,379 --> 00:33:45,102 CA: I mean, 606 00:33:45,126 --> 00:33:46,551 TED is nonpolitical, 607 00:33:46,575 --> 00:33:49,312 but we believe in the truth. 608 00:33:49,336 --> 00:33:52,058 I would say this: 609 00:33:52,082 --> 00:33:56,174 Laura Ingraham, you owe Bill Gates an apology and a retraction. 610 00:33:56,198 --> 00:33:57,366 You do. 611 00:33:57,390 --> 00:33:58,948 And anyone who's watching this 612 00:33:58,972 --> 00:34:03,762 who thinks for a minute that this man is involved in some kind of conspiracy, 613 00:34:03,786 --> 00:34:05,121 you want your head examined. 614 00:34:05,145 --> 00:34:06,383 You are crazy. 615 00:34:06,407 --> 00:34:08,996 Enough of us know Bill over many years 616 00:34:09,020 --> 00:34:12,780 and have seen the passion and engagement in this to know 617 00:34:12,804 --> 00:34:14,368 that you are crazy. 618 00:34:14,392 --> 00:34:15,564 So get over it, 619 00:34:15,588 --> 00:34:19,293 and let's look at the actual problem of solving this pandemic. 620 00:34:19,317 --> 00:34:20,777 Honestly. 621 00:34:20,801 --> 00:34:22,956 If anyone in the chat here has a suggestion, 622 00:34:22,980 --> 00:34:25,575 a positive suggestion for how you can, 623 00:34:25,599 --> 00:34:27,450 how do you get rid of conspiracies, 624 00:34:27,474 --> 00:34:29,278 because they feed on each other. 625 00:34:29,302 --> 00:34:33,191 Now, "Oh, well I would say that, because I'm part of the conspiracy," 626 00:34:33,215 --> 00:34:34,405 or whatever. 627 00:34:34,429 --> 00:34:37,282 Like, how do we get back to a world 628 00:34:39,080 --> 00:34:40,753 where information can be trusted? 629 00:34:40,777 --> 00:34:42,675 We have to do better on it. 630 00:34:42,699 --> 00:34:45,493 Are there any other questions out there from the community? 631 00:34:50,912 --> 00:34:52,425 Aria Bendix from New York City: 632 00:34:52,449 --> 00:34:55,831 "What are your personal recommendations for those who want to reduce 633 00:34:55,855 --> 00:34:59,160 their risk of infection amid an uptick in cases?" 634 00:35:00,369 --> 00:35:03,144 BG: Well, it's great if you have a job 635 00:35:03,168 --> 00:35:10,176 that you can stay at your house and do it through digital meetings, 636 00:35:10,200 --> 00:35:14,491 and even some of your social activities, 637 00:35:14,515 --> 00:35:18,274 you know, I do video calls with lots of friends. 638 00:35:18,298 --> 00:35:21,315 I have friends in Europe that, who knows when I'll see them, 639 00:35:21,339 --> 00:35:26,192 but we schedule regular calls to talk. 640 00:35:26,586 --> 00:35:31,519 If you stay fairly isolated, 641 00:35:31,543 --> 00:35:35,060 you don't run much risk, 642 00:35:35,084 --> 00:35:40,938 and it's when you're getting together with lots of other people, 643 00:35:40,962 --> 00:35:42,776 either through work or socialization, 644 00:35:42,800 --> 00:35:45,623 that drives that risk, 645 00:35:45,647 --> 00:35:51,763 and particularly in these communities where you have increased cases, 646 00:35:51,787 --> 00:35:54,464 even though it's not going to be mandated, 647 00:35:54,488 --> 00:35:58,530 hopefully, the mobility numbers will show people responding 648 00:35:58,554 --> 00:36:05,097 and minimizing those kind of out-of-the-house contacts. 649 00:36:05,121 --> 00:36:07,133 CA: Bill, I wonder if I could just ask you 650 00:36:07,157 --> 00:36:08,936 just a little bit about philanthropy. 651 00:36:08,960 --> 00:36:12,326 Obviously, your foundation has played a huge role in this, 652 00:36:12,350 --> 00:36:15,759 but philanthropy more generally. 653 00:36:15,783 --> 00:36:19,210 You know, you've started this Giving Pledge movement, 654 00:36:19,234 --> 00:36:21,929 recruited all these billionaires 655 00:36:21,953 --> 00:36:27,014 who have pledged to give away half their net worth 656 00:36:27,038 --> 00:36:29,342 before or after their death. 657 00:36:29,366 --> 00:36:30,701 But it's really hard to do. 658 00:36:30,725 --> 00:36:33,042 It's really hard to give away that much money. 659 00:36:33,066 --> 00:36:34,252 You yourself, I think, 660 00:36:34,276 --> 00:36:36,291 since The Giving Pledge was started -- 661 00:36:36,315 --> 00:36:39,635 what? 10 years ago or something, I'm not sure when -- 662 00:36:39,659 --> 00:36:43,077 but your own net worth, I think, has doubled since that period 663 00:36:43,101 --> 00:36:46,579 despite being the world's leading philanthropist. 664 00:36:46,981 --> 00:36:52,464 Is it just fundamentally hard to give away money effectively 665 00:36:52,488 --> 00:36:54,944 to make the world better? 666 00:36:54,968 --> 00:36:58,995 Or should the world's donors, 667 00:36:59,019 --> 00:37:01,221 and especially the world's really rich donors, 668 00:37:01,245 --> 00:37:03,466 start to almost commit to a schedule, 669 00:37:03,490 --> 00:37:07,272 like, "Here's a percentage of my net worth each year 670 00:37:07,296 --> 00:37:08,664 that, as I get older, 671 00:37:08,688 --> 00:37:10,425 maybe that goes up. 672 00:37:10,449 --> 00:37:12,847 If I'm to take this seriously, 673 00:37:12,871 --> 00:37:15,517 I have to give away -- somehow, I've got to find a way 674 00:37:15,541 --> 00:37:16,917 of doing that effectively." 675 00:37:16,941 --> 00:37:19,320 Is that an unfair and crazy question? 676 00:37:19,344 --> 00:37:22,733 BG: Well, it'd be great to up the rate, 677 00:37:22,757 --> 00:37:28,150 and our goal, both as the Gates Foundation or through The Giving Pledge, 678 00:37:28,174 --> 00:37:31,507 is to help people find causes they connect to. 679 00:37:31,531 --> 00:37:34,447 People give through passion. 680 00:37:34,471 --> 00:37:36,416 Yes, numbers are important, 681 00:37:36,440 --> 00:37:39,123 but there's so many causes out there. 682 00:37:39,147 --> 00:37:42,494 The way you're going to pick is you see somebody who's sick, 683 00:37:42,518 --> 00:37:45,520 you see somebody who's not getting social services. 684 00:37:45,544 --> 00:37:48,407 You see something that helps reduce racism. 685 00:37:48,431 --> 00:37:51,549 And you're very passionate, and so you give to that. 686 00:37:51,573 --> 00:37:52,774 And, of course, 687 00:37:52,798 --> 00:37:54,898 some philanthropic gifts won't work out. 688 00:37:54,922 --> 00:38:00,480 We do need to up the ambition level of philanthropists. 689 00:38:00,504 --> 00:38:02,087 Now, collaborative philanthropy 690 00:38:02,111 --> 00:38:06,179 that you're helping to facilitate through Audacious, 691 00:38:06,203 --> 00:38:09,812 there's four or five other groups that are getting philanthropists together, 692 00:38:09,836 --> 00:38:11,031 that is fantastic, 693 00:38:11,055 --> 00:38:14,207 because then they learn from each other, 694 00:38:14,231 --> 00:38:16,379 they get confidence from each other, 695 00:38:16,403 --> 00:38:20,969 they feel like, "Hey, I put in x, and the four other people put money in, 696 00:38:20,993 --> 00:38:24,377 so I'm getting more impact," 697 00:38:24,401 --> 00:38:28,828 and hopefully, it can be made fun for them even when they find out, 698 00:38:28,852 --> 00:38:31,280 OK, that particular gift didn't work out that well, 699 00:38:31,304 --> 00:38:34,182 but let's keep going. 700 00:38:34,206 --> 00:38:36,202 So philanthropy, yes, 701 00:38:36,226 --> 00:38:38,897 I would like to see the rate go up, 702 00:38:38,921 --> 00:38:42,002 and people who do get going, 703 00:38:42,026 --> 00:38:43,216 it is fun, 704 00:38:43,240 --> 00:38:45,391 it's fulfilling, 705 00:38:45,415 --> 00:38:49,523 you pick which of the family members are partnered in doing it. 706 00:38:49,547 --> 00:38:52,786 In my case, Melinda and I love doing this stuff together, 707 00:38:52,810 --> 00:38:53,977 learning together. 708 00:38:54,001 --> 00:38:58,816 Some families, it will even involve the kids in the activities. 709 00:38:58,840 --> 00:39:00,579 Sometimes the kids are pushing. 710 00:39:00,603 --> 00:39:03,426 When you have lots of money, 711 00:39:03,450 --> 00:39:06,883 you still think of a million dollars as a lot of money, 712 00:39:06,907 --> 00:39:08,769 but if you have billions, 713 00:39:08,793 --> 00:39:10,925 you should be giving hundreds of millions. 714 00:39:10,949 --> 00:39:15,221 So it's kind of charming that, in terms of your personal expenditure, 715 00:39:15,245 --> 00:39:17,264 you stay at the level you were at before. 716 00:39:17,288 --> 00:39:19,974 That's societally quite appropriate. 717 00:39:19,998 --> 00:39:23,171 But on your giving, you need to scale up 718 00:39:23,195 --> 00:39:28,755 or else it will be your will, 719 00:39:28,779 --> 00:39:33,008 and you won't get to shape it and enjoy it quite that same way. 720 00:39:33,032 --> 00:39:34,253 And so without -- 721 00:39:34,277 --> 00:39:36,055 we don't want to mandate it, 722 00:39:36,079 --> 00:39:40,919 but yes, both you and I want to inspire philanthropists 723 00:39:40,943 --> 00:39:44,482 to see that passion, to see those opportunities 724 00:39:44,506 --> 00:39:47,855 significantly faster than in the past, 725 00:39:47,879 --> 00:39:52,750 because whether it's race or disease, or all the other social ills, 726 00:39:52,774 --> 00:39:57,280 the innovation of what philanthropy can go to and do quickly 727 00:39:57,304 --> 00:40:00,545 that, if it works, government can come in behind it and scale it up, 728 00:40:00,569 --> 00:40:02,753 God knows we need solutions, 729 00:40:02,777 --> 00:40:06,112 we need that kind of hope and progress 730 00:40:06,136 --> 00:40:10,522 that expectations are high 731 00:40:10,546 --> 00:40:13,290 that will solve very tough problems. 732 00:40:13,956 --> 00:40:17,518 CA: I mean, most philanthropists, even the best of them, 733 00:40:17,542 --> 00:40:21,810 find it hard to give away more than about a percent of their net worth every year, 734 00:40:21,834 --> 00:40:25,872 and yet the world's richest often have access 735 00:40:25,896 --> 00:40:27,558 to great investment opportunities. 736 00:40:27,582 --> 00:40:31,488 Many of them are gaining wealth at seven to 10 percent plus per year. 737 00:40:31,512 --> 00:40:33,737 Isn't it the case that to have a real chance 738 00:40:33,761 --> 00:40:35,487 of giving away half your fortune, 739 00:40:35,511 --> 00:40:39,581 at some point you have to plan to give away five, six, seven, eight, 740 00:40:39,605 --> 00:40:42,085 10 percent of your net worth annually? 741 00:40:42,109 --> 00:40:46,968 And that is, isn't that the logic of what should be happening? 742 00:40:46,992 --> 00:40:49,383 BG: Yeah, there are people like Chuck Feeney, 743 00:40:49,407 --> 00:40:56,407 who set a good example and gave away all of his money. 744 00:40:56,431 --> 00:41:01,831 Even Melinda and I are talking about, should we up the rate that we give at? 745 00:41:01,855 --> 00:41:05,887 As you say, we've been very lucky on the investment side 746 00:41:05,911 --> 00:41:07,309 through a variety of things. 747 00:41:07,333 --> 00:41:11,669 Tech fortunes in general have done well, 748 00:41:11,693 --> 00:41:13,564 even this year, 749 00:41:13,588 --> 00:41:18,918 which is one of those great contrasts 750 00:41:18,942 --> 00:41:21,391 in what's going on in the world. 751 00:41:21,415 --> 00:41:26,092 And I do think there's an expectation that we should speed up, 752 00:41:26,116 --> 00:41:29,006 and there's a reason to speed up, 753 00:41:29,030 --> 00:41:32,686 and government is going to miss a lot of needs. 754 00:41:32,710 --> 00:41:35,622 Yes, there's tons of government money out there, 755 00:41:35,646 --> 00:41:37,358 but helping it be spent well, 756 00:41:37,382 --> 00:41:40,726 helping find places it's not stepping up, 757 00:41:40,750 --> 00:41:45,572 and if people are willing to give to the developing world, 758 00:41:45,596 --> 00:41:47,044 they don't have governments 759 00:41:47,068 --> 00:41:51,687 that can print checks for 15 percent of GDP, 760 00:41:51,711 --> 00:41:55,880 and so the suffering there broadly, just the economic stuff alone, 761 00:41:55,904 --> 00:41:58,409 put aside the pandemic, 762 00:41:58,433 --> 00:41:59,770 is tragic. 763 00:41:59,794 --> 00:42:02,680 It's about a five-year setback 764 00:42:02,704 --> 00:42:05,308 in terms of these countries moving forward, 765 00:42:05,332 --> 00:42:09,665 and in a few cases, it's tough enough that the very stability of the country 766 00:42:09,689 --> 00:42:11,467 is in question. 767 00:42:12,249 --> 00:42:13,408 CA: Well, Bill, 768 00:42:13,432 --> 00:42:18,885 I'm in awe of what you and Melinda have done. 769 00:42:18,909 --> 00:42:22,365 You walk this narrow path 770 00:42:22,389 --> 00:42:26,887 of trying to juggle so many different things, 771 00:42:26,911 --> 00:42:32,694 and the amount of time that you dedicate to the betterment of the world at large, 772 00:42:32,718 --> 00:42:34,422 and definitely the amount of money 773 00:42:34,446 --> 00:42:36,520 and the amount of passion you put into it -- 774 00:42:36,544 --> 00:42:37,952 I mean, it's pretty awesome, 775 00:42:37,976 --> 00:42:42,337 and I'm really grateful to you for spending this time with us now. 776 00:42:42,361 --> 00:42:43,996 Thank you so much, 777 00:42:44,020 --> 00:42:45,760 and honestly, the rest of this year, 778 00:42:45,784 --> 00:42:48,901 your skills and resources are going to be needed more than ever, 779 00:42:48,925 --> 00:42:50,101 so good luck. 780 00:42:50,669 --> 00:42:51,833 BG: Well, thanks. 781 00:42:51,857 --> 00:42:54,645 It's fun work and I'm optimistic, so thanks, Chris.