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  • Bill Gates, welcome to The Daily Social Distancing Show.

  • (chuckles): It's great to be on.

  • Let's, uh, jump straight into the first question

  • that everybody would want me to ask.

  • You delivered a TED Talk

  • where you predicted pretty much what is happening now.

  • Now, thanks to the world we live in,

  • that has spouted a bunch of conspiracy theories,

  • everything from "Bill Gates invented this virus

  • to prove himself right," or "He knew it was gonna happen,

  • and that's why he said it."

  • Was that Ted Talk about this virus,

  • or was that a hypothetical that has now come true?

  • Well, I didn't know specifically that it'd be coronavirus

  • and that it would hit in late 2019.

  • But the goal of the talk was to encourage governments

  • to make the investments so we could respond very quickly

  • and keep the case numbers very, very low.

  • And so sadly, this is not a case where,

  • you know, I feel like, "Hey, I told you so,"

  • -Mm-hmm. -uh... it, because we didn't use that time,

  • when it was clear as the biggest threat

  • to kill millions of people,

  • to have the diagnostics standing by,

  • to be ready to ramp up a... a vaccine factory.

  • A few things were done, uh, of some countries.

  • Our foundation funded some work

  • that will help with the vaccines now,

  • will help with the diagnostics.

  • But, uh, you know,

  • well, most of what was called for,

  • particularly in a New England Journal of Medicine article

  • I did that went into way more specifics

  • than I could in a short TED Talk,

  • uh, those things didn't get done,

  • and so that's why it's taking us a long time

  • to get our act together, uh, faced with this threat.

  • Here's a question I have, um, as an individual.

  • How is it that you as a nongovernment

  • knew this information and knew that it needed to be act on...

  • acted on, and governments and organizations

  • that are specifically tasked with protecting people

  • from this very thing

  • either didn't have the information or ignored it?

  • What-what do you think happened there?

  • Because I know you interact with governments.

  • You talk to organizations like the CDC, like the WHO.

  • What went wrong?

  • Well, there are lots of individuals,

  • uh, who were as worried as I was.

  • You know, people like Dr. Fauci,

  • who'd been through various epidemics.

  • And, so, when we had Ebola,

  • Zika, SARS, MERS,

  • we were lucky that they didn't transmit very easily.

  • They weren't, uh, these respiratory viruses

  • where somebody who's not very symptomatic

  • and is still walking around can spread the disease,

  • in some cases to literally dozens of people.

  • So the respiratory transmission,

  • particularly because world travel is so intense,

  • that's where I show the simulation in that speech

  • and say, "This keeps me up at night,

  • uh, more than even war,"

  • which is no small thing.

  • And yet, in terms of being systematic

  • about, okay, let's run a simulation

  • and see how would we reach out to the private sector

  • for tests or ventilators

  • and, uh, what kind of quarantine would we do?

  • You know, as we enter into this,

  • we haven't practiced at all.

  • And so you can see it's, you know,

  • every state is being forced to figure things out on their own,

  • -and, uh, it's very ad hoc. -Mm-hmm.

  • It's not like when a war comes

  • and we've done, you know, 20 simulations

  • of various types of threats

  • and we've made sure that the training,

  • communications, logistics,

  • all those pieces fall into place very rapidly.

  • You are in an interesting position

  • where, in many ways, you are an expert on this topic

  • because of the work that you now do in philanthropy.

  • You know, your goal has been to eradicate malaria

  • across the globe, focusing in Africa.

  • You work with infectious disease.

  • You work with experts in and around infectious disease.

  • When you look at the coronavirus as it stands now...

  • It's happened. Leaders acted late.

  • But what do you think needs to be done going forward?

  • You wrote an interesting op-ed about this,

  • but what do you think we need to do from the ground up?

  • From the people to the leaders to the private sector?

  • Well, the main tools we have right now

  • are the behavioral change,

  • the social distancing,

  • which, uh, often means staying at home most of the time,

  • and the testing capacity to identify

  • who in particular needs to get isolated

  • and then testing their contacts

  • to make sure that we can catch it so early

  • that a lot of people who get sick

  • don't infect anyone else.

  • Now, you know, so, our foundation is engaged

  • in projecting, uh, what's going to go on,

  • the modeling.

  • Uh, our partner IHME

  • is, you know, telling each state what they should think about

  • in terms of ventilators and capacity.

  • Further on out, the work we're doing now

  • to find a therapeutic, a drug to reduce the disease,

  • to cut the deaths down, you know,

  • we're hopeful, uh, that even in six months,

  • some of those will have been approved.

  • Uh, but the ultimate solution,

  • the only thing that really lets us

  • go back completely to normal

  • and feel good about sitting in a stadium

  • with lots of other people is to create a vaccine

  • and not just take care of our country

  • but take that vaccine out

  • to the global population

  • and, uh, so that we have vast immunity

  • and this thing, no matter what,

  • isn't going to spread in large numbers.

  • You have a unique vantage point

  • in that you have been communicating

  • with various governments around the world

  • in and around their COVID-19 response,

  • um, what they plan to do

  • and what they-they haven't done thus far.

  • Which countries do you think we should be looking to

  • for models that work, and can we apply those models

  • to a larger country like the United States?

  • So, you know, many people say Italy and Korea,

  • yes, have their numbers,

  • but they can't necessarily be applied to America.

  • Is that true or not?

  • Or is there a model that does seem to work

  • and should be followed for everybody?

  • Well, countries have differences.

  • You know, uh, South Korea

  • did get a medium-sized infection,

  • but then they used testing,

  • enforced quarantine, contact tracing

  • and really bent the curve,

  • uh, even though it looked pretty scary there for a while.

  • The epidemic in the United States

  • is more widespread, uh, than it ever got in South Korea.

  • So we're like the part of China, uh, Hubei province,

  • where a lot of the cases were in one city, Wuhan.

  • And the U.S. and China are different.

  • You know, the lockdowns that we do

  • won't be as strictly enforced,

  • but they are very, very important.

  • The way we do contact tracing

  • won't be as, uh, invasive

  • and so won't be quite as perfect.

  • But it is very good news that China,

  • uh, although they're maintaining a lot of measures,

  • they are not seeing a rebound.

  • They're not seeing cases coming back

  • even though they are sending people back to the factories,

  • sending people back to schools.

  • And, you know, so, thank goodness,

  • if we're seeing a big rebound there,

  • uh, the idea you could keep it under control

  • once you have a large number of cases,

  • like the U.S. does and many countries in Europe,

  • then it, you know, would seem almost impossible.

  • So it can be done.

  • You know, China ended up

  • with .01% of their population infected.

  • You know, our goal is to stay so it's only a few percent

  • so at least the medical penalty, uh, isn't gigantic

  • even though the economic penalty will be very large.

  • When-when you look at that balance

  • between the economic penalty and, um, the human penalty,

  • there are some who have argued that the economic penalty

  • will, over time, equal the human penalty.

  • Now, you are one of the few people in the world

  • where you actually have enough money

  • to tell us about whether or not an economy shifting

  • in this way or another way is going to cause mass deaths.

  • But how do you think we should be looking at this?

  • Because, yes, there is an economy,

  • and, yes, there is human life,

  • but where do you think the truth lies?

  • Well, the, uh...

  • There isn't a choice where you get to say to people,

  • "Don't pay attention to this epidemic."

  • Uh, you know, most people,

  • uh, they have older relatives.

  • You know, they're worried about getting sick.

  • Uh, the idea of a normal economy

  • is not there as a choice.

  • You know, about 80% of people

  • are going to change their activities.

  • If you get the other 20%

  • to go along with that nationwide,

  • then the disease numbers come...

  • will flatten, hopefully in the next month,

  • and start to go down,

  • hopefully in the month after that.

  • And then when they've gone down a lot,

  • then, in a tasteful way,

  • using prioritized testing,

  • you can start to reopen a lot of things,

  • like schools and work.

  • Probably not sports events,

  • because the chance of mass spread there is-is quite large.

  • -Mm-hmm. -And so to get back economically,

  • uh, taking the pain extremely now

  • and telling, you know, those who wouldn't,

  • uh, curb their activities,

  • "No, you must go along with the rest of society

  • "and not associate in a way

  • that we have exponential increase in these cases,"

  • uh, you know, that is the right thing,

  • even though it's extremely painful.

  • It's-it's unheard of.

  • And, you know, there are particular businesses

  • that, uh, it's catastrophic for.

  • -Mm-hmm. -That's the only way you get

  • so you can feel like you can say to the entire population--

  • ideally in the early summer, if things go well--

  • yes, now please do resume,

  • and we are through testing,

  • making sure that it won't, uh,

  • spread in some-some very, very big way.

  • So people will need the confidence

  • that the system is working

  • and smart people are making decisions,

  • and overoptimistic statements actually work against that.

  • What do you think most people are missing right now?

  • Because everyone has an opinion.

  • You know, everyone from my mom

  • to my friends to people online--

  • everyone has an opinion on coronavirus,

  • because we have very few centralized sources

  • that people trust.

  • But what do you think people are missing about this virus

  • and this moment and what we need to be doing as people?

  • Because we know the basics-- wash your hands,

  • stay at home, stay away from other people,

  • um, try to, you know, maintain a world

  • where people are moving as little as possible--

  • but-but what do you think we're missing

  • that-that people might make a mistake

  • and-and exacerbate what we're going through now?

  • Well, I-- The thing that needs to get fixed

  • in the next few weeks is to prioritize our testing capacity,

  • which is going up,

  • but making sure the right people are being tested.

  • Uh, that will guide us,

  • uh, in-in a very deep way.

  • And who are-- who are the right people?

  • Uh, if you're symptomatic

  • or somebody you've been in close contact with

  • tested positive, you know,

  • those are the broad categories.

  • Of course, in the front of the line,

  • you have health workers or essential workers

  • who have to go, you know, keep the food supply,

  • the medical system, water,

  • electricity, uh, Internet,

  • keep those things running, uh, for the people

  • who are-are mostly at home.

  • But that doesn't use up that higher percentage

  • of the testing capacity.

  • We have a lot of people without symptoms

  • who are just kind of worried,

  • and there we need to show them that,

  • until our capacity goes up a lot,

  • uh, they are going to have to wait.

  • The worst thing we have is that,

  • if-if it takes you longer than 24 hours to get the test result,

  • then you don't know--

  • You haven't been told during the very key period

  • where you're most infectious

  • to take extreme measures.

  • And so we've got to get, uh, not just the numbers up--

  • that-that confuses people--

  • it's the speed of the results.

  • South Korea was giving those results in less than 24 hours.

  • So if we have tests that are ramping up around the world,

  • we're gonna see the numbers going up.

  • Now, some have said that number

  • and the mortality rate or fatality rate

  • can be deceptive because there are so many

  • who aren't getting tested and are recovering.

  • And so we don't really know how dangerous

  • or-or how fatal this disease actually is.

  • What is-- what is needed in the realm of testing?

  • Like-like, what I'm trying to say is,

  • I understand that you want to get as many tests as possible,

  • but-but once we've tested as many people as we have tested,

  • what are we trying to get to as an end goal?

  • Well, for, um,

  • rich countries that do the right policies,

  • you should be able to, uh, plateau

  • and get the cases down with less than a few percent

  • of the population infected.

  • Uh, China, South Korea,

  • uh, you know, they are countries

  • that absolutely have achieved that,

  • and that means that your total deaths,

  • -uh, is actually not-not gigantic. -Mm-hmm.

  • Now, in developing countries,

  • the ability to do lots of testing,

  • uh, to have the patients who have severe respiratory distress

  • get treatment, uh, and do this social isolation,

  • for developing countries, it's far harder.

  • And so, you know, there,

  • will these measures actually stop it

  • from getting to a large part of the population,

  • places like India, Nigeria?

  • You know, I was talking to, uh, President Ramaphosa today,

  • who's not only president of South Africa,

  • he's the head of the African Union.

  • And he's a very strong voice,

  • encouraging the countries there

  • to act quickly

  • when the number of cases, uh, is still fairly low,

  • uh, which is true throughout Sub-Saharan Africa right now.

  • When you look at where we are now,

  • the one thing that we can't deny

  • is everybody has dealt with the coronavirus

  • on a different timeline.

  • You know? Not just across the globe.

  • I mean, even within the United States.

  • You have states like Georgia and Florida

  • that have just implemented stay-at-home orders.

  • You have many other states that haven't done it at all.

  • Is this going to fundamentally undermine the efforts

  • of other states and other countries

  • that have shut themselves down?

  • Because if the numbers dip in one country

  • and another country hasn't had the same amount of, um,

  • shutdowns or people self-quarantining--

  • for instance, if people from Brazil travel after this

  • or if people from, uh-- whether it's Belarus or Hungary

  • or any other country where a leader

  • hasn't taken it seriously,

  • will that not undermine the effort completely?

  • Is-is there a point to doing this

  • when everybody isn't doing it?

  • Well, sadly,

  • at some level of wealth,

  • there will be countries that, no matter how hard they try,

  • they will have a widespread epidemic.

  • And so, again,

  • sadly, the richer countries that do contain the epidemic

  • will not allow people from those countries

  • to come in, you know, unless they are quarantined

  • or tested or-or proved they're immune.

  • Uh, and so this is gonna stop people going across borders

  • very dramatically these next few years

  • till we get to that full vaccination.

  • Within the United States is different,

  • because we're not gonna partition the country.

  • Uh, and so, therefore, we are all in it together.

  • We can't do what we're gonna do with foreign nationals,

  • which is reduce the numbers a lot

  • and have very strict screening there.

  • We're not gonna have at every state border,

  • you know, some complex quarantine center.

  • Uh, and-and so the whole country needs--

  • Even when you have small numbers,

  • because those can exponentiate to big numbers so quickly.

  • You know, the doubling time is, like, three days

  • when you're still behaving,

  • uh, in the pre-epidemic way.

  • Uh, so, you know, each country,

  • uh, you know, has to get the entire populace,

  • even some who-who, uh,

  • initially resisted,

  • -maybe for very good reasons, -Mm-hmm.

  • because the economic effect on them, uh, is-is strong.

  • So this is powerful medicine.

  • But if you take a big dose of it earlier,

  • you-you don't have to take it for nearly as long.

  • You were one of the first people to come out

  • and, um, donate a large chunk of money

  • to fighting coronavirus

  • or helping medical workers get the equipment they need.

  • I remember the last I read,

  • it was yourself and your wife Melinda

  • who had pledged over $100 million.

  • It seems, though, that money isn't able

  • to fix this problem.

  • It seems like governments around the world are trying everything

  • they can, but it doesn't seem like it can be fixed.

  • What are you hoping to achieve in this moment in time?

  • Well, you... If we get the right testing capacity,

  • you can change by literally millions, uh,

  • the number who are infected.

  • And governments will eventually

  • come up with lots of money for these things,

  • but they don't know where to direct it,

  • they can't move as quickly.

  • And so because, you know, our foundation has

  • such deep expertise in infectious diseases,

  • we've thought about the epidemic.

  • We did fund some things, uh,

  • to be more prepared, like a-a vaccine effort.

  • Uh, our early money can accelerate things.

  • So, for example, there's...

  • Uh, of all the vaccine constructs,

  • the seven most promising of those,

  • even though we'll end up picking at most two of them,

  • we're going to fund factories for all seven.

  • And just so that we don't waste time

  • in serially saying,

  • -Oh, wow. -"Okay, which vaccine works?"

  • and then building the factory.

  • Because to get to the best case, uh,

  • that people like myself and Dr. Fauci are saying

  • is about 18 months,

  • we need to do safety and efficacy

  • and build manufacturing.

  • Uh, and they're different for the different constructs.

  • And so we'll abandon...

  • You know, it'll be a few billion dollars

  • we'll waste on manufacturing

  • for the constructs that don't get picked

  • because something else is better.

  • But a few billion in this...

  • the-the situation where we're in,

  • where there's trillions of dollars--

  • that's a thousand times more-- uh, trillions of dollars

  • being lost economically,

  • it is worth it.

  • In normal government procurement processes,

  • and understanding which are the right seven,

  • you know, in a few months, those may kick in.

  • But our foundation, you know, we can get that bootstrapped

  • and get it going, uh,

  • and, you know, save months because every month counts.

  • You know, things can reopen if thing...

  • if-if... if we do the right things, in the summer,

  • but it won't be completely normal.

  • You'll still be very worried.

  • You know, we may decide masks are important,

  • although right now, they're in short supply for health workers,

  • so people should not, uh, go and-and hoard those.

  • But the capacity of that can be brought up.

  • So it may be something that, like China today,

  • everybody who's walking around is wearing one of those.

  • -So we'll have a lot of unusual measures... -Mm-hmm.

  • ...until we get the world vaccinated.

  • You know, seven billion people--

  • -that's a tall order. -Mm-hmm.

  • But it is... it is where we need to get to,

  • uh, despite a lot of things in between now and then,

  • to minimize the damage.

  • You predicted this pandemic almost to a T.

  • And maybe it was because we were dealing

  • with other things at the time,

  • we didn't really pay that much attention.

  • Is there anything else you want to warn us about now

  • -that-that we should be looking forward to? -(laughs)

  • Is there anything else that keeps you up at night?

  • Well, this is a naturally-caused epidemic,

  • and as bad as it is,

  • it looks, if you have reasonable treatment,

  • to have a one percent fatality.

  • There could be epidemics that are worse than that,

  • including ones that aren't naturally-caused

  • that are a form of bioterrorism.

  • But I do... One thing I feel good about is

  • this is such a big, uh, change, to the world

  • that this time, it won't be like Ebola,

  • which was just there in West Africa or Central Africa.

  • This time, the tens of billions

  • to have the diagnostics standing by,

  • the vaccine manufacturing standing by--

  • this time we will, uh,

  • get ready for the next epidemic.

  • Well, I hope your words are prophetic once again.

  • Thank you so much for your time.

  • Um, good luck in all of your work

  • and, um, stay healthy out there. We need you.

  • Hey, thanks, Trevor.

  • Hopefully, we'll be playing tennis again soon.

  • You bet. Looking forward to it.

Bill Gates, welcome to The Daily Social Distancing Show.

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