Enlarge /. Despite $ trillion in economic damage, Bill Gates is optimistic that a strong pipeline of therapies and vaccines will guide the US through the pandemic.
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For 20 years, Bill Gates has been breaking free from the roles that made him rich and famous – CEO, Chief Software Architect, and Chairman of Microsoft – and dedicated his thinking and passion to the Bill and Melinda Gates Foundation by giving up profit calls and antitrust hearings disease control and carbon reduction metrics. This year, after leaving the Microsoft board, you'd have thought he'd enjoyed throwing the spotlight on the four CEOs of major tech companies who got called before Congress.
But like many of us, 2020 had different plans for gates. As the early Cassandra, warning of our unpreparedness for a global pandemic, he became one of the most credible figures as his foundation made huge investments in vaccines, treatments and testing. He also became a target of the plague of misinformation in the country when logorrheic critics accused him of planning to inject microchips into vaccine recipients. (Fact-checking: wrong. In case you're wondering.)
My first interview with Gates was in 1983, and I haven't counted the number of times I've spoken to him since then. He yelled at me (more in previous years) and made me laugh (more in recent years). But I've never looked forward to speaking to him more than I did in our Covid year. We connected remotely on Wednesday, of course. Gates did not disappoint when discussing our country's failed responses, its problems with his friend Mark Zuckerberg's social networks, and the innovations that could help us out of this chaos. The interview has been edited for length and clarity.
WIRED: They have been warning us of a global pandemic for years. After it has happened exactly as you predicted, are you disappointed with the United States' performance?
Bill Gates: Yes. There are three time frames, all of which are disappointing. There is 2015 up to this particular pandemic hit. If we had built the diagnostic, therapy, and vaccine platforms and ran the simulations to understand the key steps, we would be dramatically better off. Then there is the period of the early months of the pandemic when the US actually made it harder for commercial testing companies to approve their tests. The CDC had this very low volume test that didn't work at first, and they didn't let people test it. The travel ban came too late and it was too tight to do anything. Then, after the first few months, we finally figured out something about masks, and that guidance is important.
So you are disappointed but surprised?
I am surprised at the US situation because the brightest people in epidemiology are with the CDC. I would have expected them to do better. You would expect the CDC to be the most visible, not the White House or even Anthony Fauci. But they weren't the face of the epidemic. They are trained to communicate and not to try to panic but to get people to take things seriously. They were basically silenced from the start. We called the CDC, but they told us we had to speak to the White House a couple of times. Now they're saying, "Look, we're doing a great job testing, we don't want to talk to you." Even the simplest things that would vastly improve this system would admit that there is some imperfection and so are not interested.
Do you think it's the agencies that collapsed, or just the leadership at the top, the White House?
We can do the post mortem sometime. We are still in a pandemic and we should focus on that. The White House did not allow the CDC to do its job after March. There was a window they were engaged in, but the White House wouldn't let them do that. So the variance between the US and other countries is not the first period, but the following period, when the messages – the opening, the leadership on masks, those things – are not the fault of the CDC. They said they shouldn't open up again; You said leadership has to be a model for face mask use. I think they have done a good job since April but we have not benefited from it.
Are you optimistic at this point?
Yes. You have to admit that it has incurred trillions of dollars in economic damage and a lot of debt, but the pipeline of innovation in expanding diagnostics, new therapeutics and vaccines is actually quite impressive. And that makes me feel like we should be largely able to finish this thing for the rich world by the end of 2021, and for the world at large by the end of 2022. That is only due to the extent of the innovation that is taking place. Whenever we do this, we will have lost many years to malaria, polio, and HIV, as well as the indebtedness of countries of all sizes and instabilities. It will be years beyond that before you even get back to where you were at the beginning of 2020. It's not World War I or World War II, but it's a negative shock to the system on that scale.
In March, it was inconceivable that you would give us that schedule and say it is great.
Well, it is because of the innovation that you don't have to think about an even sadder statement. This thing will rage for five years until natural immunity is our only hope.
Let's talk about vaccines your foundation invests in. Is there something that develops relatively quickly and that could be safe and effective?
Before the epidemic broke out, we saw great potential in the RNA vaccines – Moderna, Pfizer / BioNTech, and CureVac. Currently, because of the way you make them and the difficulty of making them larger, if they are helpful, they are more likely to help in the rich countries. They won't be the most affordable, scalable solution for the whole world. There, take a closer look at AstraZeneca or Johnson & Johnson. This disease appears to be very preventable by vaccines from both the animal data and the phase 1 data. There are still questions. It will take us a while to figure out the duration (protection) and effectiveness in the elderly, although we think it will be pretty good. Are there any side effects that you really need to get rid of, in these large Phase 3 groups and beyond, through a lot of monitoring to see if there are any autoimmune diseases or conditions that the vaccine could deleteriously interact with.
Are you concerned that in our rush to get a vaccine, we will approve something that is not safe and effective?
Yes. In China and Russia they are moving at full speed. I bet there will be some vaccines out there for many patients without full regulatory review anywhere in the world. It will probably take us three or four months, no matter what, from Phase 3 data looking for side effects. At least so far, the FDA has stuck to its proof of effectiveness. So far they have behaved very professionally despite the political pressure. There may be pressure but people say no, make sure it is not allowed. The irony is that this is a president who is a vaccine skeptic. Every time I meet him he says, "Hey, I don't know anything about vaccines, and you have to meet this guy, Robert Kennedy Jr., who hates vaccines and says crazy things about them."
Didn't Kennedy Jr. talk about using vaccines to implant chips in people?
Yes you are right. He, Roger Stone, Laura Ingraham. They put it this way, "I've heard a lot of people say X, Y, Z." That's kind of a Trumpish plausible denial. Anyway, there was a meeting that Francis Collins, Tony Fauci, and I had to attend and they had no dates on anything. If we were to say, "But wait, that's not real data," they'd say, "Look, Trump told you to sit and listen, so just shut up and listen anyway." So it's a little ironic that the president is now trying to benefit from a vaccine.
What goes through your mind when you hear misinformation in a meeting and the President of the United States wants you to shut up?
That was a little strange. I haven't met the President directly since March 2018. I've made it clear that I'm welcome to speak to him about the epidemic anytime. And I've talked to Debbie Birx, I've talked to Pence, I've talked to Mnuchin, Pompeo, specifically about the question: is the US showing up to provide money to procure the vaccine for developing countries? There were a lot of meetings, but we couldn't get the US to show up. It is very important to be able to tell vaccine companies that they should build additional factories for billions of doses, that there are procurement funds to buy them for marginal cost. In this supplementary bill, I call on everyone to receive 4 billion through GAVI for vaccines and 4 billion through a global fund for therapeutics. That's less than 1 percent of the bill, but to save lives and get us back to normal, less than 1 percent is by far the most important thing if we can get it there.