Transcript: A Washington Post Live Special: Melinda & Bill Gates

MS. GATES: Thanks for having me, Frances.

MS. STEAD SELLERS: Well, I'm delighted. You have just released your annual letter, and I was struck by the personal tone in it. You've spent two decades devoting your time to global health, but what difference has this pandemic made now that it's on our doorstep to the way you think about global health and also to the way you commit resources?

MS. GATES: Well, we're living in an unprecedented time. You know, we've never lived through a global pandemic. And it's wreaking havoc on people's lives. You know, we've seen 2 million people pass away from it. You know, a hundred million people sick. But it's also devastating our global economies. And so, you know, it's interesting because we've been doing this work for 20 years on infectious diseases. We've seen global cooperation on science in a way we've never seen before. We would not have predicted this time last year that we'd have a vaccine in under a year. And yet, you know, as Bill and I project forward, we think a lot about how do we prepare for the next pandemic and how do we exit this pandemic more equal than we came into it. And those are all very top of mind for us in the work that we're doing today.

MS. STEAD SELLERS: Yeah, that brings exactly to my next question, which was about, you know, when we spoke in September, there was no vaccine. We had a good idea one would be coming. Now in your letter you talk about hope, but you also talk about the challenges of equity and distribution. We're about a month into the rollout. How do you feel about how things are going, and what are your concerns looking ahead?

MS. GATES: Well, you know, I think the vaccine distribution in the United States has been slower and more bumpy than it needed to be. That's because of the administration we had previously had not done the proper planning for the distribution. It takes good planning. But I see with this new administration that's here, they're putting the right people in charge, we're starting to see more vaccine rollout. I think you're going to see things change substantially in the next 45 days in the United States. I will say here in Seattle it's quite encouraging, because not only have our healthcare workers now been covered, but at first, they were saying they were only giving it to people up--down to 70 years old. Now they already moved it to 65. So, Bill just got his vaccine. So, I'm seeing more hope from families now that they're seeing, you know, their loved ones who are elderly actually getting vaccinated, and that's great.

MS. STEAD SELLERS: Well, let's talk about that on a global platform. The WHO and the Gates Foundation have put a lot of resources towards delivering vaccines across the world and not just here. Tell us about the timeline, 2 billion doses I think by 2021. Is that the right timeline, enough doses? Are you satisfied with those goals, or would you like to see more?

MS. GATES: Well, we'd always like to see more vaccine. The sooner we can get more vaccine that's gone through the regulatory process, the sooner we're going to have it out to people all over the world, because Bill and I have said, you know, COVID anywhere is COVID everywhere. And if we want a recovery, even in the United States, a full recovery of our economy, we need to take care of everybody else. And if we don't get enough vaccine out to others, you're going to both see more death but you're also going to see things like manufacturing not come back as quickly in the United States. You're not going to see our travel industry revitalized. So, this is important both for moral reasons and for economic reasons.

MS. STEAD SELLERS: Right, viruses don't respect borders. So should countries, wealthy countries like the U.S. and the U.K. step back from vaccinating healthy young people in order that developing countries get the opportunity to vaccinate healthcare workers and frontline workers?

MS. GATES: Well, I think those are big, tricky decisions ahead that leaders are going to have to make, which is how far do we need to get in our own countries to then make sure that we can give extra vaccine. I think what you'll see is even the U.S. is going to have extra supply, and so it's a matter of how quickly do we realize that and begin to move it out. Same thing in Europe. I think you'll start to see more move out, and hopefully we'll put more money into manufacturing and more money into Gavi so that more vaccine can be purchased and more manufacturing can happen more quickly.

MS. STEAD SELLERS: So, should wealthier countries like the U.S. and the U.K. hold back from vaccinating young and healthy people in order that the developing world gets a chance at the vaccine so they can vaccinate frontline healthcare workers and other frontline workers?

MS. GATES: Well, I think that's going to be a decision each country is going to need to make. I think you'll see in the United States, you know, we need to get to a herd immunity level. But does that mean covering all the young people? I'm not sure yet. And so, it's going to be up to the United States to look at how much--they have so many hundreds of millions of doses on order. There has to be extra supply. And yes, that should go to vulnerable populations around the world. And it should go first to healthcare workers, absolutely. Because we're going--we have to protect everybody else. That's the only way to also protect ourselves.

MS. STEAD SELLERS: So, in interviews recently I've talked to many public health experts who've talked about the expertise there is overseas. Is this a time when the U.S. should be learning from the developing world, which probably has greater experience with mass vaccination programs than the U.S. does?

MS. GATES: I think there's always chances to learn from one another. And yes, there are many places, many different countries in Africa who have dealt with infectious diseases. I mean, we learned a lot as a global community coming out of those four affected countries in Ebola. So, there are absolutely lessons to learn, and we should be learning those from one another.

MS. STEAD SELLERS: So, Melinda, I have a question that's come in from one of our viewers. This is Jacci Stuckey--I'm going to read it to you--from Ohio, who writes in with this question: What are the biggest challenges to ensuring equitable vaccine distribution in developing countries?

MS. GATES: Well, the biggest challenges are, one, planning for it. You have to plan for vaccine distribution. And number two is having enough supply. And what's holding back supply? Well, manufacturing can only go so fast, but we also need to pledge more money from high-income countries to be able to buy that vaccine and pull it through for low-income countries. So, we have both a challenge in terms of the funding and in terms of the manufacturing.

MS. STEAD SELLERS: And you talked earlier on a little bit about the economic possibilities and problems that could happen if the U.S. and other wealthy countries monopolize supply. This is much bigger than a humanitarian crisis, right? How do you see our way ahead? What are the dangers of those sorts of monopolies in supply?

MS. GATES: Well, the dangers are that you leave part of the world behind. I mean, we have infectious diseases that we've dealt with in the United States, such as malaria, and in Europe. We don't really see much malaria except a little bit that travels into the country. And yet, there are large populations all over the world, but particularly on the continent of Africa, that still deal with episodes of malaria and death from malaria. And so, the worry is that you would leave other countries behind and not say, hey, we need to deal with this for everybody.

MS. STEAD SELLERS: In your letter, you use a term "immunity inequality," and I'd love for you to explain that a little bit to our readers, what you mean by it and its impact.

MS. GATES: Well, we mean that everybody should be able to--first of all, Bill and I have this view and belief that we live out through the foundation that everybody should be able to live a healthy and productive life. And so, this immunity, which we can get through this vaccine, we need to make sure that we get equal immunity, that there's not these gaps and these inequities around the world, that everybody has a chance to get the vaccine so they can go back and live a healthy and productive life and they don't lose a loved one.

MS. STEAD SELLERS: So different countries have interpreted the frontline people or the priority people differently. I think in Indonesia, social media influencers have been given the vaccine in the hope they will spread the message. How do you draw a balance between those, the needs of individual countries, their own priorities, and fairness across the world in a--with a disease that doesn't respect borders?

MS. GATES: Well, I think we need a common understanding of what a healthcare worker is. And you can have some extras along the edges of that, because, yes, in every country we have to deal with, there's vaccine hesitancy. And so, you do want to have some influential people that can help people understand the vaccine is safe. But I think if we have a common understanding of what that population looks like, with a little bit extra on the edges, then you'd get enough vaccine out there to cover frontline workers and the key essential workers and the influencers.

MS. STEAD SELLERS: So, let's dive into the equity issue that's so important to you. In your letter you call on world leaders to put women at the center of the response. Can you talk about that, both in a personal and a broader framework as well? What does that mean to put women at the center?

MS. GATES: So, if you put women at the center, it means you make smart policies that benefit women, and it means you make investments that benefit women. And why would you do that? Because if you put a woman at the center of policy and investments, what happens is, we know she takes care of everybody else. And so, if she can lift herself up economically, she will lift her family up. And the family being lifted up, will lift up a community, will lift up the region, will lift up an economy.

So, women are no longer--shouldn't be thought of--so--for so often in the world we thought of women as the side issue or this nice to do issue when we get there. No, no, no. This is the central issue. If you want to have a robust economy, you better put the right policies in place so women can enter the labor force and have a great job in the economy.

MS. STEAD SELLERS: So there have been rumors swirling around this vaccine as there are around almost any innovation, one of them being that women of childbearing age could become infertile. What can be done to combat this kind of misinformation?

MS. GATES: Telling people to talk to their doctors. You know, our doctors know what is right for us. I don't go make a health decision for myself of what biologic I put in my body based on, you know, some random website out there. I ask my doctor, just like when my children were young, I asked my pediatrician what was right and appropriate for them. That's how you make sure that people get proper information.

MS. STEAD SELLERS: So, women that are pregnant and lactating women were also--missed out on the clinical trials despite the fact that some researchers pushed for their inclusion or for toxicity trials to take place. What can be done to make sure that women aren't left out of key medical research and also, they're not left without the information necessary to make decisions about something like this new vaccine?

MS. GATES: Well, I think we need to make sure that women are in all positions where decisions are made and have a seat at the table. So, I think if you have a woman there or an enlightened man who has done science around pregnant women or lactating women, you make more sensible decisions about vaccine trials then. Look, the whole reason to make sure that women are enrolled in trials is we know our bodies are different than a man's body. And we haven't always looked at that as a world.

Now of course a vaccine company wants to make sure, a pharmaceutical that's making a vaccine, that they don't do more harm in the trial than good. So, it's a tricky balance. But I know when you have people with seats at the table who've done this before who are women, you make better decisions.

MS. STEAD SELLERS: Blacks and other minority groups have been particularly hard hit by the virus. They're also underrepresented in the people who are taking vaccines. Is this a messaging problem? And if so, what can be done to overcome these ongoing inequities?

MS. GATES: Well, you're absolutely right. These gaps that we had in societies, COVID-19 has exposed those gaps and cracks. Quite often, the way that Black people are treated when they go to the healthcare system is not good. There's a lot of bias in the system. Or they may not have access in their area to get to a good healthcare clinic. And so, we need to make sure that the people who are giving them messages are from their own communities, are their own doctors, are their own nurses, their own healthcare providers, to make sure that they're actually comfortable. And we need to fix our healthcare system, quite frankly, so that it really serves all Americans, not just one group, one subset of the U.S. population.

MS. STEAD SELLERS: So, this is the trusted messenger, right? Finding people in communities who can pass on the message.

MS. GATES: Absolutely.

MS. STEAD SELLERS: So, you stress in your letter that you don't want profiteering of these vaccines. There have been various different--vaccines are not very popular often with pharmaceutical companies because they aren't an ongoing source of revenue. A vaccine solves a problem rather than treating it in an ongoing way. Tell us about the relationship between Oxford and AstraZeneca and whether you think--I know the Gates Foundation supported Oxford's deal with AstraZeneca. In retrospect, do you think it would have been better if Oxford had open-sourced its vaccine?

MS. GATES: Well, we, along with many other partners, supported Oxford in saying what really needs to have happened there, they had incredible science, but they had never brought a vaccine to market. And so, they needed to partner with a pharmaceutical company who had expertise bringing a vaccine to market. And so, it was us and many partners that said that's a partnership that ought to happen. Ultimately, Oxford made that decision. Now what the--what our foundation can do and has done for 20 years is try to make sure that there's equitable pricing for the developing world so that you have, you know, high-income countries pay a bit more than middle-income, than low-income. That seems to be the right way to price a vaccine. And so that's the pressure that the Foundation continues to bring to bear on the entire pharmaceutical industry.

MS. STEAD SELLERS: I'd like to talk to you now about the impact on children. You're a mother, and you see this around the world, particularly the mental health impact. We've read in news articles about increases in suicides. How do you address that, and what personal insights can you bring to this incredible problem we're facing?

MS. GATES: Well, I think, you know, we are all concerned about the mental health of everybody during this pandemic, but particularly children. And I think the isolation has been particularly hard for the elderly and for young children. And one of the primary ways that young children have more socialization is by going to a good preschool or childcare center or going to a great elementary school. And so, it's been this very tricky balance for the nation of, do you keep the schools open or do you not. I think one thing that I've seen some parents do when they're capable, is to--is to form sort of a quarantine bubble, that you might quarantine with maybe two other families where you all follow the exact same rules, but then perhaps your kids can come together to study, or one family can take care of the other family's children while the parents go off and are essential workers in society. So, I think there are ways it can be done, but it's not easy. And it's particularly not easy if you're a single mom with young kids at home. And the childcare industry is collapsing in the United States, and that's something that needs to be reinvigorated. And luckily, there was money put in the last stimulus for the childcare industry.

MS. STEAD SELLERS: Well, that's an issue I know that you've got a longstanding interest in. I'd love to see you talk about how that could play out. How should we be changing our childcare industry?

MS. GATES: Well, our childcare industry needs to be propped up. We need to really look at wages in that industry. We need to look at access. I think there's even some ways to do some innovations like matching markets between childcare providers and parents looking for good childcare. In addition, the other thing we need in the United States is a robust paid family medical leave policy. We are the only--the only industrialized nation in the world that does not have paid family medical leave. And that means that the disproportionate level of childcare falls on the mom. And it's why we're seeing so many women moving out of the labor market and losing their jobs during this pandemic. They just cannot make it work, balancing childcare and work, and that's a tragedy.

MS. STEAD SELLERS: So, when you look at the map and you think about the vaccine rollout, the number of cases, which countries do you think--and the death rate--which countries do you think have been doing well around the world?

MS. GATES: Well, I think New Zealand has been doing incredibly well under Prime Minister Jacinda Ardern. I mean, she got on it early. She did many of the right things with her government, listening to the scientists, making sure that people social distance, wore masks. She made sure that they did contract tracing. And it's interesting. Even when they were doing well early in the pandemic--I was on the phone with her--and what was she thinking about? She was thinking about all the island nations around them and how they were being affected.

And I think that's quite often what an enlightened leader does, whether it's an enlightened male or it's a female leader. They think about their own population, but they also think about all the people around them. And that's one of the reasons I am so passionate about having good female leaders, is because when women have a seat at the table, they have a different lens on society, and they make different decisions and different policies based on that lens that they have. And it's just time we have more women in these seats of power.

MS. STEAD SELLERS: Well, we have a woman vice president now. And the new administration, of course, has rejoined the World Health Organization and the Paris climate change. President Biden has made a goal of 150 million vaccines--150 million vaccines in the next 100 days. Is that the right goal? Should we--again, should be going higher? And what is the importance of these global organizations we've rejoined?

MS. GATES: Well, I think, first of all that--I think that is the right goal. You know, it's this balance between you want to go quickly but you can't go too quickly. You've got to do vaccine distribution right. But I think President Biden being able to say we can speed up even a bit more was a fantastic thing. I can tell you what it means back in my backyard here in Seattle, it means not only did they do healthcare workers and down to 70, all of a sudden, they moved it down to 65. And guess what? They also are going with mental health professionals, not just healthcare workers, meaning we can take care of people's mental health. That is a really smart thing to be doing. So that, I think, has been a good goal that the Biden administration has had, as well as listening to the science. And then, yes, rejoining these global mechanisms that are doing the right thing on behalf of the world. That global leadership has been missing, and it's been very noticed. So, I couldn't be more pleased that we're back in in those two particular areas.

MS. STEAD SELLERS: Have you or your husband been in touch with the president, the new president since he took office?

MS. GATES: We have been in touch with him, a couple of times leading up to him being in office and now since. And I think he understands obviously the importance of taking care of COVID and everybody else getting back on the--the U.S. back on a national leadership stage globally. And the other thing that I'm so pleased that he understands is this childcare infrastructure. I think it's important to remember he was a dad who was a senator who lost his wife and his young daughter. He raised two boys while he was a senator. He talks about childcare being the infrastructure that needs to be laid down in the United States to then have a more swift recovery. And that's just incredibly encouraging.

MS. STEAD SELLERS: Has President Biden asked for the Gates Foundation's help in meeting any of these goals you're so sympathetic with?

MS. GATES: Well, we certainly--we've talked to every administration that's been in office since the foundation's been here for 20 years. So, whether that's President Bush, President Obama, President Biden, we are certainly sharing information. And I think that's something that we can do with the administration and say what we think of as sensible policy. And then it's up to the administration to decide what makes sense for the country.

MS. STEAD SELLERS: So, what is the role of philanthropy, just--not just the Gates Foundation but philanthropy more broadly--in dealing with these huge global issues that face us?

MS. GATES: Well, we believe that philanthropy is part of an ecosystem. It's philanthropy. It's the private sector. It's government. It's civil society, pushing on all of those, that when you have that working between those different places in society, what happens is a philanthropy can often take a risk that a government can't take with taxpayer money. So, we can push pharmaceutical companies to create vaccines for infectious diseases or create markets for them that might not have existed before in things like malaria that still kills millions of people around the world. So, we can show ways, we can help create and be--have a seat at the table at key institutions that are created. But it's really up to government, then, to scale up, to work on infectious diseases, to work on girls' education, to work on making sure there aren't unintended pregnancies. So, we can show light and ways as philanthropists. We can push on government. We can push on other philanthropists. But it's only as part of that ecosystem, and then it takes government to actually roll things out widescale for the world.

MS. STEAD SELLERS: So, you and I talked in September about the need for global cooperation to overcome this pandemic, and it's come up several times as we've talked today. What are you optimistic about looking ahead, and what will it take to reach the goals you're thinking about?

MS. GATES: What I'm optimistic about is there are more vaccines coming that aren't on the market yet but are in late-stage trials. The more vaccines we have available, the sooner we're going to be able to manufacture more vaccines and get them out to these low- and middle-income countries. I'm also optimistic it looks like there will be a vaccine candidate out there that perhaps could be one dose. A single dose would make a huge difference, because it's much easier to get one dose, and we can also bring the price down, versus two doses and somebody's got to go twice. So those things make me optimistic.

The other thing that makes me optimistic, these days, is I see all these small acts of kindness. You know, Bill and I write in our annual letter that global health finally went local. And when I look in my backyard and I see the small acts of kindness of a young person calling their grandparents more often, or dropping off the prescription, or a family taking in other people's children during the pandemic so that that couple can go out and work, those acts of kindness add up. And on the global level, I think that's what keeps us moving forward as humanity, is the goodness in people. And I see it during this pandemic despite it being so hard.

MS. STEAD SELLERS: I'd love to ask one last question before we close. And you and Bill Gates have devoted 1.75 billion, I think, to this response. It's diverted resources across the country. What about the other public health requirements that are getting left aside--Measles, maternal health, the callings abroad? What should we do to make sure people don't get forgotten who are suffering?

MS. GATES: Well, so we haven't given up any of that other work. We are still full steam ahead. And all the money that you spoke about, that 1.75 billion, that's all new money for COVID. But what we have to do is remind people that the world has been set back, immunizations have been rolled back during this time by the equivalent of 25 years in 25 weeks. You know, things like malaria, our work there has been set back for five years. So, we need to remind everybody we are a global community, and these issues matter as well. It's not just COVID. We don't want to leave anybody behind if we really believe in an equitable world, which we do as a foundation.

MS. STEAD SELLERS: Melinda Gates, thank you for sharing your belief in an equitable world and your optimism for the future.

MS. GATES: Thanks for having me, Frances.

MS. STEAD SELLERS: Well, we were delighted to have you. Unfortunately, that's all we have time for. But after this short video, I'll be back with Melinda's husband, co-founder of the Gates Foundation, Bill Gates. Thank you for joining us.

[Video plays]

MS. STEAD SELLERS: Welcome back. If you're just joining us, I'm Frances Stead Sellers. It's now my great honor to welcome Bill Gates, cofounder of The Gates Foundation, to Washington Post Live for the first time.

Bill, it's a wonderful time to have you here.

MR. GATES: Great to talk to you.

MS. STEAD SELLERS: I'd like to start by asking about the big picture. Several years ago, you predicted a pandemic of the kind we have now, and in your annual letter, you talk about preparing for the next pandemic. What systems need to be put in place to make sure that public health experts like you aren't Cassandras and that we're well prepared and not flatfooted next time around?

MR. GATES: Well, we need better tools. So, that's on the R&D side. For example, you know, we'd like to be able to do PCR diagnostics for a lot of the population every day. And so, that needs to be ready to go quickly. There's some huge breakthroughs there that could scale that up to be 20 times what we've seen in this epidemic.

We need quick therapeutics, whether it's antibodies or drugs. And then, we need vaccines, not just for the rich countries; we need it for the whole world. And there are new approaches like MRNA, which has not fully matured: still a bit expensive, not thermal stable, but all solvable problems.

There's the R&D side, and then there's the field capability: the surveillance, the autopsies, the core epidemiologists, at least 3,000, that are able to shift from other infectious disease work to a pandemic as soon as some evidence emerges.

And so, if we'd had these things, which will cost some number of billions, we would have avoided trillions of dollars of losses and millions of lives saved.

MS. STEAD SELLERS: You have worked with health systems overseas and in this country, and worked very hard from a grassroots approach overseas. Is it harder to start from scratch overseas or to rebuild the kind of decentralized and fractured public health system--and underfunded, I would say--that there is in this country?

MR. GATES: Well, the--what we're talking about is primary health care. We're not talking about doctors or operations. So, it's utterly different than Western health care. This is, do the kids get their shots; are the antibiotics available? You know, most people in Africa live their whole life and never see a doctor, not to mention, you know, an operating room or anything like that.

So, you know, it's the basics. But fortunately, that part in terms of saving lives, creating health, and seeing a pandemic early, the primary health care system, if it's done properly, will do the job.

MS. STEAD SELLERS: You mentioned just a few minutes ago this new technology, the MRNA vaccines that we now have. Are they a true game changer going ahead? Will we see them far beyond COVID, applied to other illnesses?

MR. GATES: Yes. The Foundation started working on this with partners like DARPA over ten years ago. And even three years ago, this technique hadn't been proven, but then there were some successes of getting the MRNA into cells and getting the immune system to respond.

And now, in this pandemic, that platform's been advanced very dramatically. BioNTech and the other companies were mainly seeing an opportunity for cancer vaccines. So, the Foundation was working with BioNTech and the others to give them grants so they would also apply it to things like HIV, TB, and malaria. And so, with the coronavirus success, that work has been accelerated.

MS. STEAD SELLERS: So, we have these extraordinary vaccines that were built in record time. Of course, the first one that's become available is one that's very finicky, a labile vaccine that Pfizer, BioNTech which has strict requirements for storage and delivery. Is that likely to exacerbate delivery issues in this country compared to the developing world? It's hard enough to get it to rural counties here, but what about Africa, Southeast Asia, South America?

MR. GATES: Well, the Pfizer and Moderna vaccines won't play a large role in vaccinating the developing world where most people live. The cost, the scalability, and the thermostability issues make them imperfect for that role. So, that's why we're counting very heavily on the next three vaccines: AstraZeneca, Johnson & Johnson and Novavax, that are, you know, still moving forward in terms of all the approvals. And even in the next month, we'll have a lot more data on that. But they're cheaper, easier to scale up, and they don't have those thermostability issues.

MS. STEAD SELLERS: So, how many months behind the developed world do you see the developing world being and getting these vaccines, these new vaccines you talk about?

MR. GATES: Well, if you talk about time to first dose, there will be a small number of MRNA vaccines given to developing worlds in the next three months, but in terms of catching up, in terms of the coverage level, it's going to be, in the best case, a six-month delay and, in the worst case, a 15-month delay.

Now, if you look at the history of vaccines, it used to be over ten years. You know, before Gavi came along, the diarrheal and pneumonia vaccines that were most needed in poor countries just weren't available there and they were being given in the middle-income and rich countries where the risk of death was far lower.

MS. STEAD SELLERS: Before we go on, just--

MR. GATES: But anyway, Gavi has changed this delay, and again, we're relying on Gavi, and donations to Gavi, in order to get these vaccines procured and out to the developing countries.

MS. STEAD SELLERS: I just wanted to stop you there and ask you to explain Gavi and the Foundation's role in Gavi for our audience who aren't all vaccine experts.

MR. GATES: Great, so, Global Alliance for Vaccines was created in the year 2000. The three biggest donors are the U.K. Government, the Gates Foundation, and the United States, but with many other donors. And it buys these vaccines at the very lowest price on behalf of the poorest 77 countries. And so, it's literally been the key reason why the death rate of children every year has gone from 10 million a year in the year 2000 to now less than 5 million, getting out those diarrheal and pneumonia vaccines.

And you know, so, it's--you know, our foundation has done a lot, but our role in helping to found Gavi is probably the biggest impact we've had.

MS. STEAD SELLERS: So, yesterday, President Biden announced the intent to increase the U.S. supply from 400 to 600 million. That would allow 300 million Americans, the majority of the population, to get vaccinated in this goal of reaching herd immunity.

Tell us what the biggest trap or difficulty is going to be in delivering these vaccines. Is it logistical or is it messaging?

MR. GATES: Well, the logistics should be very, very simple. You just go online, you know, say when you're available. You get some QR code. Israel and others have shown that that shouldn't be the limiting step. And it's kind of amazing, given that we knew this was coming that the federal government didn't play the central role in creating that sort of website interaction to make sure the criteria were done right and that there was no paperwork required and that we--people can prove digitally that they've been vaccinated.

So, you know, that may take a little while to get better organized, because it was delegated. Some countries have done that well. But in the end, it's the supply and demand that will determine how quickly and at what level of the population you can get vaccine coverage.

MS. STEAD SELLERS: I talked a little bit about this with Melinda earlier on, but there are specific parts of the population, people who've been particularly hard hit. Black and minority communities have not--have had a strong vaccine hesitancy.

So, messaging, talking about that and the need for that as the twin prong in the approach to vaccine delivery. How should we be going about that?

MR. GATES: Well, if you had a digital system, then you could be seen for groups of different types, you know, geographically, race, whatever, who's not signing up. And then, you think, okay, how do we--who do they trust? How do we get a message out to them and get that willingness to be vaccinated, you know, try to drive it up? And there's experts at the CDC who've been, you know, mostly muzzled up until now who now--be available, if we had that digital tracking to see, you know, are they coming for their second dose or not, and where are the deficits? And it's a dynamic process. You know, where health care workers and elderly people, clearly, that's where you get the most benefit.

MS. STEAD SELLERS: Melinda also mentioned that you've been in discussions with the Biden administration, as you have with previous administrations. Where is The Gates Foundation? Have they asked specifically for your help in specific areas? Is messaging one of them, or targeting particular populations?

MR. GATES: Well, the--our main role is in helping with the tools. So, you know, we have ways that diagnostics can be made more accurate and scaled up. We have new therapeutics that we've done trials on that, you know, look very promising. We have the relationships with the vaccine companies. I'd say we're also quite unique in terms of the international view of the epidemic and how you get all the world's vaccine factories going full speed, and the complex regulatory and logistical issues, there.

So, there's a great conversation. You know, they have some people who are willing to face the facts on this one, and we're pleased to be talking to them.

MS. STEAD SELLERS: Are there any specific things that they've asked for from you, from the Foundation?

MR. GATES: Well, on the international response, we've been working on that, you know, since the start of the pandemic. And so, we were pleased that the latest stimulus bill got the $4 billion to go to Gavi to help procure these vaccines.

There'll be more that the U.S. needs to do as a participant in the overall process to stop the global pandemic. So, you know, that--you know, particularly in terms of how things get done in developing countries, you know, we're helping the U.S. play a constructive leadership role, which everybody expected but the U.S. didn't show up in terms of money or people or, you know, being willing to care about this until just a few weeks ago.

MS. STEAD SELLERS: So, I've read that you have regular conversations with Dr. Fauci, the infectious disease expert. Have those conversations changed with the change of administration?

MR. GATES: Well, sometimes those conversations would be a bit frustrating in that getting the follow-up on the innovations--you know, it wasn't clear who would pay attention. But you know, the basic science, you know, for example, talking about antibodies or different vaccine constructs or immunity. You know, now, we're talking a lot about these variants and what that will do. You know, fortunately, it doesn't mess up the diagnostics. It does mess up the antibodies. To some degree, it'll affect the vaccines, and it's the trials the Foundation is doing in Brazil and South Africa that we're funding that report out later this month which will really give the definitive data on do we need to create a new variant of the vaccine and combine that in.

And so, he and I were talking about the critical path in our last call and how to orchestrate Gates Foundation resources and government resources to get to the bottom of those questions.

MS. STEAD SELLERS: Wow, so this was a conversation with Fauci? You were addressing these specific questions?

MR. GATES: Yeah, because when it comes to funding the trials in Brazil and South Africa, we played quite a central role in that for a large number of the vaccines.

MS. STEAD SELLERS: So, the coronavirus is probably the--I think it is almost certainly the first disease that's had an anti-vaccine campaign before there was even a vaccine available.

You have been the target of erroneous messaging suggesting that there were microchips in the vaccines and other things. How have you gone about combatting that?

MR. GATES: Yeah, Dr. Fauci and I are out in the conspiracy theory threads quite a bit.

You know, just saying that we're trying to save lives and those messages are wrong. I don't know how that element got into the discussion. You know, it's disappointing that that kind of titillating, oversimplistic explanation is easier to click on then, you know, the truth about what a great job the world has done to get these vaccines going and, you know, how we're trying to get the volume up and, you know, tough tradeoffs in terms of who gets which vaccines first, between countries, within countries.

But you know, those conspiracy theories mean less people are willing to take the vaccine, then the epidemic will last longer and more people will die and more businesses will fail.

MS. STEAD SELLERS: President Biden has said that Americans who want the vaccine should be able to get it by this spring. Is that a realistic timeline from your point of view?

MR. GATES: Yeah. Sometime in late spring, early summer, the supply side in the United States should no longer be the constraint. And there, you know, we just have to work on the demand side, and particularly in, you know, certain communities that might be more skeptical. But yes, you know, the--even though we're in some of the toughest days in terms of the deaths--and you know, we'll have that for many months to come--we can see that, by summer, things will be very different. And if we get the immunity up enough, we'll avoid a fall wave when the weather turns back and that does drive up infectiousness.

MS. STEAD SELLERS: So, right now, some states like New York are running into shortages. Other places cannot move their vaccine quickly enough, they're not having a pick up--do you see those as really short-term problems?

MR. GATES: Well, they should be short-term problems. I mean, you just--you do a website, you tell somebody to go at a certain time. You have no paper. You know, they just show their QR code. You know, the fact that it works in Israel does suggest it might be able to work in other locations. And even within the U.S., you see some exemplars, and I think everybody will learn from them.

MS. STEAD SELLERS: Right. There's a phrase I've heard used, and that is "the Bill chill," that your voice is so loud that sometimes alternative ways of doing things are not brought up.

Could you talk to me about whether that's a concern to you and how you combat it?

MR. GATES: Well, we've chosen, Melinda and I, to use our voice to minimize childhood death, and you know, if we're wrong about that as an important cause and the tragedy of how little money was being spent to help save those lives, you know, which has incredibly positive effects, even surprisingly reducing the number of kids people choose to have once they see that their kids are likely to survive.

Yes, we have caused more of the world to think about malaria and TB and HIV, and you know, if those are worthy causes, that's a good thing; if those aren't important, we're distorting the conversation away from something else.

MS. STEAD SELLERS: But right now, of course, some of those diseases are being neglected as we all face about--face down COVID. What's your response to that? How are you keeping your concern about other public health issues in the forefront?

MR. GATES: Well, our spending on those other diseases, with very few exceptions, has been maintained. Most of Africa, other than South Africa, will actually suffer more deaths from the interruption to the primary health care system and the vaccinations there than from coronavirus directly.

And so, we're working with each country on, okay, get your supply chain back in place. Get your primary health care workers back. Make sure that the HIV medicines and the malaria bed nets are getting out there.

And so, we have avoided the worst case. A year ago, when we did the analysis of increased HIV deaths or malaria deaths, we saw that the potential setback was gigantic, and we've minimized that, at the same time as, you know, getting oxygen generators and diagnostic machines out into Africa, working with our partners, there.

MS. STEAD SELLERS: Bill, I'd like to turn to a couple of questions that have come from our audience, and I'll read them to you.

The first one is from Jeff Zuk, who writes in from Canada with this question: "So much is being made about vaccines. What about better masks?" he asks.

MR. GATES: Well, there are a huge range of mask options, you know, from the typical, multilayer cloth, up to the N95. And you know, there's--we haven't had a shortage of supply of any of those for quite some time. our main problem is the compliance.

MS. STEAD SELLERS: And I guess, with mutations, people are now being encouraged to use something more like an N95 than a cloth mask.

MR. GATES: Yeah, there is some additional benefit from the N95. I haven't seen any specific data that connects that to the variants, but you know, those variants--we have more super spreaders--that is, a higher level quantity in the nose now and that has meant that more people get infected.

MS. STEAD SELLERS: So, let me ask another audience question. This one comes from Susan Shapiro, who writes in from Pennsylvania with this question: "Given the rapid transmission of new COVID variants and the painfully slow vaccine rollout, what outlook are you projecting for the world economy?"

MR. GATES: Well, I--the vaccines will retain some level of efficacy and, over the next month, we'll understand. Probably the high-efficacy vaccines will do the best, that is, the percent reduction. And remember, the reduction in severe disease is even higher than these numbers you hear quoted, because that's the mild disease prevention. Severe disease, you know, these vaccines, so far, have been over 95 percent reduction there. We may need to do variants of the vaccine, which we would combine together and people who've already gotten the vaccine might need a third dose.

And so, the--you know, we're funding work in that area as well as funding the trials that will give us those insights. But I don't see that delaying the U.S. situation more than four to six weeks if we get the logistics and the messaging right here.

MS. STEAD SELLERS: So, I'd like to ask a little bit about long-term strategy and goals. The world has only ever eradicated one disease, smallpox. Your foundation's been working very hard to do the same with polio.

When we think about the coronavirus, should we be thinking in the long term of eradication, or will you resign yourself to a sort of flu-like situation where we have a mutating disease and vaccines that have to be updated every year?

MR. GATES: We don't know whether we should go for a full eradication, that is, literally no virus in humans, and so that it's gone. If it's feasible to do that, it has huge benefits, that you're just not facing outbreaks.

As you said, we're doing that with polio. It's proven to be very difficult. We still have wild polio in Pakistan and Afghanistan. And with the pandemic setback, it'll take us, you know, two to three years, if things well, to get that to zero.

The alternative is that, yes, you'd have to be boosted. You know, eventually we'll figure out the correlates of immunity so that we'll see how often you would need a booster, but there's quite a cost to leaving it in circulation. You know, there might be some countries where you'd have to have travel restrictions, that, you know, would hurt those countries.

So, you know, with luck, we can do the eradication. Six months from now, the world will decide on that. It's a lot easier than flu. The flu thing, the way that the variants assort there is far more difficult than it is here with coronavirus. And even in that case, we are working on a--some tools that might allow us to do a flu eradication someday in the future.

MS. STEAD SELLERS: Wow. And despite the fact that the coronavirus is mutating in months in a way that the flu virus takes a year to do, you still say it's--

MR. GATES: Well, the flu virus mutates in a dramatic way where the H and N proteins escape protection quite dramatically. So, it's really kind of a family of viruses; whereas, the coronavirus is tuning its transmission. And so, it's not as hard, but this variant thing did take the world by surprise, and you know, we're just figuring out the plan for it. So, I don't want to act like it's a simple thing, but it's way simpler than what we're dealing with flu.

MS. STEAD SELLERS: So, how many different vaccines do you think we could have a year from now?

MR. GATES: Well, the key isn't so many--how many get approved, but just the volume. The first five, you know, getting into the right factories, that could be enough for the entire world. We've been involved with getting serum factories to make AstraZeneca; that's already happening. We have--the Johnson & Johnson can be made in India. The Novavax will be made in India. And those are the world's biggest vaccine factories. And so, you know, that supply will make a huge difference. So, these tie-ups where you kind of second-source the vaccine, they're completely novel. You know, they've been pioneered because of the pandemic.

But you know, once you get enough vaccines for 80 percent of everybody, then, you know, it's--you're in great shape. And within the next year, that should be achievable.

MS. STEAD SELLERS: So, we've talked about these mutations largely in terms of the vaccines, but pinpoint a little bit more on what they mean in terms of therapeutics. You did briefly mention antibody therapy, but what is the importance of them in terms of--or even testing, PCR testing. Could they mean that PCRs will no longer be effective?

MR. GATES: Yeah, so, the diagnostics are not affected; that is, the part of the virus that they look at hasn't changed. We need to watch out for that because, in malaria, we did have a case where the diagnostics stopped working.

The saddest part of the variants beyond the increased transmission is that it's made a lot of the antibody work look potentially less promising. So, we need to get data on that. The antibodies, we have several partners, including Eli Lilly, where we're testing that. we're also trying to move it--the original approval was for an infusion, and that's hard to find the capacity, even in the U.S., to do that. We're trying to change it so it's just a shot or two shots, and that is a lot easier to do. It's an early-stage intervention. If the antibodies were perfect, it could reduce the death rate and the hospitalization rate by about 70 percent. So, we're trying to salvage the antibody work, but that may be the thing that has been hurt the most by the variants, because antibodies are more dependent on just one specific shape than the overall immune response that the vaccine generates.

MS. STEAD SELLERS: So, several tech giants, including Microsoft, have teamed up to start creating COVID-19 passports for international travel. Is that something you support and think will be the way we'll be able to break out of the sort of log jam that we're in at the moment?

MR. GATES: Well, the goal is that, if you're eventually--if travel does require some proof, that that can be done in a way that's not fraudulent.

Now, you really want to be careful so people don't feel like, you know, this is some invasion of privacy. So, yes, just having just paper cards doesn't create a very reliable system. You want to do better than that since, you know, when you spread this disease you're talking about, you know, deaths and having to shut down economies.

And so, some way of--which India's probably done the best on--some way of having digital proof would let you say, okay, if--to work in a nursing home, you need that proof; or if a country wants to see that proof to let you travel to an event, that could help us open up faster by having the ability to trust those proofs.

MS. STEAD SELLERS: I think I have time just for one last question, and it's a big one. Crises like this are natural disruptors, and they're also huge opportunities for innovations. Wars in Afghanistan and Iraq have given us improvements in traumatic brain injury; World War II gave us not only the atomic bomb but duct tape and the Jeep.

So, what do you think people will say 10, 15, 50, 100 years from now, if we hadn't had COVID, we wouldn't have X?

MR. GATES: Well, there's no doubt that some of these biological tools, whether it's making antibodies quickly or scaling up high-quality diagnostics quickly or the MRNA platform, all of those, you know, got almost a decade of experience within a two-year period. I'd say that the most dramatic impacts may be in terms of our lifestyles, that the question of should--do you need to go into the office every day? Does every worker have to be--really live very close by in order to do that?

You know, even my interaction with African leaders, now we do videoconferences which before that wasn't there. I hope that continues, because you know, making them leave their country all the time, you know, is very, very inefficient. I think telehealth has been accelerated dramatically. Online learning, which our foundation invests a lot in, I think it can--now can finally get high-quality and be used even after the pandemic as a way to individualize instruction for students and improve the quality of instruction.

And so, the, you know, digital approaches in key verticals like health and education and in just, you know, where should you live, how often do you go to the office, what is--the office looks like. You know, we still don't know, you know, will there be as many conventions in the future or quite a bit less? You know, how good can this digital collaboration software be? You know, the R&D level on that is ten times what it was a year ago. And so, a few great innovations which were wildly celebrated, including the open-mindedness to new approaches.

MS. STEAD SELLERS: Well, Bill Gates, talking to you from the East Coast, and you're on the West Coast, I take that message very much to heart. Thank you very much for joining us and sharing those insights with us, today.

MR. GATES: Great to talk to you.

MS. STEAD SELLERS: Thank you, again. That's all we have time for, but please sign in again at 2:30 this afternoon when my colleague, Arelis Hernández, will be here for a very fun interview with EGOT-winning actress, Rita Moreno. It's sure to be a no-miss affair. Thank you again for Bill Gates and Melinda Gates for joining us for this special, and to our audience at home. I'm Frances Stead Sellers.

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