in grounded theory you take a question and answer trasncript - highlight pieces of it that suprise - gee i had never heard of that before
iterate by asking more about the surprise - maybe you will go through 12 levels of deeper surprises or maybe you will
quickly see where to bridge silo of your divsipline or culture with anothers
this conversationhappened at or before 25 march between ted's chris davies and bill gates - we will color up surprises ofr us- if you do the
exercise and faind a different pathway - love to see it email@example.com
please note because
my time is pressed i have done an advanced version with 4 color codings - in the simplest version i would want to follow up
all the highlighted parts with more questions
at a more segmented level - yellow are ideas related
to curricula of corona virus as something every 5th grade teacher needs to know inside out = not necessarily new to me but i still
dont know how to help people learn since much western media coverage still distracts from coherently doing all these things
at 24/7 community reality-making
light blue seems to me to be possibly good news and or solutions
that have worled somewhere and which need to be studied even if the country which has succeeded in applying them is not approved
of by whomever rules your nation's strategy; yelow green seems like the best news of all- red is where i wonder if 3 months
later gates might have changed his mind or where i ceretainly would need to ask a lot more before his intel penetrated my
so there are 2 red sections = scroll down to the first at 21 min 59- in march
gates appears to have believed that usa could get at least as efficoent as china by now- after all he feels he invented the
core advantage of do it yourself swabs- the blunt question would be does he know feel usa has gone backwards in l'ast 3 monyths
instead of beginning to do tracing the way china does; but the other thing is because we have published no random sample of
who has the antibo[dies we still have no clear idea among the half of the wporld under 30 are there 10 times more people infected
without symptoms than with symptoms- and if there are are children under 11 not even transmitters; are teenage asymptomatics
as infectious as anyone who has been measured to have symptoms
a nicety of grounded theory:
you can learn who you want to talk to more by how they complete the coloring exercise- if you dont like my coloring but want
to learn from people who you care about most start withy the fresh transcriopt- ask each paper to color their version then
facilate an exchnage starting from where you agree and moving to the things that people fid most urgent but dont yet have
Whitney Pennington Rodgers: Hello and welcome to everyone joining us from around the globe. Thank you for being part of day two of our special series
TED Connects. This week, we're
bringing you interviews from some of the world's greatest minds to offer tools for us to navigate through and thrive in these really uncertain times. I'm Whitney Pennington Rogers, TED's current affairs curator, and I'll be one of your hosts for today's event.
Yesterday, we kicked off this series with an interview from acclaimed psychologist Susan David, who offered us some tips on how to really be our best selves in these trying times. And we're going to switch gears a little bit today from thinking about our own personal mental health to the state of our global public health systems.
Chris Anderson: Thank you. I guess we have a pretty exciting guest to introduce. On the other side of the country, let's bring in Bill Gates. Bill, they say the better-known people are, the less you have to intro them. It's great to have you here. How are you doing?
Bill Gates: I think this is an unprecedented, really disconcerting time for everyone, with things being shut down, not knowing exactly how long it's going to last, worrying about the health of all the people we care about. You know, I'm lucky that I get to connect up with video conferencing using Teams a lot, so the Foundation is stepping up and there's a lot of great people trying to help with this crisis. But it's scary for everyone.
CA: Are you basically stuck at home like
many of us watching?
BG: Yeah, almost all my meetings are using Teams now, I'm getting used to that. You know, I've gone days without seeing any coworkers.
CA: Let's start here, Bill. Five years ago, you stood on the TED stage and you gave this chilling warning that the world was in danger, at some point, of a major
pandemic. People watching that
talk now, their hair stands up
on the back of their neck -- it
is exactly what we're living through. What
happened, did people listen to that warning at all?
BG: Basically, no. You know, I was hopeful that with
the Zika and Ebola and SARS and
MERS, they all reminded us that, particularly in a world where
people move around so much, you
can get huge devastation. And
so the talk was to say, hey,
we're not ready for the next pandemic, but
in fact, there's advances in science that if we put resources against them, we can be ready. Sadly, very little was done. There were some things -- the
Coalition for Epidemic Preparedness Innovation, CEPI, was funded by our foundation, Wellcome Trust and a number of governments, to do some of the platform vaccine work, but in the area of diagnostics, antibodies, antivirals, basically doing the disease games that I talked about, where we'd simulate what needed to be done. We hardly did anything, and so now here we have a respiratory virus that is, sadly, fulfilling some of the more negative predictions I made.
CA: Last month, you said that this might be the big one. You wrote that this could be the sort of once-in-a-century pandemic that people had been fearing. Is that how you think of it still?
Well, it's awful to say this, but
we could have a respiratory virus whose case fatality rate was even higher, if this was something like smallpox, you know, that kills 30 percent of people. So this is horrific. But in fact, most
people, even who get the COVID disease, are
able to survive. So it's quite
infectious, way more infectious
than MERS or SARS were. It's
not as fatal as they were. And
yet, the disruption we're seeing, in order to knock it down, is really completely unprecedented. So this is going global, that was -- it's
respiratory, that was the great
fear. How many people end up
dying -- hopefully, if we do
the right things, it won't be a gigantic number. So, you know, we should end up not having the 1918 flu situation. We should be able to do a lot better than that.
CA: And that's because of actions that we would take. I mean, left without the right actions, the prospects are pretty deadly. If we knew what we knew in 1919, this thing could take out tens of millions of people around the world. You said -- is the
key thing here that it's got this sort of a strange combination of being certainly more dangerous than flu -- not as dangerous as something like Ebola or SARS, but more dangerous than flu by a factor, but infectious, and also infectious before symptoms have started, is that part of why it's been really hard to respond to?
BG: Right. Ebola, you're actually flat on your back before you're very infectious. So you're not at church or in a bus or at a store. With most respiratory viruses like the flu and COVID, at first you only feel a little bit of a fever and a little bit sick, and so there's the possibility you're going about your
normal activities and infecting
other people. And so human-to-human
transmissible respiratory viruses that
in the early stage aren't stopping you from doing things, that's kind of a worst case, and that's where, you know, I did a flu simulation in the 2015 talk and showed how quickly it spread. You know, versus 1918, people move around a lot more now than they used to, and so that works against us. Now the medical system that steps up to treat people is also far, far better.
CA: But when was it clear to you that unless we acted, this could be a really deadly pandemic?
BG: Well, in January it was discussed that there
was human-to-human transmission taking place. And so the alarm bells were ringing that this fits the very scary pattern that it will be very difficult to contain. And on January 23, China
did their equivalent of the shutdown. Did
it in a fairly extreme form. The
very good news is that they were able to reduce the infection rates dramatically because of those actions. But
it's January where everybody should have been on notice -- let's get our act together with testing, let's get going on therapeutics and vaccines, we've got to get organized because
we have this novel respiratory virus whose infectiousness and fatality put it in that superscary range.
And so, what did happen? Because it's such a mystery to me about the "lost month" of preparations in many countries and certainly in the US, where we are. Were you on the phone to people during early February, late January, early February, saying, "Guys, what's going on, this is a really big deal, what are we doing?" What was happening behind the scenes during that period?
BG: Well, you'd like to
have government money show up for
the key activities. We put out
100 million, we created the Therapeutics
Accelerator, there's the period
between when we realized it was transmitting and now, where we should have done more. I think the most important thing to discuss today is that in the area of testing, we're still not creating that capacity and applying it to the people most in need. And so we have health workers who are symptomatic, who can't get a test and so they don't know should they go in or not go in, and yet we have lots of tests being given to people who aren't symptomatic. So the testing thing to me, it's got to be organized, it's got to be prioritized, that is super, super urgent. The second thing is the isolation that, you know, various parts, just focusing on the US, some parts are doing that in a fairly strong way and other parts not yet, and it's very hard to do, it's
tough on people, it's disastrous
for the economy. But the sooner
you do it in a tough way, the
sooner you can undo it and go back to normal.
CA: So we'll come to
the isolation part in a minute, but
just sticking with the testing thing, I'm
just so confused as to why, with more than a month's notice -- I mean, there are so many smart epidemiologists in the US, for example, you plug numbers about infectiousness and fatality into any simulation and you see that if you don't do anything, millions of people will die. And there's a month. So what's your explanation, what do you think happened here as to why there was almost no -- a month later, there was no viable test in the US. Was this just government complexity, too many chefs in the kitchen, what on earth happened here?
BG: Well, we certainly didn't take advantage of the month of February. The good news is that the actual process, the PCR machines, we have a lot in the United States. And so there's models like South Korea, who took advantage of February, built up the testing capacity, and they were able to contact-trace and their infections have gone down, even without the type of shutdown that, because we're late, we're having to do. One thing that is good news just this week is that people had thought to do this test, that you had to have a nurse or doctor shove a swab way
up, all the way to the back of
your throat, which hurts a lot, but also, you're going to cough and potentially spread the disease
to that health care worker. So
they have to have protective equipment and
change that. We sent data to
the FDA this weekend, showing
that just an individual, by themselves, swabbing
up to the tip of their nose, the
accuracy of that test is essentially
the same as having a health care worker do it. That helps a lot. We
still have to do other things, but
that means that you don't have to change protective equipment, you just hand the patient that swab, they do it, put it in the test tube, and if the capacity is right, within 24 hours, you should get that result back.
CA: So how do you see
that playing out? Are there people going to massively scale those tests and how will ordinary citizens be able to get hold of them? Does it still have to be kind of prescribed by a doctor at some point, or at some point, will you be able to order them off
Amazon or something?
BG: Well, it's pretty chaotic today, because the government
hasn't stepped in to make sure
the testing capacity is both increased and
it's used for the right cases. There
will be a website -- and if the
federal government doesn't do it, a
lot of local governments will have to do it -- that you go to, you give your situation, including your symptoms, you're told, based on your work and your symptoms, are you a priority. If so, you're told where there are kiosks you can go to and you'll do the self-swab and just hand it over, or eventually, we'll send the kits to you at home, and then you'll send it back and hear that result. Maybe six months from now, you'll actually have a strip where you perform the test in the home, but for now, they're sending it back for the PCR processing. We can have massive capacity there. And that's how you know. The testing is everything, because
that's how you know whether you need to do more shutdown or you're starting to get to the point where you can relieve it.
CA: Some people are trying
to argue now that, almost, the
testing should be dialed back, because
the cat is out of the bag, testing
is bringing people together and risking infection, you know, forget that, let's just focus on treatment and on isolation strategies. You disagree with that. Testing is still absolutely essential and needs to be scaled dramatically.
BG: The two that go together
are testing, at very high volume, and the isolation piece. If you're a medical worker, you want to stay and do your job. If you're making sure the electricity, water, food is still available, you want to do your job, and
so testing is what indicates to you, do
you need to go into isolation and
make sure you're not the source of spread. And so, you know, testing is the key thing. South Korea did that in this massive way that everybody should learn from. And so that is paired with the isolation piece. Our goal here is to get to the point where a very small percentage of the population is infected. You know, China, only 0.01 percent of the population was infected. If you let it, if you don't do these things, you're going to get the majority of people infected and that huge overload of the medical system.
CA: Whitney has some
questions from our online audience. Whitney.
WPR: Some of the questions
that we're seeing are about how
our tech giants and leaders can
play a role in isolating this and containing this virus.
BG: The tech companies
are very involved in making sure
that some work can go on. People
can stay in touch, you know,
they can help with some of the disease modeling, they can help with the visibility of the numbers. It's actually very impressive, you get up there and you can see those numbers. Actually, they're sad numbers, but everybody's able to monitor this thing. Back in 1918, they didn't have this type of visibility, and ability to share best practices. But for a lot of people, the isolation is the key thing.
CA: Bill, one of the
riddles about this isolation strategy is
how long it has to last. A lot
of people are concerned that
the price of victory by isolating everyone is that you crash the economy, and that we have to be, basically, at home, not doing our regular jobs for three, six months, maybe all year. And so much so that there's now this big debate in the US and other countries about this may just be the wrong strategy, that we can't crash the economy that badly, we should only isolate for another couple of weeks, and then let people back, and if that means a lot of other people get sick and we eventually build up herd immunity, that may be the right way to go. What's your thought on this, what is the isolation strategy that eventually leads to us getting back to normal?
BG: It's very tough to say to people, "Hey, keep going to restaurants," you know, "Go buy new houses, ignore that pile of bodies over in the corner, just, you know, we want you to keep spending," because there's some, maybe a politician who thinks GDP growth is what really counts. It's very hard to tell people, when there's an epidemic spreading that threatens, particularly, their parents or elderly people that they know, that they should go about things knowing that their activity is spreading this disease. I don't know of any rich countries that have chosen to use that approach. It is true, if you did that approach, over a period of several years, enough
people would be infected you'd have what's called herd immunity. But herd immunity is meaningless until you infect over half the population. And so you can take -- You'll overload your medical system, so your case fatality rate, instead of being one percent, will be like three, four percent. And so, the
idea, it's very irresponsible for
somebody to suggest we can have the best of both worlds. What we need is the extreme shutdown so that in six to ten weeks, if things go well, then
you can start opening back up.
CA: So just putting the
math together from what you just said, Bill, to get to herd immunity, you
need more than half the people in the country to basically get the bug. So
in the case of the US, for example, that
would be 150 million people, thereabouts. You said that the fatality rate in that scenario, you're talking about four to five million people potential fatalities. That is just a horrifying scenario that no one should be contemplating.
BG: Even one percent
of the population getting sick, they
will treat, whoever goes for this "ignore the disease" strategy, they will treat them as a pariah state, so none of their people will go in, and none of your people will go into that. And so briefly, a few countries in Europe that hadn't really looked at this hard, considered, "OK, should we be the ones who kind
of go about business as usual?" It
is tempting, because if you got there early -- South Korea did not have to do the extreme shutdown, because they did such a good job on testing.
CA: Testing and containment.
BG: That's why it's so maddening
to me that government is not
allocating the testing to where
it's needed, and maybe that will
have to happen at the state level, because
it's not happening at the federal level. But there is no middle course on this thing. It is sad that the shutdown will be harder for poorer countries than it is for richer countries.
CA: So let's come into
that in minute. The one exception I've heard the case made for is Japan, that Japan has not contained it quite in the same way that South Korea did but has allowed people to work. It's tried to make extreme measures for protecting their most elderly population. But they've tried to find a middle scenario, haven't they?
BG: If you act -- When you have hundreds of cases, you may be able to contain it by doing great testing and great contact tracing, and restricting foreigners coming in, without as much damage to your economy. The US is past this opportunity to control without shutdown. So the worst case of what was happening in Wuhan in the beginning or in northern Italy over the last few weeks, that we avoid that. But we did not act fast enough to have an ability to avoid the shutdown.
CA: But then what I don't
understand, in the case of the US, for example, is that even if we're successful in bending the curve and reducing the number of new cases from a period of extreme shutdown, as it were, no immunity has been built up. Let's say that there's still no vaccine. Surely when you lift restrictions and people start going back to work, the whole thing just blows up again.
BG: The experience that
we're seeing in China and in South Korea is that there are not these people who are asymptomatic that are causing lots of infections. And that's a parameter that, as you build the model, you have to put in. There's an Imperial model that people talk about a lot, which shows that reopening is very hard to do. But the results of that model are not matching what we see in China, and so very likely, there aren't as many of these infecting asymptomatics. And that's why you have to be pragmatic. There's a lot we don't know. For example, seasonality may help us in the Northern Hemisphere, the force of infection will -- Respiratory viruses, to some degree, they all are seasonal. We don't know how seasonal this one is, but you know, there's a reasonable chance that the force of infection will be going down. And it's your testing that always is telling you, "Oh, my gosh, do I have to shut down more, or can I start to open up?" So particularly, right as you open up, that testing and contact tracing is saying to you -- And you can say I'm more on the optimistic side, that it will be possible to do what China's doing, where they are starting to go back to normal.
CA: And help me understand
what happened there because it
seems kind of miraculous to me, because
this virus was exploding, yes,
in Wuhan, but people moved from there to many other parts of China. How is it possible that the combination of the shutdown in Wuhan and measures elsewhere seem
to have got to the point where there are literally no new cases happening. I
mean, to me, that implies that literally, the virus is not circulating at all between humans in China. You know, there's a few tourists coming in who they
deal with, but I mean, is that
literally your interpretation of what happened, that it's no longer circulating in China?
BG: Absolutely. Take a spreadsheet and take a number like four -- one person infects four people -- and say the cycle is every 10 days. Go through eight of those cycles, and you're getting the big number. You know, start with 10,000 and then, you know, that increase. If you take the number 0.4 instead, that is, the average case infects 0.4 people, then look at what happens to that number as you go out. It drops to zero, and so things that are exponential are very, very dramatic. When they're above one, they are growing rapidly. When they're below one, they are shrinking rapidly. And so the isolation in China drove that reproductive number to well below one. And so local infection rates --
BG: yes= Below one. And that quarantine, you know, quarantine comes from "40 days," which is what they thought would help for black plague, that is our primary technique. Thank God we have testing, if we use it properly. We are doing therapeutics, which will help with the death rate, but in terms of keeping the infections below one percent of the population, it really all depends just on the two things: isolation and testing.
CA: So to quote a question
from my Twitter feed this morning for you Bill: If you were president for a month in the US, what would be the top two or three things you would do?
BG: Well, the clear message that we have no choice to maintain this isolation and that's going to keep going for a period of time, you know, probably in the Chinese case, it was like six weeks, so we have to prepare ourselves for that, and do it very well. And then use the testing and
every week, talk about what's going on with that. If you're doing isolation well, within about 20 days, you'll see those numbers really change, you know, instead of this, you'll see this, and that is a sign that you're on your way. Now, you have to stay to get more generations that are 0.4 infections per previous infection. You have to maintain it for a number of weeks there. And you know, so this is not going to be easy. We need a clear message about that. It is really tragic that the economic effects of this are very dramatic. I mean, nothing like this has ever happened to the economy in our lifetimes. But bringing the economy back and doing money, that's more of a reversible thing than bringing people back to life. And so, we're going to take the pain in the economic dimension, huge pain, in order to minimize the pain in the disease and death dimension.
WPR: We have a lot of other questions coming in. One that we've been seeing is a question about what tools are available for countries that maybe don't have the luxury of being able to social-distance, don't have great health systems in place, how should they be handling this virus?
BG: Yeah, I would say, if the rich countries really do their job well, by the summer, they'll be like China is, or some of the other countries that responded early. But in the developing countries, particularly in the Southern Hemisphere, the seasonality is large. As you say, the ability to isolate, you know, when you go out to get your food every day, you have to earn your wage, when you live in a slum or you're very nearby each other, it's very hard to do, as you move down the income ladder, than it is for a country like the United States. And so we should all accelerate the vaccine, which eventually will come, and you know, people are being responsible to say that that's going to take 18 months. And there's a lot of those being pursued. I'm talking a lot with Seth Berkley, who you're going to have later this week, who can talk a lot about the vaccine front, because he's definitely at the center of that, being the head of GAVI. We do need to get really cheap testing out to these countries, and we need to get therapeutics so you don't need to put five percent of people on respirators. Because even if they had the equipment, they don't have the personnel, they just don't have the beds, the capacity. And so the only good news is that the rich countries have this and so they will be learning about testing, therapeutics, and funding the vaccines for the entire world, to try and minimize the damage in developing countries.
WPR: Great, I'll be back
later with more questions.
CA: Bill, you mentioned
therapeutics there. What is looking
promising, is anything looking
BG: Yeah, so there's
quite a range of things going on. There's
a few that get mentioned a lot, remdesivir,
hydroxychloroquine, azithromycin, and
the data is still a bit confusing, but
there's some positive data on those. Remdesivir
is a five-day IV infusion, and
actually kind of hard to manufacture, so
people are looking at how that can be improved. The hydroxychloroquine looks like it works, somewhat, if you get in early. There's a huge list of compounds, including antibodies, antiviral drugs, and so the Gates Foundation and Wellcome Trust, with support from Mastercard and now others, created this therapeutics accelerator to really triage out. You have hundreds of people showing up and saying, try this, try that. So we look at lab assays, animal models, and so we understand which things should be prioritized for these very quick human trials that need to be done all over the
world. So the coordination on
that is very complex, globally. But
I think, you know, out of the top 20 or so candidates, probably three or four of them will work out, you know, at different stages of the disease, to reduce the respiratory distress.
CA: I heard you mentioned
that one possibility might be
treatments from the serum, the blood serum, of people who had had the disease and recovered. So I guess they're carrying antibodies. Talk a bit about that, how that could work and what it would take to accelerate that.
BG: Yeah, this has always been discussed as how could you pull that off. So people who are recovered, it appears, have really effective antibodies in their blood. So you could go, transfuse them and only take out the white cells, the immune cells. And then the question is, OK, how many patients' worth of material could you get? You know, if you have that recovered person come in, say, once a week, do you get enough for two people or five people? Then logistically, you have to take that and get it to where that need is. And so it's fairly complicated, you know, compared to a drug that we can make in high
volume. You know, the cost of
taking it out and putting it back in probably
doesn't scale as well. But there
is work being done on this. You
know, we actually started with Ebola, and
fortunately, it got done before it was needed. So that is being pursued and
it will work to some degree, but
it will be hard to scale the numbers.
CA: So it's almost like, when you talk about the need to accelerate testing, the immediate need is for testing for the virus. But is it possible that in a few months'
time, there's going to be this
growing need to test for these antibodies in people, i.e. to see if someone had the disease and recovered, maybe they didn't even know they had it. Because you could picture this growing worldwide force of heroes -- let's call them heroes -- who have been through this experience and have a lot to offer the world. Maybe they can offer blood donation, serum donation. But also other tasks, like, if you've got overwhelmed health care systems, presumably, there are kind of community health worker type tasks that people could be trained to do to relieve the pressure there, if we knew that they were effectively immune?
BG: Yes. Until we came up with the self-swab and showed FDA that that's equivalent, we were thinking that people who might be able to man those kiosks would be the recovered patients. Now we don't want to have a lot of recovered people,
you know. To be clear, we're
trying, through the shutdown, in
the United States, to not get
to one percent of the population infected. We're well below that today, but with exponentiation, you could get past that three million. I believe we will be able to avoid that with having this economic pain. Eventually, what we'll have to have is certificates of who is a recovered person, who is a vaccinated person, because you don't want people moving around the world -- where you'll have some countries that won't have it under control, sadly -- you don't want to completely block off the ability for those people to go there and come back
and move around.
CA: Bill, is your foundation helping to accelerate
the manufacture of these self
tests? What are the prospects
for really seeing scale on some
of this testing soon, not just
in the US, but globally?
BG: Yeah, our foundation, we'd been funding the thing called the Flu Study to really understand how respiratory viruses spread. It's amazing how little was understood about how important schools are, different age groups, different types of interaction. And that gave us an experience. In fact, that flu study actually was the first time coronavirus was found in
the community, because the government
was still saying you only test
people who'd come from China, but
we ran into people who had coronavirus, who
hadn't been travelers. So, that
was like an early warning sign, even
though the regulation said you weren't supposed to even look at that. So yeah, the Foundation is working with all the private sector people, the diagnostics people on this testing piece. Now that we can do the self-swab, those swabs are very easy to manufacture. The one where you had to jam it into the throat, deep turbinate, that was getting into short supply. So the swab should not be limiting, neither should the various chemicals that help run the
PCR machines. So we should be
able to get to a South Korea-type
prioritized testing thing within
a few weeks.
CA: How important is
it that the world's nations collaborate
right now? I mean, it seems like,
you know, here's this common
enemy facing humanity, it does
not know that it just crossed a border, it
does not know what race people are, what
religion they are -- it just
knows, "Here's a human, I've
got a manufacturing machine here that can make me famous." And it goes to work. It's so terrifying to me to see signs of countries starting to blame each other or the xenophobia, it just seems so toxic. What's your take on this, Bill? Do you see signs of cooperation happening, or are you also worried about the sort of, "US versus China" kind of thing that seems to be going on if we're not careful?
BG: Well, I see both. I see that countries that are recovered can help other countries. And that's fantastic. If
by the summer, we've knocked this thing down, then great, we can help other countries. There are vaccine projects all over the world, and those should be evaluated on a very neutral basis, to which one is the best to help humanity. And make sure the manufacturing capacity isn't just for rich countries, that it's scaled up, very low cost stuff for the entire
world, and that's the spirit
of GAVI, is getting vaccines out to every person. So in the science side, and data-sharing side, you see this great cooperation going on. Unfortunately, whenever you have disease, this sense of other and foreign and "Oh, stay away from me," you know, that sort of pulling inward is reinforced. And we have to avoid that. You know, ironically, we have to isolate physically, while in terms of looking at community groups that are pooling resources to help make sure food gets to everyone and help assure medical care, you know, if older people need to be moved out of common
facilities, you help out with
that, and that people aren't
suffering too much from the psychology of isolation. So our generosity has to go up towards others at the same time we're less actually physically interacting with other people.
CA: I mean, thinking
about the situation in many developing countries, I'm curious how you think of this. You mentioned, first of all, that seasonality may help, i.e. high temperatures. Is it possible that that is so far protecting, to some extent, places like India or sub-Saharan Africa and so forth?
BG: India's Northern Hemisphere. So Southern Hemisphere is lots of Africa, South America, Australia, New Zealand, Indonesia. And it is true, either the force of the infection is lower there or we're just not seeing it with testing. You know, a few months from now, we'll understand the seasonality question, which would be good news for the Northern Hemisphere, and somewhat bad news for the Southern
Hemisphere. Now more people live
in the Northern Hemisphere, including
India, Pakistan, and that would
buy us some time, and time is a big deal, because all these tools get so much better if you had to go into a second season with it. But yeah, sadly, we
could see, in the next few months, as
the Southern Hemisphere is moving into its fall and then winter, we could see a big increase there, and that is going to be very difficult. Now they don't have as many older people, but they have lots of people who are HIV positive, or have malnutrition or various lung challenges because of indoor smoke, and so the wild card is
how well can the developing countries deal with this.
CA: If you're in a country
where the majority of your population is
making less than two or three dollars a day, can you even afford a strategy that looks like, basically, shutting down the economy?
BG: I'm very worried
that there will be a massive number of deaths in those poorer countries, because
the health systems just aren't -- you
know, the number of respirators, hospitals, and of course, when you overload that system, your deaths are not just COVID deaths, but everyone else who's trying to access a system that will be somewhat in chaos, including with health workers who are getting sick.
CA: OK, we're getting
near to running out of time with this. Whitney,
maybe a last question or two from online.
WPR: Sure, we have two
from online, we're seeing thousands
of questions around these same lines. One,
there's lots of people who are really interested to hear about the kind of work that you're doing with your foundation as far as distributing tests, but also producing safety gear, masks and that sort of thing, to help with this effort for health workers.
BG: So the Gates Foundation, you know, we, very early on, gave out 100 million to help out with
all the pieces: the testing piece,
the therapeutics and the vaccines. We
are not experts in making masks and ventilators and gowns, and it's great that other people, including some 3D printing, and open-source things, that is great. Our focus, you know, like this self-swab thing, nobody had done that before, people thought it wouldn't work, we were quite sure it would work. And so that, for the globe, is a huge thing. We work a lot with both governments and private sector, so in some ways, we're kind of a bridge. And we've been talking to the heads of the pharmaceutical companies, the testing companies and, specifically, with the ones doing vaccines, including some of which are these new type of vaccines, RNA vaccines, that we've been backing for quite some time, and CEPI has been backing. And so our expertise is in those medical tools and really getting the best of the private sector engaged there. It's been a little slow. We can write checks right away, whereas the government processes, even in this situation -- you
know, there's still this notion of bidding, and not really knowing who has the unique capabilities of doing things, and so, an organization that's working on this all the time, lots of new vaccines, can step in and be helpful. And
it's really amazing. When we
talk to private-sector partners, their
interest in helping out has been absolutely fantastic. And so that's where we have a unique role.
WPR: And the other question
that we're seeing a ton of -- before
we wrap up here -- is just people
are really interested in your insight, Bill, on whether you think we are heading in the right direction, do you feel like our economy is heading in the right place, that humanity is heading in the right place, are we in a better position now than you thought we were in five years ago?
BG: Well, five years ago, I said that pandemic is this unaddressed, very, very scary thing. And that if we did the right things, we could be more prepared. Science is on our side. The fact we can be ready for the next epidemic, it's very clear how to do that. And yes, it will take tens of billions, but not hundreds or trillions of dollars. So it will be tiny compared to the economic cost. I remember when I did that presentation 2015, I put up, "Hey, a big flu epidemic could cost four trillion," and I thought, wow, that's a big number, do I really think it's that big? And I went and looked up numbers and thought, yeah, well,
that's big. This epidemic will
cost that much to the economy. So
in the short run, we are going
to have more pain and more difficulty and
people are going to have to step up to help each other. I'm still very much an optimist, you know, whether it's climate change, countries working together, biology taking the diseases, malaria, TB, you know, even advances for what are more rich-world diseases, like cancer. The amount of innovation, the
way we can connect up and work together -- yes, I'm superpositive about that. You know, I love my work because
I see progress on all these diseases all the time. Now we have to turn and focus on this, you know. Sadly, it may interrupt and the polio situation might get worse a little bit because of the distraction here. We're using a lot of the great capacity that was built up for those polio activities to try and help the developing countries respond to this very well. And that is appropriate, but the message from me, although it's very sober when we're dealing with this epidemic, you know, I'm very positive that this should draw us together. We will get out of this, and then, we will get ready for the next epidemic.
CA: That's exactly what
I was going to ask you, Bill, which
is, where is your head, do you think we will get through this? Will the leaders that matter listen to the scientists, will they? Will we make it through? Do
you believe that within a few months' time, we're already going to be looking back and saying, "Phew, we dodged a pretty bad one there."
BG: We can't say for
sure that even the rich countries
will be out of this in six to
ten weeks. I think that's likely, but as we get the testing data, we'll get more of a sense of that and people will continuously be able
to see that. But you know, the
rich countries will get out of this. The
developing countries will bear a significant price, but even they, we will get a vaccine and GAVI will get that out to everyone. So you know, two to three years from now, this thing, even on a global basis, will essentially be over with a gigantic price tag. But now we're going to know, OK, next time we see a pathogen, we can make billions of tests within two or three weeks. We can figure out which antiviral drugs work within two or three weeks and get those scaled up. And
we can make a vaccine, if we're
really ready, probably in six
months, using these new platforms,
probably the RNA vaccine. So
specifically, there are innovations that are there that will get financed, you know, I hope, quite generously, coming out of this thing. And so, three years from now, we'll look back and say, you know, that was awful, there's a lot of heroes, but we've learned a lesson and the world as a whole, with its great science and desire to help each other, was able to try and minimize what happened there and avoid it happening again.
CA: That's certainly
the optimistic scenario that
I'm craving for, myself. That
the world kind of realizes, one,
that there are certain things that you just have to unite on. Two, that science really matters and it's a miracle that science can understand this bug, you know, make a vaccine, sequence it, make therapeutics, understand how to model it -- it's kind of miraculous to me. So will we learn, now, to pay attention to scientists, because if we do, I'm sure that you feel this as well, there's an amazing analogue with climate, it's just a different timescale. That the scientists are out there, saying, "There's this huge enemy coming, if we do nothing, it's going to take millions of lives, it's going to wreck our planet. For God's sake, act, politicians! Do something." And the politicians are going, "Meh, no. We need a little more GDP, we need to win an election." And they're not acting. Do you see a scenario where this shocks politicians to actually change their thinking and their prioritization of science overall, or is that asking too much?
BG: Yeah, it's interesting
how much of this distraction will
delay the urgent innovation agenda that exists over in climate. You know, I have freed up a lot of time to work on climate. I have to say, you know, for the last few months, that's now shifted, and until we get out of this crisis, COVID will dominate, and so some of the climate stuff, although it will still go on, it won't get that same focus. As we get past this, yes, that idea of innovation and science and the world working together, that is totally common between these two problems. And so I don't think this has to be a huge setback for climate.
CA: Last question. There are thousands of people watching, many of them living alone, some quite scared, there may even be people there who have this virus and are suffering symptoms or recovering. By the way, if that's you, we'd love to hear from you, we really would. Maybe have a conversation with some of you, in a future one of these, just
understanding the experience. But
Bill, what can people do as individuals from their own homes, right now, to try and help?
BG: Well, there's a lot
of creativity, you know -- can
you mentor kids who are being forced into an online format where the school systems really weren't ready for that? Can you organize some giving activity that gets the food banks to step up where there's problems there? These are such unprecedented times, and it really should draw out that sense of creativity, while complying with the isolation
CA: Bill, I really want
to thank you for spending this time with us and for the financial investment, the time investment. You've really invested your life into trying to solve these big problems. And this is as big as they get. I have a hunch that your voice is really going to be
needed in the next few weeks. Thank you so much for your time today. This was really wonderful, hearing
from you. Thank you.
CA: OK, thanks, everyone, thanks for being part of the TED community. Look after yourselves, be smart about
this. You know, get ahead of
it. If you're in a part of the
world where this thing hasn't really hit, listen to Bill Gates. Get
ahead of it. Keep, you know,
if you possibly can, socially
distanced. No, not -- physically
distanced and socially connect. That's
what the internet is for. These
days are what the internet was built for. We can spread love, we can spread ideas, we can spread relationship, we can spread thought, without spreading a dangerous bug. So get ahead of it, and let's figure this out together. It's been wonderful spending time with you. From Whitney and from me and from the whole TED team, thank you, and over and out.
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