Watch: Bill Gates on how to end this pandemic—and prepare for the next

COVID-19 has created a cascade of negative effects on human health and well-being. In an interview with National Geographic's Susan Goldberg, Bill Gates outlines how the world can turn things around.

National Geographic’s Susan Goldberg talks to Bill Gates about his foundation's fourth annual Goalkeepers Report, and how COVID-19 has radically upended our global health.

NG Media

Watch: Bill Gates on how to end this pandemic—and prepare for the next

COVID-19 has created a cascade of negative effects on human health and well-being. In an interview with National Geographic's Susan Goldberg, Bill Gates outlines how the world can turn things around.

National Geographic’s Susan Goldberg talks to Bill Gates about his foundation's fourth annual Goalkeepers Report, and how COVID-19 has radically upended our global health.

NG Media

The COVID-19 pandemic has affected human health and well-being for the worse in nearly every measurable way, according to a new report released by the Bill & Melinda Gates Foundation. In its fourth annual Goalkeepers Report—which assesses the world’s efforts to meet goals set out by the United Nations to end extreme poverty, hunger, gender inequality, and more—the foundation finds that the COVID-19 pandemic has reversed years of progress toward nearly all of these goals and argues for a collaborative approach to end the pandemic.

In an interview with National Geographic’s Editor in Chief Susan Goldberg, Bill Gates explains how nations can work together to turn things around—and why distributing a vaccine equitably among them would save hundreds of thousands of lives. Read the transcript of their interview, which has been edited for length, below:

Susan Goldberg

Bill, it's so nice to talk with you about this Goalkeepers report. I was really struck how different it was from the last time we talked about Goalkeepers in 2018. That was much more of a positive report, all of the indicators were going in the right way. COVID has really put the brakes on that. I think your report puts it really well. It said, "In the blink of an eye, a health crisis became an economic crisis, a food crisis, a housing crisis, a political crisis. Everything collided with everything else." Which of these results do you think is the most important one? Where would you look to start to talk about this?

Bill Gates

As you say, in most years the reduction in malnutrition, the reduction in childhood death, the increase in literacy rates—there's this gradual progress that human life is getting better, people are living longer. It's amazing that [COVID-19] is so widespread in its negative effects. The actual direct effect of killing people in poor countries is a very small part of the overall damage that's been done. A big part is that their health systems, which are very fragile, have been disrupted. Vaccinations aren't taking place. Malaria bed nets are not getting out. HIV medicines are not getting out. Africa will have dramatically more deaths from these indirect effects than from the direct effects.

So the imperative is, let's bring the epidemic to an end. That takes us to a discussion about vaccines, which is the only tool to do that. And then make sure that we do restore services, even some catch up for the kids who missed those vaccinations. Even if we do our best on all those things—the vaccine, the restoration, the rich country generosity—it'll take two to three years just to get back to the beginning of 2020.

Susan Goldberg

And it has happened all so quickly. One of the things the report talks about that I found really startling was when it came to vaccine distribution and how key this is going to be in terms of survivability. This model from Northeastern University, I was really shocked, it said that 33 percent of [COVID-19] deaths will be averted if vaccines are distributed to high income countries first. But 61 percent could be averted if the vaccines are distributed to all countries proportionally to their population. Can you talk about why that is?

Bill Gates

Well, there are deaths all over. Now, no one's saying that the distribution algorithm will be totally based on equity. There'll be some tilt toward the countries that help fund the research and development. But we need to have some balance here, both the generosity to buy the vaccines for those countries to increase the manufacturing capacity—because this is more units of a vaccine than the world has ever needed—and then to help fund that availability without the rich countries taking all of that capacity.

Susan Goldberg

Do you think, though, if say the United States or other wealthy countries don't take this equitable approach, that we will be morally culpable for more deaths?

Bill Gates

The foundation's motto is all lives have equal value. The foreign aid that rich countries give has saved tens of millions of lives—things like Global Fund for HIV and Gavi, which helps buy vaccines for things like diarrhea and pneumonia. And so there is some equity in the world. But the very fact that our foundation is saving a life for every thousand dollars we spend, it shows that we do treat lives outside the U.S. as not being as valuable as those lives. It's pretty extreme.

This would be a double mistake because not only would you be sacrificing those lives but as long as you let the disease exist outside the United States or anywhere in the world, it's going to come back so you can't resume your normal activity. So of all the health crises, this is one where the world really is in it together. Even countries that did a good job on the epidemic like South Korea or Australia found it difficult for there not to be reinfections, and so they're having to continue preventative measures where they have very few cases with big disruption and economic costs. So we've got to solve it for all of humanity. It’s both just and, even from a selfish point of view, it's the smart thing to do.

Susan Goldberg

The report does make that point, repeatedly—that you can't solve a global problem with a national solution. But it sounds to me you're also worried that this might not really happen, that there won't be that global solution. Because the report comes back to this point over and over again.

Bill Gates

Well, so far, the U.S., although it is exemplary in funding the R&D for the six vaccines that are the most likely to get really strong regulatory approval by early next year, it has been absent in the discussion about creating the capacity and the aid money to buy those vaccines. Now I'm hopeful: Congress historically has been great on global health, very generous on things like HIV and malaria, and so the fact it's been overlooked, I hope that gets remedied and very quickly because every month that this epidemic stays out there literally costs trillions of dollars. And yet the billions needed for the vaccine are the only thing that will bring it to an end.

Susan Goldberg

One of the figures that really struck me was the increase in poverty. I mean, there'd been this streak of less and less poverty that had gone on for about 20 years. And now, all of a sudden, tens of millions or more people are pushed into poverty because of what's happened here. And the report talked about women really taking the brunt of that. Could you talk about that?

Bill Gates

There's no doubt that in poor countries things are tough for everyone, but women bear the brunt of that. So, as you get this reversal into poverty, it's not equitable at all. The extra work, having the kids at home, finding enough food… Extreme poverty is waking up and worrying, will you have enough to eat every day.

By 2030, the sustainable development goal is to bring an end to extreme poverty. And the track record there, particularly in Asia, has been quite good. It's been going down a lot. The place where it's been toughest is in Africa, where you have very high population growth and the difficulty of climate change making farming less predictable so you have years where you don’t get enough. We'd hoped that with generous aid, with better seeds, that Africa too would start the kind of miracles that we've seen in Asia. But this is at best a three- or four-year setback to that quest to have almost no one live in extreme poverty.

Susan Goldberg

There's so little good news in this report and understandably so. But do you see any innovations that might come out of having to deal with this disease? What are the hopeful lifelines that you could throw out there?

Bill Gates

Well, there's no doubt that having ignored the warnings about the pandemic this time, the rich countries, including the U.S., will take the threat seriously. They'll do simulations to prepare. They'll have large-scale diagnostic capability immediately available—which the U.S. in particular was the worst on that. We'll mature some of these vaccine platforms that are not only worthwhile for pandemics, but will be used to make vaccines for malaria, TB, and HIV.

Just like in war time, we've moved quickly and tried new things. Even in terms of our lifestyle: can you use telemedicine, can you use online education, can you avoid some of the business travel we do? Our eyes have been opened up and that software is getting a lot better. It's a real acceleration there.

It doesn't offset all the negative things that come out of the pandemic. But yes, the ingenuity in the pharmaceutical companies, that's why we have six vaccine candidates—several of which are extremely likely to prove safe and efficacious by early next year. If this pandemic had come 10 years ago, our internet bandwidth wouldn't have let us do our office jobs. The vaccine platforms wouldn't be as far along. So, it's phenomenal we can say that within a few years, with a little bit of luck on the vaccines, some generosity, and a real effort to get the word out that it's safe, this pandemic will come to a close. [It would be] a lot more negative to say, "Oh my God, this is going to continue indefinitely." Fortunately, because of science and the pharma companies jumping in, that's not the case.

Susan Goldberg

Do you think, as a last thought, the U.S. has learned its lesson, if you will, about taking pandemics seriously and being prepared and getting ready? I mean, the problem is, is you get ready and then nothing happens, nothing happens, nothing happens. And then you get unprepared. But do you think that this will have made that impression a lasting one?

Bill Gates

Well, we'll go into a post-mortem. The Centers for Disease Control and Prevention made some mistakes at the start. And then you had things moved up to a political level without expertise, where the willingness to admit mistakes was zero. The fact that we still have test results that take more than 24 hours, that is just a desire to say, "Oh, I solved the testing thing.” You shouldn't reimburse [companies] for those delayed test results. So we still are performing way below what we should.

I do think there'll be a lesson to let the professionals do their work. And there'll be lots of research and development about how you can ramp up testing drugs and vaccines very quickly. So, yes, unlike the title of my 2015 talk, which was, “We're not ready for the next pandemic,” I think three years from now we will be ready for the next pandemic.

Susan Goldberg

Well, I hope there isn't a next one. But I appreciate the optimism around that. Bill, thank you so much for talking with us at National Geographic about your latest Goalkeepers Report.