How we must respond to the coronavirus pandemic | Bill Gates

  Transcriber: Ivana KoromReviewer: Krystian Aparta Whitney Pennington Rodgers:Hello and welcome to everyone joining us from around the globe. Thank you for being part of day twoof our special series TED Connects. This week, we're bringing you interviewsfrom some of the world's greatest minds to offer tools for us to navigatethrough and thrive in these really uncertain times. I'm Whitney Pennington Rogers,TED's current affairs curator, and I'll be one of your hostsfor today's event. Yesterday, we kicked off this series with an interview from acclaimedpsychologist Susan David, who offered us some tipson how to really be our best selves in these trying times. And we're going to switch gearsa little bit today from thinking aboutour own personal mental health to the state of our globalpublic health systems. Chris Anderson: Thank you. I guess we have a prettyexciting guest to introduce. On the other side of the country,let's bring in Bill Gates. Bill, they saythe 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 isan unprecedented, really disconcerting time for everyone, with things being shut down, not knowing exactlyhow long it's going to last, worrying about the healthof all the people we care about. You know, I'm luckythat 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 peopletrying to help with this crisis. But it's scary for everyone. CA: Are you basically stuck at homelike many of us watching? BG: Yeah, almost all my meetingsare using Teams now, I'm getting used to that. You know, I've gone dayswithout 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 upon the back of their neck -- it is exactly what we're living through. What happened, did peoplelisten to that warning at all? BG: Basically, no. You know, I was hopefulthat with the Zika and Ebola and SARS and MERS, they all reminded us that, particularly in a worldwhere people move around so much, you can get huge devastation. And so the talk was to say, hey, we're not readyfor the next pandemic, but in fact, there's advances in sciencethat if we put resources against them, we can be ready. Sadly, very little was done. There were some things -- the Coalition for EpidemicPreparedness Innovation, CEPI, was funded by our foundation, Wellcome Trustand a number of governments, to do some of the platform vaccine work, but in the area of diagnostics,antibodies, antivirals, basically doing the disease gamesthat I talked about, where we'd simulatewhat needed to be done. We hardly did anything, and so now here we havea respiratory virus that is, sadly, fulfilling someof the more negative predictions I made. CA: Last month, you saidthat this might be the big one. You wrote that this could bethe sort of once-in-a-century pandemic that people had been fearing. Is that how you think of it still? BG: Well, it's awful to say this, but we could have a respiratory viruswhose 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 getthe COVID disease, are able to survive. So it's quite infectious, way more infectiousthan 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 upnot having the 1918 flu situation. We should be able to doa lot better than that. CA: And that's because of actionsthat 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 outtens of millions of people around the world. You said -- is the key thing here that it's gotthis sort of a strange combination of being certainlymore dangerous than flu -- not as dangerous as somethinglike Ebola or SARS, but more dangerous than fluby a factor, but infectious, and also infectiousbefore symptoms have started, is that part of whyit's been really hard to respond to? BG: Right. Ebola, you're actually flat on your backbefore you're very infectious. So you're not at churchor in a bus or at a store. With most respiratory viruseslike the flu and COVID, at first you only feel a little bitof a fever and a little bit sick, and so there's the possibilityyou're going about your normal activities and infecting other people. And so human-to-humantransmissible respiratory viruses that in the early stagearen'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 nowthan they used to, and so that works against us. Now the medical systemthat 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-humantransmission 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 equivalentof the shutdown. Did it in a fairly extreme form. The very good newsis that they were able to reduce the infection rates dramatically because of those actions. But it's January where everybodyshould have been on notice -- let's get our act together with testing, let's get going ontherapeutics and vaccines, we've got to get organized because we have this novelrespiratory virus whose infectiousness and fatalityput it in that superscary range. CA: 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 scenesduring that period? BG: Well, you'd like to havegovernment money show up for the key activities. We put out 100 million, we created the Therapeutics Accelerator, there's the period betweenwhen we realized it was transmitting and now, where we should have done more. I think the most important thingto discuss today is that in the area of testing, we're still not creating that capacity and applying itto the people most in need. And so we have health workerswho are symptomatic, who can't get a test and so they don't knowshould they go in or not go in, and yet we have lots of tests being given to peoplewho 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 thatin 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 itand go back to normal. CA: So we'll cometo 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 smartepidemiologists in the US, for example, you plug numbersabout 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 hereas 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 takeadvantage 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-traceand 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 thoughtto do this test, that you had to have a nurse or doctorshove 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 diseaseto that health care worker. So they have to have protective equipment and change that. We sent data to the FDA this weekend, showing that justan individual, by themselves, swabbing up to the tip of their nose, the accuracy of that test is essentially the sameas having a health care worker do it. That helps a lot. We still have to do other things, but that means that youdon'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 massivelyscale those tests and how will ordinary citizensbe able to get hold of them? Does it still have to be kind ofprescribed by a doctor at some point, or at some point, will you be ableto 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 capacityis both increased and it's used for the right cases. There will be a website -- and if the federalgovernment doesn't do it, a lot of local governmentswill have to do it -- that you go to, you give your situation,including your symptoms, you're told, based on your workand your symptoms, are you a priority. If so, you're told wherethere are kiosks you can go to and you'll do the self-swaband just hand it over, or eventually, we'll sendthe kits to you at home, and then you'll send it backand hear that result. Maybe six months from now, you'll actually have a stripwhere you perform the test in the home, but for now, they're sending it backfor the PCR processing. We can have massive capacity there. And that's how you know. The testing is everything, because that's how you knowwhether you need to do more shutdown or you're starting to get to the pointwhere you can relieve it. CA: Some people are trying to argue now that, almost, the testingshould be dialed back, because the cat is out of the bag, testing is bringing people togetherand risking infection, you know, forget that,let's just focus on treatment and on isolation strategies. You disagree with that. Testing is still absolutely essentialand 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 surethe 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 notthe 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 pairedwith the isolation piece. Our goal here is to get to the point where a very small percentageof the population is infected. You know, China, only 0.01 percentof the population was infected. If you let it, if you don't do these things, you're going to getthe majority of people infected and that huge overloadof the medical system. CA: Whitney has some questionsfrom our online audience. Whitney. WPR: Some of the questionsthat we're seeing are about how our tech giants and leaders can play a role in isolating thisand 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 helpwith some of the disease modeling, they can help withthe visibility of the numbers. It's actually very impressive, you get up thereand you can see those numbers. Actually, they're sad numbers, but everybody's ableto monitor this thing. Back in 1918, they didn't havethis 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 riddlesabout this isolation strategy is how long it has to last. A lot of people are concerned that the price of victoryby isolating everyone is that you crash the economy, and that we have to be, basically, at home, not doing our regular jobsfor three, six months, maybe all year. And so much so that there's nowthis big debate in the US and other countries about this may just be the wrong strategy, that we can't crashthe economy that badly, we should only isolatefor another couple of weeks, and then let people back, and if that meansa 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 usgetting 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 bodiesover in the corner, just, you know, we want youto keep spending," because there's some, maybe a politician who thinks GDP growthis 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 activityis spreading this disease. I don't know of any rich countriesthat have chosen to use that approach. It is true, if you did that approach, over a period of several years, enough people would be infectedyou'd have what's called herd immunity. But herd immunity is meaninglessuntil 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 suggestwe 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 togetherfrom what you just said, Bill, to get to herd immunity, you need more than halfthe people in the country to basically get the bug. So in the case of the US, for example, that would be 150 millionpeople, thereabouts. You said that the fatality ratein that scenario, you're talking about fourto five million people potential fatalities. That is just a horrifying scenariothat no one should be contemplating. BG: Even one percentof the population getting sick, they will treat, whoever goesfor 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 Europethat hadn't really looked at this hard, considered, "OK, should we be the oneswho kind of go about business as usual?" It is tempting,because if you got there early -- South Korea did not have to dothe extreme shutdown, because they didsuch a good job on testing. CA: Testing and containment. BG: That's why it's so maddening to me that governmentis not allocating the testing to where it's needed, and maybe that will have to happenat the state level, because it's not happeningat the federal level. But there is no middle courseon this thing. It is sad that the shutdownwill 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 heardthe case made for is Japan, that Japan has not contained itquite in the same way that South Korea did but has allowed people to work. It's tried to make extreme measures for protecting their mostelderly population. But they've tried to finda middle scenario, haven't they? BG: If you act -- When you have hundreds of cases, you may be able to contain itby doing great testing and great contact tracing, and restricting foreigners coming in, without as much damage to your economy. The US is past this opportunityto control without shutdown. So the worst case of what was happeningin Wuhan in the beginning or in northern Italyover the last few weeks, that we avoid that. But we did not act fast enoughto 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 reducingthe number of new cases from a period of extremeshutdown, as it were, no immunity has been built up. Let's say that there's still no vaccine. Surely when you lift restrictionsand people start going back to work, the whole thing just blows up again. BG: The experience that we're seeingin China and in South Korea is that there are not these peoplewho 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 modelthat people talk about a lot, which shows that reopeningis very hard to do. But the results of that modelare not matching what we see in China, and so very likely, there aren't as manyof these infecting asymptomatics. And that's why you have to be pragmatic. There's a lot we don't know. For example, seasonalitymay 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 infectionwill be going down. And it's your testingthat 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 tracingis saying to you -- And you can say I'm moreon the optimistic side, that it will be possible to dowhat China's doing, where they are startingto go back to normal. CA: And help me understandwhat happened there because it seems kind of miraculous to me, because this virus was exploding, yes, in Wuhan, but people moved from thereto many other parts of China. How is it possible that the combinationof the shutdown in Wuhan and measures elsewhere seem to have got to the pointwhere there are literally no new cases happening. I mean, to me,that implies that literally, the virus is not circulating at allbetween humans in China. You know, there's a few touristscoming in who they deal with, but I mean, is that literallyyour interpretation of what happened, that it's no longer circulating in China? BG: Absolutely. Take a spreadsheetand 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 caseinfects 0.4 people, then look at what happensto that number as you go out. It drops to zero, and so things that are exponentialare 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 numberto well below zero. And so local infection rates -- CA: Below one. BG: Below one, sorry. And that quarantine, you know, quarantine comes from "40 days," which is what they thoughtwould 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 infectionsbelow one percent of the population, it really all dependsjust on the two things: isolation and testing. CA: So to quote a question frommy Twitter feed this morning for you Bill: If you were presidentfor a month in the US, what would be the toptwo or three things you would do? BG: Well, the clear message that we have no choiceto maintain this isolation and that's going to keep goingfor 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 aboutwhat'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 signthat you're on your way. Now, you have to stayto get more generations that are 0.4 infectionsper previous infection. You have to maintain itfor 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 tragicthat the economic effects of this are very dramatic. I mean, nothing like thishas ever happened to the economy in our lifetimes. But bringing the economy backand doing money, that's more of a reversible thingthan bringing people back to life. And so, we're going to take the painin the economic dimension, huge pain, in order to minimize the painin the disease and death dimension. CA: Whitney. WPR: We have a lotof other questions coming in. One that we've been seeing is a question about what toolsare available for countries that maybe don't have the luxuryof 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 countriesreally do their job well, by the summer, they'll be like China is, or some of the other countriesthat 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 outto get your food every day, you have to earn your wage, when you live in a slumor you're very nearby each other, it's very hard to do, as you move down the income ladder, than it is for a countrylike the United States. And so we should allaccelerate the vaccine, which eventually will come, and you know, peopleare 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 lotabout the vaccine front, because he's definitelyat the center of that, being the head of GAVI. We do need to get really cheap testingout to these countries, and we need to get therapeutics so you don't need to putfive percent of people on respirators. Because even if they had the equipment, they don't have the personnel, they just don't havethe beds, the capacity. And so the only good newsis that the rich countries have this and so they will be learningabout testing, therapeutics, and funding the vaccinesfor the entire world, to try and minimize the damagein developing countries. WPR: Great, I'll be back laterwith more questions. CA: Bill, you mentionedtherapeutics there. What is looking promising, is anything looking promising? BG: Yeah, so there's quitea 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 lookingat how that can be improved. The hydroxychloroquine looks likeit works, somewhat, if you get in early. There's a huge list of compounds,including antibodies, antiviral drugs, and so the Gates Foundationand Wellcome Trust, with support from Mastercardand now others, created this therapeutics acceleratorto really triage out. You have hundreds of people showing upand saying, try this, try that. So we look at lab assays, animal models, and so we understand which thingsshould be prioritized for these very quick human trials that need to be done all over the world. So the coordination on thatis very complex, globally. But I think, you know,out of the top 20 or so candidates, probably three or four of themwill work out, you know, at differentstages of the disease, to reduce the respiratory distress. CA: I heard you mentionedthat one possibility might be treatmentsfrom the serum, the blood serum, of people who had hadthe 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 discussedas how could you pull that off. So people who are recovered, it appears, have really effectiveantibodies in their blood. So you could go, transfuse them and only take outthe white cells, the immune cells. And then the question is, OK, how many patients' worthof material could you get? You know, if you havethat recovered person come in, say, once a week, do you get enoughfor two people or five people? Then logistically, you have to take thatand get it to where that need is. And so it's fairly complicated, you know, compared to a drugthat we can make in high volume. You know, the cost of taking it outand 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 donebefore 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 needto accelerate testing, the immediate needis for testing for the virus. But is it possiblethat in a few months' time, there's going to be this growing needto test for these antibodies in people, i.e. to see if someonehad the disease and recovered, maybe they didn't even know they had it. Because you could picturethis 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 offerblood donation, serum donation. But also other tasks, like, if you've got overwhelmedhealth care systems, presumably, there are kind ofcommunity health worker type tasks that people could be trained to doto relieve the pressure there, if we knew that they wereeffectively immune? BG: Yes. Until we came up with the self-swab and showed FDA that that's equivalent, we were thinking that peoplewho might be able to man those kiosks would be the recovered patients. Now we don't want to havea lot of recovered people, you know. To be clear, we're trying,through the shutdown, in the United States, to not get to one percentof 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 whois a recovered person, who is a vaccinated person, because you don't want peoplemoving around the world -- where you'll have some countriesthat won't have it under control, sadly -- you don't want to completely block off the ability for those people to go thereand come back and move around. CA: Bill, is your foundation helpingto accelerate the manufacture of these self tests? What are the prospectsfor 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 thingcalled the Flu Study to really understandhow respiratory viruses spread. It's amazing how little was understoodabout 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 timecoronavirus was found in the community, because the government was still saying you only test peoplewho'd come from China, but we ran into peoplewho had coronavirus, who hadn't been travelers. So, that was like an early warning sign, even though the regulation saidyou weren't supposed to even look at that. So yeah, the Foundation is workingwith all the private sector people, the diagnostics peopleon this testing piece. Now that we can do the self-swab, those swabs are very easy to manufacture. The one where you hadto jam it into the throat, deep turbinate, that was getting into short supply. So the swab should not be limiting, neither should the various chemicalsthat help run the PCR machines. So we should be able to get to a South Korea-typeprioritized testing thing within a few weeks. CA: How important is itthat the world's nations collaborate right now? I mean, it seems like, you know, here's this common enemy facing humanity, it does not knowthat 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 herethat can make me famous." And it goes to work. It's so terrifying to me to see signs of countries startingto 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 onif 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 projectsall over the world, and those should be evaluatedon a very neutral basis, to which one is the best to help humanity. And make sure the manufacturing capacityisn't just for rich countries, that it's scaled up, very low cost stufffor 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 foreignand "Oh, stay away from me," you know, that sort ofpulling inward is reinforced. And we have to avoid that. You know, ironically,we have to isolate physically, while in terms of lookingat community groups that are pooling resourcesto help make sure food gets to everyone and help assure medical care, you know, if older people needto be moved out of common facilities, you help out with that, and that people aren't suffering too muchfrom the psychology of isolation. So our generosityhas to go up towards others at the same time we're less actuallyphysically interacting with other people. CA: I mean, thinking about the situationin 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 farprotecting, to some extent, places like Indiaor sub-Saharan Africa and so forth? BG: India's Northern Hemisphere. So Southern Hemisphereis lots of Africa, South America, Australia, New Zealand, Indonesia. And it is true, either the forceof 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 newsfor the Northern Hemisphere, and somewhat bad newsfor the Southern Hemisphere. Now more people livein 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 intoa second season with it. But yeah, sadly, we could see, in the next few months, as the Southern Hemisphereis 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 peoplewho are HIV positive, or have malnutritionor various lung challenges because of indoor smoke, and so the wild card is how well can the developingcountries deal with this. CA: If you're in a countrywhere the majority of your population is making less than twoor three dollars a day, can you even afford a strategythat looks like, basically, shutting down the economy? BG: I'm very worried that there will bea massive number of deaths in those poorer countries, because the health systems just aren't -- you know, the numberof respirators, hospitals, and of course,when you overload that system, your deaths are not just COVID deaths, but everyone else who's trying to accessa system that will be somewhat in chaos, including with health workerswho are getting sick. CA: OK, we're getting nearto running out of time with this. Whitney, maybe a last questionor two from online. WPR: Sure, we have two from online, we're seeing thousands of questionsaround these same lines. One, there's lots of peoplewho are really interested to hear about the kind of work that you're doingwith your foundation as far as distributing tests,but also producing safety gear, masks and that sort of thing, to help with this effortfor health workers. BG: So the Gates Foundation, you know, we, very early on, gave out 100 millionto help out with all the pieces: the testing piece,the therapeutics and the vaccines. We are not experts in making masksand 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 bothgovernments and private sector, so in some ways, we're kind of a bridge. And we've been talking to the headsof the pharmaceutical companies, the testing companies and, specifically,with the ones doing vaccines, including some of which are these newtype of vaccines, RNA vaccines, that we've been backingfor quite some time, and CEPI has been backing. And so our expertiseis in those medical tools and really getting the bestof 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 stillthis notion of bidding, and not really knowing who hasthe unique capabilities of doing things, and so, an organizationthat'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 outhas been absolutely fantastic. And so that's where we have a unique role. WPR: And the other questionthat we're seeing a ton of -- before we wrap up here -- is just people are really interestedin your insight, Bill, on whether you think we are headingin the right direction, do you feel like our economyis heading in the right place, that humanity is headingin the right place, are we in a better position now than you thought we were infive 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 readyfor 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 comparedto the economic cost. I remember when I didthat presentation 2015, I put up, "Hey, a big flu epidemiccould 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 numbersand thought, yeah, well, that's big. This epidemic will costthat much to the economy. So in the short run, we are going to have more painand more difficulty and people are going to have to step upto 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 advancesfor what are more rich-world diseases, like cancer. The amount of innovation, the way we can connect upand work together -- yes, I'm superpositive about that. You know, I love my work because I see progresson all these diseases all the time. Now we have to turnand focus on this, you know. Sadly, it may interrupt and the polio situationmight get worse a little bit because of the distraction here. We're using a lot of the great capacity that was built upfor those polio activities to try and help the developing countriesrespond to this very well. And that is appropriate, but the message from me, although it's very soberwhen we're dealing with this epidemic, you know, I'm very positivethat this should draw us together. We will get out of this, and then, we will get readyfor the next epidemic. CA: That's exactlywhat 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 matterlisten to the scientists, will they? Will we make it through? Do you believe that withina few months' time, we're already going to belooking back and saying, "Phew, we dodged a pretty bad one there." BG: We can't say for sure that even the rich countrieswill 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 continuouslybe able to see that. But you know, the rich countrieswill get out of this. The developing countrieswill 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 overwith a gigantic price tag. But now we're going to know, OK, next time we see a pathogen, we can make billions of testswithin two or three weeks. We can figure outwhich 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 innovationsthat 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 scienceand desire to help each other, was able to try and minimizewhat happened there and avoid it happening again. CA: That's certainlythe optimistic scenario that I'm craving for, myself. That the world kind of realizes, one, that there are certain thingsthat you just have to unite on. Two, that science really matters and it's a miracle that sciencecan 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 scenariowhere this shocks politicians to actually change their thinking and their prioritizationof science overall, or is that asking too much? BG: Yeah, it's interestinghow much of this distraction will delay the urgent innovation agendathat exists over in climate. You know, I have freed upa 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 scienceand the world working together, that is totally commonbetween these two problems. And so I don't think this has to bea 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 therewho 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 conversationwith some of you, in a future one of these, just understanding the experience. But Bill, what can people doas individuals from their own homes, right now, to try and help? BG: Well, there's a lotof creativity, you know -- can you mentor kids who are being forcedinto an online format where the school systemsreally weren't ready for that? Can you organize some giving activitythat gets the food banks to step up where there's problems there? These are such unprecedented times, and it really should draw outthat sense of creativity, while complyingwith the isolation mandates. CA: Bill, I really want to thank youfor spending this time with us and for the financial investment,the time investment. You've really invested your lifeinto trying to solve these big problems. And this is as big as they get. I have a hunch that your voiceis 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. BG: Thanks, Chris. CA: OK, thanks, everyone, thanks for being partof the TED community. Look after yourselves,be smart about this. You know, get ahead of it. If you're in a part of the worldwhere 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 distancedand socially connect. That's what the internet is for. These days are whatthe 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 wonderfulspending time with you. From Whitney and from meand from the whole TED team, thank you, and over and out.