July 31, 2020

Melinda Gates

Philanthropist Melinda Gates, who has committed more than $300 million to fight COVID-19, discusses the race to develop vaccines, COVID-19’s toll on women and the Trump administration’s response to the pandemic.

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She’s one of the world’s leading philanthropists with a long history of fighting infectious disease this week on ‘Firing Line.’

You know, we plan for things as nations.
We plan for earthquakes.
We plan for tsunamis.
We didn’t plan for disease.

The Bill and Melinda Gates Foundation has pledged more than $300 million to fight COVID-19 worldwide.
Five years ago, her husband Bill gave this warning.

If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus.
We need to get going because time is not on our side.

Now it’s a race against time.

We haven’t had leadership at the national level.
And so you’re seeing what’s happening and it’s chaos.

Melinda Gates is also raising awareness about the virus’ particular impact on women.

If we’re going to build back society, the way to do that is to put women straight at the center, because guess what.
They’re already at the center.

With a pandemic still raging and concerns it will get worse before it gets better, what does philanthropist Melinda Gates say now?

‘Firing Line with Margaret Hoover’ is made possible in part by… Corporate funding is provided by…
Welcome to ‘Firing Line,’ Melinda Gates.

Thanks for having me, Margaret.

You co-founded the Bill and Melinda Gates Foundation two decades ago, and since then your foundation has worked to fight global poverty and to combat infectious disease, including HIV, tuberculosis, malaria, Ebola.
And now you have committed more than $300 million to fight the COVID-19 pandemic.
My question just to start is, your work is so often focused on global health.
Could you have imagined that you would be battling a pandemic so close to home?

No, there’s no chance that we thought we would have a pandemic, you know, and that part of the start of it was here in Seattle.
So, no, this has been quite a surprise to us.
We knew eventually there would be some pandemic, but we certainly didn’t think it was going to be of this magnitude and scale at this time.
Nobody could have predicted that.

Well, we’re at the six-month anniversary of the first known case of COVID-19 in the United States from January 20th.
And right at this moment, COVID-19 cases are spiking dramatically in a majority of states.
A few months ago, did you think we would be back to square one?

No, I think we all thought just listening to the data and looking at the disease modeling, that we would have a reprieve here during the summer.
But, you know, I think it’s been especially challenging because we don’t have a national testing program with appropriate testing, contact tracing, isolation and quarantine.
And so I think it’s gotten much more difficult that people are going out more and not doing the appropriate social distancing and masks.
And so we are almost already in a second wave that really wasn’t predicted to happen until this fall.

And you think this is a second wave rather than the continuation of the first wave spreading through different states?

It’s hard to say, quite honestly, but, you know, even in some places where we’ve already had COVID, you know, we are starting to see a rise again.
And so really, it doesn’t matter what you call it.
We need to do what we know works, which is we need to practice safe social distancing and wearing masks and staying home as much as we possibly can.

Well, so your foundation is working on a lot of different areas to fight the virus from vaccines to therapeutics, providing protection to low-income countries.
You in particular, though, are focused on a group of people that you warn is being left behind, and that’s women.
Now, we know looking at the data that COVID-19 actually kills more men than women.
So tell us why you’re so concerned about women being left behind.

Well, because we know that COVID is not only wreaking havoc on our health and our bodies, but it’s also exposing the fault lines in society.
It’s having a profound effect on the poor, on women, on people of color.
And so we need to look at those issues and figure out what do we do about it.
Women are losing their job at a faster rate than men are.
Women are the ones often who are at home caring for the elderly, trying to help the child continue to learn online or taking care of the young and trying to get on the bus and go to their job.
I mean, it’s just — it’s — it’s almost impossible what we’re asking women to do during this time.
And so we need to look at that.

So you’ve just published a paper in Its title is ‘The Pandemic’s Toll on Women,’ and it details the ‘silent toll’ that the epidemic and pandemics generally have on women.
You write… Explain. How do you know this?

Well, we know from the Ebola epidemic when it hit in the four affected countries in West Africa, you had a silent pandemic that tracked right along with it, and that was maternal deaths.
And when you get more maternal deaths, you also get more childhood deaths.
And so there are things we can do to keep that system up and running.
A perfect example, not very expensive, but in Ethiopia, they said, okay, we know women are going to have more trouble now coming to the health system to deliver babies.
So they’re sending home clean birth kits so that if you give birth in your village with a midwife, you have a very inexpensive but clean home birth kit.
We know those save lives.
You can also say, hey, ambulances are an essential service.
Some countries are saying if you can’t get to a hospital by ambulance, we will instead provide a subsidy for your transport.
That makes a huge difference in terms of saving a woman’s life.

And you say that one of the solutions is to consider reproductive healthcare an essential service.
In other words, changing the classification to reproductive healthcare as an essential service will also help save lives.

Otherwise, again, we know from the Ebola crisis, you get many, many more millions more unintended pregnancies.
Women will tell you all over the world, if they can time and space their pregnancies, they are healthier and their children are more likely to be healthy and to stay safe.

You’ve written extensively in your book ‘The Moment of Lift,’ and also in ‘The Washington Post’ and other places about the unpaid work burden placed on women, that COVID-19 exacerbates in low and middle income countries but also in the United States as well.
You say even though most women now work full time outside the home, they still spend two hours or more each day on household tasks and caregiving.
They’re 10 times more likely to stay at home with their sick children, and they’re nearly three times as likely as fathers to quit their jobs and take care of their families.
How do you have the data that’s showing that COVID is increasing this trend?

Well, I’m glad you asked that because data is fundamental.
We have to be able to collect data to actually speak the truth and then know where to invest.
But there are states, luckily in the United States that collect sex disaggregated data so we can actually look at it.
We, as a foundation with many partners, have finally been investing in data in low and middle income countries.
So we can actually collect this economic data from women and we can look at it and see exactly what the trends are.
On the flip side, you can use the data then to make investments.
That is smart policy.

How is your foundation working to influence or mitigate some of the effects of the disparities against women in the COVID-19 pandemic?

Well, we are both trying to call out, as I’m doing here, what the issues are.
We’re talking to governments about smart policies.
As well, I think you’ve seen me use in the United States my voice against paid family medical leave.
We’re the only country, the only industrialized country in the world that doesn’t have it.
And if you want a woman to be able to care for a sick loved one or let’s say she gets COVID and she’s an essential worker, she needs to stay home for 14 days to take care of herself and to keep others around her safe.
You have to have the right policies to take care of that.

You also write… Now, in a normal year, schools would be opening within the next couple of weeks, but many schools may not be reopening and they’re dialing back their plans to reopen all over the country.
What does this mean for gender equity?

It’s concerning.
It’s deeply concerning because if a woman can’t see that her kids are cared for, she has no one to leave them with, how can she get on the bus and go to that job?
Or how can she make sure her mother or her father, who are elderly, are being cared for while she’s caring for children and trying to keep a job?
We have to make sure that we’re not setting women back during this COVID crisis.
And that’s why we need to have sensible government policy and good stimulus packages.

You know, it’s so interesting about this virus, how where we’re learning about it in real time.
And early on, we thought that children were vectors of this virus and that they were the ones who are silently spreading COVID-19.
And that thinking is changing a bit.
You’ve seen Denmark and Finland reopen their schools without major spikes in COVID-19 and their populations.
And so how do you think about and how should we think about as a as a country, a reopening and a return to school, but then balancing that against what is a very real spike in cases across this country?

Well, I think you see the countries that are opening their schools have a declining epidemic.
They have done sensible policies early on where people actually stayed home, and so they got a declining epidemic.
Then they’re opening very slowly and carefully and safely.
And I think what you need to do is to look at your epidemic and follow the science, but follow the measurements in your own county.
This is local health commissioners have to work with governors and mayors and superintendents to make wise decisions.
There will be places in the United States where the epidemic is slowly going down, where it probably you can safely reopen the schools and you keep measuring and watching.
There are other places where you’re having a spike in cases.
You have a spike in cases, a rising epidemic that’s rising quickly and overrunning the health care system, that’s not a time to reopen your schools, but you can only make those decisions on a local basis with really good data.

And yet we’ve seen again and again, I will tell you, we have had mayors, we have had governors on this program where you see they are not coordinating.
Does it seem to you that there is a deficiency in coordination at every level of government or are there places that are doing it right?

There are some states that I would say are doing it right and doing it right between the governors and the mayors and the health commissioners.
Look, I think, first of all, we have to say this is difficult.
You said it right to begin with, which is we are learning new information almost every single day about this pandemic, how it spreads, where it spreads, what we should do.
We don’t have all the tools yet.
So it does take incredible coordination.
Of course, the United States would have helped if we had used our CDC properly.
The CDC was set up for exactly this type of situation.
The CDC was set up originally to give guidance to local health departments.
So if we’d had a coordinated response from top to bottom, what would have happened was we would have done appropriate testing very quickly in a coordinated way.
You would have done isolation until you got the results of your test, contact tracing, and quarantining.
I think when it doesn’t come together at the top, it’s very difficult to have it come from the bottom up or the middle down.
And so that’s the situation the United States is in, unfortunately.
And it’s why we’re seeing overwhelmed health systems that just shouldn’t be overwhelmed at this stage of this pandemic.

Listen, moving on to how we’re going to tackle this, and one of the areas that you all have invested heavily in is a vaccine.
And I want to ask you, is it your view that a vaccine is ultimately the only way out of this crisis?

Well, I think a vaccine would be the quickest way out of this crisis.
That is, if we can get a vaccine that is obviously safe and efficacious.
I do think a medicine would help as well.
If we had a medicine that as soon as you got the disease, it helped tamp it down very, very quickly.
That would certainly help.
But I think probably ultimately the safest tool or the quickest tool is going to be a vaccine.
But, you know, both routes are being tried.
We and many, many, many others are investing in both paths.
You have to in many, many vaccine candidates and many medicine candidates to see which ones, you know, are safe and efficacious.

So help us understand.
I mean, ‘The New York Times’ points out that the record timing for the creation of a vaccine from scratch was with the mumps, and it took four years.
Why is there so much optimism that, in the context of this COVID-19 pandemic, we’re going to beat that record?

Well, it’s the first time you’ve seen global coordination over vaccine at the scale we’re seeing it.
And normally you do, you know, the vaccine testing, all the various stages and phases and trials, which still need to be done, and then when you have a candidate that you know is going to work, then you start investing in the manufacturing.
This time it’s being done in parallel.
And there’s so much funding going into multiple routes of a vaccine and multiple paths for manufacturing up front, some of which will be dead ends.
But you’re seeing so much money flow so quickly and so much global coordination.
I think that’s what gives people optimism.

So President Trump recently predicted that a vaccine or an effective drug would be here ‘long before the end of the year.’
So if everything goes right, what is the soonest you think that we could have a vaccine just an efficacious vaccine, maybe not scaled, but just to have one?

More than likely early next year, first half of next year.
I think that’s probably our very best case.
That’s the hopeful case.

You know, you get an efficacious vaccine, but then there are many logistics into ramping it up to scaling it.
What are some of the challenges to the production and the distribution that have to be thought through?

Well, you have to have the bioreactors to produce the vaccine and to produce it at scale.
And then luckily, in most high-income countries, we actually have very good supply chains.
And then middle-income countries have their supply chain issues.
Low-income countries also have supply chain issues, but we have a global coordinated effort.
It’s called Gavi, the Alliance for Vaccines and Immunizations.
Because of that system, we do know how to get vaccines out to all corners of the earth.
The thing that we need to do — that the global leaders need to do is to ensure first that healthcare workers get this vaccine, and there are more than 60 million healthcare workers around the world.
They’re the ones who are taking care of the rest of us.
They’re the ones who are going to make sure, okay, we help stop this disease.
People are taken care of and it doesn’t keep spreading.
So first you have to go there and then each country needs to look at their most vulnerable populations and figure out how to get the vaccine out to their vulnerable populations next.

As we develop a vaccine, once we have one, I presume there will be a rush to get one.
How should governments figure out, after healthcare workers, who gets it first?

I think in place by place, country after country, governments need to look at their most vulnerable populations.
They need to see who’s being affected the most, and they need to make sure that they get the vaccine out to those people the most quickly.

So there’s a biotech company you are well aware of, Moderna, which is based in Cambridge, Massachusetts, and it is working on an mRNA vaccine.
And early trials show that it is safe and effective.
The Gates Foundation was an early funder of Moderna back when you backed HIV therapies as well as a Zika vaccine.
Are you working on their COVID-19 vaccine as well?

We’re working on nine different vaccines with COVID, yes.

Of them, which makes you most hopeful?

You know, it’s hard to say.
Different data comes out in different weeks.
And so there are, again, of these nine candidates we’re looking at, there are three or four that look quite promising.
Obviously, I can’t talk about specific data, but, you know, as the data comes out, science is looking at it and papers are being published.
And, you know, all of that keeps moving forward.

The Trump administration support vaccine development and they call it Operation Warp Speed.
They have spent half a billion on Moderna, half a billion on Johnson & Johnson, $1.2 billion on Oxford’s AstraZeneca.
I’d like to talk to you about the right role of philanthropy versus public dollars in the context of the race to develop a vaccine.
What is the most effective balance between public and private dollars for this kind of innovation?

Well, I think one of the things we have to realize is in the United States, you know, we are lucky in the sense that the government is willing to put in large-scale research money, and that’s appropriate.
That’s how many vaccines have come forward before European governments as well put in research money.
I think the role for philanthropy, though, is to make sure that this vaccine gets purchased and distributed equitably.
The worst thing that could happen for the world is that the vaccine first goes out to the highest bidder.
And so philanthropy’s role is to say we have global mechanisms for getting these vaccines out safely and efficaciously and to everybody.
That would be Gavi, the Alliance for Vaccines and Immunization.
There’s also another global coalition called the Center for Epidemic Preparedness.
It also has money flowing through it and research dollars and manufacturing dollars to again make sure we get a vaccine and that it doesn’t go to the highest bidder but we get many, many millions of doses to cover the whole world.

There are some people who would suggest, though, that for the high-risk, high-reward portion of this, public dollars probably shouldn’t be spent.
It probably should be private dollars, philanthropic dollars, because if there are 100 trials going on, some of them are going to work, some of them aren’t.
Should the public’s money be spent on these high-risk prospects or is that a better use of philanthropic dollars?

I think it is a very appropriate role for government and I think there’s a role for philanthropic dollars.
But look, no matter who the philanthropic dollars come from, they’re never of the scale of government dollars.
The role of philanthropy is to be catalytic.
Yes, to take some risk where governments won’t.
But it’s to come alongside government and say, okay, these are other places that we should be taking risks and taking them on behalf of everybody, not just for one country.

So, this program is a revival of William F. Buckley Jr.’s ‘Firing Line’ that aired for 33 years from 1966 to 1999.
And Buckley talked about this question about the federal dollars versus philanthropy and the role that philanthropy can play with William E. Simon, who is a former Treasury secretary and was also a leading philanthropist in his day.
I’d like you to take a look at this clip and then I’ll ask you on the back side about the role of philanthropy.

When government funds are used for philanthropic reasons, then they have to scrutinize everything, and to scrutinize they have to write regulations, and they have to decide how you’re going to give it, who you’re going to give it to.
And that’s the way it would go.
And do we want government control over that area?
I don’t think so.

Well, let me ask you this.
Why is the inbuilt assumption there that in order to get more money to philanthropy, it has to go from the people to Washington to philanthropy?
Isn’t that a round trip that would seem to be unnecessary?

Most definitely unnecessary.
And I think a dollar spent by government, maybe 10 cents or 20 cents is effective at the most.
And a dollar spent by an individual, he earned the money and the rest of it, he thinks twice about where he gives the money away.

Do you think there are cases where philanthropy can be more effective than government?

Well, I think there’s a role for both philanthropic dollars and for government dollars.
Often philanthropy can be catalytic in its role.
Yes, it can usually take some risk maybe where a government can’t or won’t with taxpayer dollars, but ultimately it takes government funding to come in and fund something at scale.
A perfect example is the U.S.
school system, right?
You know, philanthropic dollars are a tiny drop in the bucket, but they can help push on the system to make it work better.
And so that is an appropriate role and use, I think, for philanthropic dollars.
And then it’s up to government to decide do we think those things that were proven out are worth investing in?

Another public/private partnership is the World Health Organization.
And the only reason I call it a public/private partnership is because, aside from the U.S. government, the strongest and the biggest funder of the WHO, as you well know, is the Bill and Melinda Gates Foundation.
You have criticized President Trump’s decision to pull back American funds from that, saying the WHO is not perfect, no institution is perfect.
But when a government pulls out its funding from a major public health organization that’s an international organization, is it fair to think that private philanthropy can fill that void?

Private philanthropy can never fill the void of U.S. government money.
So I think we have to go back to the founding of the World Health Organization.
It was founded by global leaders to deal with diseases around the world, a pandemic just like we’re in.
We would still be dealing with Ebola if the WHO hadn’t been doing its role.
Why is the Gates Foundation the second largest funder of WHO?
It’s because we’re trying to end polio.
They are instrumental.
But if you take polio and Ebola side by side, when Ebola broke out in Nigeria, in Lagos, what happened?
The WHO and the CDC immediately took a polio clinic and flipped it within 24 hours to be an Ebola clinic.
They did all the right contact tracing.
They contained the disease in Lagos, Nigeria, which is a huge hub.
So it didn’t expand around the world the way we’re seeing this disease expand.
That was the role of the WHO.
And so in the middle of a pandemic, to defund the organization that knows how to deal with these crises, wow, that doesn’t make any sense.

Earlier this year, you said you’d give the Trump administration a D minus for its response to the pandemic.
Has the grade changed?


I want to end on an upbeat note.
The last line of your piece, you write… How can women be the architects?

What I know is that women, when they have a seat at the table, when they have power, even in their local village, they create solutions that benefit everybody.
I’m seeing women in India and Africa figure out these amazing pop-up stands that are socially distanced that help people go buy their food safely.
Women have fabulous ideas because they have a lens on society that’s a bit different because they’re taking care of everybody else, the old and the young and themselves and their families.
And so it’s been no surprise to me that, quite frankly, Germany Chancellor Angela Merkel is doing quite well with their COVID response.
Prime Minister Jacinda Ardern in New Zealand, they’re doing quite well with their COVID response.
Speaking with both of those women and being on the phone, what you hear is they’re listening.
They’re asking the experts.
They’re collecting advice and data, and they’re thinking.
Prime Minister Jacinda Ardern isn’t just thinking about New Zealand.
When I spoke with her, she’s thinking about all the island nations around them.
Chancellor Merkel, her country is thinking about how do we take in other people’s COVID patients and how do we reach the people on the margins in our own countries.
That’s what women do, and that’s why I want to make sure we empower women.

With that, Melinda Gates, thank you for coming to ‘Firing Line.’

Thanks for having me.

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