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Bill Gates on where the COVID-19 pandemic will hurt the most

Bill Gates, the billionaire and philanthropist who sounded a prescient warning five years ago about the threat of a global pandemic, spoke about the need for more testing and vaccine capabilities in the fight against the novel coronavirus. 

When Gates warned in a 2015 TED Talk that “if anything kills 10 million people, it’s most likely to be a highly infectious virus rather than a war,” he envisioned a scenario not unlike the one the world is facing right now. 

The financial downturn caused by the virus will likely cost the global economy even more than Gates had predicted. While the Microsoft founder had estimated a global pandemic like this could cost global markets around $3 trillion, the Asian Development Bank has warned it could reach $4.1 trillion.    

“The whole goal of speaking out wasn’t to say I told you so, it was to make sure we did the right thing,” Gates told PBS NewsHour managing editor and anchor Judy Woodruff on Tuesday. “Sadly, not many of those things were done, so now we’re scrambling” for therapeutics and a vaccine to treat and prevent COVID-19, the illness caused by the new coronavirus, Gates said. 

Gates — whose foundation has pledged to spend billions of dollars to develop a vaccine that will safeguard against the coronavirus — spoke about what he believes needs to be done now in order to improve testing and treatment capabilities in the U.S., as well as what he envisions the world will look like as it deals with the fallout of this unprecedented global event. 

More highlights from the interview:

On improving testing and vaccination capabilities: While President Donald Trump had promised early on that Americans would have easy access to COVID-19 testing, there were issues with the initial tests rolled out by the CDC and widespread reports of an inadequate number of tests and inconsistent testing access. 

Gates said a variety of methods should be considered to increase the availability and rapidity of COVID-19 testing in the U.S., including self-swab polymerase chain reaction, or PCR tests, which patients can administer themselves from home and send to a lab for results. The Gates Foundation recently conducted a study of this testing with health care partners in Washington state, and found it was just as effective as a COVID-19 test administered by a clinician. Gates said these tests eliminate the need for personal protective equipment for those doing the testing, and better ensure the safety of health care workers. 

Even so, said Gates, the U.S. doesn’t “have a criteria to prioritize who should get tested, so even in some places, health care workers don’t get very quick results back.” He suggested needs for testing should get sorted out “with a clear indication of what the priorities are,” and added that this could be done through a digital system for patients to enter their symptoms.  

“In parallel, we have to go as fast as we can on therapeutics, and as fast as we can on a vaccine” to address COVID-19, Gates said. He estimated that some therapeutic treatments for the virus could be available in the next 3-6 months. 

A vaccine will likely take longer — by some estimates, there may not be one available until the fall of 2021. Gates said that broad vaccination for COVID-19 will need to become available “before you can be completely safe.” Until then, there’s a risk that communities could rebound unless they continue to practice strict social distancing and quarantines to see case numbers level off.  

What “normal” will look like: When asked about what a return to “normal” will look like post-pandemic, Gates said Americans should look at how other countries that are farther along with the spread of COVID-19 are currently living. 

“We need to learn from all the countries” whose policies seem to be working to prevent a rebound of COVID-19, said Gates. He mentioned China, which has started to send people back to work, but has urged people to wear masks, continued to take citizens’ temperatures and refrained from resuming large sporting events. Other countries, like Sweden, have been less strict with their lockdown policies, but have also closely monitored the spread of the virus.

Gates said he doesn’t think large gatherings will be able to resume until widespread vaccination has taken place, as the risks would outweigh the benefits of such events. When asked about what would constitute a large gathering, he responded, “We’ll have to figure out how to draw that threshold. We may understand age-specific risk at that point,” so having 30 young, healthy people in a classroom, for example, could potentially be fine.  

Gates guessed that we may have a better idea of what the new post-coronavirus normal will look like a month from now. 

How the economic downturn will affect the global psyche: The Wall Street firm Evercore is predicting a 50 percent drop in GDP this quarter and an unemployment rate of 20 percent due to the coronavirus. 

Gates said that shutting down most businesses and activity for three months in order to slow the spread of the virus was the best option from both a health and economic point of view. But he said that challenges will persist as cities and states start to re-open: “people’s psyche in terms of their wealth and their willingness to go out and do things has been deeply affected.” He added that even if the supply side of the economy starts functioning as it was before, there will be an issue restoring demand, as people will be less inclined to make investments in things like homes or travel. 

Why the developing world may be hardest hit by the virus: Thus far, deaths from the coronavirus in developing countries have remained relatively low, as fewer residents of these regions have traveled to parts of the world that have become virus hot zones. But Gates warned that as coronavirus transmissions increase in the developing world, these countries’ health systems will be further taxed and their citizens will struggle to practice social distancing. 

“The kind of social distancing rich countries do may not work” in these countries, said Gates. “Sadly, I do think the most deaths will be in those countries, and the most extreme economic pain. They’re not able to borrow 10, 20 percent of the GDP, which many of the rich countries are.” 

Gates, whose foundation has done work extensively in Africa, said that as wealthier countries like the U.S. deal with the domestic response to the coronavirus, they should consider what innovative methods could be used to alleviate suffering in developing countries as well. 


Read the Full Transcript

  • Judy Woodruff:

    Here in the U.S., Wall Street rallied for much of the day on hopes that the pandemic is easing. But oil prices fell sharply, and the rally died. The Dow Jones industrial average lost 26 points to close at 22653. The Nasdaq fell 26 points, and the S&P 500 slipped four.

    At a time when everyone is looking to understand the scope of the pandemic and how to minimize the threat, one of the best informed voices is that of businessman and philanthropist Bill Gates.

    The co-founder of Microsoft has spent the last few decades focused, through the Bill and Melinda Gates Foundation, on improving global health, including reducing the spread of infectious diseases.

    We spoke earlier this evening.

    Bill Gates, thank you very much for joining us.

    You were one of the prescient few years ago who said that an infectious disease outbreak was coming that could kill millions of people.

    How is what is happening now different from what you expected?

  • Bill Gates:

    Well, sadly, I would say that the economic damage is much greater.

    I put $3 trillion for a respiratory virus spreading around the globe. And, you know, clearly we're going to go well beyond that. You know, the whole goal of speaking out then wasn't to be able to say, I told you so when it happened. Rather, it was to make sure we did the right thing, so that diagnostics would come out right away, the timeline for a vaccine would be very short.

    And, sadly, not many of those things were done. So now we're scrambling to come up with therapeutics, scrambling to try and figure out how to get this vaccine made. But — people are rising to the occasion, but it's a very bad situation.

  • Judy Woodruff:

    Well, speaking of things that weren't done, testing, this has become one of the central problems facing the United States right now.

    President Trump said, I think, three weeks ago that there would be some sort of rapid testing. He mentioned Google. He said that was imminent.

    It hasn't happened. Why is this so hard? And what do you think it's going to take to get a rapid-turnaround test in place?

  • Bill Gates:

    Yes, we need a variety of tests.

    The testing that's currently being done, which is a PCR-based test, there was an advance that our foundation drove that now you can do a self-swab, so you could very quickly do the test without having the health care worker have to wear protective equipment and having to change that.

    So, eventually, we will have a home test that you can just swab and send back in for the PCR.

  • Judy Woodruff:

    So, what is the most immediate thing that needs to be done with regard to testing?

  • Bill Gates:

    Well, you can imagine having a Web site where you enter in the criteria of your symptoms, are you an essential worker, where you are, and it gives you back a priority level, and so all the testing operations make sure that they're only taking in enough high-priority stuff, that they can maintain a very quick turnaround, so you don't have stale results.

    That should be reasonable to put together.

    In parallel, we have got to go as fast as we can on therapeutics and go as fast as we can on a vaccine, because therapeutics can save a lot of lives and avoid the overload. And, with luck, some of those will be promising in the next three to six months.

    The vaccine is critical, because, until you have that, things aren't really going to be normal. They can open up to some degree, but the risk of a rebound will be there until we have very broad vaccination.

  • Judy Woodruff:

    Well, and you have said it may take — according to the scientists you work with and you talk to all the time, it could take up to a year-and-a-half to get that vaccine.

    What — are you saying, literally, that it could be the fall of 2021 before Americans can be safe from this COVID-19?

  • Bill Gates:

    Before you can be completely safe.

    I mean, by doing the strong social distancing that most of the country is engaged with right now, that allows you to level off the cases and bring it down. And you want to bring it down to a level that your capacity to test, to do contact tracing, to make sure the quarantine is maintained, so you don't see a big rebound, even though you have allowed most work to continue — you know, school, you know, certainly in the fall, you would like to see that go in.

    So, we want to have that period, have the economy not as damaged as it is in this extreme period, where the numbers are so big — and they have been growing exponentially — that we have got to get that down, so that it's much lower.

  • Judy Woodruff:

    But when you talk about returning to some semblance of normal, what are we saying that looks like? I mean, you mentioned keeping up social distancing. What could life look like, say, six months, a year from now?

    There's still some of these — some of these steps we're taking now, they would remain in effect?

  • Bill Gates:

    Yes. I'm working to write about that.

    The closest model today is, you look at China. They are sending people back to work, but they're wearing masks. They're checking temperatures. They're not doing large sporting events. And so they have been able to avoid a large rebound.

    There are countries like Sweden that aren't locking down quite as much and seeing, OK, do their numbers go up? If so, can you trace back, which are the activities that are causing that?

    We need to learn from all the countries. Our partner, international Health Metrics and Evaluation, is looking at forecasts, where they compatriot different countries. And then that's helping us to understand, OK, which policies in which countries seem to be working?

    And so we will be far closer to normal once we get those case numbers down, but there will be some things where the benefit to the risk, like large public gatherings, may not resume until broad vaccination has taken place.

  • Judy Woodruff:

    Meaning conventions, gathering — when you say large public gatherings, over 10 people?

  • Bill Gates:

    Yes, well, we will have to figure out how to draw that threshold.

    And we may even understand age-specific risk at that point. And so having a classroom with 30 young people in it may be just fine, because their role in transmitting the disease, we will understand in the next month or so. It may be so limited that you're far more liberal with young people getting together than you would be with a general-age audience.

  • Judy Woodruff:

    A couple questions about the economy.

    The Wall Street firm Evercore is projecting a 50 percent — that is 5-0 percent — drop in GDP this quarter, an unemployment rate of 20 percent, twice as high as during the financial crisis. They're projecting another 5 percent drop in the third quarter.

    And that's before we begin to come back. Is that your assessment?

  • Bill Gates:

    Well, again, I'm not a — as deep an expert on that as I am on vaccines.

    If you have just a three-month period of extreme shutdown, and then you were able to do a large degree of opening up, that, you know, in the end, is the best thing from a medical point of view and an economic point of view.

    One thing that will be very tricky, though, is, when we open up, you know, people's psyche in terms of their wealth and their willingness to go out and do things has been deeply affected.

    So, even once you fix these supply side by allowing people to go back to work, factories to run, then you will still have this huge question about the demand side, you know, taking trips, buying new houses, even buying a car.

    This is very unprecedented. And so, although that model you mentioned looks like one of the more negative, it — the uncertainty is such that it's not out of the realm of possibility.

  • Judy Woodruff:

    The continent of Africa is a place that you and your wife, Melinda, know very well through your foundation. You have done so much work there.

    How much do you worry about the effect of this pandemic in a place like that, when it hits there?

  • Bill Gates:

    Yes, sadly, it seems likely at this point that, even though the deaths in the developing world have been very small as yet, because not that many people with the disease went there as moved around in between rich countries, that, because their health systems are so limited, because the social distancing is much harder to do where you live in a slum right next to each other, you have to go out to get your food, there isn't the capacity to run the food distribution system with just a small percentage of the work force, like the U.S. has.

    And so trying help those countries get their testing capacity up, figure out what tactics work for them that may be different — the kind of social distancing rich countries do may not work.

    And so how do you tune that? Sadly, you know, I do think that most of the deaths will be in those countries and the most extreme economic pain. They're not able to borrow 10 percent, 20 percent of GDP, which many of the rich countries are engaged in that exercise. They just don't have the creditworthiness.

    The sense that that will drive hyperinflation would be very strong. So, even though it's super important that we deal with the domestic numbers and get those down, as we think about innovation, as we think about the rest of this year, the suffering in those countries, we also need to be thinking about that and help as much as we can.

  • Judy Woodruff:

    Did I hear you say you think most of the deaths will come…

  • Bill Gates:

    In developing countries.

  • Judy Woodruff:

    In developing…

  • Bill Gates:


  • Judy Woodruff:

    And, finally, a personal question.

    You certainly know this issue better than most anybody else, and yet it has shaken a lot of people. It has caused people who are normally, you know, together in their lives to be quite rattled.

    How do you think — how do you think you have been affected by this?

  • Bill Gates:

    Well, I'm deeply shaken.

    I — you know, every day, I'm like, are we really in this situation? Wow. You know, there are things like polio eradication that, you know, was — we were — we felt like we're making progress on that. This is going to be an unbelievable setback for that.

    You know, people are taking the resources that are funded for that and shifting them to this priority. So, you know, who knows where we will be on those other efforts?

    We have some great HIV breakthrough drugs that we want to get out into trials. Those trials aren't happening. In fact, the top people who were going to work on that are — have been reassigned to work on the coronavirus vaccine.

    So, the foundation is scrambling, because it has a lot of the key understandings and relationships to accelerate some of these solutions. But our normal work is suffering. And you just look at people who are isolated at home or, you know, overcrowded in their home, or kids who are going to lose three months of learning, the amount of pain involved in this thing is gigantic.

    And, you know, so it's deeply troubling, but we need to still act to minimize all of that.

  • Judy Woodruff:

    Well, Bill Gates, we thank you very much for spending the time with us, for talking with us today. Thank you.

    And we wish you and what you're doing at the foundation the very best.

  • Bill Gates:

    Thank you.

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