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Interview: Bill Gates talks to Recode about his new book, charity, public health

The WHO estimates that the Covid-19 pandemic has claimed the lives of almost 15 million people worldwide – not only from the virus, but also as an indirect result of the crisis, such as the inability to access other types of medical care due to hospital systems being overwhelmed. But it shouldn’t have been so catastrophic. Experts say its effects were exacerbated by a number of factors: the world was ill-prepared for the pandemic, many countries were slow to develop and provide access to Covid-19 tests, and economic inequality exacerbated the situation.

Low- and middle-income countries are still struggling to access life-saving vaccines, putting these populations at constant risk of contracting the virus. One in the USA preprint paper found that working-class Americans are five times more likely to die from Covid-19 than college-educated Americans. In general, the pandemic widening global income inequalitypartly because rich countries were able to provide more economic assistance to their residents, while poorer countries had far fewer tools to rebuild.

Two years after Covid-19 was declared a pandemic, Bill Gates wrote How to prevent the next pandemic, a book that explores how the co-founder of the Bill & Melinda Gates Foundation and global health expert believes the world should prepare for future health crises, including how we can address the longstanding problem of economic inequality, which puts already vulnerable people at even greater risk. . In the US, poverty fell in 2021 due to pandemic aid spending such as stimulus checks and the extended child tax credit. But since then poverty has risen againwith Child poverty is on the rise following the expiration of the Extended Child Tax Credit, which gave many parents a monthly cash benefit from July to December 2021.

Here are five ideas Gates explored with Recode via email on how to factor in economic inequality in preparation for the next pandemic. The interview has been lightly edited for clarity.

Weezy Kim

In your book, you mention how wary people are about the enormous power that wealthy philanthropists have today, and also admit that many governments did not take adequate steps when the pandemic hit.

How can we ensure that the government can step up next time? Do you see this as primarily a matter of funding the right agencies (and would that require higher taxes)? Is it a matter of political will? Is it something else?

Bill Gates

I hope that after the last two years – with millions of lives lost and trillions of dollars of economic impact – every country now understands that they need to be more prepared at the government level. Philanthropy can help test new ideas and mobilize resources faster than the government, but pandemic prevention needs to be funded and supported over the long term and requires global collaboration. The world cannot and should not rely on charity.

In my book, I write that governments need to prepare for outbreaks and prevent pandemics in the same way that they fund preventive measures and train for fires and earthquakes. To end preventable diseases and prevent new diseases from becoming pandemics, governments will need to increase their investment in research and development of vaccines and therapeutics, integrated disease monitoring, and well-funded multilateral organizations such as the World Health Organization (WHO). They will also need to make greater investments to improve primary health care in all countries.

The natural place for public funding is the WHO, since it was created to coordinate the global response to health problems. Philanthropy cannot be a voting member of the WHO. Each member country must decide that WHO should focus on preventing a pandemic. But right now the WHO is not funded to do much work on pandemics. It does not have a significant full-time staff. This does not require countries to conduct exercises. This needs to change if the world is to be serious about making Covid the last pandemic.

Weezy Kim

Do you think there will always be a need and space for private philanthropy to coexist with governments? What needs to change in the relationship between the private and public sectors? How can we get there? Who needs to change it?

Bill Gates

Governments play the most important role in protecting people from infectious diseases and other serious health risks. But I believe that philanthropy has a role to play – for example, we can fund initiatives that governments or the private sector cannot or do not want. Most global health problems, such as malaria, need to be addressed outside traditional market systems because they will never be profitable for the private sector. During the Covid pandemic, global collaboration between scientists, philanthropists and global health institutions (such as Accelerator ACT) have developed, tested and introduced safe and effective vaccines faster than ever before. This is a great example of how the three sectors can work together to address these big challenges.

Weezy Kim

How might government policies need to be changed to better prepare us for the next pandemic, and what role do you see billionaires/other wealthy philanthropists playing in this?

Bill Gates

One of the biggest tragedies the world has learned from Covid is that governments have not invested enough in the tools they need to effectively prepare for a pandemic. Countries need to step up and develop policies and invest more in strengthening disease monitoring, funding R&D and strengthening health systems. What I’m trying to do, and what the foundation is doing, is to help catalyze new ideas, especially those that will help provide equal access to life-saving funds for people in low-income countries who are often left behind when new innovations in health care. To the market. We also play a role in engaging the private sector by helping companies secure funding to produce tests, therapeutics and vaccines for low- and middle-income countries.

Weezy Kim

Public discourse around Covid-19 has been highly polarized and politicized. What do you think about the role of misinformation versus good and reliable information in public health outcomes?

Bill Gates

I am concerned about the spread of misinformation and conspiracy theories about public health because it makes people question their own doctors and science. It’s understandable that people are looking for simple answers because it’s been a very scary two years. And I think that most people are worried about their own health and the health of their families and loved ones. They come from the right place, but they are attracted to false information.

Weezy Kim

How big a role do you think economic inequality plays in disease outcomes? This has made access to vaccines and medicines more difficult in low- and middle-income countries, but we have seen that even in the US, black and brown communities have been hardest hit by Covid-19.

How do we make sure that economic inequality doesn’t become such an important survival factor in the next pandemic?

Bill Gates

Melinda and I founded the Gates Foundation over two decades ago because we were horrified by health inequities around the world. Since then, phenomenal progress has been made, but even today, a child born in Nigeria is about 28 times more likely to die before their 5th birthday than a child born in the United States.

When Covid arrived, existing health inequalities helped turn it into a global disaster. In my book, I offer a plan that includes three key indicators. First, we need to strengthen disease monitoring by developing early warning systems that detect new viruses and outbreaks coordinated across borders, and the world needs to get back on its feet. GERM teampaid full-time team dedicated to pandemic prevention. [Editor’s note: The Global Epidemic Response and Mobilization team is a permanent disease outbreak watchdog group that Gates’s book proposes we create.]

Second, we need to invest more in the research and development of next-generation vaccines and effective treatments, and secure manufacturing capacity in all regions of the world. And we must strengthen global health systems by investing in primary health care, especially in low- and middle-income countries and in low-income communities in rich countries.

There are programs focused on equity in health outcomes such as the Global Fund and the Global Polio Eradication Initiative, Gavi, the Global Financing Facility and CEPI. Full funding of these organizations will have a big impact on health equity around the world. [Editor’s note: These are all global health programs that the Gates Foundation has funded. The Global Fund is a public-private partnership that finances the fight against AIDS, tuberculosis, and malaria. The Global Polio Eradication Initiative is a WHO-led public-private partnership that seeks to immunize all children at risk for polio. Gavi is a public-private partnership that strives to improve vaccine access in low-income countries. The Global Financing Facility is a World Bank-led public-private partnership that focuses on promoting the health and nutrition of women and children. And CEPI, the Coalition for Epidemic Preparedness Innovations, is a public-private partnership that invests in vaccine research.]


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