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Interview: Bill Gates talks with Recode about his new book, philanthropy, public health

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The WHO estimates that the Covid-19 pandemic has killed nearly 15 million people worldwide – not just from the virus, but as an indirect consequence of the crisis, such as the inability to obtain other types of medical care because hospital systems were overloaded. But it shouldn’t be so catastrophic. Experts say its impacts have been exacerbated by a number of factors: the world was ill-prepared for a pandemic, many countries were slow to develop and provide access to Covid-19 testing, and economic inequality has all aggravated.

Low- and middle-income countries still struggle to access life-saving vaccines, putting these populations at continued risk of contracting the virus. In the United States, a preprint article found that working-class Americans were five times more likely to die from Covid-19 than college-educated Americans. Overall, the pandemic has also widened income inequality around the world, in part because rich countries have been able to provide more economic relief to their residents, while poorer countries have had far less. tools to recover.

Two years after Covid-19 was declared a pandemic, Bill Gates wrote How to prevent the next pandemic, a book that explains how the co-founder of the Bill and Melinda Gates Foundation and global health expert believes the world should prepare for future health crises – including how we can tackle the persistent problem of economic inequality that exposes the already vulnerable people at even greater risk. In the United States, poverty rates fell in 2021 due to pandemic relief spending like stimulus checks and the expansion of the child tax credit. But since then, poverty has risen again, with child poverty rates rising sharply after the expiry of the expanded child tax credit, which gave many parents a monthly cash benefit from July to December 2021.

Here are five ideas Gates explored with Recode over email on how to take economic inequality into account when preparing for the next pandemic. The interview has been lightly edited for clarity.

Whizz Kim

In your book, you mention how people are wary of the big influence wealthy philanthropists have today – while also acknowledging that many governments didn’t step up enough when the pandemic hit.

How can we ensure that the government will be able to intervene next time? Do you think it’s mostly about funding good agencies (and would that require higher taxes)? Is it a question of political will? Is it something else?

Bill Gates

I hope that after the past two years – with millions of lives lost and trillions of dollars in economic impact – every country now understands that they need to be better prepared at the government level. Philanthropy can help test new ideas and mobilize resources faster than government, but pandemic prevention needs long-term funding and support, and it requires global collaboration. The world cannot and should not rely on philanthropy to direct this.

In my book, I write that governments must prepare for epidemics and prevent pandemics the same way they fund preventive measures and practice fires and earthquakes. To end preventable diseases and prevent emerging diseases from becoming pandemics, governments will need to increase their investments in R&D for vaccines and therapies, integrated disease surveillance, and well-funded multilateral organizations, such as the World Health Organization. health (WHO). They will also need to make greater investments to improve primary health care in all countries.

The natural place for government funding is the WHO, since it was created to coordinate the global response to health issues. Philanthropy cannot be a voting member of the WHO. It is up to each member country to decide that the WHO should focus on pandemic prevention. But right now, the WHO isn’t funded to do much work on pandemics. There are not many full-time staff. It does not require countries to go through exercises. This must change if the world is serious about making Covid the last pandemic.

Whizz Kim

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

Bill Gates

Governments play the most critical 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, like malaria, must be solved outside of traditional market-based systems because they will never be profitable for the private sector. During the Covid pandemic, a global collaboration between scientists, philanthropists and global health institutions (like the ACT Accelerator) has developed, tested and deployed safe and effective vaccines faster than ever. It’s a great example of how the three sectors can work together to solve these big problems.

Whizz Kim

How might public policy need to change so that we are better prepared for the next pandemic, and what role do you see billionaires/other wealthy philanthropists playing in this?

Bill Gates

One of the greatest 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 improving disease surveillance, funding R&D and strengthening health systems. What I’m trying to do, and the foundation is trying to do, is to help catalyze new ideas, especially those that will help bring equitable access to lifesaving tools to people in low-income countries. income, who are often left behind as new health innovations arrive. at the market. We also play a role in attracting the private sector by helping companies secure funding to produce tests, therapies and vaccines for low- and middle-income countries.

Whizz Kim

Public discourse around Covid-19 has been extremely polarized and politicized. What are your thoughts on the role that misinformation versus good, reliable information plays in public health outcomes?

Bill Gates

I am concerned about the spread of public health misinformation and conspiracy theories because it causes people to question their own doctors and question science. It’s understandable that people are looking for easy answers, because those two years have been very scary. And I think 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 by false information.

Whizz Kim

What role would you say economic inequality plays in disease outcome? This has hampered access to vaccines and medicines in low- to middle-income countries, but we have seen even in the United States that black and brown communities have been among the hardest hit by Covid-19.

How to ensure that economic inequality is not such a big factor in surviving the next pandemic?

Bill Gates

Melinda and I started the Gates Foundation over two decades ago because we were horrified by health inequalities around the world. There has been phenomenal progress since then, 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 emerged, these existing health inequalities helped it become a global disaster. In my book, I offer a plan that includes three key steps. First, we must improve disease surveillance by developing early warning systems that detect novel viruses and coordinated outbreaks across borders, and the world must support the GERM team, a full-time paid group engaged in 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 R&D for next-generation vaccines and effective treatments, and secure manufacturing capacity in every region of the world. And we need to strengthen global health systems by investing in primary health care, especially in low- and middle-income countries, but also in low-income communities in rich countries.

There are programs that focus on equitable 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 would have a significant impact on global health equity. [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.]