How Bill Gates imagines life after a coronavirus

“In 2015, I asked Gates a simple question: what are you most afraid of? – E. Klein writes in the introduction to the interview. – The answer was illustrated by B. Gates on the 20th century death curve. A jump in the number of deaths was during World War I. The second – during World War II. But there was another jump between them, no less than the height of World War II. It was, he said, a flu pandemic Spanish of 1918 that killed about 65 million people Gates’ greatest fear was an infection of this type, which claimed lives in our hyperglobalized world.

Gates-funded scientists have modeled such a scenario. In a matter of days, the infection will reach every urbanized center in the world. Tens of millions of people will die in months.

Gates anticipated this and tried to warn the world. He spoke about this at TED conferences (see below) and in media interviews. The articles published in scientific journals. He proposed political solutions and spent millions on vaccines for research. And he failed. The virus appeared and we were not prepared for it to occur. Now we all live in the nightmare Gates talked about five years ago.

Gates allocated hundreds of millions of dollars and directed his fund to fight the coronavirus. Recently published a long one Article, which sets out what we know and don’t know about the COVID-19 virus and the disease it causes, and what we need to invent and use to return to a normal life safely. “

Klein spoke to Gates about these and other topics. Also about how you feel at the center of many coronavirus-related conspiracy theories? What happens if we try to return to the normal rhythm of life too soon? Why is the situation different in different cities of the world? Do rich and poor countries have to take different measures? How realistic is it to have the vaccine after 18 months?

“But first I wanted to ask you a question opposite to the one I asked in 2015: What is your hope? What is your outlook on life after a coronavirus, “writes E. Klein.

– You wrote in the New England Journal of Medicine on February 28 that COVID-19 “began to behave essentially like a century-old pathogen of concern to us.” Two months have passed since then. What did we learn during that time that made you worry more or less?

– Unfortunately, in much of Europe and the United States, the scale of the infection has begun to grow exponentially. So the death toll here is higher than we could have hoped for. We are still learning how to test correctly. In the United States, we don’t even have real numbers that reflect the real situation, because we can’t identify the right people, we can’t collect the data on time. The situation is completely uncertain. The fact that social isolation actually reduces the morbidity curve is good news. But of course this is accomplished by paying a huge price.

– When we spoke in 2015, you spoke of models that produced a 1918-year-old flu that would kill 33 million people worldwide in six months. It seems that we are not getting close to these death rates now. How do you think this is because the virus is not as contagious or deadly as it was in 1918, or because we, the global community, handle it better than you might have predicted?

– We really don’t know what will happen in developing countries, where the majority of the world population lives. The number of reported infections in these countries is still relatively small. But unless some miracle factor occurs, the chances of most deaths occurring in those countries are very high. It is more difficult for them to isolate themselves socially and do what we did. So I think it is too early to predict the final death toll.

– Let’s talk a little more about the situation in the developing world. A month ago, it seemed that the disaster was about to start in Brazil; that South Africa will suffer a catastrophe due to its large immune population; that the situation in India will become serious. Until now, it is not as bad as many people feared. Why do you think this is the case?

– For me, this is the most mysterious thing. I hope there are other reasons besides that they are not testing enough people or that people are afraid to request the test, or that people who have traveled the world are isolated from the majority of the population, which may take time to spread to workers living in slums. one or two additional months.

Their populations have a better age structure, but they also breathe more polluted air, have many cases of HIV and suffer from malnutrition, which is associated with very bad consequences. Ecuador is a city where the infection is spreading exponentially. And I immediately wonder if there is a subway in Guayaquil. You know, the situation in New York and London is worse than it would be due to the simple population density or the abundance of international travelers. What factors determine these cases of rapid spread of infection?

– For me, this is also a difficult question. The pieces of the puzzle do not fit together perfectly. Why does New York look the way it seems, but has the situation in San Francisco remained under control? And if the answer was an early introduction to the social distance requirement, why wouldn’t Florida, which closed much later and has very poor political leadership, as well as a much larger population, look worse? We see the same thing in some developing countries. It seems to me that there are factors that we do not see or underestimate correctly.

– The flu we’ve been living with for a long time kills an average of 40,000 people each year. And it’s surprising how little we know about him yet. We don’t understand why the flu is seasonal. It is difficult to understand why there is a three month period when it is very active, and then almost nine months when it is difficult to detect, depending on the hemisphere you are in.

Infectious diseases do not get as much attention as, for example, cancer or heart disease because they have almost disappeared in rich countries, which are setting scientific priorities.

Infectious diseases do not get as much attention as, for example, cancer or heart disease because they have almost disappeared in rich countries, which are setting scientific priorities. And our foundation focuses on the diseases that kill most people, as well as easing the burden of infectious disease. So it doesn’t surprise me that much. But now we are facing a very new phenomenon.

– One of the things I appreciate in your article is the section on what we don’t know. What things do we still not like to know more about?

– Seasonality and climatic effects. The farther, the more it appears that infection within the facility is a dramatic part of the infection, and our contacts in confined spaces like the subway certainly pose a great danger.

Are asymptomatic cases really not very dangerous and don’t matter much in the chain of infection transmission? Still The best study on the subject in Singapore, shows that only about 6 percent of the cases were transmitted by carriers of asymptomatic viruses. However, other people have studied in other ways, which in my head has yielded unrealistically large numbers.

We still don’t know enough about the response of the human immune system. This is very important because if the response is weak then you are not protected from a second infection. I hope not. But until we start analyzing blood plasma to see what the antibody titers are, since binary serological tests won’t help here, we’ll wander through undescribed areas.

– Going back to what you just said about binary serology testing. We saw some of their results from Santa Clara and Los Angeles counties. Much higher disease prevalences and much lower mortality rates were detected. Why do you think these studies are not reliable and useful?

– The false number of positive results for these serological tests is very very high. This is how statistics work. If you have 98 percent of those who aren’t actually infected, false positives completely outshine the real numbers. So this study says that there are ten times more people infected than those who have had symptoms. In many other cases, such as the Diamond Princess in Singapore, when the virus was tested in the body, the number of people infected was only two to three times higher.

This will be resolved. We have quantitative serological tests that are used at the population level in approximately five different countries, including some of the studies that I fund. So we swear. Understand that it would be better if tests show that more people are infected if it is related to immunity, but that is not yet known either.

– Once again, I will remember the article on pandemic preparedness that you published in 2015. You emphasized this: We are constantly exercising for war with other enemy states. We regularly conduct military exercises independently and as a member of NATO.

Pandemics have struck many times in history. We know another one will happen at the end. And we are not preparing for them. Why do you think we are more focused on mutual threats than on threats posed by nature?

– I think in part because the smaller epidemics did not affect the United States. If we look at the well-organized Asian countries, many of them pointed out in their notes: the first step, to count all the PCR machines (polymerase chain reaction machines used in laboratories to copy small segments of DNA, ed.). Step Two: Provide laboratory supplies for PCR machines. We haven’t done that until now, even though we have most of these machines in terms of population than anyone else.

Countries like Taiwan or South Korea, like MERS and SARS have been affected, have written scenarios. And now they have resorted to those scenarios, carried out all the actions listed one after the other, and saved 10 percent of their GDP and avoided a great deal of human suffering, as this respiratory illness was taken seriously immediately.

We don’t think of this as a priority for long. I needed to invest in that before. Now I remember and think: Could you speak louder and clearer about it? Very little has been done.

– In his April 23 article, he said that it is not enough to reopen the policy, we also need innovation, but we do not have it yet. What are the innovations we need?

– These are three things. First, the extent of the evidence. If a miraculous level were reached, one could check each one before boarding a cruise ship, arriving at an amusement park, or returning to work in a warehouse. But we are still a long way from that. Therefore, the test is the first important category. To this would be added the traceability of the contacts, since this is a very important factor in stopping the infection.

So we need to have medicine. And finally, we need to have the vaccine. Here are those three things.

– Let’s start with the tests. There have been repeated reports of lack of reagents and smears. This process lacked attention. What do you think is missing to achieve the type of test mode you would like?

– We have shown the Food and Drug Administration that basically any smear is adequate. You can take this sample yourself, put it in a plastic bag and send it if it arrives at the device within the established time. Therefore, smears should not be a limiting factor.

We look at who has the best antibodies, who has the production capacity. And we hope to achieve results by the end of the year.

Thanks to the research apparatus, it is possible to operate them in such a way that they operate faster. We are now analyzing this. But the device is not yet being used effectively. Even today, we don’t have those who aren’t fully charged, and we don’t make sure this is done. Shouldn’t this be a matter for the federal government? Some states have many PCR machines. Some very little.

– Let’s move on to another group of innovation. Are we likely to have medications before the vaccine?

– Definitely. Therapy is always simpler. If your medicine has spectacular benefits, you will see it with a hundred patients. Then you can try many preparations at once. This is already happening, we are investigating. The UK is doing serious work in this area. Germany is doing serious work.

There are certain compounds, not necessarily those that have already been mentioned somewhere, that offer a lot of hope. One of them is where the blood of healthy patients is analyzed and the best antibodies are found. And then either that blood is used directly, or those antibodies are produced. This method is quite promising. So we look at who has the best antibodies, who has the production capacity. And we hope to achieve results by the end of the year.

– Given what we are talking about now, how do you think the limiting factor in production chain capacity will be in six months?

– It will be difficult to expand the production of some of these vaccine constructs, in part because they are new or have a very complex chemical composition. And it’s about producing billions of doses of the vaccine. We don’t make a single vaccine by the billions. We produce hundreds of millions, but before that we have to work for decades to be effective.

Even when we get to the stage where we need to put the vaccine in glass bottles, it is a special pharmaceutical glass; there is not enough in the world. Therefore, we are also working to solve this problem, because all the components of the vaccine must be poured into the vial at some point. I hope we get to the point where it is just a production process, and these investments, which will cost the majority of billions, will save billions.

– Let me ask you a stupid question about vaccines. I see a lot of self-confidence that the vaccine will be, let’s say, in 18 months. But we still don’t have a vaccine against HIV / AIDS. There are many other coronaviruses for which we have always wanted vaccines. What are the chances that 3 billion people will be effectively vaccinated in two years?

– Very big

– Why?

– This goal is not as complex as HIV. This means that their protein spikes do not change their shape like HIV. We already had a SARS vaccine. But then the disease disappeared on its own. So we didn’t have a chance to start the third test phase. We even have an antivirus for Ebola.

So I don’t think coronavirus is an insurmountable target, but I can’t guarantee it. We have already started to see the results of animal testing. So by the end of the summer that will be clear enough. And I think at least some of the top ten buildings offer a lot of hope.

– Tell me a little about your project to previously develop different vaccine production platforms, knowing that we are still not sure what type of equipment we will need.

– Well, CEPI (Coalition for Epidemic Preparedness Innovations – ed.) It is a group that we have created that does most of this work. We finance these people directly. Several of them have new RNA methods and one has a DNA method. These new methods have certain advantages, but cannot be trusted unconditionally, because vaccines have never been developed in this way before.

– Tell me about any of those new methods. How are they different and what can improve them?

– Normally, a fragment of the virus is inserted into the vaccine, and then the immune system sees it and realizes that it is a foreign object, and decides that it should be ready to start producing antibodies immediately as soon as it is restarted. see. Therefore, at least a fragment of the virus is injected. Sometimes the whole virus, but it weakens beforehand so that it cannot reproduce abruptly. Sometimes the virus is killed beforehand and then inserted.

Many vaccines are subunits of the vaccine when the complete virus is not used. A small part is sufficient, as in the case of the protein needle coronavirus. Instead of the complete form, it is enough to enter the code, the instructions according to which that form is created. All that needs to be done is just RNA, which is trivial because it’s just those known codes that are grouped together.

That is why this approach these new companies are working on is promising: if it is effective, it will be a rapid response platform in case of future pandemics.

– If we had invested heavily in vaccine production capacity in the last five or ten years, how do we think we would be elsewhere now?

We absolutely could do that as early as this year.

There are many things you need to experience in practice to understand them: who should take the initiative and make decisions? Where do we have to raise funds? When would regulators compromise between faster results and increased safety?

People have a political instinct to look good or not look bad. The crisis is a difficult time to reflect on all the necessary details. It’s good not to feel your breath on your back when you make those scientific decisions.

– Can changes in the regulatory sphere accelerate these processes? For example, it is “people’s challenge tests”When volunteers become infected with the virus, does this seem like a possible option?

– It is up to regulators to decide. Basically, when faced with a serious illness like this, it is unethical to use challenge tests on humans. So I don’t think this method is used here. Theoretically, yes, this would allow you to see more quickly if your vaccine is effective, thus shortening all the way. But who would those volunteers be? Would they be fully informed? In the case of malaria, this is allowed because we have one hundred percent active medications. But in the case of tuberculosis, HIV, this is not allowed. And until some revolutionary innovation emerges, it should not be allowed.

– Currently, in the United States, we have not yet reached the required level of testing and have not developed a contact location system, we have done even less in treatment or vaccine trials. But some states are talking about opening up. Are you very concerned about possible second spike problems?

– Extremely disturbing. Unless the opening is very gradual and covers those things that we know will not increase the infection rate above unity. Otherwise, we will have heterogeneity, some states do well and others do poorly. The temptation to disconnect between those different parts will be very strong.

Without evidence, the opening is somewhat blind. I don’t like it sounding like a scratched record right now, but the tests should take precedence. In many areas, we will have decreasing numbers in late May and early June. If we use the rest of the time to streamline testing procedures, create a contact tracking system, then openness will make sense. And the decision about its timing should not be political but scientific.

– As a technician, what do you think of those contact tracking ideas for large-scale digital surveillance and using phones or Bluetooth to ensure quarantine compliance?

– It is difficult to describe it in general. Some tools are like helpers that remember where you were. When you are invited to an interview, you will see: a, yes, I visited that store and that store. This can be useful.

The Bluetooth range is too large, so false positive contacts will obscure everything. That would be hundreds of people in each case. Some people go further and suggest using ultrasound to determine which phones are nearby. But even this is not ideal, since many cases of infection occur in places where viruses have been left on the surfaces. A person leaves with his phone; Someone else arrives there an hour or two later, touches that virus, and becomes infected. And there is no other phone nearby at that time.

But the German method, which does not require human intervention, can work very well. As long as that database is properly maintained, it will not violate privacy rights, as has been done in some Asian countries.

– In 2015, I asked him what he was afraid of, and he replied that it was a deadly, pandemic inflammation of the airways. We are going through that nightmare now. Let me ask you the opposite question. Imagine three to five years after the vaccine was developed. What do you expect from the future?

– I hope it will unite the whole world. After World War II, we built new institutions and successfully avoided another world war. This is phenomenal. We do not use a nuclear weapon. And we have achieved this by joining together through various institutions, including the World Health Organization (WHO). No matter how bad prehistory is, the results were positive.

What is happening now are tragic events. Whatever comes out of it won’t fix the problems. But we must understand that science is important: let’s use it to avoid pandemics. We will not go out of our way until we get rid of your worldwide threat. Travel restriction is a very harsh coercive measure with many negative consequences. Even if we are forced to take it temporarily, it is not the world we would like to live in.

I have always believed in global cooperation. You can accuse me of saying, “Everyone will be convinced of my ideas.” But I really think the World War II analogy fits here.

– However, a darker option is also possible. People can conclude that we are too interconnected in various ways, that our borders are too open, that migration is too intense. We have already seen Donald Trump try to stop the green card program. Are you not afraid that this in itself is a setback to global cooperation?

– As for World War II, we know what role Germany and Japan played in starting that war. It wasn’t just some kind of bat that a boy ate.

One might have thought that this would change the attitude of the peoples of Japan and Germany forever, and we did terrible things during the war, which we regret. But it ended. My father served in the occupying forces in Japan and could not believe how friendly and cooperative they were. Very quickly we help them rebuild their country. They recovered. The feeling of mutual benefit was very strong.

– In his article, he writes that it is like a world war, but now we are all on one side. And what surprises me in the current period is the effort to oppose us. There are forces in the United States trying to accuse China of forcing the United Nations to call COVID-19 the “Wuhan virus.” China also responded in the same way.

Clearly, global cooperation is needed, not only in the field of health, but also in the economic field, to get out of this situation. However, there are leaders who see short-term benefits in inciting hostility that will make it difficult for them to get their countries out of trouble.

– I am sure that in the end the United States will show its good side, although it has not yet done so. The United States Congress has been the most generous in the world in addressing funding for HIV research. It was one of the most generous. GAVI (Global Alliance for Vaccines and Immunization) – vaccine research editor. The United States government has helped address health problems worldwide. This contributed greatly to the reduction in mortality.

In this case, it is not even a humanitarian issue. These are strategic ties and the need to ensure that the disease does not return to the United States, because we are involved in, and greatly benefit from, world trade. So I think what we are seeing right now about how the United States is behaving will end. There are many voices asking us to work together with Europe and other countries, forcing us to be part of an innovation that will complete everything.

– The United States has said it will cut WHO funds. There are people who, I legitimately believe, are disappointed with the WHO response at the start of a pandemic. How should we evaluate WHO now? Why it should be important to continue financing it.

– Imagine a fire. The fire brigade was 20 minutes late and we decided to fire them all. Yes, we should explain the reasons. But many people don’t react to events as quickly as they should. Now is not the time to look for the culprits.

WHO is the agency that helps all countries understand how the epidemic is evolving. She has a very small budget. Only the movies show boys flying around the world and hitting bioterrorists. She has no budget for that. Its budget is less than a thousandth of what the United States spends on health care. Some imagine that the WHO had to produce a vaccine, that is not even its function. He doesn’t even have funds for that job. But the WHO has done a lot of good work. It is a necessary institution.

I don’t think the United States will eventually cut its contribution and fire many people who work for WHO in a crisis like this. I think those threats will diminish. Well, at least I didn’t go down without explaining myself first.

– We knew that there would eventually be a pandemic, but we were not prepared for it. Suppose we learn this lesson that we need to be prepared for other dangers. What are the dangers we should be prepared for now?

– Well, everything is complicated enough. I don’t want to dwell on bioterrorism, but whatever the death rate from this pandemic, it is far from a bioterrorist attack when, for example, a smallpox or other specifically selected pathogen is used to cause high mortality and late symptoms, and characterized by high infectivity Fortunately, what we must do to prepare for nature’s natural pandemics is part of what we must do to prepare for bioterrorist pandemics as well.

– Do you think that poorer countries should make different tradeoffs between social isolation and economic support than richer countries?

– Definitely if you push so hard that people will no longer be able to feed, you will create civil unrest. And this is the complete opposite of social isolation. In developing countries, it is much more difficult to implement nuanced policies due to reduced resources. I think it takes a lot of ingenuity to implement appropriate policies for developing countries. And now they are trying to a great extent to do what worked in rich countries.

– There have been many conspiracy theories that use your name. For example, if you predicted something like a coronavirus, then perhaps you created it to make money from it or to use a vaccine to help control people. So why did you create the coronavirus and how does it feel to be at the center of such conspiracy theories?

– Well, that’s sad, really. Who would have thought that the makers of the Lysol disinfectant would be forced to remind people that it couldn’t be used for injections? Some people really do that. Misinformation is dangerous, especially in a crisis where people’s tendency to believe horrible things has increased.

We are all in a difficult situation, maybe a little less than the others, but still. When someone starts talking that we should blame this or that country, one or another person who is different from us, it is very dangerous. So I am very sorry that this is happening. Well, but I don’t think it’s very common, so I hope it comes out on its own.

– What surprised me during this disaster is how effective action depends on social trust and solidarity. Although it seems that we are at a time when our capacity to undermine people’s confidence in institutions exceeds our capacity to increase it.

I wonder if you have any comments on this.

– Si nos fijamos en las calificaciones de confianza de muchos políticos, han aumentado dramáticamente. Kai politikai drįsta pripažinti kažko neišmanantys, bet rodo dideles pastangas pritraukti ekspertus, manau, jog yra puiku, kad jų reitingai auga.

Socialinės distancijos lygis buvo labai aukštas. Laikui bėgant žmonių kantrybė pradeda sekti, ypač jeigu jie sulaukia gluminančių žinučių iš savo lyderių. Bet iš esmės turėtumėte jaustis gerai dėl požiūrio šalyje. Jeigu man būtumėte pasakęs, kad mes viską uždarysime, aš būčiau prognozavęs daug daugiau neigiamų padarinių.

Žmonės supranta, kas yra mirtis ir kas yra išgyvenimas. Daugelis užduodamų klausimų yra labai pagrįsti. Gaila, bet temos yra labai sudėtingos, tad gana sunku išsiaiškinti, ką mes žinome ir ko ne. Štai dėl ko aš pasistengiau visa tai surašyti į straipsnį. O po mėnesio ar dviejų aš žinosiu daugiau ir galbūt vėl parašysiu.