How to pronounce "setback"

Transcriber: Ivana Korom Reviewer: Krystian Aparta

Whitney Pennington Rodgers: Hello and welcome to everyone

joining us from around the globe.

Thank you for being part of day two of our special series TED Connects.

This week, we're bringing you interviews from some of the world's greatest minds

to offer tools for us to navigate through and thrive

in these really uncertain times.

I'm Whitney Pennington Rogers, TED's current affairs curator,

and I'll be one of your hosts for today's event.

Yesterday, we kicked off this series

with an interview from acclaimed psychologist Susan David,

who offered us some tips on how to really be our best selves

in these trying times.

And we're going to switch gears a little bit today

from thinking about our own personal mental health

to the state of our global public health systems.

Chris Anderson: Thank you.

I guess we have a pretty exciting guest to introduce.

On the other side of the country, let's bring in Bill Gates.

Bill, they say the better-known people are,

the less you have to intro them.

It's great to have you here.

How are you doing?

Bill Gates: I think this is an unprecedented,

really disconcerting time for everyone,

with things being shut down,

not knowing exactly how long it's going to last,

worrying about the health of all the people we care about.

You know, I'm lucky that I get to connect up

with video conferencing using Teams a lot,

so the Foundation is stepping up

and there's a lot of great people trying to help with this crisis.

But it's scary for everyone.

CA: Are you basically stuck at home like many of us watching?

BG: Yeah, almost all my meetings are using Teams now,

I'm getting used to that.

You know, I've gone days without seeing any coworkers.

CA: Let's start here, Bill.

Five years ago, you stood on the TED stage

and you gave this chilling warning

that the world was in danger, at some point, of a major pandemic.

People watching that talk now,

their hair stands up on the back of their neck --

it is exactly what we're living through.

What happened, did people listen to that warning at all?

BG: Basically, no.

You know, I was hopeful that with the Zika and Ebola

and SARS and MERS,

they all reminded us

that, particularly in a world where people move around so much,

you can get huge devastation.

And so the talk was to say,

hey, we're not ready for the next pandemic,

but in fact, there's advances in science that if we put resources against them,

we can be ready.

Sadly, very little was done.

There were some things --

the Coalition for Epidemic Preparedness Innovation, CEPI,

was funded by our foundation,

Wellcome Trust and a number of governments,

to do some of the platform vaccine work,

but in the area of diagnostics, antibodies, antivirals,

basically doing the disease games that I talked about,

where we'd simulate what needed to be done.

We hardly did anything,

and so now here we have a respiratory virus

that is, sadly, fulfilling some of the more negative predictions I made.

CA: Last month, you said that this might be the big one.

You wrote that this could be the sort of once-in-a-century pandemic

that people had been fearing.

Is that how you think of it still?

BG: Well, it's awful to say this,

but we could have a respiratory virus whose case fatality rate was even higher,

if this was something like smallpox,

you know, that kills 30 percent of people.

So this is horrific.

But in fact,

most people, even who get the COVID disease,

are able to survive.

So it's quite infectious,

way more infectious than MERS or SARS were.

It's not as fatal as they were.

And yet, the disruption we're seeing, in order to knock it down,

is really completely unprecedented.

So this is going global,

that was --

it's respiratory,

that was the great fear.

How many people end up dying --

hopefully, if we do the right things, it won't be a gigantic number.

So, you know, we should end up not having the 1918 flu situation.

We should be able to do a lot better than that.

CA: And that's because of actions that we would take.

I mean, left without the right actions,

the prospects are pretty deadly.

If we knew what we knew in 1919,

this thing could take out tens of millions of people

around the world.

You said --

is the key thing here that it's got this sort of a strange combination

of being certainly more dangerous than flu --

not as dangerous as something like Ebola or SARS,

but more dangerous than flu by a factor, but infectious,

and also infectious before symptoms have started,

is that part of why it's been really hard to respond to?

BG: Right.

Ebola,

you're actually flat on your back before you're very infectious.

So you're not at church or in a bus or at a store.

With most respiratory viruses like the flu and COVID,

at first you only feel a little bit of a fever and a little bit sick,

and so there's the possibility you're going about your normal activities

and infecting other people.

And so human-to-human transmissible respiratory viruses

that in the early stage aren't stopping you from doing things,

that's kind of a worst case,

and that's where, you know, I did a flu simulation in the 2015 talk

and showed how quickly it spread.

You know, versus 1918,

people move around a lot more now than they used to,

and so that works against us.

Now the medical system that steps up to treat people

is also far, far better.

CA: But when was it clear to you

that unless we acted, this could be a really deadly pandemic?

BG: Well, in January it was discussed

that there was human-to-human transmission taking place.

And so the alarm bells were ringing

that this fits the very scary pattern

that it will be very difficult to contain.

And on January 23,

China did their equivalent of the shutdown.

Did it in a fairly extreme form.

The very good news is that they were able to reduce

the infection rates dramatically

because of those actions.

But it's January where everybody should have been on notice --

let's get our act together with testing,

let's get going on therapeutics and vaccines,

we've got to get organized

because we have this novel respiratory virus

whose infectiousness and fatality put it in that superscary range.

CA: And so, what did happen?

Because it's such a mystery to me

about the "lost month" of preparations

in many countries and certainly in the US,

where we are.

Were you on the phone to people

during early February, late January, early February,

saying, "Guys, what's going on,

this is a really big deal, what are we doing?"

What was happening behind the scenes during that period?

BG: Well, you'd like to have government money show up

for the key activities.

We put out 100 million,

we created the Therapeutics Accelerator,

there's the period between when we realized it was transmitting

and now, where we should have done more.

I think the most important thing to discuss today

is that in the area of testing,

we're still not creating that capacity

and applying it to the people most in need.

And so we have health workers who are symptomatic,

who can't get a test

and so they don't know should they go in or not go in,

and yet we have lots of tests

being given to people who aren't symptomatic.

So the testing thing to me,

it's got to be organized, it's got to be prioritized,

that is super, super urgent.

The second thing is the isolation

that, you know, various parts, just focusing on the US,

some parts are doing that in a fairly strong way

and other parts not yet,

and it's very hard to do,

it's tough on people,

it's disastrous for the economy.

But the sooner you do it in a tough way,

the sooner you can undo it and go back to normal.

CA: So we'll come to the isolation part in a minute,

but just sticking with the testing thing,

I'm just so confused as to why, with more than a month's notice --

I mean, there are so many smart epidemiologists in the US, for example,

you plug numbers about infectiousness and fatality

into any simulation

and you see that if you don't do anything,

millions of people will die.

And there's a month.

So what's your explanation,

what do you think happened here as to why there was almost no --

a month later,

there was no viable test in the US.

Was this just government complexity,

too many chefs in the kitchen,

what on earth happened here?

BG: Well, we certainly didn't take advantage of the month of February.

The good news is that the actual process,

the PCR machines,

we have a lot in the United States.

And so there's models like South Korea,

who took advantage of February,

built up the testing capacity,

and they were able to contact-trace and their infections have gone down,

even without the type of shutdown

that, because we're late, we're having to do.

One thing that is good news just this week

is that people had thought to do this test,

that you had to have a nurse or doctor shove a swab way up,

all the way to the back of your throat,

which hurts a lot,

but also, you're going to cough

and potentially spread the disease to that health care worker.

So they have to have protective equipment

and change that.

We sent data to the FDA this weekend,

showing that just an individual, by themselves,

swabbing up to the tip of their nose,

the accuracy of that test

is essentially the same as having a health care worker do it.

That helps a lot.

We still have to do other things,

but that means that you don't have to change protective equipment,

you just hand the patient that swab,

they do it, put it in the test tube,

and if the capacity is right,

within 24 hours, you should get that result back.

CA: So how do you see that playing out?

Are there people going to massively scale those tests

and how will ordinary citizens be able to get hold of them?

Does it still have to be kind of prescribed by a doctor at some point,

or at some point, will you be able to order them off Amazon or something?

BG: Well, it's pretty chaotic today, because the government hasn't stepped in

to make sure the testing capacity is both increased

and it's used for the right cases.

There will be a website --

and if the federal government doesn't do it,

a lot of local governments will have to do it --

that you go to, you give your situation, including your symptoms,

you're told, based on your work and your symptoms,

are you a priority.

If so, you're told where there are kiosks you can go to

and you'll do the self-swab and just hand it over,

or eventually, we'll send the kits to you at home,

and then you'll send it back and hear that result.

Maybe six months from now,

you'll actually have a strip where you perform the test in the home,

but for now, they're sending it back for the PCR processing.

We can have massive capacity there.

And that's how you know.

The testing is everything,

because that's how you know whether you need to do more shutdown

or you're starting to get to the point where you can relieve it.

CA: Some people are trying to argue now

that, almost, the testing should be dialed back,

because the cat is out of the bag,

testing is bringing people together and risking infection,

you know, forget that, let's just focus on treatment

and on isolation strategies.

You disagree with that.

Testing is still absolutely essential and needs to be scaled dramatically.

BG: The two that go together are testing,

at very high volume,

and the isolation piece.

If you're a medical worker,

you want to stay and do your job.

If you're making sure the electricity, water, food

is still available,

you want to do your job,

and so testing is what indicates to you,

do you need to go into isolation

and make sure you're not the source of spread.

And so, you know, testing is the key thing.

South Korea did that in this massive way

that everybody should learn from.

And so that is paired with the isolation piece.

Our goal here is to get to the point

where a very small percentage of the population is infected.

You know, China, only 0.01 percent of the population was infected.

If you let it,

if you don't do these things,

you're going to get the majority of people infected

and that huge overload of the medical system.

CA: Whitney has some questions from our online audience. Whitney.

WPR: Some of the questions that we're seeing

are about how our tech giants and leaders

can play a role in isolating this and containing this virus.

BG: The tech companies are very involved

in making sure that some work can go on.

People can stay in touch,

you know, they can help with some of the disease modeling,

they can help with the visibility of the numbers.

It's actually very impressive,

you get up there and you can see those numbers.

Actually, they're sad numbers,

but everybody's able to monitor this thing.

Back in 1918, they didn't have this type of visibility,

and ability to share best practices.

But for a lot of people, the isolation is the key thing.

CA: Bill, one of the riddles about this isolation strategy

is how long it has to last.

A lot of people are concerned

that the price of victory by isolating everyone

is that you crash the economy,

and that we have to be, basically,

at home, not doing our regular jobs for three, six months, maybe all year.

And so much so that there's now this big debate in the US

and other countries

about this may just be the wrong strategy,

that we can't crash the economy that badly,

we should only isolate for another couple of weeks,

and then let people back,

and if that means a lot of other people get sick

and we eventually build up herd immunity,

that may be the right way to go.

What's your thought on this,

what is the isolation strategy

that eventually leads to us getting back to normal?

BG: It's very tough to say to people,

"Hey, keep going to restaurants,"

you know, "Go buy new houses,

ignore that pile of bodies over in the corner,

just, you know, we want you to keep spending,"

because there's some, maybe a politician

who thinks GDP growth is what really counts.

It's very hard to tell people, when there's an epidemic spreading

that threatens, particularly, their parents

or elderly people that they know,

that they should go about things

knowing that their activity is spreading this disease.

I don't know of any rich countries that have chosen to use that approach.

It is true, if you did that approach,

over a period of several years,

enough people would be infected you'd have what's called herd immunity.

But herd immunity is meaningless until you infect over half the population.

And so you can take --

You'll overload your medical system,

so your case fatality rate, instead of being one percent,

will be like three, four percent.

And so,

the idea, it's very irresponsible

for somebody to suggest we can have the best of both worlds.

What we need is the extreme shutdown

so that in six to ten weeks,

if things go well,

then you can start opening back up.

CA: So just putting the math together from what you just said, Bill,

to get to herd immunity,

you need more than half the people in the country

to basically get the bug.

So in the case of the US, for example,

that would be 150 million people, thereabouts.

You said that the fatality rate in that scenario,

you're talking about four to five million people

potential fatalities.

That is just a horrifying scenario that no one should be contemplating.

BG: Even one percent of the population getting sick,

they will treat, whoever goes for this "ignore the disease" strategy,

they will treat them as a pariah state,

so none of their people will go in,

and none of your people will go into that.

And so briefly, a few countries in Europe that hadn't really looked at this hard,

considered, "OK, should we be the ones who kind of go about business as usual?"

It is tempting, because if you got there early --

South Korea did not have to do the extreme shutdown,

because they did such a good job on testing.

CA: Testing and containment.

BG: That's why it's so maddening to me

that government is not allocating the testing

to where it's needed,

and maybe that will have to happen at the state level,

because it's not happening at the federal level.

But there is no middle course on this thing.

It is sad that the shutdown will be harder for poorer countries

than it is for richer countries.

CA: So let's come into that in minute.

The one exception I've heard the case made for is Japan,

that Japan has not contained it quite in the same way

that South Korea did

but has allowed people to work.

It's tried to make extreme measures

for protecting their most elderly population.

But they've tried to find a middle scenario, haven't they?

BG: If you act --

When you have hundreds of cases,

you may be able to contain it by doing great testing

and great contact tracing,

and restricting foreigners coming in,

without as much damage to your economy.

The US is past this opportunity to control without shutdown.

So the worst case of what was happening in Wuhan in the beginning

or in northern Italy over the last few weeks,

that we avoid that.

But we did not act fast enough to have an ability to avoid the shutdown.

CA: But then what I don't understand, in the case of the US, for example,

is that even if we're successful

in bending the curve and reducing the number of new cases

from a period of extreme shutdown, as it were,

no immunity has been built up.

Let's say that there's still no vaccine.

Surely when you lift restrictions and people start going back to work,

the whole thing just blows up again.

BG: The experience that we're seeing in China and in South Korea

is that there are not these people who are asymptomatic

that are causing lots of infections.

And that's a parameter

that, as you build the model, you have to put in.

There's an Imperial model that people talk about a lot,

which shows that reopening is very hard to do.

But the results of that model are not matching what we see in China,

and so very likely,

there aren't as many of these infecting asymptomatics.

And that's why you have to be pragmatic.

There's a lot we don't know.

For example, seasonality may help us in the Northern Hemisphere,

the force of infection will --

Respiratory viruses, to some degree, they all are seasonal.

We don't know how seasonal this one is,

but you know, there's a reasonable chance

that the force of infection will be going down.

And it's your testing that always is telling you,

"Oh, my gosh, do I have to shut down more,

or can I start to open up?"

So particularly, right as you open up,

that testing and contact tracing is saying to you --

And you can say I'm more on the optimistic side,

that it will be possible to do what China's doing,

where they are starting to go back to normal.

CA: And help me understand what happened there

because it seems kind of miraculous to me,

because this virus was exploding,

yes, in Wuhan, but people moved from there to many other parts of China.

How is it possible

that the combination of the shutdown in Wuhan

and measures elsewhere

seem to have got to the point where there are literally

no new cases happening.

I mean, to me, that implies that literally,

the virus is not circulating at all between humans in China.

You know, there's a few tourists coming in who they deal with,

but I mean, is that literally your interpretation of what happened,

that it's no longer circulating in China?

BG: Absolutely.

Take a spreadsheet and take a number like four --

one person infects four people --

and say the cycle is every 10 days.

Go through eight of those cycles,

and you're getting the big number.

You know, start with 10,000 and then,

you know, that increase.

If you take the number 0.4 instead,

that is, the average case infects 0.4 people,

then look at what happens to that number as you go out.

It drops to zero,

and so things that are exponential are very, very dramatic.

When they're above one, they are growing rapidly.

When they're below one, they are shrinking rapidly.

And so the isolation in China

drove that reproductive number to well below zero.

And so local infection rates --

CA: Below one.

BG: Below one, sorry.

And that quarantine,

you know, quarantine comes from "40 days,"

which is what they thought would help for black plague,

that is our primary technique.

Thank God we have testing, if we use it properly.

We are doing therapeutics,

which will help with the death rate,

but in terms of keeping the infections below one percent of the population,

it really all depends just on the two things:

isolation and testing.

CA: So to quote a question from my Twitter feed this morning for you Bill:

If you were president for a month in the US,

what would be the top two or three things you would do?

BG: Well, the clear message

that we have no choice to maintain this isolation

and that's going to keep going for a period of time,

you know, probably in the Chinese case, it was like six weeks,

so we have to prepare ourselves for that,

and do it very well.

And then use the testing

and every week, talk about what's going on with that.

If you're doing isolation well, within about 20 days,

you'll see those numbers really change,

you know, instead of this, you'll see this,

and that is a sign that you're on your way.

Now, you have to stay to get more generations

that are 0.4 infections per previous infection.

You have to maintain it for a number of weeks there.

And you know,

so this is not going to be easy.

We need a clear message about that.

It is really tragic that the economic effects of this

are very dramatic.

I mean, nothing like this has ever happened to the economy

in our lifetimes.

But bringing the economy back and doing money,

that's more of a reversible thing than bringing people back to life.

And so, we're going to take the pain in the economic dimension,

huge pain,

in order to minimize the pain in the disease and death dimension.

CA: Whitney.

WPR: We have a lot of other questions coming in.

One that we've been seeing

is a question about what tools are available for countries

that maybe don't have the luxury of being able to social-distance,

don't have great health systems in place,

how should they be handling this virus?

BG: Yeah, I would say,

if the rich countries really do their job well,

by the summer, they'll be like China is,

or some of the other countries that responded early.

But in the developing countries,

particularly in the Southern Hemisphere,

the seasonality is large.

As you say, the ability to isolate,

you know, when you go out to get your food every day,

you have to earn your wage,

when you live in a slum or you're very nearby each other,

it's very hard to do,

as you move down the income ladder,

than it is for a country like the United States.

And so we should all accelerate the vaccine,

which eventually will come,

and you know, people are being responsible to say

that that's going to take 18 months.

And there's a lot of those being pursued.

I'm talking a lot with Seth Berkley,

who you're going to have later this week,

who can talk a lot about the vaccine front,

because he's definitely at the center of that,

being the head of GAVI.

We do need to get really cheap testing out to these countries,

and we need to get therapeutics

so you don't need to put five percent of people on respirators.

Because even if they had the equipment,

they don't have the personnel,

they just don't have the beds, the capacity.

And so the only good news is that the rich countries have this

and so they will be learning about testing, therapeutics,

and funding the vaccines for the entire world,

to try and minimize the damage in developing countries.

WPR: Great, I'll be back later with more questions.

CA: Bill, you mentioned therapeutics there.

What is looking promising,

is anything looking promising?

BG: Yeah, so there's quite a range of things going on.

There's a few that get mentioned a lot,

remdesivir, hydroxychloroquine, azithromycin,

and the data is still a bit confusing,

but there's some positive data on those.

Remdesivir is a five-day IV infusion,

and actually kind of hard to manufacture,

so people are looking at how that can be improved.

The hydroxychloroquine looks like it works, somewhat,

if you get in early.

There's a huge list of compounds, including antibodies,

antiviral drugs,

and so the Gates Foundation and Wellcome Trust,

with support from Mastercard and now others,

created this therapeutics accelerator to really triage out.

You have hundreds of people showing up and saying, try this, try that.

So we look at lab assays, animal models,

and so we understand which things should be prioritized

for these very quick human trials

that need to be done all over the world.

So the coordination on that is very complex, globally.

But I think, you know, out of the top 20 or so candidates,

probably three or four of them will work out,

you know, at different stages of the disease,

to reduce the respiratory distress.

CA: I heard you mentioned that one possibility

might be treatments from the serum, the blood serum,

of people who had had the disease and recovered.

So I guess they're carrying antibodies.

Talk a bit about that, how that could work

and what it would take to accelerate that.

BG: Yeah, this has always been discussed as how could you pull that off.

So people who are recovered,

it appears,

have really effective antibodies in their blood.

So you could go,

transfuse them and only take out the white cells, the immune cells.

And then the question is,

OK, how many patients' worth of material could you get?

You know, if you have that recovered person come in,

say, once a week,

do you get enough for two people or five people?

Then logistically, you have to take that and get it to where that need is.

And so it's fairly complicated,

you know, compared to a drug that we can make in high volume.

You know, the cost of taking it out and putting it back in

probably doesn't scale as well.

But there is work being done on this.

You know, we actually started with Ebola,

and fortunately, it got done before it was needed.

So that is being pursued

and it will work to some degree,

but it will be hard to scale the numbers.

CA: So it's almost like,

when you talk about the need to accelerate testing,

the immediate need is for testing for the virus.

But is it possible that in a few months' time,

there's going to be this growing need to test for these antibodies in people,

i.e. to see if someone had the disease and recovered,

maybe they didn't even know they had it.

Because you could picture this growing worldwide force of heroes --

let's call them heroes --

who have been through this experience

and have a lot to offer the world.

Maybe they can offer blood donation, serum donation.

But also other tasks,

like, if you've got overwhelmed health care systems,

presumably, there are kind of community health worker type tasks

that people could be trained to do to relieve the pressure there,

if we knew that they were effectively immune?

BG: Yes.

Until we came up with the self-swab

and showed FDA that that's equivalent,

we were thinking that people who might be able to man those kiosks

would be the recovered patients.

Now we don't want to have a lot of recovered people, you know.

To be clear, we're trying, through the shutdown,

in the United States,

to not get to one percent of the population infected.

We're well below that today,

but with exponentiation, you could get past that three million.

I believe we will be able to avoid that

with having this economic pain.

Eventually, what we'll have to have

is certificates of who is a recovered person,

who is a vaccinated person,

because you don't want people moving around the world --

where you'll have some countries that won't have it under control, sadly --

you don't want to completely block off

the ability for those people to go there and come back and move around.

CA: Bill, is your foundation helping to accelerate the manufacture

of these self tests?

What are the prospects for really seeing scale

on some of this testing soon,

not just in the US, but globally?

BG: Yeah, our foundation,

we'd been funding the thing called the Flu Study

to really understand how respiratory viruses spread.

It's amazing how little was understood about how important schools are,

different age groups, different types of interaction.

And that gave us an experience.

In fact, that flu study

actually was the first time coronavirus was found in the community,

because the government was still saying

you only test people who'd come from China,

but we ran into people who had coronavirus,

who hadn't been travelers.

So, that was like an early warning sign,

even though the regulation said you weren't supposed to even look at that.

So yeah, the Foundation is working with all the private sector people,

the diagnostics people on this testing piece.

Now that we can do the self-swab,

those swabs are very easy to manufacture.

The one where you had to jam it into the throat,

deep turbinate,

that was getting into short supply.

So the swab should not be limiting,

neither should the various chemicals that help run the PCR machines.

So we should be able

to get to a South Korea-type prioritized testing thing

within a few weeks.

CA: How important is it that the world's nations

collaborate right now?

I mean, it seems like, you know,

here's this common enemy facing humanity,

it does not know that it just crossed a border,

it does not know what race people are,

what religion they are --

it just knows, "Here's a human,

I've got a manufacturing machine here that can make me famous."

And it goes to work.

It's so terrifying to me to see

signs of countries starting to blame each other

or the xenophobia, it just seems so toxic.

What's your take on this, Bill?

Do you see signs of cooperation happening,

or are you also worried about the sort of, "US versus China" kind of thing

that seems to be going on if we're not careful?

BG: Well, I see both.

I see that countries that are recovered

can help other countries.

And that's fantastic.

If by the summer, we've knocked this thing down,

then great, we can help other countries.

There are vaccine projects all over the world,

and those should be evaluated on a very neutral basis,

to which one is the best to help humanity.

And make sure the manufacturing capacity isn't just for rich countries,

that it's scaled up, very low cost stuff for the entire world,

and that's the spirit of GAVI, is getting vaccines out to every person.

So in the science side, and data-sharing side,

you see this great cooperation going on.

Unfortunately, whenever you have disease,

this sense of other and foreign and "Oh, stay away from me,"

you know, that sort of pulling inward is reinforced.

And we have to avoid that.

You know, ironically, we have to isolate physically,

while in terms of looking at community groups

that are pooling resources to help make sure food gets to everyone

and help assure medical care,

you know, if older people need to be moved out of common facilities,

you help out with that,

and that people aren't suffering too much from the psychology of isolation.

So our generosity has to go up towards others

at the same time we're less actually physically interacting with other people.

CA: I mean, thinking about the situation in many developing countries,

I'm curious how you think of this.

You mentioned, first of all, that seasonality may help,

i.e. high temperatures.

Is it possible that that is so far protecting, to some extent,

places like India or sub-Saharan Africa and so forth?

BG: India's Northern Hemisphere.

So Southern Hemisphere is lots of Africa, South America,

Australia, New Zealand, Indonesia.

And it is true,

either the force of the infection is lower there

or we're just not seeing it with testing.

You know, a few months from now, we'll understand the seasonality question,

which would be good news for the Northern Hemisphere,

and somewhat bad news for the Southern Hemisphere.

Now more people live in the Northern Hemisphere,

including India, Pakistan,

and that would buy us some time, and time is a big deal,

because all these tools get so much better

if you had to go into a second season with it.

But yeah, sadly,

we could see, in the next few months,

as the Southern Hemisphere is moving into its fall and then winter,

we could see a big increase there,

and that is going to be very difficult.

Now they don't have as many older people,

but they have lots of people who are HIV positive,

or have malnutrition or various lung challenges

because of indoor smoke,

and so the wild card

is how well can the developing countries deal with this.

CA: If you're in a country where the majority of your population

is making less than two or three dollars a day,

can you even afford a strategy that looks like, basically,

shutting down the economy?

BG: I'm very worried that there will be a massive number of deaths

in those poorer countries,

because the health systems just aren't --

you know, the number of respirators, hospitals,

and of course, when you overload that system,

your deaths are not just COVID deaths,

but everyone else who's trying to access a system that will be somewhat in chaos,

including with health workers who are getting sick.

CA: OK, we're getting near to running out of time with this.

Whitney, maybe a last question or two from online.

WPR: Sure, we have two from online,

we're seeing thousands of questions around these same lines.

One, there's lots of people who are really interested to hear

about the kind of work that you're doing with your foundation

as far as distributing tests, but also producing safety gear,

masks and that sort of thing,

to help with this effort for health workers.

BG: So the Gates Foundation,

you know, we, very early on,

gave out 100 million to help out with all the pieces:

the testing piece, the therapeutics and the vaccines.

We are not experts in making masks and ventilators and gowns,

and it's great that other people, including some 3D printing,

and open-source things, that is great.

Our focus, you know, like this self-swab thing,

nobody had done that before,

people thought it wouldn't work,

we were quite sure it would work.

And so that, for the globe, is a huge thing.

We work a lot with both governments and private sector,

so in some ways, we're kind of a bridge.

And we've been talking to the heads of the pharmaceutical companies,

the testing companies

and, specifically, with the ones doing vaccines,

including some of which are these new type of vaccines, RNA vaccines,

that we've been backing for quite some time,

and CEPI has been backing.

And so our expertise is in those medical tools

and really getting the best of the private sector engaged there.

It's been a little slow.

We can write checks right away,

whereas the government processes,

even in this situation --

you know, there's still this notion of bidding,

and not really knowing who has the unique capabilities of doing things,

and so, an organization that's working on this all the time,

lots of new vaccines,

can step in and be helpful.

And it's really amazing.

When we talk to private-sector partners,

their interest in helping out has been absolutely fantastic.

And so that's where we have a unique role.

WPR: And the other question that we're seeing a ton of --

before we wrap up here --

is just people are really interested in your insight, Bill,

on whether you think we are heading in the right direction,

do you feel like our economy is heading in the right place,

that humanity is heading in the right place,

are we in a better position now

than you thought we were in five years ago?

BG: Well, five years ago,

I said that pandemic

is this unaddressed, very, very scary thing.

And that if we did the right things, we could be more prepared.

Science is on our side.

The fact we can be ready for the next epidemic,

it's very clear how to do that.

And yes, it will take tens of billions,

but not hundreds or trillions of dollars.

So it will be tiny compared to the economic cost.

I remember when I did that presentation 2015,

I put up, "Hey, a big flu epidemic could cost four trillion,"

and I thought, wow, that's a big number,

do I really think it's that big?

And I went and looked up numbers and thought, yeah, well, that's big.

This epidemic will cost that much to the economy.

So in the short run,

we are going to have more pain and more difficulty

and people are going to have to step up to help each other.

I'm still very much an optimist, you know,

whether it's climate change, countries working together,

biology taking the diseases, malaria, TB,

you know, even advances for what are more rich-world diseases,

like cancer.

The amount of innovation,

the way we can connect up and work together --

yes, I'm superpositive about that.

You know, I love my work

because I see progress on all these diseases all the time.

Now we have to turn and focus on this, you know.

Sadly, it may interrupt

and the polio situation might get worse a little bit

because of the distraction here.

We're using a lot of the great capacity

that was built up for those polio activities

to try and help the developing countries respond to this very well.

And that is appropriate,

but the message from me,

although it's very sober when we're dealing with this epidemic,

you know, I'm very positive that this should draw us together.

We will get out of this,

and then, we will get ready for the next epidemic.

CA: That's exactly what I was going to ask you, Bill,

which is, where is your head, do you think we will get through this?

Will the leaders that matter listen to the scientists,

will they?

Will we make it through?

Do you believe that within a few months' time,

we're already going to be looking back and saying,

"Phew, we dodged a pretty bad one there."

BG: We can't say for sure

that even the rich countries will be out of this

in six to ten weeks.

I think that's likely,

but as we get the testing data,

we'll get more of a sense of that

and people will continuously be able to see that.

But you know, the rich countries will get out of this.

The developing countries will bear a significant price,

but even they, we will get a vaccine

and GAVI will get that out to everyone.

So you know, two to three years from now,

this thing, even on a global basis,

will essentially be over with a gigantic price tag.

But now we're going to know,

OK, next time we see a pathogen,

we can make billions of tests within two or three weeks.

We can figure out which antiviral drugs work

within two or three weeks

and get those scaled up.

And we can make a vaccine,

if we're really ready,

probably in six months,

using these new platforms, probably the RNA vaccine.

So specifically, there are innovations that are there

that will get financed, you know, I hope, quite generously,

coming out of this thing.

And so, three years from now, we'll look back and say,

you know, that was awful,

there's a lot of heroes, but we've learned a lesson

and the world as a whole,

with its great science and desire to help each other,

was able to try and minimize what happened there

and avoid it happening again.

CA: That's certainly the optimistic scenario

that I'm craving for, myself.

That the world kind of realizes,

one, that there are certain things that you just have to unite on.

Two, that science really matters

and it's a miracle that science can understand this bug,

you know, make a vaccine,

sequence it, make therapeutics,

understand how to model it --

it's kind of miraculous to me.

So will we learn, now, to pay attention to scientists,

because if we do, I'm sure that you feel this as well,

there's an amazing analogue with climate,

it's just a different timescale.

That the scientists are out there, saying,

"There's this huge enemy coming,

if we do nothing,

it's going to take millions of lives, it's going to wreck our planet.

For God's sake, act, politicians!

Do something."

And the politicians are going, "Meh, no.

We need a little more GDP, we need to win an election."

And they're not acting.

Do you see a scenario where this shocks politicians

to actually change their thinking

and their prioritization of science overall,

or is that asking too much?

BG: Yeah, it's interesting how much of this distraction

will delay the urgent innovation agenda that exists over in climate.

You know, I have freed up a lot of time to work on climate.

I have to say,

you know, for the last few months, that's now shifted,

and until we get out of this crisis, COVID will dominate,

and so some of the climate stuff, although it will still go on,

it won't get that same focus.

As we get past this,

yes, that idea of innovation and science and the world working together,

that is totally common between these two problems.

And so I don't think this has to be a huge setback for climate.

CA: Last question.

There are thousands of people watching,

many of them living alone,

some quite scared,

there may even be people there who have this virus

and are suffering symptoms or recovering.

By the way, if that's you, we'd love to hear from you,

we really would.

Maybe have a conversation with some of you,

in a future one of these,

just understanding the experience.

But Bill, what can people do as individuals from their own homes,

right now, to try and help?

BG: Well, there's a lot of creativity, you know --

can you mentor kids who are being forced into an online format

where the school systems really weren't ready for that?

Can you organize some giving activity that gets the food banks to step up

where there's problems there?

These are such unprecedented times,

and it really should draw out that sense of creativity,

while complying with the isolation mandates.

CA: Bill, I really want to thank you for spending this time with us

and for the financial investment, the time investment.

You've really invested your life into trying to solve these big problems.

And this is as big as they get.

I have a hunch that your voice is really going to be needed

in the next few weeks.

Thank you so much for your time today.

This was really wonderful, hearing from you.

Thank you.

BG: Thanks, Chris.

CA: OK, thanks, everyone,

thanks for being part of the TED community.

Look after yourselves, be smart about this.

You know, get ahead of it.

If you're in a part of the world where this thing hasn't really hit,

listen to Bill Gates.

Get ahead of it.

Keep, you know, if you possibly can,

socially distanced.

No, not -- physically distanced and socially connect.

That's what the internet is for.

These days are what the internet was built for.

We can spread love, we can spread ideas,

we can spread relationship, we can spread thought,

without spreading a dangerous bug.

So get ahead of it, and let's figure this out together.

It's been wonderful spending time with you.

From Whitney and from me and from the whole TED team,

thank you, and over and out.