Bill Gates interview: How to prevent the next pandemic

Philanthropist Bill Gates has released a new book titled How to Prevent the Next Pandemic.

In an interview with select African journalists, he says there are key steps the world can take to make Covid-19 the last pandemic.

His main proposal is the formation of a Germ—Global Epidemic Response and Mobilisation—team of a new full-time, paid group whose entire job is to prepare for the next outbreak.

They are the infectious disease equivalent of firefighters—a group of in-country and global epidemiologists, data scientists, logistics experts.

They would be ready to go anywhere in the world at a moment’s notice.

The Star's John Muchangi was part of the team that interviewed Bill Gates on Thursday.

Your book will be released on Tuesday, May 3. When and why did you decide to write this book?

Well, the Covid pandemic has been an incredible tragedy, with the costs, and you have economic damage. You have tens and millions of deaths.

You have education opportunities lost. It's been a very tough two years. For many countries, they've had more deaths than they had for anything since World War II.

And so you'd hope that the world would pull together and think, okay, how do we prevent this from happening again?

If you look across different countries, some did better than others. Australia, for example, has less than 10 per cent of the deaths of most of the upper-income countries because they acted very quickly.

Japan has a lot fewer deaths because they are one of the best countries at wearing masks in the world.

And so we should step back from this incredible tragedy, look at what went well and think through how do we respond quicker?

And that’s where the idea of a global team, which I call Germ comes in, and what tools should we have had.

And hopefully, people don’t forget that, even before the pandemic came, the inequities in access to health treatment were pretty stark between developing countries and upper-income countries.

The Gates foundation is one of many organisations that work on that and sadly, the pandemic has not been an exception to that.

But hopefully, it reminds people we need to do more, including strengthening health systems.

Is it too early to start thinking about future outbreaks when we’re still fighting Covid?

Well, the world doesn’t have a global government. We work through these UN organisations including the WHO.

The process of adding a new capacity at that level and making sure that it’s well funded and well-run takes time. I think [early preparation] is important for both the research agenda, some of which is going to take five to ten years, for that global capacity which always takes time to get into place and get the right consensus and funding.

And for highlighting the inequity, I think while this is still in our mind, that’s when we really ought to have the debate.

And so I thought having the book come out with a proposal, some thoughts about what Germ should look like, what the R&D agenda should look like, and a reminder about the central role of health systems – you know, I thought it was very timely.

It’s absolutely true this pandemic is not over. New variants will come along. How severe they will be is hard to predict.

The entire world has probably 60 per cent to 80 per cent infection, which is mind-blowing. And hopefully, as variants come along, that means the likelihood of severe sickness and death, that it’s not going to be as acute as it was in these big waves.

We’re still learning about variants and many of these things I talk about, like getting diagnostic machines up broadly, getting the therapeutics out broadly, those things apply to this pandemic, and we should design a system that’ll work not just for this one, but for the future threats as well.

What needs to happen to bring this pandemic to an end and ensure we never have a repeat?

Well, sadly, many epidemics burn out, like Zika, because the number of people they can infect is simply the new birth cohort.

So we have a lot of endemic diseases at very low levels causing some burden, but not huge.

Eventually, most humans will have broad enough protection from the various forms of Covid that there shouldn’t be a greater burden than we have typically with the flu.

It'll be endemic at some level. Therapeutics can help a lot. It may be the world will have to take a yearly respiratory vaccine that would include both flu and the latest for the coronavirus.

There's a big expense of putting that type of yearly vaccination in, including the elderly who are most at risk.

But the worst of this one is through, and the next one, when it comes, could be a lot worse because the death rate here was like 0.3 per cent across all age groups.

Now, 95 per cent of that was focused on people over 50.

You warned about a pandemic in your 2015 TED talk but you say 90 per cent of the views were after it was too late. Now, you’re raising an important question on preventing another pandemic. Do you think the world is listening, this time around?

It’s hard to say. The world has a lot of challenges. You’ve got the war in Ukraine, you’ve got unrest in Ethiopia, you’ve got unrest in other parts of Africa.

It’s not a simple situation, and sadly, the world’s going through  inflation, particularly food prices and fuel prices.

We’ll see fertilizer costs go up, and we’re super worried that that means a lot of African farmers will use less fertiliser. And then that means you have less food a year from now and that can be self-reinforcing.

It’s not like, even for the foundation, we’re only working on pandemic preparedness.

We’re still working on nutrition, and HIV and malaria, but given that it cost trillions and that the investment to avoid this is just billions, it seems like the most obvious thing.

And after we had world wars, we created the United Nations. In lots of ways that has, fortunately, minimised at least the larger wars since that was over.

And so, I do expect the debate during the next year to take some of my ideas and other people’s ideas and say, governments ought to like they prepare for earthquakes or fires or war, they need to do this.

The rich countries were deeply affected. And so, the financing for the Germ, the financing for the innovation and even some of the financing for the health systems should come from the rich countries.

But I can’t guarantee it because they have so many priorities and the pandemic stretched their budgets in an extreme way.

And now, with Ukraine, they see all the demands coming out of that in parallel.

How can we set up the finance and ecosystems to notch up homegrown innovation, especially for low-income countries?

Well, a lot of the innovations are achievable without high technology, and some are very high technology.

Running big Phase 3 trials about vaccines is an extremely complex thing. It's like, do you want your jet engine to work in all circumstances?

Understanding all of the different human diseases and variation to make sure vaccines are safe is ultra-complicated.

The Gates Foundation has been the primary funder of getting manufacturers outside of the West funded so that they can create new vaccines.

The way that we brought the childhood vaccine cost down dramatically was making sure there was Rotavirus [vaccine] for multiple developing country manufacturers.

We made sure there was measles vaccine from multiple developing country manufacturers. We made sure there was Pentavalent [vaccine], and then the hardest was the Pneumococcus.

It took a lot of non-market funding to get those vaccines to be created. As you know, it takes over $50 million for each new vaccine in terms of the Phase 3 trials.

And the quality of the factory and the quality of the regulator involved is very important.

The foundation is the biggest investor in African regulatory capacity, both to approve drugs and eventually to be able to review drug manufacturing as well.

Regulatory has been tough. We’ve been trying to get – the dream would be to have continent-wide regulatory alignment, but that’s been too difficult.

What we’ve been funding is more regional alignment. We’ve been at that for now over 15 years and made some progress on both regulatory quality and alignment.

There’s a lot more to do with that, which would be a necessary step to have the ideal situation, including the ability to look at manufacturing quality.

(Edited by Tabnacha O)