Bill Gates' Covid-19 vaccine plan: No country left behind

On Monday, the Bill & Melinda Gates Foundation launched its fourth annual Goalkeepers Report, featuring new data showing how the ripple effects of Covid-19 have stopped 20 years of progress toward the UN Sustainable Development Goals.

The report shows because of Covid-19, childhood vaccine coverage is dropping to levels last seen in the 1990s, setting the world back about 25 years in six months.

The pandemic has had a disproportionate impact on women, and led to massive job losses in Kenya. 

Despite the bleak projections, Bill and Melinda Gates describe a path to ending the pandemic and resuming progress toward the SDGs. In the report, which they co-author every year, they call on the world to collaborate on the development of diagnostics, vaccines and treatment; manufacture tests and doses as quickly as possible; and deliver these tools equitably based on need, rather than the ability to pay. 

BILL GATES spoke exclusively with Star's JOHN MUCHANGI on what this means for Kenya and the world. The interview took place via Microsoft 'Teams' app.

THE STAR: The Goalkeepers report shows the ripple effects of Covid-19 have stopped 20 years of progress toward the SDGs. Do we have a pathway to restore the progress and still achieve the targets by 2030?

BILL GATES: I'll say two things about that. The first is that the 2030 targets were very ambitious targets. And so even without the pandemic, many of those goals would not be achieved. Some of the goals were more aspirational than truly practical in terms of how far we could get by 2030. We were making positive progress towards all the goals, but we weren't going to get all the way there.

The second point is that the setback here is gigantic. In things like vaccination coverage, it's like a 25-year setback. Our hope is that we can restore and get back to where we were at the start of the pandemic fairly quickly. We would hope that within two years, at least on things like bed nets and vaccines and support for delivery, that by 2022, we're back making very positive progress.

Now, the economic effects in some cases are so dramatic that some of those will last past the two years. Hopefully next year, as the vaccine is being rolled out globally and the epidemic is going down, we'll really be able to look and talk about countries that have recovered all of these things best and how to spread those best practices, so the entire world by 2022, at least on the health front, is back to where we were at the start of 2020.

THE STAR: Research from the Institute of Health Metrics and Evaluation is showing that vaccine coverage in 2020 has dropped to levels last seen in 1990s. Last month, we had this announcement that Africa has eliminated wild poliovirus. How can we catch up and maybe prevent the loss of gains that we've made against some diseases?

BILL GATES: Well, running a high-quality primary healthcare system, there's a lot of African countries who do that very, very well. You have countries with very high vaccination rates. Then you have countries like Nigeria, particularly in the north, where the vaccination rates are fairly low, or the very poorest countries like the DRC (Democratic Republic of Congo), where, again, the vaccination rates are not very high.

It's constantly one of the big focuses of Gavi (the Geneva-based vaccines alliance), not just adding new vaccines but also getting the existing vaccines out to more kids. Kenya has had pretty good vaccination numbers, and so I don't know how disruptive that is. It may even vary in different parts of the country.

Our rallying cry would be to everybody, the citizens and the government, to remember how critical primary healthcare work is, particularly the vaccinations, and that some catchup work be done on both vaccinations and getting the bed nets out, so we don't see these childhood death numbers go in reverse and get substantially worse.

Vaccines are a miracle and Gavi is very proud of the partnership it has with Kenya to get those out to as many kids as possible.

Talking of the Covid-19 vaccine, what is your view on the decision by the US not to join the [WHO-led] Covax programme to distribute Covid-19 vaccines to developing countries?

In terms of the United States, it is worth noting that on the research side, the US has been the most generous in helping to fund the research activities, and so the vaccines we're expecting can get out in Africa in a big way — the ones we're most hopeful of are AstraZeneca, Johnson & Johnson, Novavax and Sanofi — all of those have strong US funding for their R&D.

The United States, sadly, has not made a commitment to helping build special manufacturing for developing countries or for the procurement of the vaccine for developing countries. I still think the US will come in. As you said, they've chosen not to use the Covax Facility because of the poor relations they've chosen to have with the WHO (World health Organisation).

But the US, I know, because I'm very involved in promoting this, they are willing to allocate money for Gavi. I'm talking with people in Congress and the ideal would be for the US to come up with $4 billion (about Sh400bn) for Gavi. The US does have a good relationship with Global Fund and Gavi. Even though they won't be part of Covax because of that WHO connection, they haven't closed the door on helping to fund the international vaccine.

Fortunately, the US has always been a leader on these things. I'm hopeful that sometime in the next five months, the US will come forward with a big contribution to that vaccine procurement.

Once we find a vaccine or vaccines that work, we need to manufacture billions of doses as quickly as possible. But right now, the world does not have this capacity. How do we go about this without compromising the production of other vaccines?

Well, fortunately, there is a lot of manufacturing capacity, and what we need to do, though, is something we've never done before, which is to have a company that creates the vaccine be willing to use manufacturing facilities of other companies, and in particular, the highest volume vaccine manufacturer in the world by far is Serum Institute (of India).

They participate in the very low-cost vaccines for developing countries. Pfizer has a much larger vaccine business, but to manufacture at high volume and low cost, there's a lot of developing country vaccine manufacturers.

We've been negotiating deals, including we put up hundreds of millions of dollars of [Bill and Melinda Gates] Foundation money to help Serum build up capacity and Bio E (Hyderabad-based vaccine manufacturer) to build up capacity. Right now, it looks like the AstraZeneca and Novavax vaccine can be made by Serum and that the Johnson & Johnson vaccine can be made by Bio E. Then as the Sanofi vaccine comes along, we'll also come up with manufacturing plans for it using some of these capacities.

My hope is that by sometime in 2022, we will be able to make the many billions of doses that we need to get the coverage. Most of these, unfortunately, are two-dose vaccines, and so, for the poorest three billion in the world, we need six billion doses, and that's a lot of doses.

This kind of collaboration will give us a path to get that. We're very hopeful that these partnerships will create that volume.

Now moving to the other issues covered in the 2020 Goalkeepers report, the pandemic has disproportionately affected women in most developing countries, including Kenya. Would you recommend social welfare programmes for the most affected, especially women?

Well, certainly there are some examples that have been done quite well. In particular, India used their ability to send money digitally through their self-help groups, and so they're able to identify the women, and so they avoid the corruption and they avoid the misclassification.

If you haven't done it in advance, if you haven't built the digital system and you haven't identified the various recipients, that's a very hard thing to do very quickly. You have to worry that the overhead or the mistargeting will be a problem. But, yes, the governments that have that capacity should be looking at that.

Obviously, the fiscal constraints for developing countries are much larger than it's been for the rich countries. The rich countries have been able to come out with huge aid programmes.

If you look at Africa, Kenya is actually fairly unique in having the ability to do digital money transfer, but actually identifying who the recipient should be and figuring out how that deficit financing takes place, that's a big challenge.

But, yeah, we're big proponents that we should bring the gender lens to this, because taking care of kids, educating kids, a lot of this has usually fallen disproportionately on the women.

In the report, you also cover the SDG Goal three target on tobacco control. During the pandemic emergency, South Africa and Botswana temporarily banned the sale of tobacco. But in some countries like Kenya, tobacco was listed as an essential product. How can governments defend their health measures against intimidation and undue influence from the tobacco industry?

Yeah, so our foundation is very involved. The Bloomberg Foundation is the biggest funder, trying to reduce the influence of tobacco companies trying to spread tobacco addiction, nicotine addiction in Africa. It's been great to see the consumption levels go down.

Governments need to try and avoid people starting smoking. The nice thing about Africa is the actual smoking levels are still pretty low. Africa should be able to benefit from the rich world, learning that smoking causes a lot of death and sickness, particularly through lung cancer.

The various African countries should restrict tobacco advertising. They should have very high taxes. They should make sure young people don't have access. I'd say we should seize the opportunity where, in many countries, tobacco use has gone down, and try to keep it at those low levels and not let the tobacco companies come back in.

Earlier, you mentioned the importance of the primary health coverage. Do you see it as a problem that during the pandemic, many developing countries diverted a lot of resources instead into tertiary health services, like building new ICUs, new hospitals?

Yes, there's no doubt that running a good health system, particularly a good primary health care system, is one of the most important things the government can do. Some governments in Africa run very high-quality primary health care systems. You can see that through the vaccination rates as a good sign whether you run that system.

As you say, it's often the case that the hospital piece is overfunded relative to the primary healthcare piece, because in the big cities, it's what's visible. And yet, the money put into the primary healthcare system throughout the entire country is how you have the highest impact and you achieve health equality.

That emphasis on making sure, even as budgets will be very tight, that primary healthcare gets the priority and that it's well run, that the salaries are paid, the people show up, it's not kind of a corrupt thing but something that mothers count on being able to go and get those vaccinations, that is super critical and we don't want to lose that during the pandemic as we try to get back to the preexisting coverage levels.

Access to broadband Internet is actually a basic need nowadays. In Kenya and I think most other developing countries, for the last six months of the pandemic, children have not had education because they couldn't access learning online. What do you think governments and the tech industry can do to reduce the cost of Internet and increase accessibility?

Well, as you say, getting Internet coverage up has a lot of benefit, both for the business sector, the economy and the government itself, whether it's telemedicine or education. Education, hopefully for young children up to, say, age 13 or 14, hopefully we can resume face-to-face school fairly quickly.

For kids in high school or even in college, the online education is often a better way of doing things, even if it wasn't for the pandemic, because you can get high-quality teachers and you can access the material at your own pace and whenever you're free.

Really increasing the quality of online education, the materials, that's important. But as you say, that's bottlenecked by the Internet access.

Internet access could be actually very inexpensive in the cities, and countries really need to make sure they are driving for a low price, high-volume type approach to Internet access.

But as you get out into the rural areas, that's more difficult. There are some technologies, like what's called Whitespaces, that companies like Microsoft are involved with that can help you get out to those rural areas, but that's the most difficult part of it.

I do hope this accelerates people's realisation of this as a key infrastructure. Obviously, in the rich world a lot of the jobs, all our Foundation staff, are doing their jobs remotely and it's actually working surprisingly well.

But that's because we have this high-quality Internet capability. That's another case that it's inequitable that developing countries don't have that capability.

Edited by T Jalio