DER SPIEGEL: Mr. Gates, the coronavirus has now officially cost the lives of almost a million people. Has this pandemic taken you by surprise?
Gates: Certain aspects of it are very surprising. Sure, the idea that the world was at risk of a human-to-human, transmissible respiratory epidemic is something that many global health experts have talked about for decades. But they mostly talked to each other. Nobody expected it could be a coronavirus. In retrospect, you can say: Hey, we have MERS, we have SARS, this coronavirus family clearly can cross the species boundary. But our understanding of the symptoms of this disease took us a long time to figure out.
DER SPIEGEL: How could we have been caught so off guard by this pathogen?
Gates: In 2015, at the end of the West Africa Ebola epidemic, I said that we’re not ready for the next pandemic. What was done between 2015 and that outbreak in late 2019 was very, very modest.
DER SPIEGEL: Could not the Gates Foundation also have done more?
Gates: Governments and nations are responsible for preparing the world for wars, natural disasters, climate change or epidemics. Not us. Yes, foundations can contribute to funding scientists. But we’re not the foundation to solve all health problems. Our focus is on the diseases that disproportionately affect developing countries, diseases that the rich world isn’t paying attention to, like HIV, tuberculosis, malaria. It just turns out that we know more about vaccinations because we hire the best people from all the vaccine companies. But it is not in our charter to be pandemicking. Governments do that.
DER SPIEGEL: Which mistakes in the fight against the pandemic bother you the most?
Gates: That we didn’t realize that masks could be such a big deal. First, we said: Don’t use masks because we need them for health workers. Then we said: Well, maybe if you’re sick, the mask is helpful. It took awhile to realize that even for people who are not infected, wearing a mask is a benefit to reduce the chance of them being infected.
DER SPIEGEL: Do you believe that progress is being made toward developing a therapy for COVID-19?
Gates: The actual trial work to test out various interventions has been extremely weak. We still don’t understand plasma. It’s mind-blowing that we’re not further along! Even with the medication Remdesivir, the data in terms of the benefit is actually pretty weak. Orchestrating the diagnostics was very poorly done, particularly in the United States, where you would have expected it to be done well.
DER SPIEGEL: How much responsibility does U.S. President Donald Trump bear for the failure of the United States to adequately respond to the corona crisis?
Gates: The U.S. response has been very, very poor, just in testing alone. We should never reimburse companies for results that take more than 24 hours to come back. We should make sure that tests are available in the inner-city communities with the heaviest burden, as opposed to the wealthier patients who have more access to our testing system. The U.S. response is so much worse than it should have been. And political leadership is squarely responsible for that.
DER SPIEGEL: Trump is pulling the U.S. out of the World Health Organization (WHO). Can initiatives like your foundation fill such a gap.
Gates: No, never. Our foundation never fills gaps the U.S. government creates. That’s not our role. The last thing you’d ever want to do, if governments are behaving irresponsibly, is to help them out.
DER SPIEGEL: Do you think it is possible that the U.S. government will revisit the decision to pull out of the WHO? Does it depend on the result of the presidential election in November?
Gates: Obviously, if the elections on Nov. 3 go one way, the U.S. will stay in the WHO and never interrupt its dues. If they go the other way, I still hope to try to convince the government that it is a wise thing, even under an America First metric, a totally selfish metric, that it is money well spent.
DER SPIEGEL: The election results may depend on a coronavirus vaccine being given emergency approval by the Food and Drug Administration (FDA) before Nov. 3. But there are significant concerns about vaccine efficacy and safety if approval is granted before testing is completed. Would it be worth the risk?
Gates: No one is going to put out a vaccine that hasn’t completed Phase 3 trials. The idea that the U.S. administration, including the head of the FDA, suggested that this is a possibility was irresponsible. Now, the companies have made it clear they’re not going to even ask for emergency use authorization without full Phase 3 data.
DER SPIEGEL: When do you think a vaccine will be available?
Gates: There is a tiny, tiny chance that Pfizer and Moderna would have enough data by the end of October. Of the six trials – AstraZeneca, Johnson & Johnson, Novavax and Sanofi, plus the two RNA vaccines, Pfizer and Moderna – I certainly expect three or four to get emergency use licenses by early 2021. As we get into 2021, I believe it’s 90 percent likely that we will have some vaccines. I doubt that will have any effect on the election. It certainly shouldn’t. Because, as it turns out, politicians don’t make vaccines.
DER SPIEGEL: The AstraZeneca trial was recently stopped because a participant was diagnosed with transverse myelitis, a dangerous spinal cord inflammation that may have been caused by an adverse immune system reaction and which can lead to paralysis. The study in Britain has since resumed. But what if the problem was, in fact, caused by the vaccine?
Gates: It is true that a vaccine candidate can trigger an underlying autoimmune condition that would have shown up at some point. We’re looking at that connection and regulators deal with this all the time. So, it’s not very surprising. Whatever is going on, it underscores the fact that having taken many different approaches is quite valuable.
DER SPIEGEL: The Gates Foundation has a significant influence on vaccine development and production. The candidates you support all bear the Gates signature. Isn’t that a risky strategy in this pandemic environment?
Gates: Even though we’re big believers in RNA-based vaccines …
DER SPIEGEL: … which describes vaccines involving the injection of some elements of coronavirus genetic material to induce antibody production – though no such vaccine has every been approved for use on humans …
Gates: … and we work with leading RNA companies to see how their vaccines can work for things like malaria, HIV and TB, for this pandemic we haven’t emphasized those. They would be ready if we waited another five or 10 years. But we need 14 billion doses quickly.
DER SPIEGEL: You are also providing funding to Moderna, Curevac, BioNTech, Inovio, all of which are pursuing RNA or DNA vaccines for the coronavirus.
Gates: That’s right. But they’re not likely to be the vaccine that we use at scale in developing countries because of the cost and scalability. I mean, I hope they help. But they are likely not the big solution. If you look at where we put our money relative to this pandemic, it’s more in AstraZeneca, Johnson & Johnson, Novavax and Sanofi. They can make billions of doses.
DER SPIEGEL: But Johnson & Johnson and AstraZeneca are working on adenovirus vector vaccines, whereas coronavirus genetic material is introduced into the body with the help of weakened cold viruses. We don’t have nearly as much experience with such vaccines as we do with proven vaccines, like those against the measles and tetanus. One could even describe them as being experimental – not without risk.
Gates: (agitated) What do you consider experimental? We’re looking at every possible way. There is no way that any vaccine that has ever been made isn’t being used to go after coronavirus. There are challenges with every one of the approaches. Making a new vaccine is a hard thing. There is no conventional approach. So just throw out the word conventional. There’s nothing conventional going on here. Everything we’re doing here is unconventional. The idea that one company designs a vaccine and another company manufactures it: That’s never been done before, ever. Regulators are tearing out their hair. I don’t think there’s any technique that is being ignored.
DER SPIEGEL: Will you get vaccinated against COVID-19?
Gates: I’m certainly not going to privilege my access to the vaccine when it’s in short supply. If, by the normal criteria, I qualify, I’m going to take it. I’ll look at the data for the emergency authorization and feel like that’s a smart thing to do. But I’m not going to cut in line in any sense. There are all sorts of people who are more important than I am in terms of getting access right now: health workers, people who work in nursing homes or jails, or people who live in multigenerational households.
DER SPIEGEL: It might be your turn quicker than you think. One in three Americans refuses to be vaccinated against COVID-19 altogether.
Gates: I hope that we can create a very strong herd immunity with 60 or 70 percent population coverage. I hope governments are able to convince enough citizens to take the vaccine without using coercive measures, because that leads to this huge backlash against the vaccine.
DER SPIEGEL: You personally are also the target of various conspiracy theories. For example, it is said that you intend to use a coronavirus vaccine to implant microchips into people. How do you deal with such narratives?
Gates: I’m not microchipping people. I did not create the coronavirus. Our foundation is about saving lives. With vaccines in developing countries, our track record over the last 20 years is one of the most amazing things humanity has done. Now, there is a huge setback with the pandemic, but we hope within a couple of years to get back to where we were and continue that steady path.
DER SPIEGEL: In hindsight, do you question your foundation’s focus over the past several years? Could you have been better prepared?
Gates: Other than the U.S. government, our foundation is the biggest investor in vaccines. We have put tens of billions of dollars into vaccines. We helped with CureVac. We helped with Moderna. We helped with Inovio. We have a relationship with BioNTech. Sadly, those vaccines aren’t as ready. If this pandemic came 10 years from now, our ability to make RNA vaccines at a very low cost and very high scale would be at a point where they would be the clear solution.
DER SPIEGEL: In addition to vaccine research, the Gates Foundation also provides support to media companies in the U.S. and Europe – including DER SPIEGEL, with around 2.3 million euros over three years. While these projects are obviously about getting more media attention for global health, they also raise questions about a covert agenda to influence the news.
Gates: If the agenda is allowing high-reputation news organizations to send more reporters to Africa to see what’s going on with children dying and what we need to be doing about malaria and HIV and neglected tropical diseases: Then, yes, there is an agenda. The current business models of some of these high-reputation organizations make it tougher for them to afford the fairly expensive reporting activities on what’s going on in those developing countries, which naturally is an issue that doesn’t get people’s attention. We picked organizations that have a good reputation and integrity. What they actually write in those articles is totally up to them. So if you think the Gates Foundation is not doing a good job on malaria, write it up. Maybe we’re wrong. Maybe malaria is not important. You get to write the articles.
DER SPIEGEL: What do you think is going to happen this fall and winter? How many deaths from COVID-19, directly or indirectly, will the world still have to endure before this pandemic comes to an end?
Gates: The answer probably – and tragically – is in the millions. COVID-19 is continuing to spread, not just in wealthy nations like the United States, but also in poorer ones. The vast majority of the deaths, though, won’t be part of the official toll. That’s because there are wide-ranging and terrible ripple effects to this pandemic. The worst of them are hitting poor countries.
DER SPIEGEL: How so?
Gates: Because COVID-19 has slowed the wheels of the global economy, 37 million people have fallen back into extreme poverty. That’s a 7 percent increase after 20 straight years of decline. And because people are poorer, they are also hungrier: The economic effects and supply chain disruptions associated with COVID-19 could double the number of food insecure people in 2020, up to 265 million people. If childhood mortality starts to creep back upward, it will probably be largely because of this rise in malnutrition. Of course, any estimate regarding the impact to life or the economy is just that – an estimate. Whether the world tilts towards the best-case scenario or the worst-case scenario depends on what our leaders do next.
DER SPIEGEL: Mr. Gates, thank you very much for this interview.