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盖茨专访:全力押注科学和创新,能让美国重回正轨吗?

盖茨专访:全力押注科学和创新,能让美国重回正轨吗?

黎克腾(Clifton Leaf) 2020年09月24日
这位科技大亨出身的公共卫生慈善家谈到了疫苗可能的时间表、口罩在阻止病毒方面的关键作用、他对单克隆抗体的希望等等。

从科技明星到公共卫生沙皇:64岁的比尔•盖茨已经两度改变了世界。图片来源:PHOTOGRAPH BY SPENCER LOWELL

这位微软公司联合创始人、比尔和梅琳达•盖茨基金会联合主席正在花费其惊人财富的相当大一部分(注释1)来解决那些伤害最贫困群体的疾病,试图以此改变世界。但今年,一代人的进步正在受到百年一遇的新冠疫情的威胁。全力押注科学和创新,能让我们重回正轨吗?

为篇幅和简明起见,本文经过编辑。

疫情vs进步

自2017年以来,比尔和梅琳达•盖茨基金会每年都会发布一份名为《目标守卫者》(GoalKeepers Report)的年度记分卡,用以评估我们在对抗全球贫困和疾病方面的表现。在最新发布的评估报告中,您开门见山地说了一句我猜您以前从未说过的话:“这种进步现在已经戛然而止。”

比尔•盖茨:是的,联合国为人类制定了这些关乎我们基本需求的目标:摆脱极端贫困,提供教育和医疗服务。这就为我们建立了一个框架,让我们每年都能做一份成绩单,并努力彰显那些做得好的国家——我们称之为典范——以激励其他国家采取最佳做法。这种渐进式进展的能见度非常低:例如,自2000年以来,我们已经将儿童死亡率降低了一半,但人们大多看不到这些进展。

然而,今年的报告与此形成了鲜明对比。从新冠疫情造成的直接影响,也就是死亡病例数量,以及它对发展中国家脆弱的卫生系统造成的巨大间接影响来看,我们已经倒退了。经过过去25年的不懈努力,我们已经将常规免疫接种率提高到84%,但在过去一年,这项比率下降了14个百分点。新冠疫情已经导致近3,700多万人陷入极端贫困。而在2020年之前的20年里,这一数字每年都在下降(注释2)。因此所有人都在说:“嘿,我们必须得终结这场疫情。”然后,我们还要努力追赶,推动疫苗接种和教育等方面回到2020年年初的水平。只有这样,我们才可以恢复这种积极的轨道。

一个让人感到乐观的机会或许是,在新冠疫情爆发后,各大公司出现了一波新的合作浪潮。私营部门现在似乎怀抱着共同的目标,果真如此吗?

没错,制药行业现在纷纷挺身而出,发挥它们应有的作用。这一点是毫无疑问的。很多大公司都愿意安排最优秀的人才从事新冠肺炎治疗和疫苗研发,这是非常壮观的一幕。这就是为什么我们现在有6种疫苗构建(制造疫苗的方法),每一种都有可能通过美国食品和药品管理局(FDA)的第三期临床试验,并在明年年初获得紧急使用许可证。其中至少有两种、三种,甚至四种疫苗很可能被证明既安全又有效。接下来,我们将面临的挑战是如何将制造规模扩大到一个闻所未闻的水平。一种以前从未采用的合作形式是,让一家没有发明疫苗的公司提供工厂设施,以便扩大制造规模。例如,印度血清研究所(Serum Institute of India)就与阿斯利康(AstraZeneca)和总部位于马里兰州的疫苗制造商Novavax达成协议。所以,我们正在设法促成这种结对合作,因为印度制造商的产量更高。它们拥有5,000升的储罐和巨大的额外产能。

新疗法

盖茨基金会还投入大量资金,助力药企研发可能有助于治疗新冠肺炎的药物。这方面有何进展?

到目前为止,在治疗方面,只有地塞米松(一种类固醇激素,1958年首次获得FDA批准)产生了显著效果。即使是吉利德科学公司(Gilead Sciences)的抗病毒药物瑞德西韦,现在仍然成效甚微。但目前有一系列试验正在进行中,其中包括一些单克隆抗体(实验室生产的一种类似人体抗体的蛋白质,能够对准特定靶点),它们最有可能带来极具戏剧性的疗效(注释3)。我们不确定,但治愈率可能会达到70%或80%那么高。其中一些数据将在接下来一两个月陆续发布。盖茨基金会专门在富士胶片(Fujifilm)旗下一家工厂预定了生产抗体产品的产能。我们必须在10月的某个时候为他们提供这样一种抗体。时间很紧迫,我们正在争分夺秒。如果抗体不起作用,或者我们没有研发出合适的抗体,我们就会损失一些钱。但这没关系,因为拥有这种产能有望带来巨大的影响,它将助力我们将抗体产品分发给发展中国家,而不是让富国把所有这些产能都拿来供他们自己使用。

与美国政府机构生物医学高级研究与发展署(BARDA)类似,盖茨基金会帮助化解了私营公司为公共利益而进行的高风险投资的风险等级。政府还可以采取什么方式来鼓励企业在科学和医学等更具革命性的前沿领域进行创新?

美国在这方面堪称典范。国立卫生研究院(NIH)每年都会提供420亿美元支持生物学基础研究,为后续的产品创新奠定了强大的根基。接下来,各大制药商就可以基于这些生物学研究成果开发药物。至于药物定价方面,确实存在各种各样的摩擦,这是一个大而复杂的话题。但在创造高薪工作岗位和领先药企,以及推动新药迅速上市方面,美国的这套体系运作得非常好。

您刚刚提到药品定价。这些新冠疫苗和药品的生产成本能否低廉到让全世界都买得起的水平?

我定期和各大制药商的首席执行官进行讨论。这些药企对新冠疫情的反应,以及制药业人士所做的这项伟大工作,已经让许多人意识到他们的能力和他们有可能给予世界的巨大帮助。这一次,他们不再被视为一个自私自利,不愿合作的产业。在人类经历上一场重大健康危机期间,也就是艾滋病疫情汹涌而至的时候,制药业最初不愿采用分级定价,也不愿以发展中国家可以负担的价格向他们提供药物,甚至向南非前总统纳尔逊•曼德拉提起诉讼(注释4)。最终,他们做了正确的事情。这就是为什么我极其珍视一些制药公司决定把优质资源投入到疫苗生产中,而且不以营利为目的的承诺。(注释5)

相信科学

生产安全有效的新冠疫苗已经够难了。而说服数十亿人接种这些疫苗可能是一件更加困难的事情。

此处的问题涉及到基本的信任:人们如何看待疫苗?众所周知,现在各种阴谋论甚嚣尘上,不只是在发展中国家,而是盛行于世界各地。这给我们带来了巨大的挑战。最极端的例子是,2003年,在尼日利亚,小儿麻痹症疫苗被说成是让妇女绝育的阴谋。不幸的是,这导致病例蔓延到十几个原本已经消灭这种疾病的国家。(注释6)那是一个巨大的挫折。我们随后找到了几位备受信赖的宗教领袖,让他们传播科学信息,并且给自己的孩子接种疫苗。最终,我们克服了这个问题。今天,人们对口罩和疫苗的态度将切切实实地决定我们多快能终结这场疫情。

说到阴谋论,社交媒体上流传着一种疯狂的说法——说是您一手策划制造了这场疫情。您可以说是全球最著名的公共卫生倡导者。您是如何应对这种疯狂的想法的?

嗯,这是个新现象。所以我不能说我有什么好的解决方案或专业知识。哪怕这种想法如此极端——你甚至可以说它非常搞笑——它仍然是一个你必须直面的问题,特别是当一些人正在把它变成政治议题,甚至威胁要诉诸暴力的时候。我也只是刚刚开始研究这件事。而且,我当然很惊讶,我们这样一个全心全意用疫苗拯救生命的组织,现在却被认为正在追求与之截然相反的目标。

奇怪的是,这种现象发生在疫苗科学正在飞速发展的时候。创造新冠疫苗的全球竞赛能否帮助我们开发一种对抗其他流行病,比如疟疾的疫苗?

实际上,我们和Moderna 公司正在做一个项目,寻求利用信使RNA平台(这种方法也被用于开发一些新冠候选疫苗)构建疟疾疫苗。新冠疫情打断了项目进程,但这是我们资助的一种方法。差不多十年前,我们就开始支持这些mRNA疫苗。它们很有前景,也有可能用于预防艾滋病和结核病。

亿万富翁兄弟情

刚刚满90岁的传奇投资家沃伦•巴菲特将自己的大部分财产托付给了您的基金会(注释7)。在长期的友谊中,您从他身上学到了什么?

我们俩的友谊到现在已经差不多30年了。我今年和沃伦聊天的次数其实比以往任何时候都要频繁。这是因为他能够洞悉世界风云,并为之着迷和惊讶。他和我坐在一起,为许多框架内发生的意想不到的事情而惊叹不已,其中包括政治、宏观经济和世界局势。他的商业知识极其丰富,见识超凡。比如,他会谈到:“嘿,你说今年还有人买家具吗?”答案是肯定的,今年的家具销量其实比去年还要高。沃伦非常关注他投资的每家企业——他在哪里看到了需求?他为什么这样认为?奥地利100年期债券以88个基点的价格出售(注释8),这意味着什么。他从我这里了解到一些关于数字领域的信息,或者一些与健康相关的创新,特别是与新冠疫情相关的药品创新。但只要坐在一起,我们就有谈不完的话题。他能够阐释非常复杂的框架,而且总是保持谦卑,这很有意思,因为他乐在其中。对于他自称知道的事情,他也非常谨慎。这么说吧,如果要找一个人谈论商业和经济,沃伦绝对是我心目中的第一人选。

大家都知道,您会在日程安排上为所谓的“思考周”腾出一些时间,躲在屋里看书,思考世界。为什么这件事如此重要?

成年人的生活很容易被各种活动占据,几乎失去了退后一步、深入阅读、深入思考或写下想法的能力。所以我会精心安排日程表,确保它不会被太多的事情填满。今年不用出差,倒是轻松了一些。我把自己当成一名学生,需要一段阅读时间来巩固知识。当我还是微软首席执行官的时候,要做到这一点尤其具有挑战性。尽管如此,我每年还是会预留两周的阅读时间。2008年从微软退休后,我就不必专门腾出一整块时间,比如整整一周,但我还是会留出很多天用来看书,写东西。如果你试图向其他人解释什么事情,最好把你的想法写下来,因为这会迫使你把事情想得更透彻一些,帮助你克服思想上的惰性。

注释:

(1)空白支票:自1994年以来,比尔和梅琳达•盖茨基金会已经向各类慈善事业捐赠了548亿美元(截至2019年第四季度)。

(2)新冠疫情的经济影响

日均收入低于1.90美元(国际贫困线)的人口数量变化

2018: -1.2%

2019: -1.5%

2020: +7.1%

数据来源:盖茨基金会

(3)药物快车道:今年3月,盖茨基金会与英国惠康基金会(Wellcome)和万事达卡公司(Mastercard)合作推出新冠肺炎治疗加速器项目,旨在加快并扩大治疗方法的开发。

(4)公关噩梦: 1998年,39家跨国制药商向南非政府(以及南非前总统曼德拉)提起诉讼,指控他们规避高价艾滋病药物享有的专利保护。这些药企最终输掉了官司,并且名誉扫地。

(5)无论贫富,一视同仁:阿斯利康和强生公司承诺在疫情期间以非营利的方式提供疫苗。170多个国家已经签署了一项由全球疫苗与免疫联盟(GAVI)牵头,名为“新冠疫苗保障机制”(COVAX Facility)的协议,其目的是确保疫苗在世界各地公平分配。

与不接种相比,接种疫苗将挽救无数生命:

当疫苗首先分发给高收入国家时:33%

当疫苗按人口数量分配到各国时:61%

数据来源:盖茨基金会

(6)终结祸患:盖茨基金会已经向全球根除小儿麻痹症事业投入了55亿美元。

(7)现在就捐赠:除了将1000万股伯克希尔-哈撒韦公司的股票,以每年支付的形式捐给盖茨基金会之外,巴菲特还携手比尔•盖茨夫妇发起“捐赠誓言”倡议,呼吁其他亿万富翁将他们的大部分财富捐赠给慈善事业。

(8)长期债券:今年6月,奥地利政府发行了价值20多亿美元的“世纪债券”, 收益率仅为0.88%。对于如此微不足道的收益来说,100年的等待时间似乎过于漫长。但由于世界各地的投资者都在寻求足够安全的资产,这笔债券最终获得超额认购。(财富中文网)

本文另一版本登载于《财富》杂志2020年10月刊,标题为《对话:比尔•盖茨》。

译者:任文科

从科技明星到公共卫生沙皇:64岁的比尔•盖茨已经两度改变了世界。

这位微软公司联合创始人、比尔和梅琳达•盖茨基金会联合主席正在花费其惊人财富的相当大一部分(注释1)来解决那些伤害最贫困群体的疾病,试图以此改变世界。但今年,一代人的进步正在受到百年一遇的新冠疫情的威胁。全力押注科学和创新,能让我们重回正轨吗?

为篇幅和简明起见,本文经过编辑。

疫情vs进步

自2017年以来,比尔和梅琳达•盖茨基金会每年都会发布一份名为《目标守卫者》(GoalKeepers Report)的年度记分卡,用以评估我们在对抗全球贫困和疾病方面的表现。在最新发布的评估报告中,您开门见山地说了一句我猜您以前从未说过的话:“这种进步现在已经戛然而止。”

比尔•盖茨:是的,联合国为人类制定了这些关乎我们基本需求的目标:摆脱极端贫困,提供教育和医疗服务。这就为我们建立了一个框架,让我们每年都能做一份成绩单,并努力彰显那些做得好的国家——我们称之为典范——以激励其他国家采取最佳做法。这种渐进式进展的能见度非常低:例如,自2000年以来,我们已经将儿童死亡率降低了一半,但人们大多看不到这些进展。

然而,今年的报告与此形成了鲜明对比。从新冠疫情造成的直接影响,也就是死亡病例数量,以及它对发展中国家脆弱的卫生系统造成的巨大间接影响来看,我们已经倒退了。经过过去25年的不懈努力,我们已经将常规免疫接种率提高到84%,但在过去一年,这项比率下降了14个百分点。新冠疫情已经导致近3,700多万人陷入极端贫困。而在2020年之前的20年里,这一数字每年都在下降(注释2)。因此所有人都在说:“嘿,我们必须得终结这场疫情。”然后,我们还要努力追赶,推动疫苗接种和教育等方面回到2020年年初的水平。只有这样,我们才可以恢复这种积极的轨道。

一个让人感到乐观的机会或许是,在新冠疫情爆发后,各大公司出现了一波新的合作浪潮。私营部门现在似乎怀抱着共同的目标,果真如此吗?

没错,制药行业现在纷纷挺身而出,发挥它们应有的作用。这一点是毫无疑问的。很多大公司都愿意安排最优秀的人才从事新冠肺炎治疗和疫苗研发,这是非常壮观的一幕。这就是为什么我们现在有6种疫苗构建(制造疫苗的方法),每一种都有可能通过美国食品和药品管理局(FDA)的第三期临床试验,并在明年年初获得紧急使用许可证。其中至少有两种、三种,甚至四种疫苗很可能被证明既安全又有效。接下来,我们将面临的挑战是如何将制造规模扩大到一个闻所未闻的水平。一种以前从未采用的合作形式是,让一家没有发明疫苗的公司提供工厂设施,以便扩大制造规模。例如,印度血清研究所(Serum Institute of India)就与阿斯利康(AstraZeneca)和总部位于马里兰州的疫苗制造商Novavax达成协议。所以,我们正在设法促成这种结对合作,因为印度制造商的产量更高。它们拥有5,000升的储罐和巨大的额外产能。

新疗法

盖茨基金会还投入大量资金,助力药企研发可能有助于治疗新冠肺炎的药物。这方面有何进展?

到目前为止,在治疗方面,只有地塞米松(一种类固醇激素,1958年首次获得FDA批准)产生了显著效果。即使是吉利德科学公司(Gilead Sciences)的抗病毒药物瑞德西韦,现在仍然成效甚微。但目前有一系列试验正在进行中,其中包括一些单克隆抗体(实验室生产的一种类似人体抗体的蛋白质,能够对准特定靶点),它们最有可能带来极具戏剧性的疗效(注释3)。我们不确定,但治愈率可能会达到70%或80%那么高。其中一些数据将在接下来一两个月陆续发布。盖茨基金会专门在富士胶片(Fujifilm)旗下一家工厂预定了生产抗体产品的产能。我们必须在10月的某个时候为他们提供这样一种抗体。时间很紧迫,我们正在争分夺秒。如果抗体不起作用,或者我们没有研发出合适的抗体,我们就会损失一些钱。但这没关系,因为拥有这种产能有望带来巨大的影响,它将助力我们将抗体产品分发给发展中国家,而不是让富国把所有这些产能都拿来供他们自己使用。

与美国政府机构生物医学高级研究与发展署(BARDA)类似,盖茨基金会帮助化解了私营公司为公共利益而进行的高风险投资的风险等级。政府还可以采取什么方式来鼓励企业在科学和医学等更具革命性的前沿领域进行创新?

美国在这方面堪称典范。国立卫生研究院(NIH)每年都会提供420亿美元支持生物学基础研究,为后续的产品创新奠定了强大的根基。接下来,各大制药商就可以基于这些生物学研究成果开发药物。至于药物定价方面,确实存在各种各样的摩擦,这是一个大而复杂的话题。但在创造高薪工作岗位和领先药企,以及推动新药迅速上市方面,美国的这套体系运作得非常好。

您刚刚提到药品定价。这些新冠疫苗和药品的生产成本能否低廉到让全世界都买得起的水平?

我定期和各大制药商的首席执行官进行讨论。这些药企对新冠疫情的反应,以及制药业人士所做的这项伟大工作,已经让许多人意识到他们的能力和他们有可能给予世界的巨大帮助。这一次,他们不再被视为一个自私自利,不愿合作的产业。在人类经历上一场重大健康危机期间,也就是艾滋病疫情汹涌而至的时候,制药业最初不愿采用分级定价,也不愿以发展中国家可以负担的价格向他们提供药物,甚至向南非前总统纳尔逊•曼德拉提起诉讼(注释4)。最终,他们做了正确的事情。这就是为什么我极其珍视一些制药公司决定把优质资源投入到疫苗生产中,而且不以营利为目的的承诺。(注释5)

相信科学

生产安全有效的新冠疫苗已经够难了。而说服数十亿人接种这些疫苗可能是一件更加困难的事情。

此处的问题涉及到基本的信任:人们如何看待疫苗?众所周知,现在各种阴谋论甚嚣尘上,不只是在发展中国家,而是盛行于世界各地。这给我们带来了巨大的挑战。最极端的例子是,2003年,在尼日利亚,小儿麻痹症疫苗被说成是让妇女绝育的阴谋。不幸的是,这导致病例蔓延到十几个原本已经消灭这种疾病的国家。(注释6)那是一个巨大的挫折。我们随后找到了几位备受信赖的宗教领袖,让他们传播科学信息,并且给自己的孩子接种疫苗。最终,我们克服了这个问题。今天,人们对口罩和疫苗的态度将切切实实地决定我们多快能终结这场疫情。

说到阴谋论,社交媒体上流传着一种疯狂的说法——说是您一手策划制造了这场疫情。您可以说是全球最著名的公共卫生倡导者。您是如何应对这种疯狂的想法的?

嗯,这是个新现象。所以我不能说我有什么好的解决方案或专业知识。哪怕这种想法如此极端——你甚至可以说它非常搞笑——它仍然是一个你必须直面的问题,特别是当一些人正在把它变成政治议题,甚至威胁要诉诸暴力的时候。我也只是刚刚开始研究这件事。而且,我当然很惊讶,我们这样一个全心全意用疫苗拯救生命的组织,现在却被认为正在追求与之截然相反的目标。

奇怪的是,这种现象发生在疫苗科学正在飞速发展的时候。创造新冠疫苗的全球竞赛能否帮助我们开发一种对抗其他流行病,比如疟疾的疫苗?

实际上,我们和Moderna 公司正在做一个项目,寻求利用信使RNA平台(这种方法也被用于开发一些新冠候选疫苗)构建疟疾疫苗。新冠疫情打断了项目进程,但这是我们资助的一种方法。差不多十年前,我们就开始支持这些mRNA疫苗。它们很有前景,也有可能用于预防艾滋病和结核病。

亿万富翁兄弟情

刚刚满90岁的传奇投资家沃伦•巴菲特将自己的大部分财产托付给了您的基金会(注释7)。在长期的友谊中,您从他身上学到了什么?

我们俩的友谊到现在已经差不多30年了。我今年和沃伦聊天的次数其实比以往任何时候都要频繁。这是因为他能够洞悉世界风云,并为之着迷和惊讶。他和我坐在一起,为许多框架内发生的意想不到的事情而惊叹不已,其中包括政治、宏观经济和世界局势。他的商业知识极其丰富,见识超凡。比如,他会谈到:“嘿,你说今年还有人买家具吗?”答案是肯定的,今年的家具销量其实比去年还要高。沃伦非常关注他投资的每家企业——他在哪里看到了需求?他为什么这样认为?奥地利100年期债券以88个基点的价格出售(注释8),这意味着什么。他从我这里了解到一些关于数字领域的信息,或者一些与健康相关的创新,特别是与新冠疫情相关的药品创新。但只要坐在一起,我们就有谈不完的话题。他能够阐释非常复杂的框架,而且总是保持谦卑,这很有意思,因为他乐在其中。对于他自称知道的事情,他也非常谨慎。这么说吧,如果要找一个人谈论商业和经济,沃伦绝对是我心目中的第一人选。

大家都知道,您会在日程安排上为所谓的“思考周”腾出一些时间,躲在屋里看书,思考世界。为什么这件事如此重要?

成年人的生活很容易被各种活动占据,几乎失去了退后一步、深入阅读、深入思考或写下想法的能力。所以我会精心安排日程表,确保它不会被太多的事情填满。今年不用出差,倒是轻松了一些。我把自己当成一名学生,需要一段阅读时间来巩固知识。当我还是微软首席执行官的时候,要做到这一点尤其具有挑战性。尽管如此,我每年还是会预留两周的阅读时间。2008年从微软退休后,我就不必专门腾出一整块时间,比如整整一周,但我还是会留出很多天用来看书,写东西。如果你试图向其他人解释什么事情,最好把你的想法写下来,因为这会迫使你把事情想得更透彻一些,帮助你克服思想上的惰性。

注释:

(1)空白支票:自1994年以来,比尔和梅琳达•盖茨基金会已经向各类慈善事业捐赠了548亿美元(截至2019年第四季度)。

(2)新冠疫情的经济影响

日均收入低于1.90美元(国际贫困线)的人口数量变化

2018: -1.2%

2019: -1.5%

2020: +7.1%

数据来源:盖茨基金会

(3)药物快车道:今年3月,盖茨基金会与英国惠康基金会(Wellcome)和万事达卡公司(Mastercard)合作推出新冠肺炎治疗加速器项目,旨在加快并扩大治疗方法的开发。

(4)公关噩梦: 1998年,39家跨国制药商向南非政府(以及南非前总统曼德拉)提起诉讼,指控他们规避高价艾滋病药物享有的专利保护。这些药企最终输掉了官司,并且名誉扫地。

(5)无论贫富,一视同仁:阿斯利康和强生公司承诺在疫情期间以非营利的方式提供疫苗。170多个国家已经签署了一项由全球疫苗与免疫联盟(GAVI)牵头,名为“新冠疫苗保障机制”(COVAX Facility)的协议,其目的是确保疫苗在世界各地公平分配。

与不接种相比,接种疫苗将挽救无数生命:

当疫苗首先分发给高收入国家时:33%

当疫苗按人口数量分配到各国时:61%

数据来源:盖茨基金会

(6)终结祸患:盖茨基金会已经向全球根除小儿麻痹症事业投入了55亿美元。

(7)现在就捐赠:除了将1000万股伯克希尔-哈撒韦公司的股票,以每年支付的形式捐给盖茨基金会之外,巴菲特还携手比尔•盖茨夫妇发起“捐赠誓言”倡议,呼吁其他亿万富翁将他们的大部分财富捐赠给慈善事业。

(8)长期债券:今年6月,奥地利政府发行了价值20多亿美元的“世纪债券”, 收益率仅为0.88%。对于如此微不足道的收益来说,100年的等待时间似乎过于漫长。但由于世界各地的投资者都在寻求足够安全的资产,这笔债券最终获得超额认购。(财富中文网)

本文另一版本登载于《财富》杂志2020年10月刊,标题为《对话:比尔•盖茨》。

译者:任文科

The Microsoft cofounder and cochair of the Bill & Melinda Gates Foundation is spending much of his prodigious fortune¹ trying to change the world—by tackling the diseases that hurt the poorest of the poor. But this year, a generation’s worth of progress is being threatened by a once-in a-century pandemic. Can an all-in bet on science and innovation set us back on course?

THIS EDITED Q&A HAS BEEN CONDENSED FOR SPACE AND CLARITY.

PANDEMIC VS. PROGRESS

Since 2017, the Bill & Melinda Gates Foundation has issued an annual scorecard, called the Goalkeepers Report, on how we’re doing in the fight against global poverty and disease. In the latest assessment, you began with words I’m guessing you’ve never uttered before: “This progress has now stopped.”

Gates: Yes, the United Nations developed these goals for humanity, which are about basic needs: getting rid of extreme poverty, providing access to education and health care. And so that creates a framework for us to do a report card every year and try to highlight the countries that are doing things well—we call them exemplars—so that we can get others to adopt best practices. The visibility of gradual progress is very low: Since 2000, we’ve cut childhood death rates in half, for example, but the progress is mostly invisible to people.

This year’s report, however, is quite a contrast. Due to the direct effects of the pandemic, in terms of the deaths it has caused, but also due to its gigantic indirect effects on fragile health systems in the developing countries, we’ve regressed. So routine immunization rates, which we’ve worked to raise to 84% over the last 25 years, are down 14 percentage points in the past year. The pandemic has pushed almost 37 million more people into extreme poverty—until 2020, that number had been going down every year for two decades.² So the call here is to say, “Hey, we’ve got to bring this pandemic to an end.” And then we have to work to catch up and get back to where we were at the start of 2020 on things like vaccination and education, so that we can resume that positive trajectory.

One opportunity for optimism, perhaps, is what seems to be a new wave of collaboration among companies in the wake of COVID-19. Is this new sense of shared purpose in the private sector real?

Well, the pharma industry is certainly stepping up to play their role. A lot of the big companies are agreeing to put their best people on both therapeutics and vaccines, so that’s pretty spectacular. And that’s why we have six vaccine constructs [methods of building vaccine], each of which could possibly be through an FDA Phase III clinical trial and receive an emergency-use license by early next year. The likelihood is that at least two, three, or four of those will probably prove to be both safe and efficacious. Then we’ll be faced with the challenge of scaling up manufacturing to a completely unheard-of level. The form of cooperation that’s never been done before is having a company that did not invent the vaccine provide its factories so that they can scale up that manufacture. Serum Institute of India, for example, has deals with AstraZeneca and [Maryland-based vaccine maker] Novavax. So we’re facilitating those pairings because the Indian manufacturers are much higher volume. They’ve got 5,000-liter tanks and huge built-in extra capacity.

New therapies

The Gates Foundation has also invested heavily in possible medicines to treat COVID-19. What progress are you seeing there?

So far, in the way of therapeutics, there’s dexamethasone [a steroid hormone first approved by the FDA in 1958], which is the only treatment that has significant impact. Even [Gilead Sciences’ antiviral agent] remdesivir, right now, is still showing pretty modest results. But there’s a pipeline of things being tested, including a number of monoclonal antibodies [lab-produced proteins that act like human antibodies, homing in on specific targets], which have the best chance of having fairly dramatic outcomes.³ We don’t know for sure, but the cure rates could be very high, like 70% or 80%. Some of that data will start being published in the next month or two. The Gates Foundation reserved capacity at a factory owned by Fujifilm to manufacture an antibody product. We have to provide them with the thing by sometime in October, so we’re scrambling. If the antibodies don’t work out or if we don’t have the right ones, then we’ll lose some of that money. But that’s fine, because the potential impact of having that capacity, which is significant, would let us get it out to developing countries without having just the rich countries take all that capacity just for their usage.

The Gates Foundation—in a similar vein as BARDA, the U.S. government’s Biomedical Advanced Research and Development Authority—de-risks a lot of the riskier investments that private companies make for the common good. How else can governments encourage innovation on the more revolutionary fronts of science and medicine?

The U.S. is exemplary in this. We’ve got $42 billion a year of NIH money that often lays the research foundation for understanding the biology so that the product innovation can go on and companies can then develop medicines based on that biology. There is all sorts of friction about what drug prices should be, which is a big, complex topic, but the U.S. system—in terms of creating high-paying jobs and leading companies here and in getting the availability of new medicines to the U.S. very quickly—that’s working pretty well.

You mentioned drug pricing. Can these COVID-19 vaccines and medicines be made cheaply enough that the world can afford them?

I have a regular discussion with the pharma CEOs. Their response to the pandemic and this great work that pharma people are doing has reminded many of their capacities and how they can be helpful to the world—as opposed to the industry being viewed as kind of selfish and uncooperative. In the last big, big health crisis we had, when the HIV epidemic came along, the industry didn’t have a willingness initially to do tiered pricing, to get the drugs out to the developing countries [at prices they could afford], and they ended up in a lawsuit with former South African President Nelson Mandela.⁴ Eventually, they did the right thing. And that’s why I think the commitment today by some of these companies to put resources into the vaccine manufacture, and to do it on a nonprofit basis, is pretty valuable.⁵

Trust in science

It’s hard enough producing enough safe and effective vaccines against COVID-19. Persuading billions of people to take them may be harder yet.

The issue is just basic trust—how do people think about vaccines? With all the conspiracy theories out there, you know, we’ve got a challenge with that—not just in the developing countries, but everywhere. The most extreme example was where the polio vaccine was said to be a plot to sterilize women in Nigeria in 2003. And sadly, that led to cases spreading to a dozen countries where the disease had been eliminated.⁶ That was a huge setback. But there we got the trusted religious leaders to get the message out and give the vaccine to their children, and so, eventually, we overcame that. Today, people’s attitudes towards masks and the vaccine, will, in a concrete way, help determine how quickly we bring this pandemic to an end.

Speaking of conspiracy theories, there was an insane one floating on social media about you—that you had somehow created this pandemic. You’re arguably the best-known champion of public health on the planet. How do you get past that sort of crazy?

Well, it’s a new phenomenon. So I can’t say I have some great solution or expertise. And even though it’s so extreme—you could almost say it’s humorous—it is potentially a real problem, particularly when you have some people turning it into a political thing and even talking about taking violent action. So, I’m just learning about this. And, I’m certainly surprised that the organization that’s done more to save lives with vaccines is now being treated as though our goals are kind of the opposite.

Strangely, this is happening at a time when vaccine science in general seems to be advancing at breakneck speed. Can the race to create COVID vaccines help us develop one against, say, malaria?

We actually have a concrete project with Moderna to do a malaria vaccine construct using the messenger RNA platform [a method also being used for some COVID vaccine candidates]. That is somewhat interrupted by the pandemic, but it is an approach that we funded. We started backing these mRNA vaccines almost a decade ago. They are very promising and could be used potentially for HIV and tuberculosis as well.

Billionaire bromance

The legendary investor Warren Buffett, who just turned 90, has entrusted much of his own fortune to your foundation.⁷ What have you learned from him in your long friendship?

I’m talking to Warren actually more regularly this year than at any time during our friendship, which is almost 30 years now. And it’s because of his ability to look at what’s going on in the world and be fascinated and surprised. He and I sit and marvel over the unexpected things that are going on in many frameworks: political, macroeconomic, and in the world at large. He knows so much more about business, and he sees so much. Talking about, “Okay, are people buying furniture this year?” And the answer is yes, actually it’s at higher levels than last year. And going through each of his businesses—where has he seen the demand, and why he thinks that is? Or talking about an Austrian 100-year bond selling at 88 basis points⁸ and what that means. He hears a little bit from me on the digital realm, or about some of this health-related innovation, particularly related to the pandemic. But, you know, we never run out of things to talk about. He just brings such a sophisticated framework—and he always has this humility that goes with it, which makes it so much fun because he’s having fun. He’s also very careful about what he claims to know. You know, I’d rather talk to him about business and the economy than anyone else. 

You’re known for clearing time on your calendar for “Think Weeks,” where you hole up in a cabin, read books, and ponder the world. Why is this so essential?

Adult life is so easy to fill up with activities. The ability to step back and read deeply or think deeply or write up thoughts is largely missing. And so I work hard on my schedule to make sure I’m not filling it up with too many things. It’s been a little bit easier with no travel this year. So I think of myself as a student where I need almost like a reading period to consolidate my knowledge. It was particularly challenging when I was CEO of Microsoft. Eventually, I got to two weeks a year that I was setting aside. Since I retired from Microsoft in 2008, I don’t have to do it necessarily as one block, a week at a time, but I do set aside lots of days, and then I say, “Did I write the memo that I intended to write?” The act of writing—when you try to explain it to someone else—is where you really are forced to think things through and not be sloppy in your thinking.

*****

Between the lines

(1) Blank check: Since 1994, the Bill & Melinda Gates -Foundation has awarded $54.8 billion in grants (through Q4 2019).

(2) A pandemic’s economic fallout

Projected change in people earning less than $1.90 per day (intl. poverty line):

2018: -1.2%

2019: -1.5%

2020: +7.1%

Source: Gates Foundation

(3) Fast lane for meds: In March, the Gates Foundation partnered with the U.K. foundation Wellcome and Mastercard in a COVID-19 Therapeutics Accelerator designed to speed up—and scale up—the development of treatments.

(4) PR nightmare: In 1998, 39 multinational drugmakers sued the South African government (and Mandela, its former President) for circumventing patent protections on exorbitantly priced medicines for HIV/AIDS. The pharma companies would ultimately lose their legal battle—and much of their reputation.

(5) Rich and poor alike: AstraZeneca and Johnson & Johnson have promised to deliver vaccine on a nonprofit basis through the pandemic. More than 170 nations have signed on to a GAVI-led compact called the COVAX Facility, whose aim is to ensure that vaccines are distributed equitably around the world.

Death averted, compared with a no-vaccine scenario:

When a vaccine is distributed to high-income countries first: 33%

When a vaccine is distributed to countries according to their population size: 61%

Source: Gates Foundation

(6) Ending a scourge: The Gates Foundation has committed $5.5 billion to the global polio eradication effort.

(7) Give it away now: In addition to committing 10 million shares of Berkshire Hathaway stock (in annual payments) to the Gates Foundation, Buffett joined with Bill and Melinda to launch the “Giving Pledge,” an effort to encourage fellow billionaires to commit to giving the majority of their wealth to philanthropy.

(8) Long-lasting bond: In June, the Austrian government issued more than $2 billion worth of “century bonds,” yielding just 0.88%. One hundred years may seem like a long time to wait for little gain—but with much of the world looking for safety, this auction was oversubscribed.

A version of this article appears in the October 2020 issue of Fortune with the headline “The Conversation: Bill Gates.”

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