Interview: Bill Gates talks to Recode about his new book, philanthropy, public health

Interview: Bill Gates talks to Recode about his new book, philanthropy, public health

The WHO estimates that the Covid-19 pandemic killed almost 15 million people around the world – not just because of the virus, but as an indirect consequence of the crisis, such as the inability to obtain other types of medical care because hospital systems were overloaded. But it didn’t have to be so catastrophic. Experts say its impacts have been exacerbated by a number of factors: the world was ill-prepared for a pandemic, many countries were slow to develop and provide access to Covid-19 tests, and economic inequality everything got worse.

Low- and middle-income countries are still struggling to access life-saving vaccines, putting these populations at constant risk of contracting the virus. In the US, one preprint paper found that working-class Americans were five times more likely to die from Covid-19 than college-educated Americans. All in all, the pandemic also had expanded global income inequalitypartly because rich countries were able to provide greater economic relief to its inhabitants while poorer nations had far fewer tools to recover.

Two years after Covid-19 was declared a pandemic, Bill Gates wrote How to prevent the next pandemic, a book describing how Bill and Melinda Gates co-founder and global health expert believes the world should prepare for future health crises – including how we can address the enduring problem of economic inequality that puts already vulnerable people at even greater risk. in the USA, poverty rates fell in 2021 due to pandemic relief expenditures such as incentive checks and extended tax credit for children. But since then, poverty has risen againwith child poverty rates are rising sharply after the expiration of the extended tax credit for children, which gave many parents a monthly cash benefit from July to December 2021.

Here are five ideas Gates explored with Recode via email on how to take into account economic inequality when preparing for the next pandemic. The interview is slightly edited for clarity.

Whizy Kim

In your book, you mention how cautious people are about the great influence that rich philanthropists have today – while acknowledging that many governments did not adequately step up when the pandemic struck.

How can we ensure that the government is able to strengthen next time? Do you see this mostly as a matter of funding real agencies (and would that require higher taxes)? Is it a matter of political will? Is it something else?

Bill Gates

I hope that after the past two years – with millions of lives lost and billions of dollars of economic impact – every country now understands that it must be more prepared at the government level. Philanthropy can help test new ideas and mobilize resources faster than government, but pandemic prevention needs to be funded and supported in the long run and requires global cooperation. The world cannot and should not rely on philanthropy to lead this.

In my book, I write that governments must prepare for outbreaks and prevent pandemics by financing preventive measures and practices for fires and earthquakes. To stop preventable diseases and prevent new diseases from becoming pandemics, governments will need to increase their investment in research and development for vaccines and therapies, integrated disease monitoring and well-funded multilateral organizations such as the World Health Organization (WHO). They will also have to make greater investments to improve primary health care in all countries.

The natural place for government funding is the WHO, as it was created to coordinate the global response to health problems. Philanthropy cannot be a member of the WHO with the right to vote. It is up to each member state to decide that the WHO should focus on pandemic prevention. But currently, the WHO does not have the funding to work hard on pandemics. There is no significant number of full-time employees. It does not require countries to go through exercises. That must change if the world is to take Covid seriously as the last pandemic.

Whizy Kim

Do you think there will always be a need and space for private philanthropy to coexist with governments? What, if anything, needs to change about the private-public sector? How do we get there? Who needs to change that?

Bill Gates

Governments play the most critical role in protecting people from infectious diseases and other serious health risks. But I believe that philanthropy has a role to play – for example, we can fund initiatives that governments or the private sector cannot or will not. Most global health problems, such as malaria, need to be addressed outside of traditional market-based systems, as they will never be profitable for the private sector. During the Covid pandemic, global collaboration between scientists, philanthropists, and global health institutions (e.g. ACT accelerator) developed, tested and implemented safe and effective vaccines faster than ever before. This is a great example of how the three sectors can work together to solve these big problems.

Whizy Kim

How could public policies change to better prepare for the next pandemic, and what role do billionaires / other wealthy philanthropists play in this?

Bill Gates

One of the greatest tragedies the world has learned through Covid is that governments have not invested enough in the tools they need to effectively prepare for a pandemic. Countries need to strengthen and develop policies and invest more in improving disease surveillance, funding research and development, and strengthening health systems. What I’m trying to do, and the foundation is working, is to help catalyze new ideas, especially those that will help give people in lower-income countries fair access to life-saving tools, which are often left behind as new health innovations come on the market. We also play a role in attracting the private sector by helping companies secure funding to produce tests, therapies and vaccines for low- and middle-income countries.

Whizy Kim

The public discourse around Covid-19 was extremely polarized and politicized. What is your conclusion about the role that misinformation plays in relation to good, reliable information in public health outcomes?

Bill Gates

I am concerned about the spread of misinformation and conspiracy theories about public health because it leads to people questioning their doctors and questioning science. Understandably, people are looking for easy answers because two years has been very scary. And I think most people are worried about their health and the health of their families and loved ones. They come from the right place, but they are attracted by false information.

Whizy Kim

How big do you think economic inequality plays in the outcome of the disease? This has hampered access to vaccines and drugs in low- and middle-income countries, but we have seen even within the U.S. that black and brown communities were some of the hardest hit by Covid-19.

How do we ensure that economic inequality is not such a major factor in the survival of the next pandemic?

Bill Gates

Melinda and I founded the Gates Foundation more than two decades ago because we were horrified by health inequalities around the world. Phenomenal progress has been made since then, but even today, a child born in Nigeria is about 28 times more likely to die before his 5th birthday than a child born in the United States.

When Covid emerged, these existing health inequalities helped make it a global disaster. In my book, I propose a plan that includes three key measures. First, we need to improve disease surveillance by developing early warning systems that catch new viruses and epidemics coordinated across borders, and the world needs to rise the GERM teama paid full-time group dedicated to pandemic prevention. [Editor’s note: The Global Epidemic Response and Mobilization team is a permanent disease outbreak watchdog group that Gates’s book proposes we create.]

Second, we need to invest more in research and development for next-generation vaccines and effective treatments, and ensure production capacity in all regions of the world. We need to strengthen global health systems by investing in primary health care, especially in low- and middle-income countries, but also within low-income communities in rich countries.

There are programs that focus on equitable health outcomes, such as the Global Fund and the Global Polio Eradication Initiative, Gavi, the Global Financing Facility, and CEPI. Full funding for these organizations would have a major impact on health equity around the world. [Editor’s note: These are all global health programs that the Gates Foundation has funded. The Global Fund is a public-private partnership that finances the fight against AIDS, tuberculosis, and malaria. The Global Polio Eradication Initiative is a WHO-led public-private partnership that seeks to immunize all children at risk for polio. Gavi is a public-private partnership that strives to improve vaccine access in low-income countries. The Global Financing Facility is a World Bank-led public-private partnership that focuses on promoting the health and nutrition of women and children. And CEPI, the Coalition for Epidemic Preparedness Innovations, is a public-private partnership that invests in vaccine research.]



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