You're listening to Ted Talk Daily, Amelie's Hugh Coronavirus has killed more than half a million people worldwide and the virus continues to overwhelm the U.S. and several developing countries. Today, ahead of Ted, Chris Anderson interviews the technologist and philanthropist Bill Gates. Gates helps us understand what's happening with the pandemic, what makes covid so novel and what researchers are doing to knock down the virus's numbers.

And there's talk today. It's longer than our usual, but it's worth sticking with. Bill Gates takes some time to address some conspiracy theories circulating about himself, which is pretty great. We have an amazing conversation today with none other than Bill Gates. He has become one of the most trusted voices on this pandemic and where it's heading and what we might do about it. After all, it's been a topic along with public health, a topic of fascination for him for many years, gave a great TED talk about it five years ago, warning the world he has access to the world's best scientists.

He's really good at converting what they say into understandable English, and he has a foundation able to do a lot of interventions relevant to it. So it's always exciting talking with him.

Welcome, Bill Gates. Thank you. All right. It's great to have you here, Bill.

We we had a conversation about three months ago about this pandemic, and then fewer than a thousand people in the US had died and fewer than 20 thousand worldwide. I mean, the numbers now are like one hundred twenty eight thousand dead in the US and more than half a million worldwide in three months. What what is your diagnosis of what is possible for the rest of this year? You look at a lot of models. What do you think best and worst case scenarios might be?

Well, the range of scenarios, sadly, is is quite large, including that as we get into the fall, we could have death rates that rival the worst of what we had in the April time period.

And if you get a lot of young people infected, eventually they will, in fact, old people again. And so you'll get into the nursing homes, the homeless shelters, the places where we've had a lot of our deaths, the innovation track, which, you know, probably will touch on diagnostics, therapeutics, vaccines, there's good progress there, but nothing that would fundamentally alter the fact that this fall in the United States could be quite bad. And that's worse than I would have expected a month ago, the degree to which we're back at high mobility, not wearing masks.

And now the virus has gotten into a lot of cities that it hadn't been in before in a significant way. So it's going to be a challenge. You know, there's no case where we get much below the current death rate, which is about 500 deaths a day. But there's a significant risk we'd go back up to the even two thousand a day that we had before because we don't have the distancing the behavior change to the degree that we had in April and May.

And we know this virus is somewhat seasonal so that the force of infection, both through temperature, humidity, more time indoors, will be worse as we get into the fall.

So there are scenarios where in the US, like if you extrapolate those numbers forward, we end up with, what, more than a quarter of a million deaths per chance even this year? If we're not careful and worldwide, I guess the death toll could by the end of the year, be well into the millions within us. Is there evidence that the hotter temperatures of the summer actually have been helping us? They're not absolutely sure, but certainly the agency model definitely wanted to use the season, including temperature and humidity, to try and explain why May wasn't worse than it was.

And so as we came out in, the mobility numbers got higher. The models expected more infections and deaths to come out of that. And, you know, so and we see in the southern hemisphere, you know, Brazil, which is the opposite season, all of South America is having a huge epidemic. South Africa's having a very fast growing epidemic. Fortunately, Australia, New Zealand, the last countries in the southern hemisphere are at really tiny case counts.

And so although they they have to keep knocking it down, you know, they're talking about, oh, we have 10 cases. That's a big deal. Let's go get rid of that. So they're in there, one of these amazing countries that got the numbers so low that test quarantine and trace is working to get them, keep them at very near zero and perhaps a bit by being easier to isolate and buy less density, less population density, but nonetheless, smart policies down there.

Yeah, everything is so exponential that a little bit of good work goes a long ways. It's not it's not a linear game. If you know contact tracing, if you have the number of cases we have in the U.S., it it's super important to do, but it won't get you back down to zero.

It'll it'll help you be down, but it's all too overwhelming.

OK, so in May and June in the US, the numbers are actually slightly better than some of the models predicted. And it's hypothesized that that might be partly because of the warmer weather.

Now we're seeing really would you describe it as really quite alarming, upticks in the case, rates in the US? That's right.

It's it's in, say, the New York area. The case is continued to go down somewhat. But in other parts of the country, primarily the south right now, you have the increases that are offsetting that and you have testing positive rates in young people that are actually higher than what we saw even in some of the tougher areas. And so clearly, younger people have come out of mobility.

More than older people have increased their mobility. So the age structure is right now very young. But because of multigenerational households, people who work in nursing care homes, unfortunately, that will work its way back. But the time lag and the transmission back up into the elderly will start to push the death rate back up, which is down, you know, way down from 2000 to around 500 right now. And is that partly because there's a three week lag between case numbers and fatality numbers and also perhaps partly because there have been some effective interventions and we're actually seeing the possibility that the overall fatality rate is actually falling a bit now that we've gained some extra knowledge.

Yeah, certainly you your fatality rate is always lower when you're not overloaded, and so Italie when they were overloaded, Spain, even New York at the start, certainly China there, you weren't even able to provide the the basics, the oxygen and things. A study that our foundation funded in the UK has found the only thing other than Ramdas severe that is a proven therapeutic which is the dexamethasone that for serious patients is about a 20 percent death reduction.

And there's still quite a pipeline of those things. You know, hydroxy chloroquine never established positive data. So that's pretty much done. There's still a few trials ongoing. And so you always have when you talk about death rates, the good news is some innovation we already have and we'll have more even in the fall. We we should start to have monoclonal antibodies, which is the therapeutic, the single therapeutic that I'm most excited about, just putting the pieces together on death rates in a well functioning health system.

So take the US when places aren't overcrowded. What do you think the current fatality numbers are approximately going forward, like as a percentage of total cases? And we are we below one percent perhaps?

If you found every case, yes, you're you're well below one percent, people argue your point four point five by the time you bring in the never symptomatic.

It probably is below point five. And, you know, that's good news. This this disease could have been a five percent disease. The transmission dynamics of this disease are more difficult than even the experts predicted. The amount of pre symptomatic and never symptomatic spread. And the fact that it's not coughing where you would kind of notice, hey, I'm coughing. Most respiratory diseases make you cough this one in its early stages. It's not coughing. It's singing, laughing, talking.

Actually, still, particularly for the super spreaders, people with very high viral loads, causes that spread. And and that's pretty novel. And so even the experts have to say, wow, this caught us by surprise. The amount of asymptomatic spread and the fact that there's not a coughing element is not a major piece like the flu or TB that is devilish cunning.

But by the virus, I mean, how much is that non symptomatic transmission as a percentage of total transmission? I've heard numbers. It could be as much as half of all transmissions are basically pre symptomatic. Yeah, if you count pretty symptomatic, then most of the studies show that's like at 40 percent and you know, and we also have never symptomatic of the amount of virus you get in your upper respiratory area is somewhat disconnected. Some people will have a lot here and very little in their lungs.

And what you get in your lungs causes the really bad symptoms and other organs, but mostly the lungs. And so that's when you seek treatment. And so the worst case in terms of spreading is somebody who's got a lot in the upper respiratory tract, but almost none in their lungs. So they're not care seeking. Right, and so if you add in the never symptomatic to the non to the pre symptomatic, do you get above 50 percent of the transmission is actually from non symptomatic people?

Yeah, transmission is harder to measure. You know, we see certain hotspots and things, but that's a huge question. Whether the vaccine will it, will it besides avoiding you getting sick, which is what the trial will test, will it also stopped you from being a transmitter?

And maybe they'll use this as a moment to just talk about where the where the quest for the vaccine is and what are just some of the key things we should all be thinking about as we track the news on this.

The. There's three vaccines that are, if they work, are the earliest The Moderna, then you have the AstraZeneca, which comes from Oxford and the Johnson and Johnson, those are the three early ones. And we have animal data that it looks potentially good, but not definitive, particularly will it work in the elderly? And we'll have human data over the next several months. Those three will be guided by the safety and efficacy trial.

That is, we'll be able to manufacture those, although not as much as what we'll be able to manufacture those before the end of the year, whether the phase three will succeed and whether it'll complete before the end of the year.

I wouldn't be that optimistic about phase three is where you you need to really look at all the safety profile and and efficacy, but those who get started and then there's there's four or five vaccines that use different approaches that are maybe three or four months behind that Novavax, Sanofi, Merck.

And so we're funding. Factory capacity for a lot of these some complex negotiations are taking place right now on this to get factories that will be dedicated to the countries, the poor countries. It's called low and middle income. And the very scalable constructs that include AstraZeneca and Johnson and Johnson will focus on those, the ones that are inexpensive. And you can build a single factory to make 600 million doses.

So a number of the vaccine constructs are potential. You know, I. I don't see anything before the end of the year. That's really the best case.

The case that if you and your foundation weren't on the picture here, that the market dynamics would likely lead to a situation where as soon as a promising vaccine candidate emerged, the richer countries would basically snap up, gobble up all available initial supply. But that what effectively you're doing by giving manufacturing guarantees and capability to some of these candidates, making it possible that at least some of the early vaccine units will go to poor countries. Is that correct?

Well, it's not just us, but yes, we're in the central role there, along with the group we created called SEPI Coalition for Preparedness.

And the European leaders agree with this. Now we have the expertise to look at each of the constructs and say, OK, where is there a factory in the world that has capacity that can build that? Which one should we put the early money into? What should the milestones be? Where will shift the money over to a different one? Because the kind of private sector people who really understand that stuff, some of them work for us and we're trusted party on these things.

We get to coordinate a lot of it, particularly at manufacturing piece. Usually you'd expect the US to think of this as a global problem and be involved. So far, no, no activity on that front has taken place. I am talking to people in the Congress and the administration about when the next relief bill comes along that, you know, maybe one percent of that could go for the tools to help the entire world. And so it's possible, but it's it's unfortunate.

And the vacuum here, the world is not that used to. And a lot of people are stepping in, including our foundation, to try and have a strategy, including for the poor countries who will suffer a high percentage of the deaths and negative effects, including their health systems. Being overwhelmed in most of the deaths will be in developing countries despite the huge deaths we've seen in Europe, in the US.

I mean, I wish I could be a fly on the wall and hearing your Melinda talk about this because of all of the ethical crimes, let's say, executed by leaders who should know better. I mean, it's one thing to, you know, not moral mask wearing, but to. To not play a role in helping the world when faced with a common enemy respond as one humanity and instead. You know, catalyse a really unseemly scramble between nations to fight for vaccines, for example, that just seems that surely history is going to judge that harshly.

That is that is just sickening. And isn't it? Am I missing something?

Well, in the it's not quite as black and white is that the US has put more money out to fund the basic research on these vaccines than any country by far. And that research is not restricted. There's not like some royalty that says, hey, if you take part money, you have to pay the US a royalty. They do to the degree they fund research, it's for everybody to the agreed upon factory suits just for the US. The thing that makes this top is that in every other global health problem, you know, the US totally lead smallpox eradication.

The US is totally the leader on polio eradication with key partners CDC, Rotary, UNICEF, our foundation and UN HIV, what under President Bush, Bush's leadership.

But it was very bipartisan. This thing called papa was unbelievable, you know, that has saved tens of millions of lives. And so it's that the world always expected the US to at least be at the head of the table financially strategy. OK, let's you know, how do you get these factories for the world, even if it's just to avoid the infection coming back to the US or to have the global economy working, which is good for US jobs to have demand outside the US.

And so the world is kind of you know, there's all this uncertainty about which things work and there's this, OK, who's in charge here? And, you know, so the worst thing, the withdrawal from WTO, that is a difficulty that hopefully will get remedied at some point because we need that coordination through WHL.

Bill, I want to ask you something about what it's been like for you personally through this whole process, because weirdly, even though your your passion and good intent on this topic seems completely bloody obvious to anyone who's spent a moment with you, there are these crazy conspiracy theories out there about you. I just checked in with a company called Signal that monitors social media spaces. They say that to date on I think on Facebook alone, more than four million posts have taken place that associate you with some kind of conspiracy theory around the virus.

I read that there was a poll that more than 40 percent of Republicans believe that the vaccine that you would roll out would somehow plant a microchip in people to track their location. I mean, I can't even believe that that poll number and then some people are taking this seriously enough and some of them have even been researched a little bit on Fox News and so forth. Some people are taking this serious enough to to sort of make really quite horrible threats and so forth.

You seem to do a good job sort of shrugging this off. But really, like I don't like who else has ever been in this position? How are you managing this? What on earth world are we in that this kind of misinformation coming out that what can we do to help correct it? I'm not sure and. You know, it's a new thing. That, you know, there's conspiracy theories, I mean, Microsoft had its share of controversy, but at least that related to the real world, you know, you know, did Windows crash more than it should?

And, you know, we definitely have antitrust problems, but at least I knew what that was when this emerged.

I have to say, my instinct was to joke about it. People have said that's really inappropriate because it's a very serious thing. It is going to make people less willing to take a vaccine.

And of course, once we have that vaccine, it'll be like masks where getting lots of people when particularly when it's a transmission blocking vaccine, there's this huge community benefit to widespread adoption of that vaccine.

And so I am caught a little bit unsure what to say or do because the conspiracy piece is a new thing for me and. What do you say that doesn't give credence to the thing, the fact that a Fox News commentator in England was saying this stuff about me, microchip being people that serve, isn't that surprising? Because that's what they heard on the TV? It's it's wild. And people are currently seeking simpler explanations, then going in and studying virology.

I mean. That is nonpolitical, but we believe in the truth. I would. You know, I would say this, Laura Ingraham, you owe Bill Gates an apology and a retraction. You do. And let's look at the actual problem of solving this pandemic.

Well, Bill, you know, I'm in awe of what you and Melinda have done. You know, you walk this. Narrow path of trying to trying to juggle so many different things and that the amount of time that you dedicate to the betterment of the world at large and definitely the amount of money and the amount of passion you put into it, I mean, it's pretty awesome. And I'm really grateful to you for spending this time with us now.

Thank you so much. And honestly, the rest of this year, your skills and resources are going to be needed more than ever. So good luck. Well, thanks, that's fine work and I'm optimistic, so thanks, Chris. Thank you, Bill Parks.