Wired: At this point, are you optimistic?

Bill Gates: Yes. You have to admit there’s been trillions of dollars of economic damage done and a lot of debts, but the innovation pipeline on scaling up diagnostics, on new therapeutics, on vaccines is actually quite impressive. And that makes me feel like, for the rich world, we should largely be able to end this thing by the end of 2021, and for the world at large by the end of 2022. That is only because of the scale of the innovation that’s taking place. Now whenever we get this done, we will have lost many years in malaria and polio and HIV and the indebtedness of countries of all sizes and instability. It’ll take you years beyond that before you’d even get back to where you were at the start of 2020. It’s not World War I or World War II, but it is in that order of magnitude as a negative shock to the system.

In March it was unimaginable that you’d be giving us that timeline and saying it’s great.

Well it’s because of innovation that you don’t have to contemplate an even sadder statement, which is this thing will be raging for five years until natural immunity is our only hope.

Let’s talk vaccines, which your foundation is investing in. Is there anything that’s shaping up relatively quickly that could be safe and effective?

Before the epidemic came, we saw huge potential in the RNA vaccines—Moderna, Pfizer/BioNTech, and CureVac. Right now, because of the way you manufacture them, and the difficulty of scaling up, they are more likely—if they are helpful—to help in the rich countries. They won’t be the low-cost, scalable solution for the world at large. There you’d look more at AstraZeneca or Johnson & Johnson. This disease, from both the animal data and the phase 1 data, seems to be very vaccine preventable. There are questions still. It will take us awhile to figure out the duration [of protection], and the efficacy in elderly, although we think that’s going to be quite good. Are there any side effects, which you really have to get out in those large phase 3 groups and even after that through lots of monitoring to see if there are any autoimmune diseases or conditions that the vaccine could interact with in a deleterious fashion.

Are you concerned that in our rush to get a vaccine we are going to approve something that isn’t safe and effective?

Yeah. In China and Russia they are moving full speed ahead. I bet there’ll be some vaccines that will get out to lots of patients without the full regulatory review somewhere in the world. We probably need three or four months, no matter what, of phase 3 data, just to look for side effects. The FDA, to their credit, at least so far, is sticking to requiring proof of efficacy. So far they have behaved very professionally despite the political pressure. [Continue reading…]