Susan Goldberg: Bill, it's so nice to talk with you about this Goalkeepers report, but I was really struck how different it was from the last time we talked about Goalkeepers in 2018. And that was so much of a more positive report, all of the indicators were going in the right way. And COVID really has just put the brakes on that. I think your report puts it really well. It said, "In the blink of an eye, a health crisis became an economic crisis, a food crisis, a housing crisis, a political crisis. Everything collided with everything else." So, what about all of these results, do you think is the most important one? Where would you look to start to talk about this?

Bill Gates: Well, as you say, in most years the reduction in malnutrition, the reduction in childhood death, the increase in literacy rates, there's this gradual progress that a human life is getting better, people are living longer. And it's amazing that this is so widespread in its negative effects. And the actual direct effects of killing people in poor countries is a very small part of the overall damage that's been done. A big part is that their health systems that are very fragile, have been disrupted. So vaccinations aren't taking place. Malaria bed nets are not getting out. HIV medicines are not getting out. And so Africa will have dramatically more deaths from these indirect effects than from the direct effects.

So the imperative is, let's bring the epidemic to an end. And that takes us to a discussion about vaccines, which is the only tool to do that. And then make sure that we do restore the services, even some catch up for the kids who missed those vaccinations. And even if we do our best on all those things, the vaccine, the restoration, the rich country generosity, it'll take two to three years just to get back to the beginning of 2020.

Susan Goldberg: And it has happened also quickly. One of the things that the report talks about, that I found really startling, was when it came to vaccine distribution and how key this is going to be in terms of survivability. This model from Northeastern University, I was really shocked, it said, "That 33% of the deaths will be averted if vaccines are distributed to high income countries first. But 61% could be averted if the vaccines are distributed to all countries proportionally to their population." Can you talk about why that is?

Bill Gates: Well, there's deaths all over. Now, no one's saying that the distribution algorithm will be totally based on equity. There'll be some tilt towards the countries that help fund the R & D. But we need to have some balance here, both the generosity to buy the vaccines for those countries, to increase the manufacturing capacity, because this is more units of a vaccine than the world has ever needed. And then to help fund that availability without the rich countries taking all of that capacity.

Susan Goldberg: Do you think though, if countries, say the United States or other wealthy countries don't take this equitable approach, that we will be morally culpable for more deaths?

Bill Gates: Well, the foundation's motto is all lives have equal value. And the foreign aid that rich countries give has saved tens of millions of lives. Things like Global Fund for HIV and Gavi, which helps buy vaccines for things like diarrhea and pneumonia. And so there is some equity in the world. But the very fact that our foundation is saving a life for every thousand dollars we spend. It does show that we do treat lives outside the US, as not being as valuable as those lives. And it's pretty extreme.

This would be a double mistake because not only would you be sacrificing those lives. As long as you let the disease exist outside the United States or anywhere in the world, it's going to come back. And so you can't resume your normal activity. And so of all the health crises, this is one where the world really is in it together. Even countries that did a good job on the epidemic like South Korea or Australia, and found it difficult for there not to be reinfections. And so they're having to continue preventative measures, where they have very few cases with big disruption and economic costs. And so here, we've got to solve it for all of humanity. And so it's both just, and even from a selfish point of view, it's the smart thing to do.

Susan Goldberg: Well. I mean, the report does make that point, repeatedly. That you can't solve a global problem with a national solution. But, it sounds to me you're also worried that this might not really happen, that there won't be that global solution. Because, I mean, that report comes back to this point over and over again.

Bill Gates: Well, so far, the US, although it is exemplary in funding the R & D for the six vaccines, that are the most likely to get really strong regulatory approval, by early next year. The US has been absent in the discussion about creating the capacity and the aid money to buy those vaccines. Now I'm hopeful, that Congress, historically has been great on global health, very generous on things like HIV, malaria. And so the fact it's been overlooked, and I hope that gets remedied and very quickly. Because, every month that this epidemic stays out there, literally costs trillions of dollars. And yet the billions needed for the vaccine are the only thing that will bring it to an end.

Susan Goldberg: One of the figures in there that really struck me, was the increase in poverty. I mean, here, there'd been this terrific streak of less and less poverty, I think it had gone on for about 20 years. And now all of a sudden, tens of millions or more people, are pushed into poverty because of what's happened here. And the report talked a little bit about women really taking the brunt of some of that. Could you talk about that?

Bill Gates: Yeah. There's no doubt in poor countries, things are tough for everyone, but women bear the brunt of that. So, as you get this reversal into poverty, it's not equitable at all. The extra work, having the kids at home, finding enough food. Extreme poverty is waking up and worrying, will you have enough to eat every day. And the goal by 2030, the sustainable development goal, is to bring an end to extreme poverty. And the track record there, particularly in Asia, has been quite good. It's been going down a lot. The place where it's been toughest is in Africa, where you have very high population growth, you have the difficulty of climate change making the farming less predictable. So you have years where you don't get enough. And we'd hoped that with generous aid, with better seeds, that Africa too, would start the kind of miracles that we've seen in Asia. But this at best, is a three or four year setback to that quest, to have almost no one live in extreme poverty.

Susan Goldberg: There's so little good news in this report and understandably so. But do you see any innovations that might come out of having to deal with this disease? Or do you see anything that... What are the hopeful lifelines that you could throw out there?

Bill Gates: Well, there's no doubt that having ignored the warnings about the pandemic this time, the rich countries, including the US, will take the threat seriously. And they'll do the kind of simulations to prepare. They'll have large scale diagnostic capability immediately available. Which the US in particular, was the worst on that. We'll mature some of these vaccine platforms that are not only worthwhile for pandemics, but will be used to make vaccines for malaria, TB, and HIV. And so just like in war time, we've moved quickly and tried new things. Even in terms of our lifestyle, can you use telemedicine, can you use online education, can you avoid some of the business travel we do. Our eyes have been opened up. And that software is getting a lot better. And so it's a real acceleration there.

It doesn't offset all the negative things that come out of the pandemic. But yes, the ingenuity in the pharmaceutical companies, that's why we have six vaccine candidates. Several of which are extremely likely to prove safe and efficacious by early next year. So if this pandemic could come 10 years ago, our internet bandwidth wouldn't have let us do our office jobs. The vaccine platforms wouldn't be as far along. So, it's phenomenal we can say that within a few years, with a little bit of luck on the vaccines and some generosity, real effort to get the word out that it's a safe. This pandemic will come to a close. So a lot more negative would be saying, "Oh my God, this is going to continue indefinitely." That fortunately, because of science, the pharma companies jumping in, that's not the case.

Susan Goldberg: And so do you think, as a last just thought, has the US learned its lesson, if you will, about taking pandemics seriously and being prepared and getting ready? I mean, the problem is, is you get ready and then nothing happens, nothing happens, nothing happens. And then you get unprepared. But, do you think that this will have made that impression a lasting one?

Bill Gates: Well, we'll go into a post-mortem. The CDC made some mistakes at the start. And then you had things moved up to a political level without expertise, where the willingness to admit mistakes was zero. So, the fact that we still have test results that take more than 24 hours, that is just a desire to say, "Oh, I solved the testing thing. You shouldn't reimburse for those delayed test results." So, we still are performing way below what we should. So, I do think there'll be a lesson to let the professionals do their work. And there'll be lots of research and development about how you can ramp up testing drugs and vaccines very quickly. So, yes, I think unlike the title of my 2015 talk, which was, We're Not Ready for the Next Pandemic, I think three years from now, we will be ready for the next pandemic.

Susan Goldberg: Well, I hope there isn't a next one. But, I appreciate the optimism around that. Well, Bill, thank you so much for talking with us at National Geographic about your latest Goalkeepers report.

Bill Gates: Thank you.