In 2015, on the heels of a frightening Ebola outbreak in Africa, Bill Gates gave a TED talk titled "The next outbreak? We're not ready." In it, he outlined ways in which the world was unprepared for a threat entirely different from the one his generation had grown up fearing.
"It's not missiles; it's microbes," he asserted.
On Oct. 21, the Microsoft co-founder recalled that talk when he spoke with Lloyd Minor, MD, dean of the School of Medicine, during a StanfordMed LIVE event. They discussed the impact of the coronavirus pandemic on global health, the race for vaccines and therapeutics, and how to renew the faltering trust many Americans feel in science and medicine.
Gates' wake-up call in 2015 included remarks about the importance of ensuring the availability of antiviral medications, therapeutic antibodies and high-speed diagnostic testing to prepare for a coming pandemic. "Sadly, not that much was done," he told Minor. "The idea of 'germ games' to simulate what governments would need to do to move quickly - that didn't take place."
Gates noted that, as a result, the full scope of the COVID-19 crisis dwarfs what he had expected would happen in a pandemic.
"In 2015, I talked about a $3 trillion economic cost," he said. "In this pandemic, even though the death rate is way lower than it might have been, the economic devastation has been much greater. It will easily get to $10 [trillion] or perhaps even $15 trillion overall over the next two years before we really get completely back to normal."
Other impacts
The pandemic has led to other problems too, including a reduction in normal vaccination rates and an increase in mental health issues, Gates said.
"A lot of these secondary things are harder to measure than the deaths," he said. "A lot of kids will lose more than a year of schooling during this whole process."
The breakdown of health care systems in developing countries is likely to be particularly devastating, Gates said, as food insecurity and political instability caused by the pandemic threaten governments' ability to provide medications and vaccines. "This is going to cause a much higher death toll than COVID directly," he said.
Minor and Gates also discussed the progress toward and challenges of identifying, producing and distributing a vaccine around the globe; how clinical trials could be better coordinated; how biotechnology and innovation can be accelerated in the developing world; and how the pandemic has underscored racial inequities in the United States.
"COVID-19 has laid bare a number of injustices and inequities in our own country in health and health care delivery," Minor said. "The mortality of COVID-19 among communities of color is significantly higher than in white communities. And there's the sad fact that ZIP code is a more accurate determinant of life expectancy in our country than is genetic code. How as a society do we address these problems that have been in our face for a long time but now are much more difficult to ignore than in the past because of the effects of COVID-19?"
Distrust of vaccines, shifting recommendations
Minor and Gates also addressed the public's growing distrust of vaccines and the sometimes conflicting and shifting recommendations on mask-wearing by government organizations like the Centers for Disease Control and Prevention and the World Health Organization.
"When you bring people very bad news that affects them in a meaningful way, the fact is that there's going to be some pushback that you're not doing this for good reasons," Gates said, likening the response to that of people urged to change their ways due to climate change. "It's tricky, because there is uncertainty. We have to admit there's a lot we don't know. We have to be willing to admit our mistakes, and be willing to deliver bad news."
"For many of us as leaders, these have been the most challenging eight to nine months in our careers," Minor said. "What advice do you have for us in leadership roles?"
Gates chuckled. "This is a period where it's easy to work 24 hours a day. We have to say OK, it's not just for the next few months, but sadly the next few years where even in the best case we get an elimination of this disease. So you really want to work for the long haul."
Minor and Gates ended their conversation with a discussion about books. Gates recommended several, including Bijal Trivedi's Breath from Salt, which tells the story of the desperate push for new cystic fibrosis therapies from the point of view of scientists, clinicians and patients' family members; Michelle Alexander's The New Jim Crow, which explores racism in the criminal justice system; and one Gates had just begun: Fareed Zakaria's Ten Lessons for a Post-Pandemic World.
"It's a very promising title," Gates said.
