Bill Gates, billionaire philanthropist and co-chair of the Bill and Melinda Gates Foundation, is optimistic the Covid-19 pandemic could end in 2022 if countries cooperate and do “a brilliant job”. In a Skype interview with TOI’s Surojit Gupta, Gates acknowledges India’s crucial role in ramping up manufacturing of a possible vaccine. Edited excerpts:
The way the pandemic has spread, do you think it is primarily an administrative and governance failure across the world?
I am sure once we get through the pandemic we’ll be able to look back and say, you know, which countries got testing going very quickly, which countries did contact tracing, the various measures like wearing masks. The leadership in terms of getting people to adopt that varied a lot from country to country. Some countries, particularly those that had to deal with MERS or SARS, got the testing and quarantine in place very quickly. And because this is exponential, if you can stop something at a low level it never gets to those big numbers.

This year’s Goalkeepers report talks about global poverty. Governments across the world are stretched for funds. How does one resume the fight against poverty?
The key of the report is to make it clear to people that it’s not just the direct impact of Covid where the deaths are horrific. The less wealth a country has, the less extra capacity there is in that health system. So, things like routine immunisation, or in Africa, malaria bed nets, HIV medicines — we have had disruptions to all of those things. In some of these countries, those secondary effects will actually cost more deaths.
If we do a brilliant job, we end the pandemic in 2022. If we are lucky to have a lot of good vaccines that are made in volume, I am sure the health system should be able to get back fairly quickly. But the economic damage, particularly in countries that couldn’t borrow huge additional sums like some of the rich countries, will have big setbacks. Some of the extreme poverty-type things could take us five to 10 years to get back to where we were at the start of 2020.

What is your assessment of India’s efforts at combating Covid-19?
I am not an expert on the Indian epidemic. India’s got high-density cities. People don’t have big houses. A lot of the work is not the kind of office work that’s easily done over an internet connection. So, the very difficult tradeoffs of what you do in terms of economic activity versus trying to stop the disease spread. If the fall is as tough as many of the models are predicting, you have tough challenges.

When do you think the world can expect a vaccine and what are your views on vaccine nationalism?
This has got to be a global effort. You need many countries to have the scientists working together, many countries for the trials of vaccines. For the first time, we are going to have a vaccine that’s created by one company that, in fact, will be manufactured by other companies as well.
India has a huge role to play in that because the highest volume vaccine manufacturers in the world, including Serum, BioE, Bharat (Biotech) — they have capacity. We have been in lots of conversations with the companies with the vaccines that look like they will be low-cost and very scalable, including AstraZeneca, Novavax, Sanofi, and Johnson & Johnson. All of those, if they succeed in their Phase 3, we want to be able to ramp up that manufacturing capacity.
By early next year, of the leading, say, six vaccines, probably three of them will work. I think most of the world will want a vaccine that’s been reviewed by a top-notch regulator — generally, the USFDA, or Europe, or UK. If we can get these western vaccines through partnerships, particularly with India, into high volume; if we can get the money to procure them for even the poorest countries, I think the western vaccines will be used overwhelmingly.

If there were delays and there wasn’t enough money to donate them, then countries might face a challenge of, okay, should they use an unproven — Russian — vaccine, or what should they do?
Our foundation is looking at all the Chinese vaccines. Some of them may work well. But the Chinese regulator isn’t yet at a level where most countries would immediately say, “Okay, just because they like it, we’re going to tell our citizens to go take this.”

What are the lessons to be learned from the pandemic?
Well, certainly, the governments failed to prepare. Very little was done, although CEPI (Coalition for Epidemic Preparedness Innovations) was created. But you know, we will do a lot to make sure that when the next one comes, we are far more ready with testing, drugs and vaccine platforms that can move very quickly.
How much will Covid-19 set back the efforts of primary and preventive healthcare and what can India do to mitigate that?
Primary healthcare in India has been improving over the decades. New vaccines have been introduced, childhood survival has improved quite a bit in India. We have to get back to where we were at the start of the year, and then get back on that curve. Of course, the competing budget priorities are going to be very difficult, as people craft this overall recovery plan.

What would be the new normal?
A lot of what’s happened in this pandemic has accelerated the digital revolution that was going to take place anyway. More of the shopping was going to be online. More of education was going to be online. To give one example where India is certainly one of the leaders, India was able to use its digital financial capability, where Aadhaar and the overall NPCI payment system works very well. It was able to use that to get money out, particularly to women. So, other countries look at that with envy. There’s a lot of countries the (Gates) foundation and India together are talking to about, “Okay, let’s help you implement this type of system.”
Given the economic impact of lockdowns, how can countries balance between protecting lives and livelihoods?
Fortunately, the interest rate costs are fairly low for most governments. So, a lot of what we’re seeing is that they’re going to borrow money and, you know, replace some of the incomes of the people who aren’t able to go in and do work. For example, tourism is completely decimated. And it will take another year probably before that will get back in place. These are very difficult tradeoffs.
Personally, how has the pandemic affected you?
Sadly, the pandemic is tougher on the people who were behind before. If you are an office worker, like I am, if you have a nice size house with a great internet connection, the pandemic has not been a disaster. I am actually surprised how the foundation’s work has continued.
How does one bridge the digital divide in countries like India where many poor students risk dropping out of school and college?
The quality of education in India before the pandemic was not ideal. And so, (there’s) the opportunity to say: “Okay, there’s places in India where kids get very, very good education, but overall the system could become a limit on India’s economic growth.” Teacher training can be done in an online fashion. Some of the things that have been working in terms of the digital revolution (may be applied to education). Now, those won’t happen overnight. And they mostly work for older students. You have to have an internet connection and a device. Partnerships with private companies may make sense, or making sure that if somebody is using the internet connection just for education, that that’s priced very, very inexpensively. Time is on India’s side. Groups like Jio are building out infrastructure. But getting the teachers and the training, and the content — that could be a limiting factor.
Social media is polluting discourse and skewing politics in India and the US. What do you think is the solution?
We need to get the truth to travel as fast as or faster than the interesting lie. And yet, right now, because many of those (lies) are couched in kind of a, “Hey, this other group is spreading the infection. They are bad people” — that us-versus-them thinking — some of those malign messages spread way faster than the truth. How do we have the trusted leaders get their voice to be stronger than the crazy stuff? There, social media companies are trying. But we haven’t found a good enough solution. Because the crazy thinking is getting out too much.