SVA Speaker Series: Bill Gates in Conversation with Ron Conway

  • The best forecasting is done by IHME, which is a group at the University of Washington that the Foundation funds. They called this rebound in all the European countries about a month ago where most of the models did not. Now, models are pretty inaccurate, but the basic trend is clear: things are going to get worse.
  • US cases and deaths will likely rebound into the Fall, as we’re seeing almost everywhere in the world.
  • Seasonality factor — People will spend more time indoors and because of the way your upper respiratory tract works, when it’s colder the virus replicates more.
  • We expect that we’ll go back up to over 60K infections per day, and the death rate will get back up to ~1500 a day.
  • The good news is that innovations are starting to arrive.
  • Monoclonal antibodies should work both for treatment and for prophylaxis.
  • Have shown promising results as a therapeutic when administered early in the patient’s illness.
  • Eli Lilly and Regeneron are in the lead for development and both have applied for emergency use licenses, but AstraZeneca and a few others are only a few months behind.
  • Eli Lilly has applied to the FDA for approval of a 0.7 gram dose and another option is a 0.3 gram dose, which would be possible to administer via intramuscular shot. Larger doses (above 0.3 grams) can only be administered by IV infusion.
  • It doesn’t scale for prophylaxis, but for treatment, if the 0.3 gram intramuscular shot works, then we can apply monoclonal antibodies worldwide.
  • Remdesivir is an antiviral drug that seems to have a pretty modest effect. Merck also has an option that is pretty far along.
  • Dexamethasone — has shown promising results in a recent UK trial. The foundation joined the Africa Medical Supplies Platform to help scale-up this treatment after the results were released.
  • We’ve never had so many vaccine efforts focused on one target. It’s mind blowing.
  • There are seven notable efforts for vaccine development — mostly big pharma companies in the West; two or three should be available by the end of the year, and they will all be a two-dose shot (second dose taken ~a month after the first).
  • Funding for these R&D efforts has been led by the US government, CEPI, which the Foundation funds, and from direct funding from the Gates Foundation.
  • The first vaccine available will likely come from Pfizer. They’ve done a really great job on an RNA vaccine in partnership with BioNTech. Unfortunately, it is relatively expensive to make and fairly hard to scale up, but they’ll figure out how to scale it up for the US (not for the entire world).
  • If a vaccine is extremely efficacious (90% transmission blocker) you only need about 70% population coverage in order to completely stop the virus spread and go into exponential decline, as opposed to exponential growth.
  • If things go well with both vaccines and therapeutics, things will be moving back toward normal, hopefully next year. However, even with, say, a 70% vaccination rate in the US, things can’t return entirely to normal because there is always the risk of the disease coming in from the rest of the world. Once we determine which of the vaccines is best at transmission blocking it must be distributed very broadly.
  • Current home tests cost about $5 to produce and are in short supply.
  • They don’t catch early stage disease, so understanding how to deal with that lack of sensitivity is important.
  • It is also crucial to report all results (even negative) to local health authorities to help inform our approach to interventions. We don’t want a lot of people doing tests where they don’t report the outcome, so ideally, the strip test either needs to have some sort of Bluetooth-to-phone connection, or you’d have to take a photo of your results and the barcode and make sure that gets back to the public health authorities.
  1. Take the swab and stick it into a little bit of liquid, and then pour the liquid on the nitrocellulose strip. It will register a color result that indicates whether you’ve tested positive or negative. This is called a strip test or point of care test.
  2. Put the swab into a barcoded plastic bag provided in the test kit, and you send it in to the central lab, which is hopefully doing it at this new low-cost way of doing the PCR.
  • You have to give allowances to your employees so they can improve their equipment.
  • You have to understand that people with kids are under a lot of stress.
  • You have to understand, are there employees who are just having a really tough time? And you have to figure out how to reach out to them, even in just a comforting, friendly way.
  • Hiring new employees is a bit strange because virtual work doesn’t allow for the normal casual interactions of in-person collaboration. The software is going to get a lot better, but right now it doesn’t afford that.
  • Nobody ever writes a check to the Giving Pledge itself. Nobody ever solicits you to give to something in particular.
  • Pledgers don’t pool money, but we’re learning from each other about what’s worked well and what’s not worked well. The meetings are all optional; it’s just learning together.
  • The benefits mostly come through the annual meeting or specialized meetings where members begin discussing causes that are important to them. For example, there was recently a meeting about the oceans because many of our 200 members are interested in cleaning up our oceans. Also a lot of philanthropists’ kids get together to talk about how they are working in their families or thinking about philanthropy.
  • People outside the US see philanthropy as a great strength of the US. But it should be probably triple the size it is today. It’s about 2% of the economy and we could do a lot better, particularly at a time like this.
  • Tech entrepreneurs not only bring their resources and their energy, but they also see how digital approaches can help you achieve more. I think the tech industry has something they can bring in terms of the innovative thinking that can help with tough social goals.

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