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Bill Gates, philanthropist, at CNN Town Hall on April 30: So we’re entering into a tough period. If we do it right, we’ll only have to do it once for six to 10 weeks. It has to be the whole country. And having states go with different things, or thinking you can do it county by county, that will not work. The cases will be exponentially growing anywhere you don’t have a serious shutdown.

Dr. Sanjay Gupta: That was Bill Gates talking to Anderson Cooper and me eight weeks ago.

At the time, over 63,000 Americans had died from Covid-19. But since then, that number has skyrocketed. And while many states are trying to reopen businesses and operate in this new normal, some are reporting their highest daily case counts since the pandemic began.

The only end in sight seems to be the arrival of a vaccine.

That’s why Bill Gates is contributing hundreds of millions of dollars toward coronavirus vaccine trials through the Bill & Melinda Gates Foundation.

So, Anderson and I sat down with Gates for another conversation. And in this episode, you’ll hear what he had to say about the prospect of a vaccine for Covid-19.

I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is “Coronavirus: Fact vs. Fiction.”

Gupta: Bill, thanks so much for coming back to speak with us. I thought we’d be having a different conversation, frankly, end of June, about this.

Last time we spoke, I asked you about cognitive dissonance. You know, this idea that people are already taking victory laps, acting as if the pandemic is over. How much do you think that’s contributing? I mean, we know about the testing issues, we’re going to talk about that, masks, physical distancing, but just the mindset overall.

How much do you think that’s contributing, this cognitive dissonance, and why? Why here?

Gates: Well, it’s almost as though people have a willingness to go into lockdown once and, you know, for a certain period. You know, maybe that’s not surprising. Then it takes to get them to extend it past a certain thing or even to inconvenience themselves with masks, you know, requires maybe somebody they know to not only test positive, but maybe get very sick as well.

And so the range of behaviors in the US right now, some people who are being very conservative in what they do and some people are basically ignoring the epidemic. It’s, you know, huge. And, you know, we’ve worn out people’s patience. And if they don’t see it in some way, they, you know, some people almost feel like it’s a political thing, which is unfortunate.

Gupta: So right now, there’s been roughly 5 to 7% of the United States population that’s been infected with the virus. That’s a rough number. It’s a lot of people. But I know you’ve heard a lot from people like Dr. Michael Osterholm, who’s the director and founder of the Center for Infectious Disease Research and Policy in Minnesota.

And he said this interesting quote this past week. He said, “The virus is not going to slow down transmission overall. It may come and go, but it’s going to keep transmitting until we get at least 60 or 70 percent of the population infected, which may give immunity or if we get a vaccine.” So I’m just wondering, do you agree with him that unless we get a vaccine, that that percentage of Americans will likely get infected?

Gates: That’s right. And even with the vaccine, there’s two characteristics of a vaccine. One is whether it protects you individually from getting sick. The other is whether it stops you from being a transmitter of the disease. And it’s possible the vaccine will be better at protecting you individually and not stop you from transmitting. We’re trying to look at the various vaccines and see how they measure up on those two dimensions. But it’s not guaranteed that the vaccine will be a perfect transmission blocker.

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Gupta: You know, the thing that has sort of struck me about this, Bill, is that I’ve been reporting on this for a long time. I haven’t seen a lot of data. I saw a little bit of the Moderna data from the phase I trial, eight patients who developed the neutralizing antibodies.

The only peer-reviewed published data that I’ve seen has actually come out of China, an adenovirus vaccine trial over there. We’re seeing a lot of press releases. We’re seeing a lot of preprints. It’s not peer reviewed. I’ve got to tell you, it makes me nervous. You know, we like to dig into this stuff. You’re optimistic, I know, about the vaccines. Are you seeing something that we’re not seeing? Or how should we take that?

Gates: Well, there’s two vaccines, the Oxford [University] AstraZeneca and the Johnson & Johnson, that are similar in their approach, they both use an adenovirus vector where the animal data looks promising. And those are the two with the most promise because we know how to scale up the manufacturing.

And our foundation is putting together agreements where we put hundreds of millions in to have factories that are available even to the countries that aren’t super wealthy. They may not succeed. But I’m hopeful for those two vaccines and that’s why, you know, we’re putting up, you know, hundreds of millions. So it’ll be completely wasted if those don’t succeed. But you’re right. The amount of human data is modest.

Anderson Cooper, CNN anchor: I want to play something that Dr. Fauci talked about during his testimony about a vaccine, let’s play that.

Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases: And I believe it will be when and not if we get favorable candidates with good results. We will be able to make them available to the American public. As I said to this committee months ago, within a year from when we started, which would put us at the end of this calendar year and the beginning of 2021.

Cooper: I mean, you mentioned timeline a little bit. Is that realistic? And also you talked about distribution, you know, having a vaccine that works and then actually getting it distributed and figuring out how it’s distributed and paid for. What sort of a timeline is that?

Gates: The big problems are safety and efficacy. And phase III trials are very complex to do. And you may see a safety signal that forces you to try out in a broader set of people. The two constructs, both Fauci and I are very hopeful that they’ll work. I talk to him regularly, more often than he talks to some other people. And his view of the chances and our view are very aligned. We’re seeing the same data. We’re sharing the same data. So I have a lot of hope for those two constructs.

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If the safety and efficacy is there, the factory piece is being done. The cost of those two vaccines, the ability to scale up production is very, very strong. And the logistics in the US are not an issue at all. We can get this thing out there. Now, some people, you know, you’ll have a choice of whether you take the vaccine or not. So there’s that final hurdle.

Cooper: In terms of who gets the vaccine first, your wife, Melinda Gates, said that, this week that health care workers should get the vaccine first. And then she said, quote, “It’s also going to be Black people who really should get it first and many indigenous people, as well as people with underlying symptoms and then elderly people.” People who are more adversely affected and more at risk than others in the population. Do you agree with that?

Gates: Yeah. So if what we know is that it protects you from getting sick and if it works all the way up into very high age ranges, then the rational thing to do would be to take the risk for each person and go down and, you know, the person most at risk of getting infected and having bad outcomes, you would go down and get the vaccine to them first. And, you know, clearly certain jobs expose you more, we know that. Certain locations.

Unfortunately, ethnicity is associated both with higher infection rates and, adjusted for age, somewhat worse outcomes. And so that would influence how during the period of shortage you actually do that allocation. So across countries, this is going to be complicated. And within countries, it’s going to be complicated, at least for the people who want the vaccine, which, you know, should be most people.

Cooper: I mean, you saw this coming years ago. No one really listened to you then.

Gupta: I listened to you, just for the record.

Cooper: A lot of people watched your TED talk. But the changes weren’t made. The tens of billions of dollars you talked about that would be needed to invest in fast-tracking vaccines and monitoring zoonotic viruses and the like. It wasn’t spent. If authorities are listening to you tonight, what is your advice, or, or leaders listening to you, what’s your advice? And is a vaccine the only avenue to do this ending? Or what happens between now and then?

Gates: Well, testing numbers will keep going up, and there’s some breakthroughs there that could get us into much larger numbers. What I call mega testing. The therapeutics work. Dexamethasone, that’s real, that’s great. You know, some new ways of formulating remdesivir. And there’s two other drugs that, in the assays, show effectiveness there. You know, we will get the death rate down.

We do need to think about the world here. And you know, that, I’m still pretty disappointed. And without US leadership, it’s been hard to pull together, you know, a response. And now the developing countries are bearing the brunt of the burden. Brazil is, it’s very tough there. India is starting to be very tough. It’s possible to ramp up testing for a new pathogen very, very fast.

So I’m not fatalistic about future pandemics, even though I’m disappointed we didn’t get ready for this one. And even during the pandemic, the US in particular hasn’t had the leadership messages or the coordination that you would have expected.

Cooper: But basically, we’re still not doing enough now on this pandemic?

Gates: No, not even close. I mean, just, you know, people died today.

Gupta: Bill Gates did tell us to prepare for a global pandemic five years ago. We didn’t. And now we are dealing with those consequences.

I’m certainly glad to hear about Bill’s optimism about finding a vaccine. But it’s important to remember that this will still be a long road ahead — and there will almost certainly be more setbacks along the way. If we stay the course — wear a mask, keep a physical distance and each of us does our part — we will reach the end of this pandemic sooner, rather than later.

We’ll be back tomorrow. Thanks for listening.

If you have questions, please record them as a voice memo and email them to [email protected] — we might even include them in our next podcast.

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