Bill and Melinda Gates Talk Vaccines, the Coronavirus and Hope

AARP: Bill, you lost your father in September. How did the pandemic affect your last days with him?

Bill: My dad was an incredible person and role model. His passing was not unexpected — he was 94 years old and his health had been declining — so we had some time to reflect on just how lucky we are to have had him in our lives for so many years. We were very fortunate to be able to be with him when he passed. We weren't able to celebrate his life with all of our friends and family as we had hoped, though. Losing your dad is never easy, but the pandemic certainly made it harder — something I know far too many people can relate to over this last year.

AARP: Much of your work around the world is focused on countries and populations that have been left behind, forgotten or discriminated against.

AARP: The vaccine rollout has been slow and, in many states, chaotic. You have been working on infectious diseases for decades, fine-tuning the ability to deliver vaccines cheaply on a large scale. How would you have managed the initial COVID vaccine distribution?

Melinda: I think it's important to keep in mind that there has never been a vaccine rollout like this. The world has never tried to deliver a brand-new vaccine to every person in every country, sequenced by risk level. It's really, really hard to do. That said, given our foundation's experience with some much smaller-scale vaccine rollouts in the past 20 years, there are some features that the successful ones seem to have in common. First, strong leadership at both the national and local levels. Second, careful advanced planning. And third, high levels of trust in the health system among communities.

One of the ways to maintain trust in the health system is to deliver health based on need, not on who can pay. On a global level, we're deeply concerned the pandemic will perpetuate what we're calling immunity inequality, with low-income countries waiting months and months for vaccines. It should be obvious now that COVID-19 anywhere is a threat everywhere — that an outbreak in one place will quickly pop up in others. That's why we're urging governments in wealthy countries to support a global effort to reach people everywhere with vaccines. We were thrilled to see the U.S. include $4 billion for Gavi, an international organization that gets vaccinations to people in developing countries, in its latest COVID-19 relief package. The more countries live up to this shared responsibility, the sooner everyone will be safe.

AARP: What do you think are the most significant advances we have made so far in testing, treatment and vaccines?

Bill: It's hard to overstate how amazing the scientific breakthroughs we've made so far are. Monoclonal antibodies are a big deal — if a patient gets them early enough, they can reduce the death rate by as much as 80 percent. The fact that both of the vaccines that have been approved for use are over 90 percent effective is remarkable. Monoclonal antibodies and mRNA vaccines are invaluable tools for fighting this pandemic, and I expect we'll continue to refine both technologies and use them to fight other diseases in the future.

The next critical step is to ensure that these innovations reach everyone, not just those who can afford to pay. Moving forward, the world must continue to develop affordable innovations, like vaccines that don't require cold storage or tests that don't require lab equipment. We have made some progress in these areas, but more work is needed.

AARP: You say in your letter that “hope is on the horizon.” What, specifically, triggered that hope?

Melinda: If the projections turn out to be true, it will mean that we're living through some of the deadliest days of the pandemic right now as we speak — so we realize that this is a complicated moment to be talking about hope.

In our letter, we quoted Winston Churchill, who, after a key battle in World War II, famously said: “This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” We think that's an apt way to describe this moment in time, too. COVID-19 is costing more lives than ever, and we are still in the middle of unimaginable suffering. But the world finally has the tools we need to start turning the tide against the virus. And those are going to start making a real difference soon.

As hard as it is to imagine right now, the pandemic will end. The enormous sacrifices people are making right now won't be necessary forever. Grandparents are going to be able to hug their grandchildren again. Students are going to be able to go back to in-person school. It will, eventually, be safe to have weddings and birthday parties and all those other events that bring people together in meaningful ways. And maybe knowing that there is light at the end of the tunnel will make it easier for people to stay committed to all the steps they're taking right now to keep themselves and their communities safe.

AARP: What do you think it will take to put this pandemic behind us — or is that even possible?

Melinda: The whole world needs to come together to ensure that the lifesaving science developed in 2020 saves as many lives as possible in 2021. Again, that means getting a vaccine to everyone on the planet who needs one, regardless of their ability to pay. It also means enforcing proven public health guidelines — like mask wearing, good ventilation and physical distancing. That's how we end disease transmission.

But as Bill said, this is going to be a defining event in the lives of everyone on this planet. We're going to be hearing about this pandemic for decades. Any crisis this big is going to have ripple effects. And the world's response to this crisis will, too. I've been struck by public opinion polling that shows huge majorities of people across countries agree that they do not want to go back to the way things were — they want the world to come out of this crisis more equal. I hope the world lives up to those aspirations. And if so, this terrible and tragic experience we've all lived through may actually be a turning point toward something better.

AARP: You note in your letter that “no one needs to be convinced that an infectious disease could kill millions of people or shut down the global economy” and that “the pain of this past year will be seared into people's thinking for a generation.” 

AARP: Bill, as last year came to a close, you predicted that the emergence of the COVID-19 vaccines would “make 2021 better than 2020.” Does the slow rollout of the vaccine temper your optimism?

Bill: I understand why many people are feeling frustrated. Initial supplies of COVID-19 vaccines are extremely limited around the world, so it isn't surprising that we are seeing delays in access. Manufacturers need to scale up capacity to address that problem. The distribution challenges that Melinda mentioned are no small hurdle, but I'm hopeful that we will have a much smoother process for getting existing doses out to people in the United States soon.

I'm also optimistic that more vaccine candidates will be approved as safe and effective in the months to come, which will help speed things up. By the second half of 2021, we could see an unprecedented volume of vaccine doses if we do things right. I still think life in the United States will likely be much closer to normal this year than last.