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Friday, April 19, 2024

Bill Gates Is So Over This Pandemic

When Bill Gates took the stage at this year's TED conference, he brought with him a battered wooden bucket he'd made by hand. With a wide mouth and small handles at the top, the water pail was a replica of one from ancient Rome. In the year 6 AD, a devastating fire prompted Emperor Augustus to organize the Cohortes Vigilum—the night watch. The watchmen relied on this not-so-disruptive technology to fulfill their duties as Rome's dedicated firefighting squad.

Standing in front of the crowd in Vancouver in his usual crewneck sweater and dress slacks, Gates used the prop to illustrate one of the points in his new book, How to Prevent the Next Pandemic. He proposed a modern version of the Cohortes Vigilum that sounds almost like a pitch for a television series: a permanent team of 3,000 people around the globe called GERM—Global Epidemic Response and Mobilization. The group would monitor potential outbreaks, develop close relationships with public health officials around the world, and oversee drills to prepare for the inevitable—and potentially even worse—sequels to Covid.

The insistent optimism he brought to this idea and much of his speech was nothing like the bleak alarm of his 2015 TED talk, a jeremiad about our lack of preparedness for an imminent pandemic. That presentation has garnered 43 million views on the TED site; unfortunately, he says, 90 percent of them came after Covid made his prediction tragically accurate.

Still, it wasn't until I sat down with Gates a few hours after this year's speech that I realized how fully his attention has shifted away from what, to my mind at least, is an ongoing crisis. He even took it in stride that conference-goers had to make their way past anti-vaxxers calling for his imprisonment and worse. He was less amused at how Covid has (understandably) drawn attention and resources away from the other diseases of interest to the Bill and Melinda Gates Foundation. (Even though the eponyms of the foundation have divorced, they are, at least for now, still working together.)

Such complaints aside, he was doggedly upbeat, not just about pandemics but in his view of the state of the world, which, it turns out, is much sunnier than mine. Only days after our interview did I learn that the Cohortes Vigilum failed to contain the Great Fire of Rome in 64 AD, a fact I definitely would have asked him about had I known.

I have interviewed Gates dozens of times, and as the years go on, I find he is more likely to employ the pointed (and often funny) sarcasm he used to only display privately or in internal meetings. This was no exception, as he met with derision and mockery my suggestions that (a) even for the privileged, there are significant risks in the current crisis, and (b) in general, the world is becoming scarier and more resistant to logic and science. Reflecting his confidence in vaccines, we conducted our conversation maskless. The interview is edited for space and clarity.

LEVY: In 2015 you talked about a global institution to prepare for future outbreaks. In the new book you pitch a more specific vision: a billion-dollar organization you call GERM, which among other things would concoct elaborate mock-ups of outbreaks.

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GATES: We were trying to get the world to do disease simulation drills. But they always ended up being just desktop simulations, where you don't really call up the diagnostic companies and see if they can give you PCR machines, or you don't really say, “Let's impose a quarantine—where are we going to put 3,000 people, and how are we going to enforce it?” When the military or the fire department do drills, they do physical, in-the-world exercises.

It's about the importance of practice. If you look at the countries that were successful with Covid, it's basically places like Australia that came to understand that public health labs don't have 100 percent of the capacity to do the job of testing everybody. After a practice run, you'd write at the top of your piece of paper: Call the PCR companies and make sure you have the budget to stand behind whatever commitments you're making. This was a huge failure in the US.

We were supposedly the most prepared country, right? Was all that preparation wasted?

Yes, it was wasted.

A premise of your book is that Covid has made it easier to take steps to prevent the next pandemic. But I wonder if that's true. We now have millions of people who are skeptical of public health, with knee-jerk resistance to anything the government proposes, creating a weird headwind.

Most of the elements of my plan are not controversial. Diagnosis and quarantine aren't that controversial. I guess extreme quarantine could be. Therapeutics didn't end up being that controversial. It's really only masks that became controversial. You know, we have a half a million dead bodies—


Well, the US has 600,000 now. [Note from Levy: As of publication it's more than a million.] So I expect this will be like a war, where, after it's over, we think seriously about how to prevent it from happening again.

Well, it's still happening. Some people even question whether it's wise to gather for TED.

Because why?

We're still in a pandemic.

The greatest risk of people coming to this conference was getting into a car. Should they have taken a car? It's very controversial! People should think hard about getting into cars! I mean, people are dying. I think somebody died today. We could look it up. I mean, let's be serious. Is no one willing to be numeric anymore?

[Levy: I looked it up later. In March, epidemiologist Katelyn Jetelina wrote that the chance of dying from driving 250 miles is 1 in a million, or what's called 1 micromort. In a year, the average American driver racks up about 54 micromorts. For plenty of TED-sters (vaccinated, boosted, roughly 65 years old), the chance of dying after a Covid infection is 6,000 micromorts—“a little more risky than one year of active service in Afghanistan in 2011,” she wrote.]

Are you saying the pandemic is essentially over, at least for rich countries?

No, it's not over. We don't know enough about variants. Nobody predicted the Omicron variant. It's one of the great unexplained events. And we've always been pretty stupid about the science of transmission. I've been calling Congress and saying, be more generous on the international response, and I've been calling Germany, the UK, and France. When the US doesn't take a leadership role in global health, it creates a vacuum.

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We no longer have a supply problem with vaccines. The only question left is, are you limited by demand or by logistics. In less vaccinated countries, there isn't much demand. In Nigeria, Covid would be, like, the 15th-largest cause of death—you've got HIV, TB, malaria, diarrhea. So when you say to them, “Hey, number 15,” they're like, “Well, what about number one, number two, number three, number four—show me some dead bodies!”

I love these articles that say, “Hey, if these countries don't vaccinate themselves, they're going to generate variants and screw us.” There's not much science to support that.

Wait, you're saying that vaccinating globally wouldn't reduce the chances of a more dangerous variant?

What science do you have that suggests that? These are not transmission-blocking vaccines. Do you have that through your head? Vaccines do not reduce the number of cases. Where's the logic? You're going to get less variants because … ? What the hell is this?

[Levy: OK. Larry Brilliant, an epidemiologist whom Gates cites in his book, says it's true that with Omicron, the current vaccines did a relatively poor job of preventing transmission. But they still cut the likelihood of getting sick, and they shorten the course of the disease in infected people, giving potential variants less time to emerge. “Anybody who says that vaccinating as many people as possible is not important in preventing variants is making a mistake,” says Brilliant.]

I've been struck by the pushback on vaccines. It seems that in terms of being a science-based, logic-based society, we're going backward.

I think you're a naive person. How popular was evolution before the pandemic? Less than 50 percent.

[Levy: He's close. A University of Michigan study of the last 35 years reported that acceptance of evolution became the majority opinion in 2016.]

People weren't taking to the streets or blocking borders to demonstrate against biologists like they are with vaccines.

We're not a broadly scientific debating society. Are you sure that we went backward?

Well, you've been the object of criticism for years, but before the pandemic very few people were marching around outside and calling for your arrest or execution.

Now I'm a focus. Anthony Fauci and me. There's some pretty crazy stuff, right up there with QAnon, Pizzagate, all that stuff. I wouldn't have anticipated that. To the degree that people don't want to use masks, that's a problem.

On top of everything else, we have Ukraine. You're not alarmed that we're going backward?

I'd rather be alive today than at some time in the past. And I'd highly recommend that to other people. So if you think we're going backward, wow.

In some respects, I do think that. We're not too far apart in age. The years when we grew up and conducted our careers were, for some people, a sort of a golden age in this country.

Would you have wanted to be a gay person 40 years ago? Would you rather be a woman then than now?

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I said for some people.

What does “for some people” mean? The kings have always done OK. The dukes have too. So, recently, for the earls, it got a little tough.

They're passing anti-gay laws in Florida.

No, they're not passing anti-gay laws. Sodomy used to be illegal in the United States. There was no gay marriage. The idea that you think that's a complete retrace, that maybe the 1950s were better, that's a complete loss of perspective.

So you're cool with the trends that we're seeing now?

The polarization of US politics, and what that might lead to, is something that I can't fit in my normal framework that things improve.

OK, there's something that we both agree is a regression.

I still think we can improve the human condition. I think innovation is very much on our side.

It seems to me a lot of the trends you point to as improvement—better education, life expectancy, civil rights—are tied to the liberalization and democratization we saw in the latter half of the 20th century. That seems to have been halted or reversed.

I'm a big fan of liberalization. But if you take what it was like to be a Chinese citizen in 1980, compared to a pre-pandemic year like 2019, you see better life expectancy, education, health, and most things we care about. They're way better off, without much credit going to liberalization. It's true that innovation tends to occur in places that are liberal. Mostly, those have also been the rich places.

How does the Russian invasion of Ukraine affect your causes?

The war in Ukraine is a gigantic setback for the work we do. Attention levels will be down for the causes we work on.

There's an odd afterword to your book that talks about workplace technology and the metaverse. It's almost like you couldn't hold back your optimism about it.

In the case of remote meetings, the metaverse is pretty cool—3D immersive technology can make them more like face-to-face meetings than Hollywood Squares meetings. But the big thing is computers becoming more intelligent. That's more important than 3D immersion or glasses as a form factor. The computer today is still not very intelligent. It doesn't know your activities, your priorities. You wouldn't even trust it to take your new mail and text messages and sort them for you based on your context. So the most profound thing that's going to happen in software is to have truly intelligent agents. That's way more important than the metaverse, way more important than Web3.

You've been talking about intelligent agents for a while.

Yes. And I will keep talking about it until my damn agent can do it for me.

STEVEN LEVY (@stevenlevy) wrote about the metaverse in issue 29.12/30.01

This article appears in the June 2022 issue. Subscribe now.

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