Hours before the Bill and Melinda Gates Foundation announced an additional $ 250 million commitment to “support research, development, and equitable delivery of life-saving tools” in the fight against Covid-19, raising its overall commitment to fight the pandemic at $ 1.75 billion. , Bill Gates, co-chair of the foundation, spoke with HT during a Zoom call. The conversation ranged from vaccine development to Gavi’s stuttering progress, the Vaccine Alliance’s Covax program, which aims to ensure that Covid-19 vaccines are accessible and affordable for poor countries, until the time the world returns. to normal. Edited excerpts:
Let’s start with the vaccines. Given the progress made with vaccines in the last 12 months and the way we’ve gone to find a vaccine for Covid, we now have a handful of vaccines and maybe there are even more that work, do you think we’ve figured this out? Is it one of those tech problems we’ve solved? So the next time there’s a big illness, won’t it take us a long time to get vaccinated and we could probably have one in 12 months?
It is very impressive that we have a vaccine in 12 months. And, you know, we will actually have multi-focus shots for the first trimester. The mRNA method, which our foundation and a branch of the United States government called Darpa have been funding for over 10 years, has proven to be the fastest. Now, the mRNA platform is not a fully mature platform. In fact, this is the first vaccine to be made that way. The actual thermostability, cost, and scalability of making an mRNA vaccine is not as good as it will be for AstraZeneca, Johnson & Johnson, and Novavax. Some of the other builds the world knows how to climb, and in 5-10 years, we’ll get the [mature] mRNA platform, [and it] it will get rid of those problems.
Do you think there is some kind of global north-south divide with the vaccine, because many of the vaccines are being purchased by the global north and countries like India have not reached vaccine deals with too many companies?
Yes, there is a big challenge when you get into a pandemic, that the normal market mechanism will take the scarce resources and only make them available to the richest countries and the richest people in those countries. And so, obviously, you want governments to step up, both with resources and with a more equitable allocation of those scarce resources. The good news about it is that if we can get a lot of vaccine factories to do something that has never happened before, which is to be a second source, that is, to do like AstraZeneca or Novavax or Johnson & Johnson vaccine in factories in India: then we increased capacity and the trade-off of having such a short supply won’t be as painful. Rich countries will get a little more from the initial allocations, but if we really push for these factories to work, then we can. [that] it is not such a serious problem. That is why I was very excited that Serum (Indian Institute), partly with our help (the Gates Foundation has given $ 150 million to SII through Gavi) and partly with its own resources, is already manufacturing [the] AstraZeneca vaccine, and there is a fix that once Novavax is ready, which will be in the first or second trimester, Serum will, too. And then Johnson & Johnson is talking to other Indian companies about possibly making its vaccine. So the only way to fix this is to get a lot of capacity, and that’s why it’s important that we have these vaccines that are cheaper and easier to scale – they go into the mix. [The] The AstraZeneca vaccine will be approved in the UK before the end of the year, and then the other two in the first or second trimester. But this is challenging, and this is the key role the foundation is playing, in making sure things like oxygen machines, dexamethasone, monoclonal antibodies, and most importantly, vaccines, reach the entire world.
Do you think Covax (the Gavi initiative, WHO) will make a difference?
It’s been a little slow because the United States hasn’t come forward to put money into it yet. Almost every day I talk to politicians, Congress, about it. We need to get at least $ 4 billion there, for this Gavi vaccine procurement effort. And I’m hopeful, you know, but we don’t have it yet, and there’s a question that we get it before January 20. I can’t prove it, but I think we’ll make it through at some point, and I think getting the United States to step forward as it has in the past, for things like HIV and malaria, has a proud record there … I think which will start to unlock a lot of money, so that at least for Gavi countries that vaccines, that financing for vaccines is not a limitation, and it is clear to manufacturers that this very low price will be reimbursed cost, the cost-based price, so they go full throttle.
In the middle of next year there should be no supply problems, right? We will have enough vaccinations.
Yes. I think because these other vaccines will be approved for the summer of 2021, in all these different constructions; it will be more about the logistics of getting the vaccines out. I think we will raise the money and we will have the manufacturing capacity, and so that, you know, for the rich world in 2021 and for the world as a whole … in the first half of 2022, we should be able to get the vaccine coverage that it largely ends this pandemic.
Do you think things will be back to normal by the end of next year, by the summer of next year: children go back to school, businesses reopen completely?
There will be … By the summer of 2021, rich countries will have more vaccine coverage than other countries. Thus, the rich countries will mostly return to normal. But I still think that because the virus will be in the world, we will still be somewhat conservative regarding big public events, we will still have to wear some mask. We really need to eliminate this virus, almost everywhere or what we have seen, even in countries that have done a super good job, like Australia, Singapore, Hong Kong or South Korea, they are always at risk of reinfection. So they have had to restrict tourism and other travel, but by the summer that will start to open up. They won’t be fully back to normal, but sometime in the first half of 2022, I think we can say that we are back to normal.
Tell us a little about all the interventions that the Gates Foundation has made to help countries and companies on the Covid front.
Well, you know, we’ll do an autopsy when it’s all over. [There were] many countries that reacted much faster and many countries where the messages about wearing masks were much better. Here in America, while America did the best job of funding R&D, in almost every other category, I would have expected it to be one of the best in the world, but we certainly weren’t. In some cases, we were as bad as the worst cohort of countries in terms of how we increased our testing and how we got our agency, the CDC, to be visible and talk about best practices.
Covid was, in 2020, the main focus of the foundation?
Well, particularly if you include the idea that Covid has asked us to take out mosquito nets, HIV drugs, we need to make special efforts to sustain those efforts. Now, you know, take an area like tuberculosis; the number of TB tests in India has dropped quite a bit, and we will see a lot of spread [of the disease] there.
This new contribution of $ 250 million that we announced today brings us to $ 1.75 billion, specifically for Covid, and that is manufacturing capacity and money for research, development and acquisition for several of the tools, including vaccines. That’s a lot, it’s more than most governments have done, but we spend about $ 6 billion a year, so we keep all other priorities as a base. And adding this on top. Then we will spend more. We will spend extra money because it is a unique situation.
Some of our efforts have been delayed, such as some of the new vaccine trials or new drug trials have been delayed, so sadly that was money we couldn’t spend. But generally, most of the Covid stuff is in addition to our other expenses.
One of the interesting things is that while we seem to have had reasonable success with vaccines, we have had fairly low success rates with drugs. We have not been able to find drugs that can treat Covid or any of the other drugs besides steroids.
The therapeutic area has been disappointing. You know, dexamethasone (we funded a UK trial on that) is pretty low cost, having about a 30% reduction in deaths in a late stage intervention. Remdesivir may have a modest benefit, but it is not huge and it is quite expensive. We are now trying to reformulate it to be cheap, but we may not do it in time to make a big difference. So, the therapeutic area that I’m most excited about, which doesn’t exist yet, is monoclonal antibodies. We have partnered with Eli Lilly, and if we can show that instead of having to do this through an intravenous infusion, we can give her two injections which are called subcutaneous or sub-cu injections, with 0.5g of the Eli Lilly antibody, it is possible. that we can reduce hospitalizations and deaths by more than 70%. Not done yet. Eli Lilly obtained emergency authorization for the infusion approach in the United States, but we are now doing additional trial work because infusion is difficult to scale up. It is still possible that in a couple of months it will be an important therapeutic treatment. We reserve the factory’s ability to make these antibodies, in a factory owned by Fuji Film; we’re looking at eli lilly’s antibody [treatment] for developing countries, and India is one of the countries we are talking about. There is still work to be done, which can be a very powerful therapy.
You have been studying what is happening around the world. Why are the waves sharp and concentrated in some regions and spread out in others? We still don’t seem to be able to explain that?
We understand some of the factors that go into that, but I must say that it is very surprising at times. We know that cold weather allows the virus to multiply more and draws people indoors and to areas where there are older people; Multigenerational homes and increased activity indoors that we know are associated with a higher rate of illness. But our ability to take that and put it into a model and predict what will happen in the field or in New Delhi or in the US has been pretty weak. They fund a group called International Health Metrics and Evaluation (IHME), great forecasters, and they are willing to forecast four months into the future that other people weren’t willing to do, and they’ve had some things they’ve done better, but even they’ve been Surprised. They called this fall an upturn that hit the Northern Hemisphere, particularly Europe and the United States. They predicted that.
The epidemic in some poor areas, particularly in Africa, has not been very bad, and yes, that is partly the young population and the fact that they are outdoors a lot, but still we are surprised how Covid in a direct sense has not It has been huge in Africa, although the economic disruption is causing major problems not only in health, but also in education and employment.