Melinda Gates: vaccines, inequality and caregiving
The co-founder of the Melinda & Bill Gates Foundation tells FT editor Roula Khalaf, in an interview recorded on April 29, that women have lost $800bn of income in the pandemic and on average have contributed 30 hours a week to unpaid caregiving work, essential to bring economies back to full health
Interview by Roula Khalaf
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Melinda Gates, thanks so much for being with us.
Thanks for having me.
Let's start with the pandemic, and with vaccine nationalism. Something that I know is of great concern to you, you've spoken up about. Your foundation has done some research. You modelled vaccine scenarios to see the impact, whether... if there was nationalism and if there was vaccine fair distribution. And you found a very clearly that the deaths were doubled in the case of rich countries hoarding vaccines. That is what is happening today, isn't it?
It is. You're seeing wealthy nations vaccinate their populations and it's incredibly unfortunate.
Do you accept that, to a certain extent, it is quite difficult for governments who know that they need to be re-elected or elected, that there is a lot of political pressure on them to vaccinate their own population first?
...and how do you strike that balance between convincing them that actually what's happening in India today, for example, will affect them down the road?
Well I think if you're a leader of a country, absolutely you want to vaccinate your population. And so, while I say it's disappointing to see that the wealthy countries are vaccinating, it's great for their nation. But I think you should vaccinate up to a point, and you hit a certain age population where you say, OK, we're going to pause and make sure that we then put both money and extra supply on the global market.
There's a mechanism called COVAX. It needs $2bn more funding, and it needs vaccine supply. But we know - thank goodness it got set up during the pandemic - we know it can distribute vaccine. It's distributed vaccine to 40 countries already, but it needs more money and more supply. So I think you don't need to vaccinate all the way down, say, to your teen population before you - you can certainly make a donation now of money - but before you send out vaccine doses to COVAX.
So where would you draw the line? Is it for under 30s, for example? So once you've vaccinated everyone who's over 30 then you would suggest that donations are made to developing and poorer countries?
Yes. I think you pick an age.. 20, 30... right in that range. You give money now, so we fully fund COVAX. But you also start to give vaccines, and you give extra doses. We will get out of this problem as the manufacturing comes along and there's far more of it. But look, to have low-income countries who can't even vaccinate their healthcare workers. I mean that's the system people are going into to take care of one another. You have to get the entire health system populated and the elderly vaccinated as well.
This, to a certain extent, is what a lot of leaders have talked about, but are not actually doing. So there have been proposals, for example, that 5 per cent or 6 per cent of your own vaccine supply should be donated. What can you do, and what do you think can be done in order to convince governments to do this now?
Well you can both use the moral argument - we don't want to see more people die. We're seeing it on the news, every morning when you turn on the news, we're seeing what's happening around the world. Governments are starting to realise, oh my gosh, if we don't get the global population vaccinated we're going to have more variants, and they're going to spring up in different places in the world, and bounce back into our own countries. So that is an argument that absolutely leaders are listening to.
And they want to get, not just their own economy reopen, they want to get the world's economy reopen. If you want to get tourism going again, you want to get manufacturing going again, it benefits all of us to have the global economy reopened. So those are arguments that are being made, and governments are beginning to listen.
Who do you think is listening?
I do think the US government is looking at their supply of vaccine and deciding, OK, how much of it should we do through COVAX? How much should we do bilaterally? So I think you're going to start to see some movement there.
Let's talk about patents and IP. I know that the foundation defends patents to drive innovation. Some activists argue that they really should be overturned, and this is a very special case, the global pandemic. What's your thinking on this?
Well I think you have to look at, where is the current problem in the system right now during this pandemic, and how do we fix that piece of the system? So if you look at what we call the upstream, the R&D piece. A vaccine, several vaccines have been created in the shortest period possible in the history of the world for a disease that humanity has never seen. So that part of the system is actually working today.
The piece that is not working today is the manufacturing. We have huge manufacturing bottlenecks, we don't have enough raw materials, we don't have manufacturing in the right places. And so it's allowing the nations that have the manufacturing in place to hoard their vaccines. And so we've got to fix that piece, and then we also have to do the appropriate tech transfers from the pharmaceutical companies and have the incentives so that they tech transfer. And so that's the role of-...
So you favour tech transfers, but not patents?
Not changing the patent system as it exists right now in the middle of a pandemic. That system has benefited, is benefiting the world at the moment.
But it doesn't have to set a precedent necessarily, does it? Given that this is such a special case.
But you're seeing the tech transfers happen. So when you're in the middle of a pandemic, I wouldn't take down the system that's working. I would look at, where is the problem? It's a manufacturing problem.
Should we look at the IP piece over time? Absolutely, and maybe what you do is set up ahead of time in a pandemic. Hey, if they're going to be certain companies that are able to make vaccines, how do you keep them incentivised to do those tech transfers? And how do we put the money in up-front to have manufacturing?
We should have far more manufacturing on the continent of Africa. But if you look at the current system, the AstraZeneca vaccine, we've been deeply involved in the tech transfer that happened to Serum Institute in India, they are pumping out millions of doses every month. They're about to get up to 100m doses a month.
But now they are in a situation, which is quite ironic, because there was... AstraZeneca is being made there. But now they're in a situation where they will not be able to send it anywhere else.
Because they've got a new surge.
Exactly, and so that's my point. That's why we need to have manufacturing in far more places around the world, so that we can get it out and you don't have this hoarding problem that we're seeing right now.
You mentioned AstraZeneca and the vaccines made by both AstraZeneca and Johnson & Johnson are the ones that are expected to immunise a lot of people in poorer countries. And yet they seem to carry this very rare blood clotting disease, the side effects. What impact do you think this is going to have? And do you think that it is already increasing vaccine hesitancy?
Well we know if you interview populations today, for instance in France, there was already vaccine hesitancy. And if you talk to people, it is going up because of what they're hearing about this thrombosis. However, once you start rolling vaccine out, what we've seen even in the US, is that the vaccine hesitancy begins to go down. We all want to know that what we're putting in our bodies, these biologics, are safe for us, and for our family members, and our grandparents. And so it will go down over time. Four out of five people on the continent of Africa still say they want the AstraZeneca or the J&J vaccine.
It's interesting that in the UK it hasn't really increased vaccine hesitancy. People are taking it every single day, and everyone's desperate for it.
That's right. And I think you have to look at what are the number of cases? Sure it's tragic for those who do have these cases of thrombosis, but you also have to look at what are your chances of getting COVID and ending up on a ventilator or dying. And so if you weigh that cost-benefit analysis, certainly I would take the J&J vaccine, even though I'm a female in the age category that has that risk.
Yeah, I'm with you on that. But how do you rate the overall performance of the pharma industry in this pandemic? I wonder whether companies could have acted, not necessarily faster but with greater transparency.
There have been a lot of calls, for example, for contracts to be published and to be made public. There was a dispute between the UK and the EU when it comes to AstraZeneca, and in fact the UK's now suing AstraZeneca. Do you think that there could have been more transparency? And there should have been more transparency?
There certainly could have been more transparency. I don't think you can rate the entire industry overall. I think you have some good actors in this pandemic, and some not good actors. And I think we'll see as this rolls forward, you know who is making enormous profits off of vaccine, versus who did do the right thing and do tech transfers. So you know I think there is a reckoning to be had here, but I don't think that during the middle of a pandemic I should be criticising the pharmaceutical industry writ large.
You've written a lot about the impact of Covid-19 on women and girls. And you've been making the case that to recover fully from the pandemic, leaders have to respond to the ways that it's affecting men and women differently. What should be done? And do you see any good examples of what is being done, any models that other governments could look at?
Yes, so... I'm really glad you brought this up. I mean Oxfam published a report just yesterday that says, women have lost $800bn of income. And so why is that? There are multi-reasons. Women often hold the informal jobs or the low-income jobs in many countries, but the predominant reason is caregiving. And so finally we're seeing what's always been there all along.
Women on average do 30 hours of caregiving a week. That is like another full-time job. And so I'm seeing countries that had already good, paid family medical leave policies, they're recovering more quickly. So what should be done? I think we should look at this caregiving as infrastructure.
We should say, we can't just rely on women to do it. If women are going to work they have to have some solutions for caregiving. It's both caregiving for the elderly, and for children. So robust paid family medical leave policies, looking at women's jobs and investing in women's jobs, and looking at data. We've got to collect data so we understand women's lives and where to make investments on their behalves.
You've called on President Biden to appoint a tzar for caregiving because you think that the whole system is broken. Have you had discussions with the administration about this, and what's their reaction?
I've had many discussions with the administration on these topics. Both before, when it was president-elect Biden, and since then, and even just last week. But the point is to look at caregiving as infrastructure. And if you look at the plan put forward by the president, just yesterday, he sees caregiving as infrastructure. As key infrastructure to bring the US economy back. So they are doing a lot, and they're really thinking hard, and Congress is now thinking hard about how do we implement that, and how do we pay for it, but it is important.
Where do you think that the balance lies between the role of government funding versus philanthropy? The Biden administration clearly sees a more active social role for government, and it would fund it with higher taxes. How do you feel about the tax rises that are being proposed? And do you think that the pandemic because it exposed inequality so starkly has changed Americans' views of government and of taxes?
Well I think you can't answer that question yet. I think you'll have to see in the next election what people think about government role. And so as the Biden administration rolls out more government programmes, I think you'll see in three or four years how people have reacted to that.
But what I know is that yiu need a robust system in our democracy that involves government, private sector, civil society, and philanthropy. When you get those all working right you come up with solutions. But the US today has a lot of gaps in its safety network, and so that's why you're seeing this vast inequality, and Covid has finally exposed it.
So I think you're going to see more government policies coming forward. I think they're finally going to address caregiving. You know we are the only country in the world, of the OECD countries that doesn't have paid family medical leave. And yes they're going to have to find a way of paying for that, and so that probably will be taxing the wealthy more.
And how do you feel about much higher taxes on the wealthy?
Bill and I have said for over the last two years, the wealthy should be taxed more. Exactly how you do it and what the right policies are? I'm not a tax expert, but there are definitely ways to do it. And you shouldn't have this society where you have such vast inequity.
Let me ask you this. I think when I was reading your annual letter, you and Bill's annual letter, you compared the impact of the pandemic to the impact of the second world war on your parents' generation. And you said that the world has an important opportunity to turn the lessons of the pandemic into a healthier, more equal future for all. Do you see signs of that? Or once we go back to normality the old habits will come back and everything will revert to pretty much the old normal?
Well I don't think we know, yet, what normal is going to look like going forward. But what I know is these gaps that existed, Covid has exposed them. And so now it's the role of civil society and philanthropy to keep that conversation alive and push it forward.
So you're already seeing the G7 nations come together in June to talk about a pandemic preparedness plan that thinks more about how do we build out a manufacturing network. How do we build out a surveillance network so we see these diseases more when they crop up? So we have to use this moment, if we're going to build back. And you saw after world war two is things like Nato came forward, the UN came forward. So we need to build those systems, so we are more prepared as a world.
So you think that what we will... one of the measures that we will see is a different type, or possibly a reformed World Health Organization?
Well I do think there'll be a postmortem on the World Health Organization. But I think you'll see the global community coming together to say, what else do we need? Knowing that other pandemics are going to come, and if we saw them much more quickly with the right surveillance system all over the world, we could have, if we had a small workforce of people, maybe about 3,000 people that could go out and respond, we contain it where it is.
And so we do have to figure out as a world, how do you fund that? Where do you house that? How do you set up the surveillance? And how do you set up the manufacturing? So that if we need more... diagnostics is a problem, or you need more medicines, or we need more vaccines it can be produced in many, many places around the world, not just in the wealthy nations.
Do you assume that we're going to be living with this pandemic for a couple of more years at least?
Do you already see an end?
Well I just know from other diseases, it takes a long time until a disease is actually eradicated or burns itself out. And so without having vaccines out writ large... I think you'll see lots and lots of vaccinations by the end of 2022. But in this meantime, what happens with variants in various spots? And then can the vaccines be tuned really quickly to deal with all of those variants? So that story is yet to be written. Luckily...
That's the big challenge for the pharma industry.
Right, and luckily the mRNA vaccines will be able to be tuned, it looks like very, very quickly. But many of the others will take more like 9 or 10 months. So it's still to be seen what will happen from this pandemic.
And how has the pandemic affected you personally? Obviously you've received a lot of praise for your work, but a lot of criticism also from people on the anti-vax fringe. How have you been coping?
Well the disinformation is really hard to see. And for me personally it has much more to do with... I think of the women I've met in places all over the continent of Africa, or in places in India and I think how are they coping? And it's unfortunate to see the disinformation spread because I know it means that they may be less likely to get their families vaccinated. So that's been hard to see.
On the other hand, you know I see my own anxiety during a pandemic. Can we go out? Can we go to the grocery store? What can my 18-year-old daughter do safely? So I understand people's anxiety, and I just try to keep looking forward and say what's the work the foundation can do to make vaccines, diagnostics, and therapeutics get out there faster. And it has meant a lot more video calls this year than ever before. But you know I feel incredibly... we're fortunate as a family for the privilege we have, and for having a nice garden I can walk in every day.
Melinda Gates, thank you for giving us your time.