Betsy McKay
Five years ago, Bill Gates warned that the biggest potential killer the world faced wasn’t war, but a pandemic. The billionaire spent hundreds of millions of dollars to find faster ways to develop vaccines and create disease-tracking systems. He urged world leaders to build national defenses against new infectious diseases.
Looking back, Mr. Gates said, “I wish I had done more to call attention to the danger.” The Microsoft Corp. co-founder is now squaring off against the scenario he sought to forestall.
“I feel terrible,” he said in an interview. “The whole point of talking about it was that we could take action and minimize the damage.”
In his second career as philanthropist and co-chair of one of the wealthiest foundations dedicated to global health and American education, Mr. Gates, 64 years old, has put himself at the center of the Covid-19 pandemic that has killed more than 283,000 people and crashed the world economy.
The Bill & Melinda Gates Foundation pays for researchers seeking treatments, and it is working with pharmaceutical executives and governments to produce billions of doses of promising vaccines while they are being tested so they can be dispensed as soon as regulators approve them. The foundation has helped reserve space in a manufacturing plant so production of the most effective new medicines can begin quickly.
Mr. Gates questions pharmaceutical company chief executives, digging into the details of vaccine production. “Every day, it’s, OK, are we going to run out of glass vials?” he said. “You may think that’s a simple part of it, but nobody’s ever made 7 billion vaccines.”
He discusses the evolving science of the pandemic with U.S. and world leaders. In TV interviews and his blog posts, he explains the logic behind lockdowns to slow the spread of the virus and the slow path to reopening commerce and schools. “Covid-19 has started behaving a lot like the once-in-a-century pathogen we’ve been worried about,” Mr. Gates wrote in a February article for the New England Journal of Medicine.
His high profile during the pandemic has also made him a target of conspiracy theories and antivaccine groups.
Experts in public health and global development have criticized Mr. Gates and his foundation at times for his self-appointed role. With its rich coffers, the foundation is deciding in some cases which diseases take priority and how they are fought, they say.
“All we do is we spend our money, and we share our opinions,” Mr. Gates said. “We’re not making the decision at the end of the day.”
Covid-19, the disease caused by the new coronavirus, has if anything shown the limits of any one person—even the world’s second richest—to stop a pandemic. The virus, Mr. Gates said, is “the most dramatic thing ever in my lifetime by a lot.” It has disrupted foundation work to eradicate polio, vaccinate children in low-income countries and other longtime priorities, though funding for those programs continues.
So far, the Gates Foundation has committed $305 million in the search for Covid-19 vaccines and drug remedies, as well as aid to get medicines and supplies to lower-income countries. Before the pandemic is over, Mr. Gates said, “we will end up spending a lot more.”
Novel threat
Mr. Gates and his wife, Melinda Gates, established their foundation in 2000 with an interest in finding biomedical innovations against infectious disease and ways to deliver them. In 2014, Ebola focused their attention with an epidemic that killed at least 11,300 people world-wide.
“The world as a whole doesn’t have the preparedness for epidemics,” Mr. Gates said in a November 2014 interview with The Wall Street Journal. He had just sat through a presentation about promising Ebola drug treatments and had met with a Nigerian physician who survived the infection.
“What’s to stop some form of SARS showing up?” he said, referring to the 2002-2003 epidemic of severe acute respiratory syndrome, caused by another coronavirus. Next, he said, could be “SARS II.”
In March 2015, Mr. Gates warned in a widely watched TED Talk that an infectious disease pandemic posed a greater threat to the world than a nuclear war because nations have built so few defenses. He called for an international warning-and-response system with mobile units of medical personnel, rapid diagnostics, drug stockpiles and technologies to produce vaccines in months.
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“An epidemic is one of the few catastrophes that could set the world back drastically in the next few decades,” he wrote that month in the New England Journal of Medicine.
Mr. Gates joined other global-health experts calling for better public-health defenses. “In no way was I a lone voice,” he said. “The one thing that’s unique about my voice, though, is that I haven’t spent my life in infectious diseases.”
He explained the risks of a pandemic to 2016 U.S. presidential candidates and urged them to make preparedness a national priority. He also made the pitch to President-elect Trump at a Trump Tower meeting in December 2016. The White House declined to comment.
At the 2017 Munich Security Conference, an annual gathering on international security policy, Mr. Gates said that “getting ready for a global pandemic is every bit as important as nuclear deterrence and avoiding a climate catastrophe,” according to his prepared remarks.
In Munich, he talked about faster ways to make vaccines. One idea was to use ready-made components to build custom vaccines against new viruses, saving time.
The foundation around that time committed $100 million for a coalition of donors and governments to finance new vaccines for emerging infections. Such vaccines are expensive to develop and largely unprofitable because demand for them is sporadic. The Coalition for Epidemic Preparedness Innovations is now funding development of vaccines, including for Covid-19.
Mr. Gates took advantage of his ability to reach leaders of government, which he said were the only entities with the means to build preparedness.
“I chose, when I met with people all the way up to the top, in Europe, in the U.S., around the world, to talk about this pandemic risk,” he said.
He views philanthropies as catalysts. “I’m putting hundreds of millions of the foundation’s money into this,” he said. “But it’s really a governmental thing, just like the defense budget is there to help with an outbreak of war.’”
Many world leaders agreed in principle with him. But the lack of an immediate threat made most countries reluctant to spend the large sums needed to defend against a galloping pandemic. “I wish the warnings that I and other people gave had led to more coordinated global action,” he said.
Frustrated at inaction abroad, Mr. Gates turned to a project close to home. He wanted to know how best to slow the transmission of respiratory viruses that can cause pandemics.
“Whenever I asked about respiratory viruses, like how important are schools and if you do shutdowns, how much can you drop the transmission, and even…do masks actually help or not?” he said, there weren’t clear answers.
The questions prompted him to invest more than $20 million of his own money for a study that got under way in 2018. It was designed to find better ways to test for flu, trace infections using genetics and stop its spread. Researchers began testing flu samples from people in the Seattle area.
In mid-January, as China imposed a lockdown on Wuhan, where the virus first spread, Mr. Gates began peppering his foundation’s scientists with questions: What drugs are most promising? How long until we have a vaccine? How could the foundation help accelerate trials?
The foundation began committing funds to kick-start development of treatments and vaccines for the new coronavirus.
Mr. Gates hosted a meeting of epidemiologists and global health experts in mid-February. The likelihood of Covid-19 being contained in China was probably less than 25%, he told his senior staff after hearing the experts, people close to him said.
When Mr. Gates saw the virus spreading to more countries, he questioned the foundation’s scientists as well as heads of pharmaceutical companies about testing capacity, plans for vaccines and ways the foundation could help.
Toward the end of February, researchers in the Seattle-area flu study, by then in its second year, discovered Covid-19 in a test sample from a teenager. Genetic analyses showed the sample might be tied to an earlier case in the area. That suggested “there was a fair amount of community spread,” said Trevor Bedford, a genomic epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle who helped direct the flu study.
That same week, health officials discovered a Covid-19 outbreak at a Kirkland, Wash., nursing home, about 11 miles from Mr. Gates’s home.
After years of warning about a deadly pandemic, Mr. Gates faced one in his backyard.
Founding mission
Mr. Gates has been castigated in recent weeks by commentators and online news sites on the left and the right—that his charitable work was intended to burnish the image of a ruthless capitalist, and that he was shielding China for calling an investigation of Beijing’s response to the emerging virus a “distraction.”
Some posts on Facebook and elsewhere have spread more sinister conspiracy theories, including that he wants to implant microchips in people to track who has been tested for Covid-19, an allegation flagged as false by Facebook. A common theme of such stories is that he seeks to profit from the crisis.
A spokeswoman for Mr. Gates said the couple have pledged to give most of their estimated $106 billion fortune to charity before they die or in their will. “These conspiracy theories and misinformation are completely false,” she said.
Mr. Gates drew criticism from an April 15 tweet defending the World Health Organization. It came in response to President Trump announcing that his administration would suspend funding to the WHO to review the agency’s response to Covid-19. The Gates Foundation is the second-largest funder of the WHO, after the U.S.
“We need WHO, and interrupting them for a lot of investigations—I don’t get the whole thing, I really don’t,” Mr. Gates said. “We have a pandemic where WHO is playing a very key role. If anything, they need more resources.”
The Gates Foundation began with a mission to reduce inequity around the world by improving health and education. It focused on infectious diseases partly because there is little profit for pharmaceutical companies to invest in developing medicines for them compared with cancer and other chronic diseases. It reported a $46.8 billion endowment in 2018, the latest available figure.
The foundation has spent $235 million on pandemic preparedness and response directly since August 2014, in addition to the $305 million spent on Covid-19, the foundation said.
Government leaders and public-health officials follow Covid-19 forecasts by the Institute for Health Metrics and Evaluation at the University of Washington, which is funded by the Gates Foundation. The group has nearly doubled its projection of U.S. deaths to 137,184 by early August.
Mr. Gates said the world’s efforts to thwart a pandemic “fell short of what ideally would have been done.” Looking ahead, he is more optimistic.
“My hope now is that leaders around the world, who are responsible for protecting their citizens, will take what has been learned from this tragedy and invest in systems to prevent future outbreaks,” he said.
Betsy McKay, The Wall Street Journal
Write to Betsy McKay at betsy.mckay@wsj.com