崔娃连线专访比尔·盖茨：美国的情况更像湖北！

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1. 布隆伯格哈佛商学院毕业典礼致辞
   

崔娃连线专访了比尔·盖茨，聊到各国的做法不同，美国是否应该效仿意大利或韩国。盖茨说美国的情况更像湖北，但又做不到中国严格的隔离和接触者追踪，所以美国只能努力把感染比例维持在几个百分点（中国0.01%）。还说直到疫苗研发出来之前，即使几个月后复工开学，也无法恢复以前的生活，大规模赛事仍会中断。现在不鼓励戴口罩，主要是因为医护人员缺口罩，等美国口罩的供应跟上了，也许大家也会像中国一样上街戴口罩。说的都挺实在的。最后崔娃还主动说要一起打网球。

中文精简版

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Bill Gates, welcome to The Daily Social Distancing Show.

It's great to be on. 

Let's, uh, jump straight into the first question that everybody would want me to ask. You delivered a TED Talk where you predicted pretty much what is happening now. 

Now, thanks to the world we live in, that has spouted a bunch of conspiracy theories, everything from "Bill Gates invented this virus to prove himself right," or "He knew it was gonna happen, and that's why he said it." 

Was that Ted Talk about this virus, or was that a hypothetical that has now come true? 

Well, I didn't know specifically that it'd be coronavirus and that it would hit in late 2019. But the goal of the talk was to encourage governments to make the investments so we could respond very quickly and keep the case numbers very, very low. And so sadly, this is not a case where, you know, I feel like, "Hey, I told you so," -Mm-hmm. -uh... it, because we didn't use that time, when it was clear as the biggest threat to kill millions of people, to have the diagnostics standing by, to be ready to ramp up a... a vaccine factory. 

A few things were done, uh, of some countries. Our foundation funded some work that will help with the vaccines now, will help with the diagnostics. But, uh, you know, well, most of what was called for, particularly in a New England Journal of Medicine article I did that went into way more specifics than I could in a short TED Talk, uh, those things didn't get done, and so that's why it's taking us a long time to get our act together, uh, faced with this threat. 

Here's a question I have, um, as an individual. How is it that you as a nongovernment knew this information and knew that it needed to be act on... acted on, and governments and organizations that are specifically tasked with protecting people from this very thing either didn't have the information or ignored it? What-what do you think happened there? 

Because I know you interact with governments. You talk to organizations like the CDC, like the WHO. What went wrong? Well, there are lots of individuals, uh, who were as worried as I was. You know, people like Dr. Fauci, who'd been through various epidemics. 

And, so, when we had Ebola, Zika, SARS, MERS, we were lucky that they didn't transmit very easily. They weren't, uh, these respiratory viruses where somebody who's not very symptomatic and is still walking around can spread the disease, in some cases to literally dozens of people. So the respiratory transmission, particularly because world travel is so intense, that's where I show the simulation in that speech and say, "This keeps me up at night, uh, more than even war," which is no small thing. 

And yet, in terms of being systematic about, okay, let's run a simulation and see how would we reach out to the private sector for tests or ventilators and, uh, what kind of quarantine would we do? 

 You know, as we enter into this, we haven't practiced at all. And so you can see it's, you know, every state is being forced to figure things out on their own, -and, uh, it's very ad hoc. -Mm-hmm. It's not like when a war comes and we've done, you know, 20 simulations of various types of threats and we've made sure that the training, communications, logistics, all those pieces fall into place very rapidly. You are in an interesting position where, in many ways, you are an expert on this topic because of the work that you now do in philanthropy. You know, your goal has been to eradicate malaria across the globe, focusing in Africa. You work with infectious disease. You work with experts in and around infectious disease. When you look at the coronavirus as it stands now... It's happened. Leaders acted late. 

But what do you think needs to be done going forward? You wrote an interesting op-ed about this, but what do you think we need to do from the ground up? From the people to the leaders to the private sector? 

Well, the main tools we have right now are the behavioral change, the social distancing, which, uh, often means staying at home most of the time, and the testing capacity to identify who in particular needs to get isolated and then testing their contacts to make sure that we can catch it so early that a lot of people who get sick don't infect anyone else. Now, you know, so, our foundation is engaged in projecting, uh, what's going to go on, the modeling. Uh, our partner IHME is, you know, telling each state what they should think about in terms of ventilators and capacity. 

Further on out, the work we're doing now to find a therapeutic, a drug to reduce the disease, to cut the deaths down, you know, we're hopeful, uh, that even in six months, some of those will have been approved. Uh, but the ultimate solution, the only thing that really lets us go back completely to normal and feel good about sitting in a stadium with lots of other people is to create a vaccine and not just take care of our country but take that vaccine out to the global population and, uh, so that we have vast immunity and this thing, no matter what, isn't going to spread in large numbers. 

You have a unique vantage point in that you have been communicating with various governments around the world in and around their COVID-19 response, um, what they plan to do and what they-they haven't done thus far. Which countries do you think we should be looking to for models that work, and can we apply those models to a larger country like the United States? 

So, you know, many people say Italy and Korea, yes, have their numbers, but they can't necessarily be applied to America. Is that true or not? Or is there a model that does seem to work and should be followed for everybody? Well, countries have differences. You know, uh, South Korea did get a medium-sized infection, but then they used testing, enforced quarantine, contact tracing and really bent the curve, uh, even though it looked pretty scary there for a while. The epidemic in the United States is more widespread, uh, than it ever got in South Korea. 

So we're like the part of China, uh, Hubei province, where a lot of the cases were in one city, Wuhan. And the U.S. and China are different. You know, the lockdowns that we do won't be as strictly enforced, but they are very, very important. The way we do contact tracing won't be as, uh, invasive and so won't be quite as perfect. 

But it is very good news that China, uh, although they're maintaining a lot of measures, they are not seeing a rebound. They're not seeing cases coming back even though they are sending people back to the factories, sending people back to schools. And, you know, so, thank goodness, if we're seeing a big rebound there, uh, the idea you could keep it under control once you have a large number of cases, like the U.S. does and many countries in Europe, then it, you know, would seem almost impossible. So it can be done. 

You know, China ended up with .01% of their population infected. You know, our goal is to stay so it's only a few percent so at least the medical penalty, uh, isn't gigantic even though the economic penalty will be very large. 

When-when you look at that balance between the economic penalty and, um, the human penalty, there are some who have argued that the economic penalty will, over time, equal the human penalty. 

Now, you are one of the few people in the world where you actually have enough money to tell us about whether or not an economy shifting in this way or another way is going to cause mass deaths. But how do you think we should be looking at this? Because, yes, there is an economy, and, yes, there is human life, but where do you think the truth lies? Well, the, uh... There isn't a choice where you get to say to people, "Don't pay attention to this epidemic." Uh, you know, most people, uh, they have older relatives. 

You know, they're worried about getting sick. Uh, the idea of a normal economy is not there as a choice. You know, about 80% of people are going to change their activities. If you get the other 20% to go along with that nationwide, then the disease numbers come... will flatten, hopefully in the next month, and start to go down, hopefully in the month after that. 

And then when they've gone down a lot, then, in a tasteful way, using prioritized testing, you can start to reopen a lot of things, like schools and work. Probably not sports events, because the chance of mass spread there is-is quite large. -Mm-hmm. -And so to get back economically, uh, taking the pain extremely now and telling, you know, those who wouldn't, uh, curb their activities, "No, you must go along with the rest of society "and not associate in a way that we have exponential increase in these cases," uh, you know, that is the right thing, even though it's extremely painful. It's-it's unheard of. 

And, you know, there are particular businesses that, uh, it's catastrophic for. -Mm-hmm. -That's the only way you get so you can feel like you can say to the entire population-- ideally in the early summer, if things go well-- yes, now please do resume, and we are through testing, making sure that it won't, uh, spread in some-some very, very big way. 

So people will need the confidence that the system is working and smart people are making decisions, and overoptimistic statements actually work against that. What do you think most people are missing right now? Because everyone has an opinion. You know, everyone from my mom to my friends to people online-- everyone has an opinion on coronavirus, because we have very few centralized sources that people trust. 

But what do you think people are missing about this virus and this moment and what we need to be doing as people? Because we know the basics-- wash your hands, stay at home, stay away from other people, um, try to, you know, maintain a world where people are moving as little as possible-- 

but-but what do you think we're missing that-that people might make a mistake and-and exacerbate what we're going through now? 

Well, I-- The thing that needs to get fixed in the next few weeks is to prioritize our testing capacity, which is going up, but making sure the right people are being tested. Uh, that will guide us, uh, in-in a very deep way. 

And who are-- who are the right people? 

Uh, if you're symptomatic or somebody you've been in close contact with tested positive, you know, those are the broad categories. Of course, in the front of the line, you have health workers or essential workers who have to go, you know, keep the food supply, the medical system, water, electricity, uh, Internet, keep those things running, uh, for the people who are-are mostly at home. 

But that doesn't use up that higher percentage of the testing capacity. We have a lot of people without symptoms who are just kind of worried, and there we need to show them that, until our capacity goes up a lot, uh, they are going to have to wait. The worst thing we have is that, if-if it takes you longer than 24 hours to get the test result, then you don't know-- You haven't been told during the very key period where you're most infectious to take extreme measures. 

And so we've got to get, uh, not just the numbers up-- that-that confuses people-- it's the speed of the results. South Korea was giving those results in less than 24 hours. So if we have tests that are ramping up around the world, we're gonna see the numbers going up. 

Now, some have said that number and the mortality rate or fatality rate can be deceptive because there are so many who aren't getting tested and are recovering. And so we don't really know how dangerous or-or how fatal this disease actually is. What is-- what is needed in the realm of testing? 

Like-like, what I'm trying to say is, I understand that you want to get as many tests as possible, but-but once we've tested as many people as we have tested, what are we trying to get to as an end goal? 

Well, for, um, rich countries that do the right policies, you should be able to, uh, plateau and get the cases down with less than a few percent of the population infected. Uh, China, South Korea, uh, you know, they are countries that absolutely have achieved that, and that means that your total deaths, -uh, is actually not-not gigantic. -Mm-hmm. Now, in developing countries, the ability to do lots of testing, uh, to have the patients who have severe respiratory distress get treatment, uh, and do this social isolation, for developing countries, it's far harder. 

And so, you know, there, will these measures actually stop it from getting to a large part of the population, places like India, Nigeria? You know, I was talking to, uh, President Ramaphosa today, who's not only president of South Africa, he's the head of the African Union. And he's a very strong voice, encouraging the countries there to act quickly when the number of cases, uh, is still fairly low, uh, which is true throughout Sub-Saharan Africa right now. 

When you look at where we are now, the one thing that we can't deny is everybody has dealt with the coronavirus on a different timeline. You know? Not just across the globe. I mean, even within the United States. You have states like Georgia and Florida that have just implemented stay-at-home orders. 

You have many other states that haven't done it at all. Is this going to fundamentally undermine the efforts of other states and other countries that have shut themselves down? Because if the numbers dip in one country and another country hasn't had the same amount of, um, shutdowns or people self-quarantining-- for instance, if people from Brazil travel after this or if people from, uh-- whether it's Belarus or Hungary or any other country where a leader hasn't taken it seriously, will that not undermine the effort completely? Is-is there a point to doing this when everybody isn't doing it? 

Well, sadly, at some level of wealth, there will be countries that, no matter how hard they try, they will have a widespread epidemic. And so, again, sadly, the richer countries that do contain the epidemic will not allow people from those countries to come in, you know, unless they are quarantined or tested or-or proved they're immune. Uh, and so this is gonna stop people going across borders very dramatically these next few years till we get to that full vaccination. 

Within the United States is different, because we're not gonna partition the country. Uh, and so, therefore, we are all in it together. We can't do what we're gonna do with foreign nationals, which is reduce the numbers a lot and have very strict screening there. We're not gonna have at every state border, you know, some complex quarantine center. Uh, and-and so the whole country needs-- Even when you have small numbers, because those can exponentiate to big numbers so quickly. You know, the doubling time is, like, three days when you're still behaving, uh, in the pre-epidemic way. 

Uh, so, you know, each country, uh, you know, has to get the entire populace, even some who-who, uh, initially resisted, -maybe for very good reasons, -Mm-hmm. because the economic effect on them, uh, is-is strong. So this is powerful medicine. But if you take a big dose of it earlier, you-you don't have to take it for nearly as long. You were one of the first people to come out and, um, donate a large chunk of money to fighting coronavirus or helping medical workers get the equipment they need. I remember the last I read, it was yourself and your wife Melinda who had pledged over $100 million. 

It seems, though, that money isn't able to fix this problem. It seems like governments around the world are trying everything they can, but it doesn't seem like it can be fixed. What are you hoping to achieve in this moment in time? Well, you... If we get the right testing capacity, you can change by literally millions, uh, the number who are infected. And governments will eventually come up with lots of money for these things, but they don't know where to direct it, they can't move as quickly. And so because, you know, our foundation has such deep expertise in infectious diseases, we've thought about the epidemic. 

We did fund some things, uh, to be more prepared, like a-a vaccine effort. Uh, our early money can accelerate things. So, for example, there's... Uh, of all the vaccine constructs, the seven most promising of those, even though we'll end up picking at most two of them, we're going to fund factories for all seven. And just so that we don't waste time in serially saying, -Oh, wow. -"Okay, which vaccine works?" and then building the factory. Because to get to the best case, uh, that people like myself and Dr. Fauci are saying is about 18 months, we need to do safety and efficacy and build manufacturing. Uh, and they're different for the different constructs. 

And so we'll abandon... You know, it'll be a few billion dollars we'll waste on manufacturing for the constructs that don't get picked because something else is better. But a few billion in this... the-the situation where we're in, where there's trillions of dollars-- that's a thousand times more-- uh, trillions of dollars being lost economically, it is worth it. In normal government procurement processes, and understanding which are the right seven, you know, in a few months, those may kick in. 

But our foundation, you know, we can get that bootstrapped and get it going, uh, and, you know, save months because every month counts. You know, things can reopen if thing... if-if... if we do the right things, in the summer, but it won't be completely normal. You'll still be very worried. You know, we may decide masks are important, although right now, they're in short supply for health workers, so people should not, uh, go and-and hoard those. 

But the capacity of that can be brought up. So it may be something that, like China today, everybody who's walking around is wearing one of those. -So we'll have a lot of unusual measures... -Mm-hmm. ...until we get the world vaccinated. You know, seven billion people-- -that's a tall order. -Mm-hmm. But it is... it is where we need to get to, uh, despite a lot of things in between now and then, to minimize the damage. 

You predicted this pandemic almost to a T. And maybe it was because we were dealing with other things at the time, we didn't really pay that much attention. Is there anything else you want to warn us about now -that-that we should be looking forward to? 

- Is there anything else that keeps you up at night? Well, this is a naturally-caused epidemic, and as bad as it is, it looks, if you have reasonable treatment, to have a one percent fatality. There could be epidemics that are worse than that, including ones that aren't naturally-caused that are a form of bioterrorism. 

But I do... One thing I feel good about is this is such a big, uh, change, to the world that this time, it won't be like Ebola, which was just there in West Africa or Central Africa. This time, the tens of billions to have the diagnostics standing by, the vaccine manufacturing standing by-- this time we will, uh, get ready for the next epidemic. 

Well, I hope your words are prophetic once again. Thank you so much for your time. Um, good luck in all of your work and, um, stay healthy out there. We need you. 

Hey, thanks, Trevor. Hopefully, we'll be playing tennis again soon. You bet. Looking forward to it.

这是2015年比尔·盖茨做的TED演讲。他认为在未来几十年里，如果有什么可以使上千万人失去生命，那比较有可能是个有高度传染性的病毒，而不是战争。不是导弹，而是微生物。

我们在防止疫情的系统上投资很少，还没有准备好预防下一场疫情大爆发。

The nex outbreak? We're not ready

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