Bill Gates says there's a better way to fight Covid, future pandemics

A piece of that preparedness puzzle includes optimizing vaccine distribution. COVAX, the world’s vaccine facility, finally has enough doses to allocate and distribute to countries. However, COVAX is still struggling to quickly put shots in arms, particularly in low- and middle-income countries with weaker health systems.

Gates said the process should be based on each country’s preferences. It’s possible that nations, including the 30 that are still recording 10 percent immunization rates, only want to target vulnerable populations, he said.

“It’s up to the countries. What does Ethiopia want? What does Nigeria want? If there’s Covid vaccination that goes on, the real benefit is where you can get any decent dollars per year of life saved,” the billionaire philanthropist said. “That’s going after people who are old, or have other conditions that make them seriously at risk of this thing.”

Still, Gates said, strengthening health systems in poorer countries is key to improving distribution in the next pandemic. Well-structured health systems have more trained vaccinators and more resources to target vaccine hesitancy.

“When you want to get 95 percent coverage … vaccine hesitancy would probably create an upper bound way below that,” Gates said. “Willingness to take vaccines is partly driven by dead bodies. If you’re a very young population that’s very thin, you just don’t see the same thing. But if you get the trust hierarchy, which in many countries is the religious leaders, to visibly vaccinate their kids, then you can overcome some of that.”

The Gates Foundation is one of the largest funders of the fight against Covid-19. It has given billions of dollars to support the distribution of vaccines as well as diagnostic and therapeutics. It has also donated $120 million to shore up country-specific and regional responses in sub-Saharan Africa and South Asia.

That work will continue, Gates said, adding that he is also beginning to think about how the world can prepare for future disease outbreaks. He has a book about pandemic preparedness coming out in May.

Over the past two years, the global health community has grappled to keep pace with the virus. But now that Omicron cases are declining in dozens of countries and hundreds of millions of vaccine doses are coming online each month, the world might now be able to think more broadly about preparedness and future response.

That’s what dozens of global health leaders gathered at the Munich Security Conference to discuss this week.

“In 2015, lots of people talked about what it would take to stop a pandemic. The formula hasn’t changed,” Gates said. “We need to fund global surveillance to see the next pathogen early. We need to fund the R&D for better diagnostics [and] therapeutics. Given the deaths, the economic damage, and all sorts of other negative things that came out of this pandemic, the cost to fund the new tools … is almost nothing.”

Gates and others envision making vaccine production and administration more efficient, including using a vaccine to protect against Covid-19, the flu and respiratory syncytial virus, or RSV. The mechanism for that vaccine could also change, Gates said.

“In the future, we don’t want to use a needle. It may turn out that you take your first dose as a micro-patch and your second dose as an inhalation because to get infection blocking you actually want secretory antibodies in the nose. And we’ve never been good at that,” he said. “That’s partly why [the vaccine doesn’t] block infection. If we come along with an infection blocker … then you could even think about eradication. But we’re quite away from that.”

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