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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?

  • Yeah.

  • ...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.

  • That's right.

  • 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