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00:00[CC may contain inaccuracies] I was going to take you through kind of two big questions and then like a third one on top and the two main areas are how do we. Stop this current disease or try and try it trying. How do we conquer it. And then secondly how do we try and prevent future codes when. I want to ask you a bit about the sort of general effects you think this has had on society. But let's begin with this immediate one which I know you've written about. But how do we conquer this disease now. And I know you've talked about three steps and things but maybe you could you could take us through what you think are sort of realistic program one that is. Well the vaccines are very good news and the supply constraints will be largely solved as we get out in the middle of next year and so we'll be limited by the logistics and the demand in a lot of countries. It's not clear what the demand level will be. Ironically in a country like many in sub-Saharan Africa where the epidemic hasn't been as visible your demand for the vaccine it's challenging to generate that. But we'll do the best we can on that. The other thing that's pretty impressive is that Merck and now Pfizer have oral antivirals. That the Merck drug we've been able to reformulate to get it to be less than eight dollars and so we'll be able to have anyone. Whose age or medical condition makes them have significant risk. Immediately began what's called presumptive treatment as soon as they test positive. So between natural immunity. Vaccine immunity. And these oral treatments that can scale up in a way that the antibodies never did. You know the death rate in the super disease rates ought to be coming down pretty dramatically. And you know by next summer getting to be saved quite a bit lower than the average seasonal flu level is assuming there's no surprise variance which right now the evidence is that's not that likely but it can never be ruled out. What's it what you think. You just mentioned next summer. What do you think victory looks like in this. Is it effectively taking Covid back. You also mentioned the flu. Does it is effectively making Covid a kind of flu like disease. I know. I know it is. But it is that the kind of version of what victory is in your brain. Yeah. Things are fairly binary. I mean if you know death rates from driving were ten times what they are. People might think wow. They're not you know flu is accepted. The average year of life lost for both you and Covid is about 8 years because it's so prevalent in the elder versus the young. And we accept about a 60 thousand average per year rate there. Now I happen to think as part of the tools innovation to avoid the next pandemic we are to go on eradicate flu as well because its mutations are another source of a significant source of future pandemic risk. But yes the idea that economic activity will resume in full once you get to flu levels it's very likely. Now you'll have some hotspots real still hopped out of non part of cynical into interventions or you know huge incentives for people to get protected. Just to push you a bit on the vaccination things you have if you look at the way that countries are dealing with this. You have two very different different ways of doing it. If you're going to take to extremes you could argue that the country which I live in Britain which tends to have opened up a lot relied on vaccination and is taking a slight. We'll see what happens with it happens attitude at one end. At the other end you have China which is really clamping down but actually closing things down. Where do you when you look at those. What do you see problems with both. Well which which sort of basic strategy. You have more trust in. Well it any country. That was able to do what China did and stop it early before it exponentially did up where you had case rates above 2 percent of the population. That's a huge blessing that they were able to do that. That means they have very little natural immunity. And so they have to drive their vaccination coverage up dramatically before they drop sort of that wall that's allowed them to elude infection from coming in but then wind up the epidemic you know with you know 100 the deaths that happened out of most of the rich countries. And you know you've got to see that as as largely virtual assault. But there isn't. There is though. There is a difference. There is. If you look at places like Singapore and New Zealand Australia they also have got a very good number. The Chinese numbers are amazingly good and possibly good some people might say. But even if that even if that saving a bit that's still amazingly good. What's interesting though is that China has absolutely doubled down on this strategy. By contrast we're in Singapore Australia New Zealand. They are opening up a bit. They're going in another direction. The Chinese strategy would seem to require keeping things locked down for perhaps another year. Yeah. So the the question of when you reopen up is you'll see different strategies on that. So what you try to do is drive your vaccination rate up and get a mix of the antibodies and the empty barrels in stock and train your medical system. So that's available to your death rate is down in the face of Delta. Maintaining that wall is very hard and many countries will now decide that between their vaccination rate and the antivirals the benefit of allowing people to flow in and out of the country particularly against what it's like to maintain against Delta. Then it's time to open up. But the death rate even of those countries will be say a fiftieth of what it's been in lots of Europe. The UK is kind of at the end of the spectrum more of this fall. They kind of said hey let's act like it's blue. And they're you know paying somewhat of a price in. In deaths. But you know they are allowing people to do a lot of things even at COP 26 at the receptions. You know they make you wear your mask on the street where your risk is very low. But once people in receptions they were taking their masks off. That was that is hard to explain even even to British people. This government has explained a lot of things to us. If we if you look at posturing look a little bit which I know you've also looked at this issue of the longer term perfect preparedness. If if we have you know we can argue whether China is doing the right thing or the wrong thing at the moment but assume that what you say is right and we push it back to flu like levels. What as a kind of world do we need to do to prevent. Other record epidemics coming along. Where do you see the main focus. The. Well we need a few pieces we need at the Covid level several thousand people. Who are experts in this and are totally dedicated to stopping infectious diseases. And ready to go. And they'll have do like germ games like war games where countries practice. And what those countries would try and be ready for is bringing up the diagnostic capacity even 10 times faster than say Australia which was one of the best. And then being able to implement the non pharmaceutical interventions very quickly then we need better tools. You know if we'd have the vaccine even faster if we'd had these oral antivirals. Not now but a year ago. And if we had a vaccine that was so powerful that it prevented breakthrough cases which is now. Those are a big part of these transmission chains. The science to do that you know we should be able to conquer. So you know literally for a few tens of billions. We'll build a set of tools within eight to 10 years and a surveillance capacity at the global level which will mean that for a pathogen like this we pay you know 1 percent of the price that we did this time and just push you in a couple of things on their own vaccines. I'm just I'm intrigued. You've been you've been involved in these for a long time. Did we get lucky with Covid with vaccines. Because a lot of people seem to think that the speed with which we developed a vaccine this time was was lucky. Not it was due to the skill of the people involved. But from a governmental societal point of view a lot of governments person would be one very obvious example. Example what kind of bailed out by the speed the unexpected speed of a vaccine. Do you think that's fair. We have three types of vaccines. Here we have the MRI knee which you know the inventors are appropriately lauded for the work they did 10 years ago. Organizations like us start when our foundation for funding that. But none of those vaccines work until the epidemic. So the fact that it didn't come five years ago when that morning would not have been ready. You could say that's luck. Then we had viral vector vaccines like the AstraZeneca Thompson and Johnson. Those were invented about eight years ago actually partly through HIV and Ebola type efforts. And then finally we had a class of vaccines like the Chinese and activated which we've been able to make those for decades and decades. And so if this had come five years ago everybody would it probably made inactivated vaccines which are not quite as good but they work. And you know those could have been made in scale. So yes it helped that MRSA was there but it wouldn't have been the end of the world not to have that. And next time we really going to have some good vaccines that you know will understand the duration and we won't have breakthrough cases like with the measles vaccine. You know when you said you talked about creating this having you invest a few tens of billions of dollars and you end up with that kind of vaccine preparedness. Is that money going to come from foundations like yourself or do you think it's actually going to do during this time. Governments will actually spend the money. Well if you can buy an insurance policy that costs the actual global surveillance piece the two to three thousand people that's only a billion a year. The bigger number is all that aren't guesswork. Both of those have huge benefits even when you're not in a pandemic year. So I'm a little surprised we're not yet focused on this because you know the US you'd expect normally to jump in with increased R and D. But I think over the next year if we keep reminding people that you know this cost trillions and it killed millions. That this is going to be the best insurance policy that anybody ever talked about. You know compared to defense budgets are fire departments or earthquake preparations this is very dramatically more effective. Very very eloquently put it across. The reason why governments should do this. But the question I asked you is do you think they will. Which is a slightly different one. Yes I think they will. I feel like they've been a little slow to come on to this but you know the the US is often expected to lead on things like this which we haven't done yet. But I certainly hope you'll check in the voice of the foundation will be out there talking about what these priorities should be in getting rid of things like the flu has huge benefits that you know that alone should be very exciting to people. Even I would contribute towards doing that on the on the underlying issue. You mentioned the word surveillance. One of the. This moves slightly into longer term consequences. Do you think people are now much more willing to hand over data to let people look at things like help. I mean you look at the origins of Covid. There was huge problems about where exactly it came. Being able to work out all those sort of issues. And you I mean you've had endless anti vax conspiracy theories and things like that. Do you think that people of that on the whole people have changed their minds about their willingness to hand over data when it comes to things like health. Well I'm not sure that. You know this was an interesting trust case test of people's trust in their politicians or their health system. And you know statistically we didn't do as well as I would have expected. You know in fact you know I'm cited as some you know mastermind of some evil and a lot in many many cases. So no I didn't expect any of that. You know in some ways the politicization of you know taking vaccines and helping protect other people you can almost say that's a step backwards. You know I hope vaccine acceptance for other diseases like. Measles is not reduced by this but you know a lot of people jumped in and took the vaccines. But a meaningful minority. In most countries were led down a path of believing that not only was there rather rare side effects but that the vaccine wasn't properly tested or was part of some evil conspiracy. Essentially I mean even we last night we talked to the Singaporean prime minister. You and I might disagree about lots of things to do with governments but we would both vaguely put Singapore high up on the list of governments which have generally done a good job. But even here you have 60000 people who pretty much refuse to take that 60 thousand vulnerable people who have generally refused to take vaccines. Do you think that that is a problem globally. I'm surprised they have that problem in Singapore. I thought they had a laugh for people to hold themselves. Yeah I'm kidding. You know boy getting big compliance is hard you know. My main experience of this before the pandemic was our work on polio where we have to get about 85 percent of the kids to take the vaccine. And from time to time we'll get rumors that make it very very hard to achieve that. And then we'll get trusted leaders to set an example and give the weather in this case oral drops to their kids. We've been able to succeed in that to the point where now polio a wild polio is only in Pakistan and Afghanistan. So if you stick with it and talk to the right people you can succeed. In the case of this pandemic we want people to get vaccinated rapidly so that we stop those transmission chains up to the elderly who you know the US still is said over a thousand deaths a day. Yeah. And the other problem to a trust free obviously to do is surveillance and preparedness is between governments and without going into the details. China has a slightly murky role in the origins of this virus. Do you think that people now are willing to trust government. Would you trust governments to reveal things about viruses in the future. Yes the sequence of this virus was made available at record speed much quicker than much quicker than we had. I agree. I agree with that. But it was still it was not. There were still people complaining about it before it became sort of publicly available. I think. It you'll never be perfect at the start. You can imagine an epidemic starting and say you know DRC or Somalia and it would be even more difficult to get going as quickly as we did. So you know I wouldn't assume that we're going to do much better in terms of a little bit of confusion at the start in the future. You know a lot of the risk of future pandemic comes out of sub-Saharan Africa. So we need surveillance systems that can work even when the local government is dysfunctional or not interested in and trumpeting the information. Now I see one last question which I hinted at the beginning. If you if you look at all the kind of consequences that people are talking about because of this disease and in this case I'm looking wider than just healthcare or do you think the biggest of the various changes that people think they've detected which is the one which most intrigues you which is the one why you think that really is something happening in society because of what has happened in Covid. Well the breaking of the assumption that you have to go on lots of trips you have to go to the office every day. You prove your interest in the moment. Yeah. And the you know the rush to entertain in that software which you know we're just very much in the beginning of how you know teams or zoom or various software products help you out with that remote presence. So you know whether it's doctors appointments or types of education or just you know five days a week. I don't think we know yet how people are going to take advantage of that. But for the first time people are thinking wow. To some degree this works and the software is going to keep getting better in ways that I think will surprise people. One very quick thing on that education. One last thing education. I know you've always been interested in and you've looked at this the idea of digital education and people really embracing that. Do you think that is I mean a lot of people have talk about health as a consequence of this. Do you think that that is is a bigger long term thing. I remember years ago talking to you about the Khan Academy and things like that but that type of adoption of online methods. Do you think that's finally going to happen. Well the quality of online curriculum. Keeps going up and our foundation is very involved in that it's our biggest bet for education is to have math curricula that's fun and interesting. And even if you fall behind and start to feel discouraged that both the software and your peers and adults come in and help you keep that journey going that you know we need that. We need great improvements in the quality of education. What we've done so far mostly works for motivated students. So weirdly the gap between the motivated student and the not motivated student is actually arguably gotten bigger because the tools worked so well for the motivated students. So the breakthrough that our foundation is now putting literally hundreds of millions into is how to use that interactivity and data. In a way that you can motivate kids have part of their self-image be OK. This is valuable to me. It will help me and my future. And so I'm an optimist about that. But you know these are still it's still unproven. How much digital curriculum can raise the average math education in any country.

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