Bill Gates on vaccines, Trump, and why social media is “a poisoned chalice”

From Steven Levy's interview with Bill Gates. Here are the highlights, some of which may be news to you:

At this point, are you optimistic?

Yes. You have to admit there’s been trillions of dollars of economic damage done and a lot of debts, but the innovation pipeline on scaling up diagnostics, on new therapeutics, on vaccines is actually quite impressive. And that makes me feel like, for the rich world, we should largely be able to end this thing by the end of 2021, and for the world at large by the end of 2022. That is only because of the scale of the innovation that’s taking place. Now whenever we get this done, we will have lost many years in malaria and polio and HIV and the indebtedness of countries of all sizes and instability. It’ll take you years beyond that before you’d even get back to where you were at the start of 2020. It’s not World War I or World War II, but it is in that order of magnitude as a negative shock to the system.

In March it was unimaginable that you’d be giving us that timeline and saying it’s great.

Well it’s because of innovation that you don’t have to contemplate an even sadder statement, which is this thing will be raging for five years until natural immunity is our only hope.

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Are you concerned that in our rush to get a vaccine we are going to approve something that isn’t safe and effective?

Yeah. In China and Russia they are moving full speed ahead. I bet there’ll be some vaccines that will get out to lots of patients without the full regulatory review somewhere in the world. We probably need three or four months, no matter what, of phase 3 data, just to look for side effects. The FDA, to their credit, at least so far, is sticking to requiring proof of efficacy. So far they have behaved very professionally despite the political pressure. There may be pressure, but people are saying no, make sure that that’s not allowed. The irony is that this is a president who is a vaccine skeptic. Every meeting I have with him he is like, “Hey, I don’t know about vaccines, and you have to meet with this guy Robert Kennedy Jr. who hates vaccines and spreads crazy stuff about them.”

[...]

You helped fund a Covid diagnostic testing program in Seattle that got quicker results, and it wasn’t so intrusive. The FDA put it on pause. What happened?

There’s this thing where the health worker jams the deep turbinate, in the back of your nose, which actually hurts and makes you sneeze on the healthy worker. We showed that the quality of the results can be equivalent if you just put a self-test in the tip of your nose with a cotton swab. The FDA made us jump through some hoops to prove that you didn’t need to refrigerate the result, that it could go back in a dry plastic bag, and so on. So the delay there was just normal double checking, maybe overly careful but not based on some political angle. Because of what we have done at FDA, you can buy these cheaper swabs that are available by the billions. So anybody who’s using the deep turbinate now is just out of date. It’s a mistake, because it slows things down.

But people aren’t getting their tests back quickly enough.

Well, that’s just stupidity. The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.

Why don’t we just do that?

Because the federal government sets that reimbursement system. When we tell them to change it they say, “As far as we can tell, we’re just doing a great job, it’s amazing!” Here we are, this is August. We are the only country in the world where we waste the most money on tests. Fix the reimbursement. Set up the CDC website. But I have been on that kick, and people are tired of listening to me.

Edit: this probably should go in the coronavirus topic since there is very little about social media.