Bill Gates says we should treat and prevent pandemics like fires: with a permanent task force

In a 2015 TED Talk in Vancouver, Bill Gates warned that the next major global threat could be a virus — and that the world was not ready.

That video has been viewed on YouTube more than 36 million times. In a follow-up talk at the TED conference in Vancouver last month, the Microsoft co-founder and billionaire philanthropist said more than 90 per cent of those views came too late — once the COVID-19 pandemic was already underway.

"We didn't do much to get ready, even though I wasn't the only one out there saying that. A little bit of prevention would have made a big, big difference," Gates said in an interview with The Sunday Magazine host Piya Chattopadhyay.

In his latest book, titled How to Prevent the Next Pandemic, Gates lays out the lessons he's learned from COVID-19 through his work with the Bill and Melinda Gates Foundation, and possible solutions for the future.

Vaccine shortage over, but equity still a problem

Of course, the pandemic isn't old news yet. Gates says we're losing momentum in the race to vaccinate the world — but he argues it's more a problem of distribution than production of vaccine doses at this point.

"The problem we had to start with, which was the shortage of vaccines, is completely solved. That is, there are excess vaccines actually expiring. And so the limit on vaccination is much more the demand and the logistics of getting those vaccines to people," he said. 

Last September, the World Health Organization (WHO) called for 70 per cent of the world's population to be vaccinated by mid-2022. The United Nations called it "an ambitious global target" — one that "the world is nowhere near reaching" as of the end of March.

And while more than 10 billion doses have been administered according to the UN, only one per cent was given to low-income countries, leaving 2.8 billion people who still haven't gotten a first dose.

The global vaccine distribution program COVAX — which includes the WHO, and two organizations funded by the Gates Foundation — also set ambitious goals for wealthy countries to distribute or pay for vaccine doses in other countries, but haven't yet met their targets.

Canada has only donated 15 million of the 38 million doses it promised to share from its own supplies, but demand for those has also fallen this year.

Gates asserted that COVAX has largely been successful, despite the missed targets. "The idea that we could make 14 billion vaccines enough for the whole world, you know, that was just a pipe dream. And so it's quite phenomenal how the ramp up has taken place," he said. 

But the problem of vaccines expiring in countries like Canada illustrates a "gigantic inequity" when doses can't make their way to low-income countries, he said.

Would waiving vaccine patents help?

One possible solution some experts have floated is to waive patents and intellectual property protections on the vaccines, allowing more countries to produce doses for themselves.

It was originally proposed by India and South Africa, and supported by other countries like the United States.

In Canada, the federal government insists it "has not rejected the waiver proposal," but still has questions, and is committed to finding "consensus-based solutions."

Gates, however, contends that waiving patents in 2021 wouldn't have meaningfully increased the vaccine supply, and that the AstraZeneca-Oxford vaccine has already been made available to several countries.

I have so much respect for Bill Gates ... but whether he likes it or not, intellectual property rules remain a barrier.- Winnie Byanyima, People's Vaccine Alliance

"They trained in over 20 companies how to make it, one of those that we funded with a $300 million grant, Serum [Institute of India], has now made over 1.4 billion of the AstraZeneca vaccine that they called Covishield," he said.

Waiving patents by the fall of 2021 or later, he argued, would only lead to oversupply of doses without solving the problem of distribution to low-income countries.

Brittany Lambert, a policy and advocacy specialist for Oxfam Canada, said waiving vaccine patents wouldn't be as helpful now as it would have been a year ago, before the supply issues had improved.

"It's a shame that it's taken so long that, in essence, this has become less relevant now. And, you know, there are lots of lives that have been lost because of it," she told CBC Radio.

But she added that similar patent waivers could still be useful for other supplies like tests and treatments.

Gates said his foundation is working with other "low-cost manufacturers" to manufacture mRNA vaccines, as well as future products that use the newer mRNA technology.

Winnie Byanyima, co-chair of the People's Vaccine Alliance, says Covishield alone won't be enough to vaccinate people in middle to low-income countries. After India recently widened its booster shot availability, she said, many Covishield doses are bound to be used as third doses at home instead of first doses abroad.

She said there were potentially 100 countries ready to manufacture MNRA vaccines now, if the patents for Moderna and Pfizer's shots were lifted.

"I have so much respect for Bill Gates ... but whether he likes it or not, intellectual property rules remain a barrier" for people in low-income countries, she said.

Rapid response team could contain outbreaks: Gates

One of his pitches is the creation of an internationally assembled team called Global Epidemic Response and Mobilization — or GERM, for short.

Made up of about 3,000 experts from various disciplines, its sole job would be to identify and suppress outbreaks of disease anywhere around the world, hopefully before they spread out of control.

WHO, he explained, doesn't have a full-time rapid pandemic response unit, like the hazmat-wearing squads you might see in an old action movie. But the idea has more in common with your neighbourhood fire department.

"Fortunately, [fire] doesn't kill that many people, but it's partly because we practice all the time, and we have these full-time people," he said.

Gates estimates that GERM would cost about $1 billion US a year to operate, but he said that would only increase the WHO's budget by about 25 per cent.

He's no stranger to the inner workings — and funding — of WHO. The Gates Foundation is its second-largest donor, more than most countries. That's raised concern over whether a private organization or single citizen should have that much potential influence over global health policies.

Lambert said that Gates and his foundation have done "incredible things" in the interest of global health, which she noted that many other billionaires are not currently doing. But she added that governments could shoulder more of that weight if they taxed billionaires more effectively.

"If we could find a way to better tax it, so that those decisions could be then taken democratically by governments, etc., that would be the ideal situation," she said.

Gates noted that his foundation isn't a voting member of WHO's assembly, and that the bulk of his contributions have focused on polio eradication efforts. He added that the foundation's work stands out mostly because governments haven't historically contributed as much as they could.

"Nobody would be happier than I would, if the Gates Foundation's funding became a much smaller proportion of global spending in the coming years — because … these are investments in a healthier, more productive world," he wrote.

Written by Jonathan Ore with files from CBC News. Interview with Bill Gates produced by Andrea Hoang.