Co-chair of Gates Foundation, Bill & Melinda Gates Foundation
Bill Gates on Covid Fight, Pandemic Preparedness: Bloomberg NEF
Bill Gates, the billionaire co-founder of Microsoft Corp, discusses the global fight against Covid-19 and the importance of pandemic preparedness. He speaks with John Micklethwait at the Bloomberg New Economy Forum.
About Bill Gates
Bill Gates, co-chair of the Gates Foundation, faced renewed scrutiny in February 2026 following the release of Justice Department documents related to Jeffrey Epstein. The documents included draft emails, apparently written by Epstein to himself, containing graphic and unverified allegations about Gates. Gates denied the claims in interviews, stating that he only attended dinners with Epstein, never went to Epstein's island, and never met any women through him. He said he regretted every minute spent with Epstein and apologized for the association. His ex-wife, Melinda French Gates, said in response to the documents that questions about the allegations were for her ex-husband to answer, not her. At the World Economic Forum in Davos in January 2026, Gates focused on global health and artificial intelligence. He announced a $50 million partnership between the Gates Foundation and OpenAI called "Horizon 1000," which aims to deploy AI tools in 1,000 primary healthcare clinics in Africa, starting in Rwanda. Gates described the initiative as a way to improve healthcare quality and efficiency by using AI to reduce paperwork and help patients communicate in their local languages. He also warned that global health funding cuts had led to an increase in childhood deaths for the first time in 25 years, with 4.8 million children under five dying in 2025 compared to 4.6 million the year before. Gates said the U.S. aid cuts were "abrupt and cruel" and expressed hope that funding would be restored.
Transcript (28 segments)
✨ AI-enhanced transcript with speaker attribution
I
Interviewer0:00
I was going to take you through two big questions and then a third one on top. The two main areas are how do we stop this current disease, try to conquer it, and secondly how do we try to prevent future Covids. Then I wanted to ask you about the general effects you think this has had on society. But let's begin with this immediate one, which I know you've written about: how do we conquer this disease now? I know you've talked about three steps, but maybe you could take us through what you think a realistic program on that is.
B
Bill Gates0:41
Well, the vaccines are very good news, and the supply constraints will be largely solved as we get out into the middle of next year. 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, generating demand for the vaccine is challenging. But we'll do the best we can. The other thing that's pretty impressive is that Merck and now Pfizer have oral antivirals. The Merck drug we've been able to reformulate to get it to be less than eight dollars, so we'll be able to have anyone whose age or medical condition makes them have significant risk immediately begin 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, the death rate and severe disease rates ought to be coming down pretty dramatically. By next summer, getting to be quite a bit lower than the average seasonal flu level, assuming there's no surprise variance. Right now the evidence is that's not that likely, but it can never be ruled out.
I
Interviewer2:25
What do you think? You just mentioned next summer. What do you think victory looks like here? Is it effectively taking COVID back to flu-like levels?
B
Bill Gates2:46
Yeah, things are fairly binary. I mean, if death rates from driving were 10 times what they are, people might think wow. Flu is accepted. The average years of life lost for both flu and COVID is about eight years because it's so prevalent in the elderly versus the young, and we accept about 60,000 average per year. I happen to think as part of the tools innovation to avoid the next pandemic, we ought to eradicate flu as well, because its mutations are another significant source of future pandemic risk. But yes, the idea that economic activity will resume in full once you get to flu levels is very likely. You'll have some hot spots where you'll still have to have non-pharmaceutical interventions or huge incentives for people to get protected.
I
Interviewer3:59
Just to push you a bit on the vaccination thing: if you look at how countries are dealing with this, you have two very different ways. At one extreme, Britain has opened up a lot, relied on vaccination, and is taking a 'we'll see what happens' attitude. At the other end, China is really clamping down and closing things down. Where do you see problems with both, or which basic strategy do you have more trust in?
B
Bill Gates4:39
Well, any country that was able to do what China did and stop it early before it exponentiated up, where case rates were above two percent of population, that's a huge blessing. They have very little natural immunity, so they have to drive their vaccination coverage up dramatically before they drop the wall that's allowed them to exclude infection. But they'll end up with a hundredth the deaths of most rich countries, and you've got to see that as largely virtuous.
I
Interviewer5:28
But there is a difference, Bill. If you look at places like Singapore, New Zealand, Australia, they also have very good numbers. The Chinese numbers are amazingly good, impossibly good some might say. But even if they're fibbing a bit, they're still amazingly good. What's interesting is that China has absolutely doubled down on the strategy, while Singapore, Australia, and New Zealand are opening up a bit. The Chinese strategy would seem to require keeping things locked down for perhaps another year.
B
Bill Gates6:01
Yeah, so the question of when you reopen, you'll see different strategies. You try to drive your vaccination rate, get a mix of antibodies and antivirals in stock, and train your medical system so that 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, it's time to open up. But the death rate of those countries will still be a 50th of what it's been in lots of Europe. The UK is at the end of the spectrum this fall; they kind of said 'let's act like it's flu' and they're paying somewhat of a price in deaths. But they are allowing people to do a lot of things. Even at COP26 receptions, they'd make you wear your mask on the street where risk was low, but once at receptions they were taking their masks off. That is hard to explain even to British people.
I
Interviewer7:26
Looking at the longer-term preparedness: if we push it back to flu-like levels, what do we as a world need to do to prevent other epidemics? Where do you see the main focus?
B
Bill Gates7:58
We need a few pieces. We need a WHO level of several thousand people who are experts in this, totally dedicated to stopping infectious diseases, ready to go, doing germ games like war games. Countries would try to be ready by bringing up diagnostic capacity even 10 times faster than Australia did, which was one of the best, and then quickly implementing non-pharmaceutical interventions. We need better tools: a vaccine even faster, oral antivirals a year ago, and a vaccine so powerful that it prevents breakthrough cases, which are now a big part of transmission chains. The science to do that we should be able to conquer. For a few tens of billions, we can build a set of tools within eight to ten years and a surveillance capacity at the global level, meaning that for a pathogen like this, we'd pay one percent of the price we did this time.
I
Interviewer9:17
Just to push you on vaccines: did we get lucky with COVID vaccines? A lot of people think the speed was lucky. From a governmental point of view, many governments were bailed out by the unexpected speed. Is that fair?
B
Bill Gates9:52
We have three types of vaccines here. The mRNA, whose inventors are appropriately lauded for work they did 10 years ago, funded by organizations like DARPA and the Gates Foundation. But none of those vaccines had worked until the epidemic. The fact that it didn't come five years ago when mRNA would not have been ready—you could say that's luck. Then we had viral vector vaccines like AstraZeneca and Johnson & Johnson, invented about eight years ago partly through HIV and Ebola efforts. Finally, we had inactivated vaccines from China, which we've been able to make for decades. If this had come five years ago, everybody would have made inactivated vaccines, which are not quite as good, but they work and could have been made at scale. So yes, it helped that mRNA was there, but it wouldn't have been the end of the world not to have it. Next time, we will have some good vaccines where we understand the duration and won't have breakthrough cases like with the measles vaccine.
I
Interviewer11:14
You talked about investing a few tens of billions for vaccine preparedness. Will that money come from foundations like yours, or do you think governments will actually spend it this time?
B
Bill Gates11:34
If you combine the insurance policy of global surveillance, the two to three thousand people needed is only a billion a year. The bigger numbers for R&D have huge benefits even when you're not in a pandemic year. I'm a little surprised we're not yet focused on this. The US would normally jump in with increased R&D. But over the next year, if we keep reminding people that this costs trillions and killed millions, this will be the best insurance policy anybody ever talked about. Compared to defense budgets, fire departments, or earthquake preparations, this is dramatically more effective.
I
Interviewer12:28
You've put across the reasons why governments should do this, but do you think they will?
B
Bill Gates12:38
Yes, I think they will. I feel like they've been a little slow to come on to this, but the US is often expected to lead on things like this, which we haven't done yet. Certainly the voice of the foundation will be out there talking about these priorities. Getting rid of things like the flu has huge benefits that alone should be very exciting to people. I would even contribute to doing that.
I
Interviewer13:14,
On the issue of surveillance, do you think people are now much more willing to hand over data for health purposes? Look at the origins of COVID and the conspiracy theories. Have people changed their minds about data sharing for health?
B
Bill Gates13:51,
This was an interesting trust test of people's trust in their politicians or health system. Statistically, we didn't do as well as I would have expected. I'm cited as some mastermind of an evil plot in many cases. No, I didn't expect any of that. In some ways, the politicization of taking vaccines and helping protect others could be seen as a step backwards. I hope vaccine acceptance for diseases like measles is not reduced by this. A lot of people jumped in and took the vaccines, but a meaningful minority in most countries were led down a path of believing the vaccine wasn't properly tested or was part of an evil conspiracy.
I
Interviewer15:04,
Even last night we talked to the Singaporean prime minister. We might put Singapore high up in the list of governments that did a good job, but even there, 60,000 vulnerable people have refused to take vaccines. Is that a global problem?
B
Bill Gates15:32,
I'm surprised they have that problem in Singapore. Getting big compliance is hard. My main experience before the pandemic was our work on polio, where we have to get about 85% of kids to take the vaccine. From time to time, rumors make it very hard to achieve that. We get trusted leaders to set an example, and we've succeeded to the point where wild polio is only in Pakistan and Afghanistan. If you stick with it and talk to the right people, you can succeed. In this pandemic, we want people to get vaccinated rapidly to stop transmission chains. The US still has over a thousand deaths a day.
I
Interviewer16:40,
The other problem with trust and surveillance is between governments. China had a slightly murky role in the origins of this virus. Do you think people will trust governments to reveal things about viruses in the future?
B
Bill Gates17:01,
The sequence of this virus was made available at record speed, much quicker than we thought.
I
Interviewer17:11,
I agree with that, but there were still people complaining before it became publicly available.
B
Bill Gates17:20,
It will never be perfect at the start. Imagine an epidemic starting in the DRC or Somalia; it would be even more difficult to get going as quickly as we did. I wouldn't assume we're going to do much better with a little confusion at the start in the future. A lot of the risk of future pandemics comes out of sub-Saharan Africa, so we need surveillance systems that work even when local government is dysfunctional or not interested in trumpeting the information.
I
Interviewer18:03,
One last question. Looking at the consequences of this disease beyond healthcare, what is the biggest change that most intrigues you? Where do you think something is really happening in society because of COVID?
B
Bill Gates18:28,
The breaking of the assumption that you have to go on lots of trips or go into the office every day. The rush to use software like Teams or Zoom for remote presence. Whether it's doctors' appointments, types of education, or five days a week in the office, we don't know yet how people will take advantage of that. But for the first time, people are thinking, wow, to some degree this works. The software will keep getting better in ways that I think will surprise people.
I
Interviewer19:18,
On education, you've always been interested in digital education. Do you think that adoption of online methods is finally going to happen?
B
Bill Gates19:46,
The quality of online curriculum keeps going up. Our foundation is very involved in that. Our biggest bet for education is to have math curricula that is fun and interesting, so that even if you fall behind and feel discouraged, the software, peers, and adults come in and help you keep that journey going. We need great improvements in the quality of education. What we've done so far mostly works for motivated students, so the gap between motivated and non-motivated students has arguably gotten bigger because the tools work so well for the motivated. The breakthrough our foundation is investing hundreds of millions into is how to use interactivity and data to motivate kids, so that part of their self-image is that this is valuable and will help their future. I'm an optimist about that, but it's still unproven how much digital curriculum can raise the average math education in any country.