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CNN Live Event/Special

Bill Gates On Fight Against Coronavirus; Bill Gates On Coronavirus Testing Vaccine Efforts And Reopening The Country; Welcome Wyatt Morgan Cooper. Aired 9-10p ET

Aired April 30, 2020 - 21:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

[21:00:00]

ANDERSON COOPER, CNN HOST: You said that U.S. had not hit its peak. So at this point do you think we have peaked and where do you think we are right now in kind of arc of the pandemic?

BILL GATES, CO-CHAIR, BILL & MELINDA GATES FOUNDATION: Well, certainly we hit our first peak and if we stayed with the social isolation policy then most places of the country continue to see a decline because people are going to go back to more association in some places in the country it's very likely that there'll be future peaks as well.

COOPER: And when you say future peaks that's different peaks in different places, and that's more deaths? I mean that's more deaths than would have been otherwise.

GATES: That's right. There will be deaths in the summer and in the fall. There's still some unknown about the seasonality. Will we be lulled into complacency in the summer only to be pushed back up in the fall? And there's a lag time as people implement policies for the first month not everyone will be taking advantage of those.

You can think hey these policies are good, let's go looser and yet the peoples' behavior is just starting to take advantage of those. And so very quickly you can get yourself back into exponential growth.

COOPER: Go ahead, Sanjay.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: That's a point that I think has really struck me this past week, Bill. I've been talking to a lot of people and there does seem to be this cognitive dissonance. On the one hand people are acting like we're close to the end of this.

And you know really taking victory laps in places and then we hear for example Dr. Freedman wrote today that this is sort of still just very much the beginning, the worst health threat in a hundred years and reminding us that the Spanish flu took 2 years really. I don't want to unnecessarily frighten people, but do you sense the same thing? Is there a cognitive dissonance right now?

GATES: Well, it's hard to deliver bad news, and particularly when we can't say it with 100 percent certainty. Maybe the summer is helping out here, but we saw Singapore who was very tight. They opened up, they got a problem. They had to close back down.

Japan thought they could use certain policies then declare an emergency. And Asia it's important to say they're testing and they're contacts tracing and their quality is above the United States. The United States does not prioritize who gets tested, and the United States does not make sure you get answers within 24 hours.

We have an authorized kiosks or home testing. That's still regulatory thing that's tied up. So our testing numbers should never be compared. If you're a high income person you can get tests a lot of times. If you're low income you're not likely to get tested at all. So our system fails to have the prioritization that would give us an accurate picture what's going on.

COOPER: Do you think there should be home testing people can just do on their families?

GATES: Well, we have to make sure that we're applying the testing where necessary, but, yes. You should be able to get a test at home if you're symptomatic, then very quickly all of your contacts which would include your household, they should be tested.

That's a perfect example where you need that answer very quickly so people know who should isolate instead of going out and being at work. This becomes even more important as we're doing this opening up policies.

So the speed of testing, South Korea happened to use kiosks that worked well for them. In the U.S. we could use kiosks, we could use pharmacies, but we have prioritization and quick turnaround. Anytime you get an answer say three days later, don't count that.

Take that out of the numbers, these charts people show. You've got all those bogus test and the inequity all built into that funny number.

DR. GUPTA: One thing I don't know if you saw, Bill, Paul's comments he is a Nobel prize winning economist, this is going to sound far-fetched to people but he suggests that the entire country essentially be tested every 2 weeks, and he says it is quite possible that if you go to places like the BARD Institute and a lot of university, laboratories and commercial laboratories that actually were able to do this.

It would cost about $100 billion a year he said, but that would be the key to actually getting things open until we have a vaccine or something. When you hear those sorts of proposals, what do you think?

GATES: Yes, I just wrote a piece in the foundation called "Mega Testing." And the question was can we get from this bogusly measured 200,000 a day up to what you just complied which was over 20 million a day. You know, that is a factor of 100 greater.

And to an economist, okay, that must sound simple. But where was his system for collecting those swabs? You know, which swabs we're using. We haven't gotten the - swabs approved by FDA yet which would give you a lot of volume. You know BARD is working with us on that but it's got to get approve.

[21:05:00]

GATES: Even to get the 200,000 to be real and to get it up to something like the 500,000, you know, the lack of CDC engagement on the website with priorities means that that's really in bad shape. The contact tracing you have to be able to quickly get a test out to that contract.

That's what the Asian countries who have done well have shown us. Yes, there are approaches that may or may not work to get way above the 200,000 a day. They don't exist yet there are things where you use agriculture PCR machines or things where you use crisper, and we should invest in those.

But we can't on getting to that mind-blowing number, so-called mega testing, we should pursue it. But no chance should be based on it because the chance of working actually some super high.

COOPER: So let me just double back to what you said the 200,000 testing a day which we hear from a lot of podiums from a lot of people, you say that's a bogus number can you just explain why that's a bogus number?

GATES: If you get your test result within 24 hours so you can act on it, and then let's count that. If you're making sure that low income people have equal access and it's not just, you know, the delivery person is asymptomatic getting tested every day because they go into wealthy neighborhoods.

The queues for that testing process, those are not prioritized. So if you have a relationship with a doctor who has connection with the lab you'll get to the front of the line. And other countries actually have criteria for taking this very scarce resource it's about saving lives that are about seeing if we're doing the right thing and allocating that in a just way.

COOPER: Sorry, just part of my ignorance on this. So you're saying the tests that take 3 to 4 days to get results, toss those out because in that 3 to 4 days that person is going to interact with an untold number of people?

GATES: Yes, what's the point of the test? You're period of greatest infectiousness. There's a little bit before you're symptomatic, which that's very difficult. But, you know, once you get symptomatic and you get that test, that's your key remaining days of infectiousness are about 3 or 4 days.

And so if you get the test three days later and what's the point, do you just write apology notes to the people you ran into for the last three days?

DR. GUPTA: You should write apology notes. But I have a question about an op-ed that Michael Osterholm wrote about. I don't know if you saw that but basically you know we think of these tests binary if you can get one and you get the results it tells you, you have the virus so you don't.

But I was looking up some of these false negative rates Bill and I'm sure you've seen this as well, but even with these if you get a good tests even some of the false negative rates are as high as 15 percent, some even a little bit higher than that. That's pretty significant.

Is that an issue that can be addressed, do you think? I imagine it would have to be brought down in order for all these other things you're talking about to work.

GATES: Definitely as we look at non-PCR formats that's going to be a huge problem. The PCR test if it's done properly that collected which you know we've shown the self-swab does pretty well at that. If you get it to the machine in a reasonable time frame it should be quite accurate.

Now, we need to keep calibrating. It was great, finally somebody pointed out that the serology tests were particularly bad with them lots and lots of false positives. So we need to keep calibrating these tests. Most the PCR tests should catch a lot of the cases, so I wouldn't expect to see a 15 percent false positive rate.

But you also have that period where you're pre symptomatic and what we're seeing now is that you're viral load, I was hoping the viral load would be low in the pre-symptomatic phase and the studies that had been done as we go into homeless shelters, nursing facilities, what we're seeing is that there are a number of individuals with a very high viral load.

And that probably determines your infectiousness that are pre symptomatic and some that are never symptomatic but that's far less than pre symptomatic.

COOPER: I know your foundation has invested in research around testing specifically on the self-swab testing. Can you just explain to me - I can't wrap my head around why these swabs are so hard to get to where they need to go? I know I've been told they're really - they're not like Q-tips that you buy in a store, thought they're actually, you know, sort of hard to make I guess, but it's a swab.

[21:10:00]

COOPER: What am I missing?

GATES: We have data in front of the FDA that we're hoping they'll act onto show that basically all the swabs work quite well and all the ways of transporting the swab back to the machine work quite well. But when the original approval was done, it was done assuming that there was very modest falling.

So this thing where you need a health care worker and this thing that they jam it to the back of your throat that was okay because it was a low volume thing. And it wasn't something infectious that when you jam it in you probably in fact the health care worker unless they're changing their personal protection equipment every time. So nobody had really thought, okay, what about the self-swab. And, you know, in the state of Washington that's being used to great effect for our assessment network. So the FDA registration is with a very particular swab.

Now we're in this dire situation where the good news is, is that most swabs were concluding swabs like polyester dry which are available in big quantities and you know BARD is getting engaged on that. So the swab thing it's weird it's taking so long, but that is not a fundamental limit that holds fact.

We should have a lot of those swabs prepositioned so that when you feel symptomatic you either have it or you just go to the pharmacy, get it and immediately if you're prioritized by the website you give it in and then you get a result back very quickly.

DR. GUPTA: You know I had the test done with the nasal where they really put that swab far back. And one of the things they kept telling me was this has to be done properly because again you could increase your false negative rates if you don't do the test properly.

Even if you get the swabs is that a concern do you think or have you seen with the self-swabbing that people just don't get a good enough sample?

GATES: The data is there. This was filed like over three weeks ago. The data is there comparing where you would take a patient and you would do it both ways and show, you know, it works extremely well. The speed of contact tracing if you want to try and open up this contact tracing thing has got to be taken seriously.

South Korea took it seriously. It looks like there's an effort in New York that Mayor Bloomberg is driving, helping out with that will do some of that. It - you know it's kind of strange that there's not clear Federal guidance that that's a necessary part of reopening is to have the quick turnaround tests that actually low income people can get access to but the contact tracing to follow-up so those people hear very quickly if they've been infected.

COOPER: You really - you do start - you rightly mentioned this a lot. You really see the inequities that previously exist in a society at times like this the inequities in terms of access to health care, access to - you know you just see the imbalances, the inequalities that are in a society.

GATES: Yes, no, low income student probably is not getting online instruction as much as the suburban kid. You know, the household that you're confined to is probably very different. So, yes, like most bad things poor countries will probably have it the worst and the poorer lower income people in the United States will have it worse.

DR. GUPTA: I don't know if you saw some of the reporting that came out of China from David Culver, our China Correspondent but he's talking about this app that he essentially now has where he is just going through China it sort of lets him into certain places based on places that he's been and what's happening with particular clusters of infections.

It's quite sophisticated. I'm curious you talk a lot about contact tracing because that's an important step obviously. What do you think the role of technology is when you think about sort of contact tracing has been around since the 18th century. What should it look like now in terms of technology do you think?

GATES: Well, fundamentally when someone tests positive, and which, again, very quickly after they get that result then you interview them, and of course their household is going to be the first step there. And under current social activity there won't be a gigantic number.

There will be a few places they've been and few people they've been with and some variance there but those people will be prioritized to get a quick turnaround test, and that's how you quench this exponential growth.

[21:15:00]

GATES: If you have really good testing, prioritized, quick turnaround then your opening up can be far more liberal than if you don't have this thing. Most of the Asian countries stayed pretty closed down and they had this contact tracing.

In terms of technology, I don't think we'll force download the locations you've been in like some countries did. I don't think that's necessary. You might use it as a reminder that you picked voluntarily to run an app that you can look back at the last 14 days and it'll help you with that dialogue or automate some of that dialogue.

But I think the way Germany's doing it, you know, or Austria or Denmark, there's a lot of really good examples that are probably more in line with our privacy sensitivities.

COOPER: I've asked a lot of different state, local officials about contact tracing. None of them really will say, yes I feel or the public health people in various states will say yes, I feel great where we're at, yes we have great people. Many of them have tried to be kind of optimistic and sort of talk about, well, we're really going to start to think about that or ramp up.

Is there a number of how many people need to be employed doing contact tracing? You know, Sanjay and I have been talking about this for ages. We've heard everything from, you know, 300,000 to over a million. Do you have a number?

GATES: Well, if you wait longer until the disease numbers have dropped down then your number of active cases is much lower. And that's the equation that should be run. How many contact tracing people do I have? How many can they each do per day? What's the average number of contacts and where am I on these positive tests?

Once I really let every symptomatic have that access and I have the capacity for the contacts. It's not a complicated equation. New York and Washington State, the two I know the best are moving to do a system a lot like Germany.

You could just look at the productivity there and the number of people per case there. It's not that hard. It's not like we don't have people like everybody's in America is tied up doing important work. You can train somebody to do this work fairly quickly.

Remember we're spending trillions for the economic relief here, so the idea that we actually get serious about the health related thing like the testing, you know, it seems pretty obvious that there should be clear Federal guidelines.

DR. GUPTA: Do you - I know we're going to talk about vaccines, something that you're obviously very focused on, but if we get to this point that we're talking about, Bill, with testing and having enough contact tracing which you say you know we should be able to get to these things, can we get to some sense of normalcy then? What does normalcy look like at that point?

GATES: We had great testing and contact tracing, quick turnaround and prioritize. You can open far more than you were in the first phase. And, you know, ideally you would wait until you're really ready to do that well

And then you would be very careful about the activities that properly modified posed the least risk of infection and the greatest benefit in society. So things like manufacturing, constructions that are physical activities.

Schools one that's hard to get the design right, but there's so much benefit I hope we can do that well. A lot of office jobs you know should stay the way they are because the productivity loss although it's not zero it's not gigantic, so we shouldn't use up the contact budget we have on things that the benefit isn't, you know, very, very high.

So like big public events not until the miracle therapeutic or the widespread immunity from the vaccine has gotten us into a third phase, which is the only one you would call normal.

DR. GUPTA: Can I just ask a follow-up question about schools for a moment? K through 12 and then also colleges what we hear as people have heard is that while younger people can certainly get infected and even get very sick, it is less likely for that to happen in someone who is younger.

And I also know that you've funded things like the Khan Academy which is more like online education. What do you think of the idea of a more robust online education for a while or may be even you know past the pandemic for college or maybe even some of the grade school students?

[21:20:00]

GATES: If you get into younger ages the effectiveness of online gets worse and worse. And as you get into kids that don't have the equipment, the internet connection the place that's quiet where they can do that work it gets worse and worse. And so if you take an extreme case, highly motivated college student where the college has worked on that online material for a long time and there's no lab work involved, yes, that can be really top-notch. In fact, there are a lot of institutions who offer that and the quality of education is very good.

If you get down to a, you know, kindergartner in the inner city I don't think that online experience measures up to the socialization and exposure and ability of their parents to go up and do their job, that physical kindergarten provides.

COOPER: You know you talked about Federal guidelines and overall the need for a strong Federal presence leading the way in something like this, though clearly in the United States it's up to Governors and the state by state and the difference with localities.

Just looking overseas in terms of what in all pandemics that you've worked on, in all disease preventive stuff that you've worked on, what is the model that works in terms of is it the strong Federal, you know, a strong central leadership taking sort of ownership of it? Is that the best or what have you seen that works?

GATES: Well, historically the U.S. CDC has been very strong. And whenever there'd be problem not even in the U.S., you know, their advice would be brought to bear, and they'd have very clear advice on things like testing prioritization, so that is a deep set of skills where there, you know, getting input from all the states.

But an entire world that's the best group of people. There's an opportunity here for them to help with testing prioritization. And, you know, I hope they'll seize it.

DR. GUPTA: I know that with regard to China sort of looking at other countries you don't want to look too much in the rearview mirror in terms of what went right or what went wrong there? But are there some lessons learned because we're still in this Bill, you know I mean, we can learn lessons even right now. Are there some lessons as to how this information flowed from China to the United States and what should we take away from that?

GATES: Well, many countries were - listened to what was being said in January and took action. And I'm sure every country wishes that they had listened more to that. What you ended up with in the places where you're seeing massive deaths is you had community spread, and in February you didn't jump on it.

You weren't testing in the community. You didn't have all the PCR machines activated to do those tests. Some places listen today what was being said in January and did those things. And some did not. There are also a lot of things we could have done in terms of innovation way before the epidemic showed up.

And when we finally go back through this thing we'll say why the modest number of billions that would have given us quick diagnostics, quick Antivirals and Antibodies, quick vaccines, why didn't we make those investments? But now we have. We've suffered this in the U.S. in particular this unbelievable tragedy, and we don't get to go back and fix, you know, January and February. But we just need to take now this desire to open up and say, okay, how do you build the testing system that will minimize the deaths that can come out of more liberal policies?

COOPER: In terms of the therapies and vaccines just in the last couple of days have had good news when it comes to treatment of the virus with Remdesivir, with some promise in trials? You said you suspect a treatment would need to be about 95 percent effective in order for things to go back to normal.

How achievable is that, do you think? What do you see when you think about vaccines and treatments?

GATES: Well, the therapeutics, you know, many of them look like they're a dead end. And the ones who look promising are pretty modest effects. You know, I don't think you're going to say, hey, you know, Remdesivir was 11 days versus 15 days for severe patients, let's go to the movies.

But every little bit helps, and you'll have combination therapies, and you'll figure out different ways of applying those things, so I think every month the therapy story, they'll have some good news. There are a lot of trials out in various countries. The list of things being tried is very long.

[21:25:00]

GATES: The one I'd have to say I'm the most optimistic about is taking antibodies and manufacturing those. You know, finding the best antibody that the human immune system has made, its affinity to the spike protein and getting it out enlarge numbers.

That has a chance of being very dramatic, like over 80 percent of patients avoid the disease. And that is moving full speed ahead. Our therapeutics accelerator just reserved pretty gigantic antibody factory to make sure we can pick the very best of all the antibodies and get it into that factory and make it available to those who need it very, very quickly.

COOPER: Bill, just stay with us. We're going to take a quick break. We're going to continue the conversation about the latest reporting and hope of a vaccine. We'll continue our conversation in a moment.

(COMMERCIAL BREAK)

COOPER: This is CNN's Global Town Hall. We've been speaking with Bill Gates Co-Chair of the Bill and Melinda Gates Foundation.

DR. GUPTA: We have more questions and Bill has been kind enough to stick around for a bit longer.

COOPER: So you have written in your paper that short of a miracle treatment which we can't count on the only way to return to the world to where it was before COVID-19 showed up is highly effective vaccine that prevents the disease?

[21:30:00]

COOPER: You then point out the typical development timeline for a vaccine is 5 years. We're talking to Dr. Anthony Fauci earlier, he was saying you know he can't guarantee it but he's hopeful of a vaccine perhaps as early as January. Is that realistic you think?

GATES: Well, when people keep saying, hey, you know, are you real betting against something really wonderful happening, you know, won't you let us think maybe it could happen sooner or sooner, nobody wants to spoil the party. And there's great progress on a vaccine.

I have to say the fact that Oxford, their monkey data their - Moderna made progress by an - Pfizer these companies are moving at full speed. They've totally prioritized this. Our vaccine team is working with them to say, okay, what can we do to help you making sure that the funders understand how to rank these various activities in terms of what's most promising to be cheap and scale?

But until you have a phase three plan that has the safety and efficacy plan approved by a regulator that's going to give the indemnification, that yes, we want to put this out to all these healthy people, until then you're just kind of speculating and nobody is near to writing that phase three plan and taking it to a gold standard regulator.

So the best case now is, you know, somewhere early next year you always have to be careful is the first unit to be manufactured or is that 100 million, 300 million, 7 billion you know so what volume are you talking about?

So some days trees are going to start faster than I expected. The RNA approach which we've been backing for over a decade, there are three of those that are all progressing. Thank goodness we also have some non-RNA approaches because we've never had approved RNA vaccine.

So think like the Novavax the Johnson & Johnson and JSK those also are very promising. So, yes, it's exciting. But the idea of being pressed to give a date, you know, I try and say the same thing Dr. Fauci is because he and I are looking at the same data, and we want to let people know it's quite a range of possibilities.

DR. GUPTA: Dr. Fauci is always being pinned down on these things because like you said people want to hear some optimistic news. It's interesting as well with that Oxford study as you know, Bill, they are planning on having 6,000 people enrolled by the end of May, which is some sort of land speed record.

They tested this - you may know this, Anderson, but they had a bunch of monkeys, they exposed the monkeys to the virus and all the monkeys got infected. Then they vaccinated six monkeys and none of those monkeys became infected. So really small but promising although they say as you know mice lie and monkeys exaggerate.

That's a saying in medicine. Do you think that there might be several different types of vaccines that could then come out? We think about the different types that are being tested, but might we have several different that are offered at some point?

GATES: We need to back enough that the chance of success is very high. Most vaccines don't succeed. The HIV vaccine is the most famous in our foundation and the U.S. government is the two big founders there, and it will happen, but it's taken a long, long time and still tough.

HIV is a much, much tougher target than Coronavirus is. Coronavirus is a bit of an unknown target and in the next few months we'll understand the natural immune response so much better because we're doing the blood plasma, hyper immune Globulin work and that's informing the antibody work and that's informing the vaccine work.

So in the next 60 days we will know a lot more about immune response including a weird phenomena where vaccines sometimes can cause a problem. We'll start to get a sense of that antibody dependent enhancement if that's a problem for some of these constructs.

So the fact we have a lot and will pick the best one to build factories in parallel I'd say that's going very well. And the regulator in the U.K. case the MHRA allowed Oxford to go ahead faster than I expected they would. So that is going to help with the schedule.

COOPER: You talked about the immune response. Do you - do we know or do we know when we'll know about immunity, if antibodies equal immunity?

GATES: Yes, in a few months this idea of, okay, the asymptomatic what's the range there? The mild disease what's the range there? You know, how does that correlate with age or conditions?

[21:35:00]

GATES: In the work we're doing where we're getting recovered patients to donate blood, now we're going to go find some asymptomatic cells to get them to donate blood, and we're looking to concentrate it down to this Hyper immune Globulin.

As part of that, that industry does a really good job of qualitative immune measurement. There's another doing some t-cell side measurement. But, yes, that is one of the unknown that will finally be known in a few months.

DR. GUPTA: Yes, I think it's really important I think what you're saying is that not all antibodies are the same. You could find some particularly good antibodies, stick them in a test tube with the virus and see if they neutralize the virus in effect.

Right before the break I think you were talking about the idea - I think you were sort of referencing Monoclonal Antibodies finding some of these super antibodies, and then essentially cloning them and turning them into a medicine. Is that right?

GATES: Sorry, the word antibodies comes up in multiple context, but when I was talking about manufacturing, yes, that's monoclonal antibodies and that's the factory foundation therapeutic accelerator group reserved in massive capacity.

COOPER: You just mentioned the company Moderna and you mentioned them the last time we spoke, their development of a vaccine with your foundation helping fund. Can you give us a status update on that since they have now begun human trials and received I think 43 million in Federal funding?

GATES: Yes, backed them as they have several others and they went into humans in March. You really would like to wait the three months to see what the immune response is? You're doing dose ranging, and one of the challenges Moderna is scale. If the doze is 250 micrograms, then their factory can make a tenth as much is it the doze is 25 microgram.

So in the phase one they're doing some dose ranging work and then they'll see how that connects to the antibody response. So if they're lower dose even in elderly people shows a very strong response that would be good news.

If the lower dose kind of has no effect and you have to go all the way to that 250 then either you're going to have build a miracle factory or you're going to have to have many of these vaccine constructs, because getting that up to even a billion would take way too long.

DR. GUPTA: But overall when you compare these RNA or DNA vaccines are they overall, though, easier to manufacturer than the traditional vaccine? Typically people think of a little bit of a virus used to make a vaccine or little bit of an inactivated virus to make a vaccine. Are these DNA or RNA vaccines going to be easier to manufacture despite the dosage?

GATES: Eventually, yes but because they're not mature. The issue of not only making the RNA, how you make the lipid that they're inside? You caught the RNA vaccine field it didn't get the massive funding if we want to be ready for a pandemic that it probably would have?

So we've never gone through this. Five years from now we would have been further along. So even though conceptually their manufacturing job is easier because there are first things here about the lipid and the dosing, there are manufacturing challenges also very large.

There's almost none of these construct that don't have some problem, but, hey, we're here to solve problems. This is the most important tool, the most urgent tool mankind has to invent.

DR. GUPTA: Yes, I mean that's why we're spending so much time talking about vaccines. Once we get to that point there's 7 billion roughly people on the planet, so how should these big decisions get made such as who should get the vaccine first? When mass vaccinations could begin?

You know, paying for it all. And you know we talked about this, Bill, and there's still anti-vaccine sentiment out there as well which is hard to believe considering what we're going through but what about these big questions in terms of who and paying for it and when?

GATES: If the vaccine is reasonably effective you won't have to get 100 percent coverage. This term herd immunity which is overused because it only matters when you have high percentage, like over half the population can't be part of the transmission chain.

If you vaccinate, you know, 80 percent of the population and the vaccine is highly effective, say 90 percent effective, then you can't get exponential spread. You know, and so then you're in the wonderful situation that you can think of the world like you did before Coronavirus came along.

[21:40:00]

GATES: The forum where that was created after World War II to discuss global health issues is the W.H.O. and that's you know all the countries belong to that and they sit and they discuss and they come up with policies that have to do with quarantine and health checks and things that nature.

So they'll be involved and there's a group of funders that are thinking, okay, how do we fund this even for poorer countries, the developing world? They're coming together and talking about W.H.O. you know - will help which - for poor countries will help.

The U.S. hasn't shown up in that dialogue yet, but I'm very optimistic given the history of the U.S. involvement in global health like Malaria and HIV that Congress will choose they have to show up and contribute and help coordinate and make sure this is run the right way because the U.S. has the skills when they're activated.

DR. GUPTA: Are you suggesting that poorer countries or countries with, you know, more disenfranchised health care systems should be earlier on the list, you know, if we're going to rollout vaccines, ultimately enough for who needs it or who should get it, should those countries be earlier?

GATES: It's going to be very tough because you're going to have the countries that finance the work. You're going to have the countries where the trial was done. You're going to have the countries where there's the highest infectious rate because social isolation doesn't work there.

And under those W.H.O. auspices, you know, lots of discussions will take place and hopefully the U.S. is there at the table helping those decisions be made in a smart way. It's all module to how constrained the manufacturing is.

If you can make 500 million doses in a month you're going to be very limited by - which we're working on that the final stage of the manufacturing and just getting the distribution networks out there. If you can only make, say, 50 million a month of all the successful vaccines, then you're going to have one of the toughest prioritization problems ever, and that's up to regulators and governments, and, you know, the U.S. can be part of that discussion.

COOPER: You talk - you mentioned herd immunity. I'm wondering when you look at what's the path that Sweden has taken, and then you look at, you know, their caseload, their death toll compared to Denmark, Norway, other countries in that region.

I'm wondering what you make of the way they're going about it. Are there lessons in there? Is it as black and white as it appears or it seems like if their health care system is able to keep up with the caseload are they just experiencing things in a shorter truncated time that we are going to ultimately experience?

GATES: Well, if you look at different countries got different levels of exposure at different times. For example Germany has done things well, but they did have the benefit they saw Italy being overwhelmed, and their exposure came after Italy so they were able to respond.

But now the exposure in Sweden and Germany were about at the same time. If you look at the - which is a group that we fund, if you look at their forecast. If you look at the death rate in Sweden versus Germany that they forecast it's way higher up in Sweden.

And so, you know, somebody can decide, a politician, if that's what really happens was it worth it. You know, that's what this is all about is if you open activity "X," you know, are you willing to accept a somewhat higher health burden because of that?

Sweden they made their decision. They seem happy with their decision, but they are forecast to have substantially higher death rate than most other countries.

COOPER: One of the things in your paper that I thought was particularly interesting were the things we need to learn about the virus. Like if it is weather dependent how many people never get symptoms but are contagious? What symptoms mean you should get tested? I mean, there's so much we still don't know about this.

GATES: Yes, there are many countries where the epidemic is not nearly as intense as we would expect, and so is it just a delayed effect? Is there something about the vaccines they get in their youth? People think this BCG vaccine might be helpful thing.

We don't know, so we have to assume it's going to be as bad in all those countries. You know, on the Southern Hemisphere you have Brazil, Australia, South Africa have cases so they're not completely immune even though the force of infection may be less.

[21:45:00]

DR. GUPTA: You famously talked about preparing for a pandemic, anticipating one several years ago. I think you gave a Ted Talk about this. You and I have talked about your concerns about a pandemic, flu in particular but you can talk about this in the same way.

I'm curious if we did everything we could to prepare for a pandemic, as a country or world we did everything we could, could we be prepared? I mean, is there a price tag on that? Is it possible, or is there more sort of like a weather event that, you know, we can predict but can't completely mitigate against?

GATES: Well, we've seen even without that preparation, if you use January and February properly and did community testing, you didn't have to go through this, you know, horrific economic cause.

Yes, we pour tens of billions a year and I was very specific in the New England Journal Medicine article, these tools can be developed enough that an epidemic like this one could have been stopped at very small numbers.

You know, the Chinese were able to stop it at fairly small numbers even though they were country number one. Now they use very stringent measures. But for something that's not even 5 percent of the defense budget, below that you can have pandemic preparedness, innovation, stockpiles, simulation that at least for this threat would have been overwhelmingly successful.

COOPER: At the end of your paper you compare the pandemic to World War II is a generational defining moment that no one lives through will ever forget it. What do you think it would be most remembered about this pandemic? And how do you think it may change - you know, if everybody is generationally affected by it, how do you think it may change things, society?

GATES: Well, there are huge negatives and World War II was incredibly bad, and yet out of it came institutions where we haven't had a war of that type ever since then. And so there was this constructive response that, you know, I think humanity should be very proud of that record.

Here I think if nations are willing to come together and say, okay, you know, this was a problem for all of us, what mutually should we be doing this time forward? There's a blueprint that I and others wrote down about the types of things that should be done that will take place.

How much we would have changed our behavior you know that accelerates digitization now when you look at TV shows and people say wow they're shaking hands, I guess this movie was made not this year.

So we are getting used to different norms. Business trips and going to conventions, you know, will that be reduced by a significant amount once we get out of this? And it's the younger generation and the way they react to this that will really shape why it's a defining event.

COOPER: Bill Gates as always, thank you so much. It's really fascinating to just talk to you. Really appreciate it.

DR. GUPTA: Thank you.

GATES: Thank you.

COOPER: Up next a very special personal moment of hope which is an announcement and a welcome. We'll be right back.

[21:50:00]

(COMMERCIAL BREAK)

COOPER: It's been a difficult time in all of our lives and there are certainly many hard days ahead. It is I think especially important in these times of trouble to try to hold on to moments of joy and moments of happiness.

I mean, as we mourn the loss loved ones were also blessed with new life and new love. So, I just wanted to take a moment to share with you some joyful new of my own. On Monday I became a father. I've never actually said that before out loud and it still kind of astonishes me.

I am a dad. I have a son, and I want you to meet him. This is Wyatt Cooper. He's three days old. He's named after my dad who died when I was 10-years-old. I hope I can be as good dad as he was. My son's middle name is Morgan which is a family name on my mom's side.

I know my mom and dad like the name Morgan because while I was going through their things recently I found a list they made 52 years ago when they were trying think of a name for me. Morgan was on the list.

So that's Wyatt Morgan Cooper, my son. He was - he was 7.2 pounds at birth, and he is sweet and soft and healthy, and I am beyond happy. As a gay kid, I never thought it would be possible to have a child, and I'm so grateful for all those who paved the way and for the doctors and nurses and everyone involved in my son's birth.

Most of all, I am eternally grateful to a remarkable surrogate who carried Wyatt, watched over him, lovingly, tenderly and gave birth to him. It's an extraordinary blessing which she and all surrogates give to families who can't have children.

My surrogate has a beautiful family of her own, amazing supportive husband. I'm also so thankful for all the support that they have given Wyatt and me. She has kids of her own. And I appreciate their support as well.

My family is blessed to have this family in our lives. I do wish my mom and dad and brother were alive to meet Wyatt, but I like to believe that think they can see him. I imagine them all around each other smiling and laughing and watching, looking down on us happy to know that their love is alive in me and in Wyatt and that our family continues a new life and new love. Back with me and Sanjay.

DR. GUPTA: Anderson--

COOPER: I told Sanjay a couple of days ago.

DR. GUPTA: Yes, I've been bursting at the scenes. I can't believe I kept this secret. I told you - I called Anderson right away and just - I'm so, so happy for you. I am just - I'm thrilled for you. I don't know how you just got through what you just read. I was looking for the Kleenex here.

[21:55:00]

DR. GUPTA: But I'm really happy for you. You know Anderson as well I like to give gifts. You got the mask from Selay. So I actually went out and bought something for Wyatt. Here it is. Yep. Look at that not that he's not going to watch TV and know what his dad does for a living but this is a very nice, soft CNN Satellite Truck. I don't think they have Satellite Trucks anymore. But this is it. COOPER: They do have satellite trucks.

DR. GUPTA: I'm going to send that to Wyatt. It will be from Uncle Sanjay.

COOPER: Thank you.

DR. GUPTA: Make sure to tell him it's from Uncle Sanjay.

COOPER: I will.

DR. GUPTA: I'll wipe it down before I send it. Don't worry.

COOPER: Okay. Yes, I'll probably going to be calling you up for some parenting advice and how to deal with? I've done the diapers and it's - it's an interesting process. Not what I expected.

DR. GUPTA: You're going to be a great dad, Anderson. I'm just so - you're going to be an amazing dad. I'm just so happy for you.

COOPER: I've got a lot of good people in my life, so I hope so. Sanjay thanks. We'll be right back.

(COMMERCIAL BREAK)

DR. GUPTA: Welcome back to our Town Hall. In case you haven't heard, Anderson Cooper is a father. Congratulations again.

COOPER: Thanks, thanks.

DR. GUPTA: A lot of you at home have been writing us and asking about how you can help. You can find out by going to cnn.com/coronavirus you get a lot of information there.

END