Thursday, April 30, 2020

Bill Gates and Pandemic I

Bill Gates has been front and centre during the current pandemic.  Media outlets, Ellen DegeneresStephen Colbert and many others have been lining up to hear Dr. Gates MD pontificate on the COVID-19 pandemic and, in particular, the development of a vaccine as a "cure for the sweaty masses".  One Gates-related item caught my eye; GatesNotes, Bill Gates personal blog.  Let's look at what he had to say about the current pandemic.

Here is a screen capture showing the key posting:

Here is his introduction noting that bolds throughout are mine:

"The coronavirus pandemic pits all of humanity against the virus. The damage to health, wealth, and well-being has already been enormous. This is like a world war, except in this case, we’re all on the same side. Everyone can work together to learn about the disease and develop tools to fight it. I see global innovation as the key to limiting the damage. This includes innovations in testing, treatments, vaccines, and policies to limit the spread while minimizing the damage to economies and well-being. 

This memo shares my view of the situation and how we can accelerate these innovations.  The situation changes every day, there is a lot of information available—much of it contradictory—and it can be hard to make sense of all the proposals and ideas you may hear about. It can also sound like we have all the scientific advances needed to re-open the economy, but in fact we do not. Although some of what’s below gets fairly technical, I hope it helps people make sense of what is happening, understand the innovations we still need, and make informed decisions about dealing with the pandemic."

Gates then goes on to explain how important it was to reduce the R0 (R naught) or reproduction rate of the SARS-CoV-2 virus in order to prevent exponential growth in the number of infected persons.  The solution was the current civil-rights crushing, government imposed lockdown of society in what can only be described as one of the world's largest social experiments.

He then proceeds to outline the economic costs of the current pandemic:

"The economic cost that has been paid to reduce the infection rate is unprecedented. The drop in employment is faster than anything we have ever experienced. Entire sectors of the economy are shut down. It is important to realize that this is not just the result of government policies restricting activities. When people hear that an infectious disease is spreading widely, they change their behavior. There was never a choice to have the strong economy of 2019 in 2020.

Most people would have chosen not to go to work or restaurants or take trips, to avoid getting infected or infecting older people in their household. The government requirements made sure that enough people changed their behavior to get the reproduction rate below 1.0, which is necessary to then have the opportunity to resume some activities."

This is pretty easy to say when you are ensconced in your 66,000 square foot waterfront home, counting your massive financial holdings:

Het then goes on to discuss the role of the Gates Foundation in the pandemic and in the control of infectious diseases as a whole:

"In normal times, the Gates Foundation puts more than half of its resources into reducing deaths from infectious diseases....

Now that the epidemic has hit, we are applying our expertise to finding the best ideas in each area and making sure they move ahead at full speed. There are many efforts going on. More than 100 groups are doing work on treatments and another 100 on vaccines. We are funding a subset of these but tracking all of them closely. It is key to look at each project to see not only its chance of working but also the odds that it can be scaled up to help the entire world.

One urgent activity is to raise money for developing new tools. I think of this as the billions we need to spend so we can save trillions. Every additional month that it takes to get the vaccine is a month when the economy cannot return to normal. However, it isn’t clear how countries will come together to coordinate the funding. Some could go directly to the private sector but demand that their citizens get priority. There is a lot of discussion among governments, the World Health Organization, the private sector, and our foundation about how to organize these efforts."

Rather than even mentioning the concept of herd immunity, Gates outlines potential treatments, all involving the efforts of "Big Pharma", most particularly the development of a vaccine:

"Short of a miracle treatment, which we can't count on, the only way to return the world to where it was before COVID-19 showed up is a highly effective vaccine that prevents the disease…

Researchers can save time by compressing the clinical safety/efficacy phases while conducting animal tests and building manufacturing capacity in parallel. Even so, no one knows in advance which vaccine approach will work, so a number of them need to be funded so they can advance at full speed. Many of the vaccine approaches will fail because they won’t generate a strong enough immune response to provide protection. Scientists will get a sense of this within three months of testing a given vaccine in humans by looking at the antibody generation. Of particular interest is whether the vaccine will protect older people, whose immune systems don’t respond as well to vaccines.

The issue of safety is obviously very important. Regulators are very stringent about safety, to avoid side effects and also to protect the reputation of vaccines broadly, since if one has significant problems, people will become more hesitant to take any vaccines. Regulators worldwide will have to work together to decide how large the safety database needs to be to approve a COVID-19 vaccine…

An RNA vaccine is significantly different from a conventional vaccine. A flu shot, for example, contains bits of the flu virus that your body’s immune system learns to attack. This is what gives you immunity. With an RNA vaccine, rather than injecting fragments of the virus, you give the body the genetic code needed to produce lots of copies of these fragments. When the immune system sees the viral fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit

A big challenge for vaccine trials is that the time required for the trials depends on finding trial locations where the rate of infection is fairly high. While you are setting up the trial site and getting regulatory approval, the infection rate in that location could go down. And trials have to involve a surprisingly large number of people. For example, suppose the expected rate of infection is 1 percent per year and you want to run a trial where you would expect 50 people to be infected without the vaccine. To get a result in six months the trial would need 10,000 people in it.

The goal is to pick the one or two best vaccine constructs and vaccinate the entire world—that’s 7 billion doses if it is a single-dose vaccine, and 14 billion if it is a two-dose vaccine. The world will be in a rush to get them, so the scale of the manufacturing will be unprecedented and will probably have to involve multiple companies…"

I believe that's enough of Bill Gates' musings for this posting.  Let's close with this summary which has a very interesting and perhaps prophetical comment, noting that he completely ignores the 1957 and 1968 influenza pandemics:

"Melinda and I grew up learning that World War II was the defining moment of our parents’ generation. In a similar way, the COVID-19 pandemic—the first modern pandemic—will define this era. No one who lives through Pandemic I will ever forget it. And it is impossible to overstate the pain that people are feeling now and will continue to feel for years to come...

At the same time, we are impressed with how the world is coming together to fight this fight. Every day, we talk to scientists at universities and small companies, CEOs of pharmaceutical companies, or heads of government to make sure that the new tools I’ve discussed become available as soon as possible. And there are so many heroes to admire right now, including the health workers on the front line. When the world eventually declares Pandemic I over, we will have all of them to thank for it."

Thank goodness that the Gates family foundation is there to ensure our healthy futures as the human race anticipates Pandemic II, Pandemic III, Pandemic IV etcetera ad nauseam.  One might be almost be forgiven for thinking that Bill Gates is looking forward to his indispensable advice as a world-leading epidemiologist and vaccinologist when future pandemics lay waste to humanity.

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