Back society, the way to do that is to put women straight at the center, because guess what. Theyre already at the center. With a pandemic still raging and concerns it will get worse before it gets bter, what does philanthropist Melinda Gates say now . Firing line with Margaret Hoover is made possible in part by. Corporate funding is provided by. Welcome to firing line, Melinda Gates. Hanks for having me, margaret. You cofoundethe bill and Melinda Gates foundationo cades ago, and since then your foundation has worked to fight global poverty and to combat infectious disease, including hiv, tuberculosis, malaria, ebola. And noyou have committed more than 300 million to fight the covid19 pandemic. My question just to start is, your work is so often focused on global health. Co d you have imagined that you would be battling a pandemic so close to home . No, theres no chancewe that we thoughould have a pandemic, you know, and that part of the start of it was here in seate. So, no, this has been quite a surprise to us. We knew eventually there would be some pandemic, but we certainly didnt think it was going to be of this magnitude and scale at this time. Nobody could have predicted that. Well, were at the sixmonth anniversary of the first known case of covid19 in the United States from january 20th. And right at this moment, covid19 cases are spiking dramatically in a majority of states. A few months ago, did you think we would be back to square one . No, i think we all thght just listening to the data and looking at the disease modeling, that we would have aeve here during the summer. But, you know, i thi its been especially challenging because we dont have a national testingrogram with appropriate testing, contact tracing, isolation and quarantine. And so i think its gotten much more diffult that people are going out more and not doing the appropriate social distancing and masks. And so we e almost already in a second wave that really until this fall. To happen and you think this is a second wave rather thathe continuation of the first wave spreading through different states . Its hardo say, quite honestly, but, you know, even in some placese where weready had covid, you know, we are srting to see a rise again. And so really, it doesnt matter what you call it. We eed to dwhat we know works, which is we need practice safe social distancing and Wearing Masks and staying home as much as we possibly can. Well, so your foundation is working on a lot of difrent areas to fight the virus from vaccines to therapeutics, oviding protection to lowIncome Countries. You in particular, though, are focused on a group of people that you warn is being left behind, and thats women. W noknow looking at the data that covid19 actually kills more men than women. So ell us why youre so concerned about women being left behind. Well, because we know that covid is not oy wreaking havoc on our health and our bodies, but its also exposing the fault lines in society. Its having a profound effect on the poor, on women, on people of color. And so we need to look t se issues and figure out at do we do about it. Women are losing their job at a faster rate than men are. Women are the ones often who ari at home for the elderly, trying to help the child continue to arn online or taking care of the young and trying to get on the bus and go to their job. I mean, its just its its almost impossible what were asking women s time. Uring t and so we need to look at that. So youve just publisheda per in foreign affairs. Its title is the pandemics toll on women, and itls the silent to that the epidemic d pandemics generally have on women. You write. Explain. How do you know this . Ol well, we know from the epidemic when it hit in the four affected countriesaf in wesca, you had a silent pandemic that tracked right along with it, and that was maternal deaths. And when you get more maternal deaths, you also get more childhood deaths. And so there a things we can do to keep that system up and running. E, a perft exam not very expensive, n t in ethiopia, they said, okay, we know woe going to have more trouble now coming to the Health System to deliver babies. So theyre sending home clean birth kits so that if you give birth in your village with a midwife, you have a very inexpensive but clean home birth kit. We know those save lives. S you can alsoay, hey, ambulances arevi an essential s. Some countries are saying if you cant get to a hospital by ambulance, we will instead provide a subsidy r your transport. That makes a huge difference in terms of saving a wons life. And you say that one of the solutions is to consider repructive healthcare an essential service. In other words, changing the classification to reproductive healcare as an essentiaservice will also help save lives. Absolutely. Otherwise, aga, we know from the ebola crisis, you get many, many more millione nintended pregnancies. Women will tell you all ov the world, if they can time and space their pregnancies, they are healthier and their children are more likely to be healthy and to stay safe. Youve written extensively in your book the moment of lift, an the Washington Post and other places about the unpaid work burd placed on women, that covid19 exacerbates in low and middle Income Countries bualso in the united state as well. You say even though most women now workll ime outside the home, they still spend two hours or more each day on household tasks and caregiving. 10 theyrimes more likely to stay at home with their sick children, esd theyre nearly three t as likely as fathers to quit their jobs and take care of their familiesh how do ye the data thats showing that covid is increasing this trend . Well, im glad you asked that because data is fundamental. We have to be able to collect data to actually speak the tth and then know where to invest. But there are states, luckily in the United States that collect sex disaggregated ta so we can actually look at it. We, as a foundation with many partners, have finally been investing in data in low and middle Income Countries. Soe can actually collect this Economic Data from women and we can look at it and see exactly what the tree. On the flip side, then to make investments. That is smart policy. How is your fndation working to influence or mitigate some of the effects of the disparities against women in the covid19 pandemic . Well, we are both trying to call out, as im doing here, what the issues are. Were talking to governments about smart policies. El as i think youve seen me use in the United States my voice against paid family medical leave. Were the only country, the only industrlized country in the world that doesnt have it. And if you want a woman to be able to care for a sick loved one or letsay she gets covid and shes an essential worker, she needs to stay home for 14 days to take caref herself and to keep others around her safe. You ve to have the right policies to take care of that. You also write. Now, in a normal year, schos would be opening within the next couple of weeks, but many schools may not be reopening and theyre g back their plans to reopen all over the country. What does this mean for gender equity . Its concerning. Its deeply concerning because if a woman cant see that her kids are cared for, she has no one to leave tm with, how can she get on the bus and go to that job . Or how can she make sure who are elderly,r father, are being cared for while shes caring for children red trying to keep a job . We have to make that were not setting women back during this covid crisis. And thats why we need to have sensible government policy and good stimus packages. You know, its so interestin abis virus, how where were learning about it in real time. And early on,ha we thoughtchildren were vectors of this virus and that they were the ones who arsilently spreading covid19. And that thinking is changing a bit. Youve seen denmark and finlande reopen schools without major spikes in covid1n their populations. And so how do you think about and how shoulde think about as a as a country, a reopening and a retu to school, but then balancing that against what is a very real spike in cases across this country . Well, i think you see the countries that are opening their schools have a declining epidemic. They have done sensible polici early on where people actually stayed home,t and so they a declining epidemic. Then theyre opening very slowly and carefully and safely. And i think what you need to do is to look at your epidemic and follow t science, but foow the measurements in your own county. This is local Health Commissioners have twork with governors and mayors to make wise deciss there will be places in the is slowly going down,he epidemic where it probably you can safely reopen the schools a keep measuring and watching. There are other places where esure having a spike in c you have a spike in cases, a rising epidemic thatsising quickly and overrunning the health care system, thats not a time to reopen your schools, decisions on a local basis with really good data. And yet weve seen again and again, i will tell you, we have had mayors,go we have harnors on this program where you see they are not coordinating. Does it seem to u that there is a deficiency in coordinationl at every lf government or are there places that are doing it right . There are some stes that i would say are doing it right and doing it right between the governors and the mayors and the Health Commissioners. Look, i think, first of all, we have to say this is difficult. You said it right to begin with, which we are learning new information almost every single dayis about thandemic, how it spreads, where it spreads, what we should do. We dont have all the tools yet. So it does take incredible coordination. Of crse, the United States would have helped if we had used our cdc properly. The cdc was set up for exactly this type of situation the cdc was set up originally to give guidance local health departments. So if wed had a coordinated response fm top to bottom, what would have happened was we would have done appropriate testing very quickly c inrdinated way. You would have done isolation until you got the resultsnt of your test, t tracing, and quarantining. I think whent doesnt come together at the top, its very difficult to have it come from the bottom up or the middle down. And so thats the situatn the United States is in, unfortunately. And its why were seeing overwhelmed Health Systems that just shouldnt be overwhelmed at this stage of this pandemic. Listen, moving on to how were going to tackle this,of and onhe areas that you all have invested heavily in is a vaccine. And i want to ask you, is it your view that a vaccine is ultimately the only way out of this crisisw l, i think a vaccine would be the quickest way out of this crisis. That is, if canet a vaccine that is obviously safe and efficacious. I do think a medicine would help as well. Ci if we had a me that as soon as you got the disease, it helped tamp it down very, very quickly. That would certainly help. But i think probably ultimately the safest tool orhe quickest tool is going to be a vaccine. But, you know, both routes are being tried. We and many, many, many othersin arsting in both paths. You have to in many, many vacci candidates and many medicine candidates to see which ones, you know, are sa and efficacious. So help us understand. I mean, the New York Times points out that the record timing for the creation of a vaccine from scratch was with the mumps, and it took four years. Why is there so much optimism that, in the conte of this covid19 pandemic, were going to beat that rord . Well, its the first time youve seen global coordination over vaccine at the scale were seeing it. And normally you do, you know, the vaccine testing, all the various stag and phases and trials, which still need to be done,he and thenyou have a candidate that you know is going to work, then you start investing this time its being done in parallel. And theres so much funding going into multiple routes of a vaccine and multiple paths for manufacturing up front, some of which will be dead ends. But youre seeing so much money flow so quickly and so much global coordination. I think thats what gives people optimism. So prident trump recently predicted that a vaccine or an effective drug would be here long before the end of the year. So if everything goes right, what is the soonest you think at we could ha a vaccine just an efficacious vaccine, maybe not scaled, but just thave one . More than likely early next year, first half of next year. I think thats probably our very best case. Thats the hopeful case. You kw, you getac an effus vaccine, but then there are it up to scaling io ramping what are some of the challenges to the production and the distributi that have to be thought through . Well, you have to have the biorctors to produce the vaccine and to produce it at scale. And then luckily, in most highIncome Countries, we actually ha very good supply chains. And then middleIncome Countries have their supply ain issues. LowIncome Countriesly also have suhain issues, but we have a global coordinated effort. Al itsd gavi, the alliance for vaccines and immunizations. Beuse of that system, we do know how to get vaccines out to all corners of the earth. The thing that we need to do that the Global Leadersed o do is to ensure first that healthcare workers get this vaccine, and there are more than 60 million healthcare workers around the world. Theyre the ones who arear takingof the rest of us. Theyre the ones who are going make sure, okay, we help stop this disease. People are taken care of and it doesnt keep spreading. So first you have to go there and then each country needs to look at their most vulnerable populations and figure out how to get the vaccine out to their vulnerable populaons next. We aevelop a vaccine, once we have one, i presume how should governments figure. Out, after healthcare workers, who ge it first . I think in place by place,un country after y, governments need to lookhe at t most vulnerable populations. They need to see whos being affected the most, and th need to make sure that they get the vaccine out to those people the most quickly. So theres a Biotech Company you are well aware of, moderna, which is based in cambridge, massachusetts, and it is working on an mrna vaccine. And early trials show that it is safe and effective. The an early funder of moder back when you backed hiv therapies as well as a zika vaccine. Are you working on theird co vaccine as well . Were working on nine different vaccines with covid, mas. Of them, whics you most hopeful . You know, its hard to say. Different data comes out in different weeks. And so there are, again, of these nine candidates were looking at, there are three or four that look que promising. Obviously, i cant talk about as the data comes , you know, science is looking at it and papers are being published. Y an know, all of that keeps moving forward. The trump admintration support vaccine developmt and they call it operation warp speed. They have spent half a bilon on moderna, half a billion on johnson johnson, 1. 2 billion on oxfords astrazena. Id like to talk to you aboute ght role of philanthropy versus public dollars in the context of the race to develop a vaccine. At is the most effective balance between public and private dollarsin for thisof innovation . Well, i think one of the things we have to realize is in the United States, we are lucky in the sense that the government is willing to put in largescale research money, and thats appropriate. Thats how many vaccines have come forward before european governments as well put in research money. Th i thinrole for philanthropy, though, is to make sure that this vaccine gets purchased the worst thing equitably. That could happen for the world is that the vaccine first goes out to the highest bidder. And so philanthropys role is to say we have global mechanisms for getting these vaccines a out safe efficaciously and to everybody. That would be gavi, the alliance for vaccines and immunization. E thalso another Global Coalition called the center for epidemic preparedness. It also has money flowing through it and Research Dollars and manufacturing dollars to again make sure we get a vaccine and that it doesnt go to the highe bidder but we get many, many millions of doses to cover the whole world. Om there arepeople who would sugges though, that for the highrisk, highreward portiondo of this, publiars probably shouldnt be spent. It probably should be private dollars, philanthropicollars, because if there are 100 trials going on, some of them are going to work, some of them arent. Should the publics money be spent on these highrisk prospects or is that a better use of philanthropic dolla . I think it is a very appropriate role for government and i think theres a role for philanthropic dollars. But look, no matter who the philanthropic dollars come from, theyre never of the scaleer of gent dollars. The role of philanthropy is to be catalytic. Yes, to take some risk where governments wont. But its to come alongside government a say, okay, these are other places that we should be taking risks and taking them on behal of everybody, not just for one country. So, this program is a revival of william f. Buckley jr. s firing line that a for 33 years from 1966 to 1999. D and buckley tabout this question about the federal dollarsnt versus phiopy and the role that philanthropy can play with william e. Simon, who is a was also a leadingcretary and philanthropist in his day. Id like you to ta t a look s clip and then ill ask you on the back side about the role of philanthropy. When Government Funds are used for philanthropic reasons, then they have to scrutinize everything, and to scrutinize ey have to write regulations, and they have to decide how youre going to give it, and thats the way it would go. And do we want government control over that area . I dont think so. Well, let me ask you this. Why is the iuilt assumption more money to philanthropy, it has to go from the people to washington to philanthropy . Isnt at a round trip that would seem to be unnecessary . Most definily unnecessary. And i think a dollar spent by govern