‘For the next pandemic, we’ll have gigantic mRNA factories in India’

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Bill Gates, co-chair of the Bill & Melinda Gates Foundation, says the Delta variant will make it difficult for the world to end the pandemic by 2022, missing his last year’s estimate. In a telephone interview to TOI+, Gates spoke on a range of issues, from vaccinating the elderly to creating factory capacities large enough to supply vaccines for the entire world within 200 days. Excerpts:
Last year, you talked about the possibility of ending the coronavirus pandemic by 2022. Do you still think it’s possible?
Everyone has been surprised by the Delta variant and how transmissive it is. India was the first place where there was, tragically, explosive growth in cases. The number of cases has come down from that peak, but we have to get these vaccines out far more broadly than we have done so far.
The foundation is very proud that back in the spring of 2020 we got $300 million to Serum (Institute of India). Serum has executed very well on ramping up the volume, making really record numbers of vaccines. Now, we wish we’d have even more, but in the months ahead the numbers are going to go up quite a bit. Novavax will come into the picture. We’ll have Johnson & Johnson. We’ll figure out what can be done with the booster. We’re not quite sure about that right now, but that’s probably beneficial as we get into 2022.
I’d say Delta was the worst variant that anyone ever expected, and so we probably will have cases into part of 2022, and the importance of getting the vaccine coverage up, very high, is even more clear now. My prediction, based on Delta, is that we’ll miss that goal somewhat.

In this year’s Goalkeepers Report you highlight the innovations that Covid-19 has triggered. Which are the ones that hold potential?
Now that the world understands its vulnerability to a pandemic, there will be a huge amount of research and invention of new tools. The diagnostics – we could scale that up much faster. The therapeutics we could do a lot better. We should have a goal that we have so much factory capacity that, even within 200 days, we could make enough vaccines for the entire world.
Will this work, to be ready for the next pandemic, and will it have benefits beyond the pandemic preparedness? The answer is absolutely yes. The mRNA platform, we’re working with that German company, BioNTech, to do an HIV vaccine using their mRNA technology. We have a malaria vaccine. We think that we can do a very low-cost flu vaccine and bring the worldwide level of flu down dramatically.
Ideally, we would eradicate some of these respiratory viruses because they actually create quite a significant health burden even in normal years, and of course, they can mutate into a form that could cause the next pandemic. I’m hoping that all countries will increase their research in these areas. We’re working with the United States, Europe and the UK on increasing their research budgets. I would hope that India would join in that as well.
What is your view about the way vaccine-making has progressed in India?
Most low-cost vaccines in the world are made in India, and that has saved literally millions of lives because of the partnership we have with those three companies (Serum, BioE, Bharat Biotech). It’s kind of natural that, in the spring of 2020, as the pandemic came along, we talked with Serum about both AstraZeneca and Novavax, and we hoped that they’d do a great job making AstraZeneca, and they will be making Novavax.
Likewise, BioE – we’ve facilitated their discussions with Johnson & Johnson. We’re looking forward to that production coming out, either late this year or early next year… Bharat Biotech took the coronavirus vaccine, it’s invented in India, with ICMR, and brought that up as a low-cost vaccine, not only for India but for the entire world.
Over the years, Gates Foundation has partnered with the government of India and with Indian vaccine manufacturers in the development of affordable, high-quality vaccines – for India and for the rest of the world. It is encouraging to see India step up during the Covid-19 pandemic and develop safe and cost-effective vaccines that will save millions of lives.
What should be done to fix the problem in India’s healthcare system in the short term and what are the long-term steps?
India should invest even more in its primary healthcare system to make sure that primary healthcare centres are well-staffed, the people are well trained.
Overall, the health conditions in India over the last decade have improved. We’ve got vaccine coverage up. We’re not as high as we should be. We’ve got the birth attendant quality – delivering in a facility – we’ve got those numbers up, and so maternal-infant mortality has gone down.
Our foundation has focused in particular on Bihar and Uttar Pradesh for health in general. When it came to building oxygen centres for Covid, and special interventions for Covid, we were able to draw on the strong relationships we had in participating there. Although the pandemic is tragic, it highlights the importance of primary healthcare with the need to invest more, both financially and in the quality of primary healthcare.
If you look at the overall spending on primary healthcare, it has not gone up as much as it should. India is a democracy and there will be a debate about that as an increased priority.
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The challenge has changed from vaccine availability to vaccine hesitancy. How can governments address it more effectively?
Politicians are speaking out clearly and then setting examples by getting vaccinated themselves, and constantly repeating that message, and making sure that the trust networks – whether it’s religious leaders or people in villages that people look up to and trust – are always delivering positive messages, and whatever negative rumour comes out doesn’t fester on social media in such a way that people are worried.
Every country has had vaccine hesitancy. I’m not that expert on India, but if I look at the numbers, some of the numbers look good. Do we get to 100% of healthcare workers? I’m told that it’s about 70% right now.
The people who are the priority, of course, are the elderly, and I guess, in India, about 65% got their first dose. We should pick that up to 100% for the second dose. The benefit of the vaccine to the elderly is very, very high, and that’s how you get your deaths down. The leadership on the positive message about the vaccine, from what I know, has been quite good in India. It hasn’t turned into one party likes it and another party doesn’t like it.
This is a case where the US has not done the best job, but every country has to really work on this every single day to get every percentage point increase. Right now, you’re not in a big wave but there could be a future wave. So, we have to maintain this as a super-high priority.

There’s a lot of vaccine wastage in several advanced economies. What should be done to prevent this and ensure global cooperation?
It’s been somewhat inequitable. We keep a spreadsheet of where all the doses of the world are, and where they should be given. We weren’t ready, the world wasn’t ready for this pandemic. And so, as we look back on Covax, where the foundation has been very involved, there are some lessons. We could have done some things better, but the key has been the supply, which no one was funding in the spring of 2020 other than the US government.
We got full cooperation between the Western inventors and the Indian manufacturers. The mRNA, sadly, is different enough that there was no capacity for that particular type of vaccine outside the rich countries. Even there, it was completely new.
For the next pandemic, we will make sure we have gigantic mRNA factories in India and the rest of the developing world to achieve our 100-day goal of being able to make vaccines for everyone.
The pandemic has also widened the digital divide. What are the solutions?
A lot of students should have access to at least a mobile phone. And some learning around maths and reading and writing can be done on the mobile phone.
Obviously, when the classroom shut down, in India, a lot of kids simply didn’t learn. And so, there’s a deficit there. Sadly, the education quality in India isn’t quite as strong as you’d like it to be. If I had to say what’s the other thing besides health that, both in terms of resources and quality, should be an increased focus to invest in India’s future, I’d put health number one, maybe because that’s where I work, and education number two.





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