until natural immunity is our only hope

In March it was unimaginable that you’d be giving us that timeline and saying it’s great.
Well it’s because of innovation that you don’t have to contemplate an even sadder statement, which is this thing will be raging for five years until natural immunity is our only hope.

Let’s talk vaccines, which your foundation is investing in. Is there anything that’s shaping up relatively quickly that could be safe and effective?

Before the epidemic came, we saw huge potential in the RNA vaccines—Moderna, Pfizer/BioNTech, and CureVac. Right now, because of the way you manufacture them, and the difficulty of scaling up, they are more likely—if they are helpful—to help in the rich countries. They won’t be the low-cost, scalable solution for the world at large. There you’d look more at AstraZeneca or Johnson & Johnson. This disease, from both the animal data and the phase 1 data, seems to be very vaccine preventable. There are questions still. It will take us a while to figure out the duration [of protection], and the efficacy in elderly, although we think that’s going to be quite good. Are there any side effects, which you really have to get out in those large phase 3 groups and even after that through lots of monitoring to see if there are any autoimmune diseases or conditions that the vaccine could interact with in a deleterious fashion.

Are you concerned that in our rush to get a vaccine we are going to approve something that isn’t safe and effective?

Yeah. In China and Russia they are moving full speed ahead. I bet there’ll be some vaccines that will get out to lots of patients without the full regulatory review somewhere in the world. We probably need three or four months, no matter what, of phase 3 data, just to look for side effects. The FDA, to their credit, at least so far, is sticking to requiring proof of efficacy. So far they have behaved very professionally despite the political pressure. There may be pressure, but people are saying no, make sure that that’s not allowed. The irony is that this is a president who is a vaccine skeptic. Every meeting I have with him he is like, “Hey, I don’t know about vaccines, and you have to meet with this guy Robert Kennedy Jr. who hates vaccines and spreads crazy stuff about them.”

Wasn’t Kennedy Jr. talking about you using vaccines to implant chips into people?
Yeah, you’re right. He, Roger Stone, Laura Ingraham. They do it in this kind of way: “I’ve heard lots of people say X, Y, Z.” That’s kind of Trumpish plausible deniability. Anyway, there was a meeting where Francis Collins, Tony Fauci, and I had to [attend], and they had no data about anything. When we would say, “But wait a minute, that’s not real data,” they’d say, “Look, Trump told you you have to sit and listen, so just shut up and listen anyway.” So it’s a bit ironic that the president is now trying to have some benefit from a vaccine.

What goes through your head when you’re in a meeting hearing misinformation, and the President of the United States wants you to keep your mouth shut?

That was a bit strange. I haven’t met directly with the president since March of 2018. I made it clear I’m glad to talk to him about the epidemic anytime. And I have talked to Debbie Birx, I’ve talked to Pence, I’ve talked to Mnuchin, Pompeo, particularly on the issue of, Is the US showing up in terms of providing money to procure the vaccine for the developing countries? There have been lots of meetings, but we haven’t been able to get the US to show up. It’s very important to be able to tell the vaccine companies to build extra factories for the billions of doses, that there is procurement money to buy those for the marginal cost. So in this supplemental bill, I’m calling everyone I can to get 4 billion through GAVI for vaccines and 4 billion through a global fund for therapeutics. That’s less than 1 percent to the bill, but in terms of saving lives and getting us back to normal, that under 1 percent is by far the most important thing if we can get it in there.

Speaking of therapeutics, if you were in the hospital and you have the disease and you’re looking over the doctor’s shoulder, what treatment are you going to ask for?
Remdesivir. Sadly the trials in the US have been so chaotic that the actual proven effect is kind of small. Potentially the effect is much larger than that. It’s insane how confused the trials here in the US have been. The supply of that is going up in the US; it will be quite available for the next few months. Also dexamethasone—it’s actually a fairly cheap drug—that’s for late-stage disease.
I’m assuming you’re not going to have trouble paying for it, Bill, so you could ask for anything.
Well, I don’t want special treatment, so that’s a tricky thing. Other antivirals are two to three months away. Antibodies are two to three months away. We’ve had about a factor-of-two improvement in hospital outcomes already, and that’s with just remdesivir and dexamethasone. These other things will be additive to that.
You helped fund a Covid diagnostic testing program in Seattle that got quicker results, and it wasn’t so intrusive. 

The FDA put it on pause. What happened?

There’s this thing where the health worker jams the deep turbinate, in the back of your nose, which actually hurts and makes you sneeze on the healthy worker. We showed that the quality of the results can be equivalent if you just put a self-test in the tip of your nose with a cotton swab. The FDA made us jump through some hoops to prove that you didn’t need to refrigerate the result, that it could go back in a dry plastic bag, and so on. So the delay there was just normal double checking, maybe overly careful but not based on some political angle. Because of what we have done at FDA, you can buy these cheaper swabs that are available by the billions. So anybody who’s using the deep turbinate now is just out of date. It’s a mistake, because it slows things down.
But people aren’t getting their tests back quickly enough.

Well, that’s just stupidity. The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.

Why don’t we just do that?
Because the federal government sets that reimbursement system. When we tell them to change it they say, “As far as we can tell, we’re just doing a great job, it’s amazing!” Here we are, this is August. We are the only country in the world where we waste the most money on tests. Fix the reimbursement. Set up the CDC website. But I have been on that kick, and people are tired of listening to me.

As someone who has built your life on science and logic, I’m curious what you think when you see so many people signing onto this anti-science view of the world.

Well, strangely, I’m involved in almost everything that anti-science is fighting. I’m involved with climate change, GMOs, and vaccines. The irony is that it’s digital social media that allows this kind of titillating, over simplistic explanation of, “OK, there’s just an evil person, and that explains all of this.” And when you have [posts] encrypted, there is no way to know what it is. I personally believe government should not allow those types of lies or fraud or child pornography [to be hidden with encryption like WhatsApp or Facebook Messenger].

Well, you’re friends with Mark Zuckerberg. Have you talked to him about this?

After I said this publicly, he sent me mail. I like Mark, I think he’s got very good values, but he and I do disagree on the trade-offs involved there. The lies are so titillating you have to be able to see them and at least slow them down. 

Like that video where, what do they call her, the sperm woman? 

That got over 10 million views! [Note: It was more than 20 million.] Well how good are these guys at blocking things, where once something got the 10 million views and everybody was talking about it, they didn’t delete the link or the searchability? So it was meaningless. They claim, “Oh, now we don’t have it.” What effect did that have? Anybody can go watch that thing! So I am a little bit at odds with the way that these conspiracy theories spread, many of which are anti-vaccine things. We give literally tens of billions for vaccines to save lives, then people turn around saying, “No, we’re trying to make money and we’re trying to end lives.” That’s kind of a wild inversion of what our values are and what our track record is.