As the coronavirus pandemic rapidly spread across the United States in March, Bill Gates peppered his longtime friend Jeff Raikes with the science behind testing for the disease during dinner at his home in Medina, Washington.
The two men ate sushi – at an “appropriate” social distance, Raikes said – while Gates detailed the challenges of using nasopharyngeal swabs that reach deep into nasal passages to test for the novel coronavirus. Instead, Gates offered that self-testing with simpler, shorter swabs could be more effective and wouldn’t require health-care workers to risk infection themselves, said Raikes, a former senior leader at Microsoft who went on to run the Bill & Melinda Gates Foundation.
“He is in his element right now,” said Raikes, who has worked closely with Gates for four decades.
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As the virus has spread, killing more than 239,000 people globally, Gates has used his fame and wealth to push for science-based approaches to end the pandemic. Having studied infectious diseases for the past 20 years as part of his philanthropic work, Gates has warned about the potential for a pathogen-spread pandemic since 2015, in a TED Talk, lectures and medical journal articles. Since February, the foundation he runs with his wife has given away $250m (£199m) to expand testing for the coronavirus and find a cure for Covid-19, the disease it causes.
But the coronavirus is unlike any global health challenge Gates has faced. He’s spent years trying to address health threats vexing the developing world, such as malaria, polio and HIV. Those diseases have either vaccines or therapies, but the countries where they remain a major threat lack health systems to deliver them to people, something the Gates Foundation is trying to fix. When it comes to the coronavirus, though, there is neither a vaccine nor a therapy, and it’s spread to both rich and poor countries.
With the coronavirus afflicting rich countries as well as developing ones, Gates also needs to navigate the thickets of US politics. One new challenge for Gates: pressing messages that often run headlong into comments by President Donald Trump that lack scientific basis. In an interview, Gates noted past global health achievements by the United States, such as President George W Bush’s support for drugs to address the Aids epidemic sweeping across sub-Saharan Africa nearly two decades ago.
“People are hoping for US leadership. It’s still an opportunity we haven’t seized,” Gates said. “The vacuum of waiting for the US to step in and help out with that, there’s still a huge opportunity there.”
Gates hasn’t directly criticised Trump, and he remains largely apolitical. But research he has cited has undermined some of the president’s claims. The Gates Foundation, for example, is funding a clinical trial on hydroxychloroquine, the drug Trump that tweeted could, when combined with azithromycin, be “one of the biggest game-changers in the history of medicine.” Gates, though, focused on the data, writing in a 23 April blog post that early indications from the trial suggest “the benefits will be modest at best”.
Gates also took aim at the president’s plans in April to suspend payments to the World Health Organisation in response to the UN agency’s handling of the coronavirus pandemic.
“Halting funding for the World Health Organisation during a world health crisis is as dangerous as it sounds,” Gates tweeted on 14 April, arguing that the no other organisation is capable of replacing the agency. The Gates Foundation is the second-biggest donor to the WHO, after the US government.
“Bill is a guy who believes in science and technology and the positive impact that can have in the world,” Raikes said. “I think at least subconsciously, like many of us, he’s been disturbed by the attack on science,” though Raikes acknowledged that he hasn’t talked specifically with Gates about the topic.
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