At a 2015 TED talk in Vancouver, Bill Gates warned that the next major global threat could be a virus — and the world wasn’t ready.

This video has been viewed on YouTube over 36 million times. In a follow-up talk at the TED Conference in Vancouver last month, the Microsoft co-founder and billionaire philanthropist said more than 90% of those opinions came too late – once the COVID-19 pandemic hit. was already underway.

“We didn’t do much to prepare, although I wasn’t the only one to say so. A little prevention would have made a big, big difference,” Gates said in an interview with The Sunday Review host Piya Chattopadhyay.

In his latest book, titled How to prevent the next pandemicGates lays out lessons he’s learned from COVID-19 through his work with the Bill and Melinda Gates Foundation, and possible solutions for the future.

The vaccine shortage is over, but equity remains an issue

Of course, the pandemic is not yet old news. Gates says we are losing momentum in the race to vaccinate the world – but he argues it’s more a problem of distribution than production of vaccine doses at this point.

“The problem we had to start with, which was the shortage of vaccines, is completely solved. That is to say, there are excesses of vaccines that actually expire. And so the limit of vaccination is much more the demand and the logistics of getting these vaccines to people,” he said.

Last September, the World Health Organization (WHO) called for 70% of the world’s population to be vaccinated by mid-2022. The United Nations called it an “ambitious global goal” – the one that “the world is far from reaching” at the end of March.

And while more than 10 billion doses have been administered according to the UN, only 1% has been administered to low-income countries, leaving 2.8 billion people who have still not received a first dose.

The COVAX Global Vaccine Distribution Program – which includes the WHO and two organizations funded by the Gates Foundation – has also set ambitious goals for rich countries to distribute or pay for doses of vaccines in other countries, but do not have not yet achieved their goals.

Canada has only donated 15 million of the 38 million doses it promised to share from its own supplies, but demand for those has also fallen this year.

Gates asserted that COVAX was largely successful, despite the missed targets. “The idea that we could make 14 billion vaccines enough for the whole world, you know, that was just a pipe dream. And so it’s pretty phenomenal to see how the ramp-up has happened,” said he declared.

But the problem of vaccines expiring in countries like Canada illustrates “gigantic inequity” when doses can’t get to low-income countries, he said.

Would giving up patents on vaccines help?

A possible solution that some experts have proposed is to forego patents and intellectual property protection on vaccines, allowing more countries to produce doses for themselves.

It was initially proposed by India and South Africa, and supported by other countries like the United States.

In Canada, the federal government insists he “did not reject the waiver proposal”, but still has questions and pledged to find “consensus-based solutions”.

Gates, however, argues that waiving patents in 2021 would not have significantly increased vaccine supply and that the AstraZeneca-Oxford vaccine has already been made available to several countries.

I have so much respect for Bill Gates… but whether he likes it or not, intellectual property rules are still a barrier.– Winnie Byanyima, People’s Vaccine Alliance

“They’ve trained over 20 companies how to make it, one of which we funded with a $300 million grant, Serum [Institute of India]has now made over 1.4 billion of the AstraZeneca vaccine which they have called Covishield,” he said.

Abandoning patents by fall 2021 or later, he argued, would only lead to an oversupply of doses without solving the problem of distribution to low-income countries.

Brittany Lambert, policy and advocacy specialist for Oxfam Canada, said waiving patents on vaccines won’t be as helpful now as it would have been a year ago, before supply issues hit. have improved.

“It’s a shame that it took so long that basically it’s become less relevant now. And, you know, there’s a lot of lives that have been lost because of that,” she told CBC Radio.

But she added that similar patent waivers could still be useful for other supplies such as testing and treatment.

Gates said his foundation was working with other “low-cost manufacturers” to manufacture mRNA vaccines, as well as future products using new mRNA technology.

Winnie Byanyima, co-chair of the People’s Vaccine Alliance, says Covishield alone will not be enough to vaccinate people in middle to low income countries. After India has recently expanded its booster availabilityshe said, many doses of Covishield are intended to be used as third doses at home instead of first doses abroad.

She said there were potentially 100 countries ready to make MNRA vaccines now, if patents for vaccines from Moderna and Pfizer were lifted.

“I have so much respect for Bill Gates…but whether he likes it or not, intellectual property rules are still a barrier” for people in low-income countries, she said.

Rapid response team could contain outbreaks: Gates

One of his arguments is the creation of an international team called Global Epidemic Response and Mobilization – or GERM, for short.

Comprised of around 3,000 experts from various disciplines, its sole job would be to identify and suppress disease outbreaks all over the world, hopefully before they spiral out of control.

The WHO, he explained, does not have a full-time pandemic rapid response unit, like the hazmat teams you might see in an old action movie. But the idea has more in common with your neighborhood fire department.

“Fortunately, [fire] doesn’t kill a lot of people, but that’s partly because we’re training all the time and we have these people full time,” he said.

Gates estimates that running GERM would cost about US$1 billion a year, but he said it would only add about 25% to the WHO’s budget.

He is no stranger to the inner workings – and funding – of the WHO. The Gates Foundation is its second largest donor, more than most countries. This has raised concerns about whether a private organization or a single citizen should have so much potential influence on global health policy.

Lambert said Gates and his foundation have done “incredible things” in the interest of global health, which she noted many other billionaires are not currently doing. But she added that governments could shoulder more of that burden if they taxed billionaires more effectively.

“If we could find a way to tax it better, so that those decisions can then be made democratically by governments and so on, that would be the ideal situation,” she said.

Gates noted that his foundation is not a voting member of the WHO assembly and that the bulk of his contributions have focused on polio eradication efforts. He added that the foundation’s work stands out primarily because governments have historically not contributed as much as they could.

“No one would be happier than I if funding for the Gates Foundation became a much smaller proportion of global spending in years to come – because…these are investments in a healthier, more productive world,” he said. he wrote.

Written by Jonathan Ore with files from CBC News. Interview with Bill Gates produced by Andrea Hoang.