Bill Gates isn’t about to be contemplating his touchdown dance yet. You don’t get to devote your life to battling the world’s most intractable problems by declaring victory before a fight is over. But in a letter Gates released this morning, headlined, “These breakthroughs will make 2021 better than 2020,” it’s clear that the co-director of the Bill and Melinda Gates Foundation is feeling pretty sanguine about the year ahead—particularly when it comes to COVID-19.
The Gates letter, which comes a month before the expected January release of Melinda Gates’s Annual Letter, sees a lot to be optimistic about in the recent course of the pandemic—as well as a number of things to remain wary about. Clearly, Gates takes heart in the recent emergency use authorization of both the Moderna and Pfizer-BioNTech vaccines, as well as by the straightforward and decidedly lower-tech truth that face masks and distancing remain exceedingly effective in slowing the spread of the virus as the vaccines are being rolled out.
“When I think back on the pace of scientific advances in 2020, I am stunned,” he writes. “Humans have never made more progress on any disease in a year than the world did on COVID-19 this year.”
The Gates Foundation itself can take some credit for that breakneck pace, having been funding research on the mRNA technology that underlies both the Moderna and Pfizer-BioNTech vaccines since 2014. Not only is the technique effective, it makes for an easier-to-produce vaccine, since the mRNA shot causes the body itself to produce the spike protein that elicits an antibody reaction, rather than taking the time and making the effort to manufacture it in a lab.
But that doesn’t mean it will be easy to produce the 5 to 10 billion doses of vaccine Gates estimates the world will need to slam the brakes on the pandemic—assuming two doses are necessary for some vaccines and an estimated 70% of the population must be inoculated to stop transmission. Together, all of the vaccine companies on the planet produce only 6 billion doses of vaccines against multiple diseases each year, Gates says. One way to accelerate production is through what are known as second-source agreements, which the Gates Foundation has helped broker and bankroll. The agreements pair vaccine developers like Pfizer with downstream manufacturers, which crank out the drugs the upstream companies invent. Much in the way automobile companies—which excel at mass production—retooled during World War II to manufacture tanks and other military armaments, so have high-output drug manufacturers like the Serum Institute of India, the biggest vaccine producer in the world, partnered with AstraZeneca to mass-produce the vaccine the latter company is developing.
“They’ve already begun production, so there will be doses available for low- and middle-income countries if [Astra-Zeneca’s] vaccine is approved for use,” Gates writes. “And our foundation took on some of the financial risk, so if it doesn’t get approved, Serum won’t have to take a full loss.”
Distribution is a potential choke point, of course. It’s one thing to produce 10 billion vaccines in a handful of manufacturing plants, it’s another thing to get them into billions of arms. The Gates Foundation is already working with 16 pharmaceutical manufacturers to make sure the vaccines are distributed widely and equitably, in cooperation with national governments which must take over the job of distributing the vaccines once they’ve arrived in-country.
Gates takes heart in the fact that some of 2020’s ostensible failures have in fact been critical successes. There are only a few drugs that have, to date, been proven effective at treating COVID-19, among them dexamethasone and monoclonal antibodies. But at the beginning of the pandemic, there were potentially thousands of such drugs. Finding the few winners among them was made immeasurably easier by a collaboration among the foundation, Mastercard and the Wellcome Trust to develop the Therapeutics Accelerator, taking advantage of scanning technology that already exists in the pharmaceutical industry to screen the thousands of candidate compounds at high speed. The vast majority failed.
“That was disappointing, but it was a useful disappointment,” Gates writes. “It spared the medical field millions of dollars and a year or two of laboriously going from one company to another, testing one compound after another.”
COVID-19 surveillance is becoming easier too, thanks to the development of at-home tests that speed diagnosis and spare the public the painful nasal swabs that have become one of the signature indignities of the pandemic. Also in development are cell-phone sized devices that the foundation has helped deploy in 55 countries, able test a sample from a patient and automatically upload a positive or negative result—without the patient’s identity, in order to protect privacy—to a central database, speeding oversight of where the disease is spreading.
Finally, Gates takes heart that most of sub-Saharan Africa—which is often harder hit than any other part of the world when a pandemic rages—is actually escaping with a comparatively lower case and mortality rate. Part of that is that the African population is young compared to most non-African nations, and young people tend to suffer less-severe cases of the disease. Part too is that in the continent’s extensive rural communities there is less time spent indoors, with families and crowds having less occasion to breathe the same air.
Clearly, none of this means that the pandemic is beaten—or even that victory is close. But it does mean we have entered the end game. When the pandemic first began, Gates wrote in his blog, “this is like a world war, except in this case, we’re all on the same side.” That could have been too rosy a take. When human beings are pushed to our limits as the pandemic has done, we don’t always behave at our best. But researchers, manufacturers and the public have mostly stepped up to the challenge. And this world war will, before too long, looks like it will be won.
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