adequate provision of vaccines to more coun- tries around the world. Beyond this being the right thing to do, it’s a smart thing to do.


: Where is the Gates Foundation focusing its efforts at themoment?

: We are fighting a multi-front battle here. There’s still work that we’re doing on the

upstream side of research and development (R&D). We’ve been funding the development of some of the treatments — monoclonal antibod- ies, for instance. We’ve been funding more rapid diagnostics that can help some countries just get a better handle on the epidemiology and make it easier for people to diagnose cases of Covid-19 more quickly. Onthe vaccine side,we’ve been pretty active

in trying to assess whether some of these vari- ants are going to mean that these vaccines are less effective in the future. But the biggest part of what we’re doing is the advocacy that we think is going to be needed to help make sure that the tools available today get distributed to people that need themin poor countries. Weworked actively with the last USadmin-

istration to see if there was a way through some of the stimulus measures that were passed to include some funding that would support vaccine distribution. The Trump administration approved a $4bn investment in Gavi to help some of those efforts. We’re working with the new administration to try to make sure that this nearly $2tn measure that president Joe Biden is putting forward includes a substantial amount for interna- tional efforts tomake sure these countermeas- ures are made available. We’ve been working with representatives at G7 and G20 to make sure that Covid-19 and its vaccine are both sig- nificant priorities.


:What is the private sector’s role?

: I’ve seen some efforts underway to get the private sector to be more engaged in help-

ing with the rollout of the vaccine. They can provide a lot of logistical support. Companies like FedEx, and UPS can help with some of the distribution efforts in richer countries. I think there’s a huge opportunity for the biotech and pharma sectors to make sure they continue to be on the front line, whether it’s on these vari- ants or discovering new therapies, and help the world to make sure we’re prepared, no matter the direction that this pandemic takes. I’m hopeful that more private sector compa-

nies will step up in terms of direct contributions to supporting vaccine efforts.Alot of companies have done extremely well in the past year or so. Maybe there’sanopening forsomeof those com- panies to nowbe a part of ending the pandemic.


: What are the lessons to be learned from the global response to Covid-19?

: One of the first legacies is just the recogni- tionthat local healthis global health.Until

February/March 2021

recently, I don’t think it really resonated, or people didn’t make the connection, just how interconnected the world is, and that an other- wise isolated incident in a small part of China can very quickly morph into a global health cri- sis. That is fundamental. One of the great stories coming out of

Covid-19 is the co-operation that took place on the R&Dside, and the fact that we were able to develop a suite of vaccines in a little under a year is a scientific breakthrough for the ages. I hope it’s with same kind of ingenuity that we’re able to think about other diseases: vac- cines for cancers and other diseases that have long plagued people, particularly in poor countries. If we can take that know-how and apply it against other things that have affected millions of people for a long time, but also to make sure that we’re prepared in the future, that would be enormously benefi- cial for the world. The pandemic has also really brought to

light the inequity that existed in R&D. A lot of biotech priorities are focused on conditions that represent a tiny share of the global bur- den of diseases. And that’s typically been where more of the money in the profit is — extending a person’s life in a rich country by a few months has much more of a profit mar- gin than trying to develop new tools that could benefit millions of people. So, I hope we have a rebalance of some of those priori- ties in the future. Specifically to the mRNA vaccine platform, it really gives us an ability to think in a more creative way about how to develop and use that platform for other dis- eases and vaccine preventable diseases, but also vaccines as therapies for cancers and other conditions. I think there’s also just a real kind of reck-

oning when it comes to the process by which some of these tools were developed and approved. I think there’s going to be a new way of thinking on how regulators can really sup- port amore rapidway of approving use in a safe way, but perhaps in a new way, that is less time consuming. And we’ve also seen a lot of cooper- ationamongcompanies.We’ve seen the second sourcing agreements whereby products that are developed by one company may be manu- factured by another. That’s also a good prece- dent for future collaboration. And finally, I would say it just really under-

scores the need to get to get busy working on things that haven’t yet become health threats. There are organisations like CEPI that are work- ing on pathogens that could one day become epidemic or pandemic. It’s really important that this notion of a world being better pre- pared through investments like CEPI, but also surveillance and understanding the connec- tion of zoonotic diseases to human health, is appreciatedmore than ever.■

Joe Cerrell is managing director of the Bill & Melinda Gates Foundation.



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