Ensuring wide distribution of a Covid-19 vaccine will be critical and a key concern is initial doses being cornered by high-income countries, Melinda Gates, cofounder of the Bill & Melinda Gates Foundation, told ET’s Teena Thacker in a phone interview. Commenting on the Goalkeeper’s 2020 report released by the foundation on Tuesday, Gates, 56, said Covid had resulted in 25 years of progress on vaccinations being wiped out in 25 weeks. She expressed concern about tuberculosis spreading in India apart from spikes in maternal mortality and vulnerable sections descending into extreme poverty. At the same time, she lauded the Indian government’s cash-transfer programme for the disadvantaged. Gates will be one of the speakers at the ET Women’s Forum 2020. Edited excerpts:
Indicators such as rates of routine vaccination and global poverty have seen a rapid fall and, as the report says, we are back below levels in the 1990s on many vaccination programmes.
Yes, so the 25 years of progress that has been made on vaccinations unfortunately has been erased in 25 weeks, and the drop in vaccination rates is deeply concerning because we know it’s vaccines that keep families and children safe. Measles, for instance, is a highly communicable disease, and, you know, 12 to 18 people get it for every one person that gets it, so to not have measles vaccine campaigns going forward is devastating for communities, and it’s why we’ve got to get back to some of these basic health services, like vaccines.
What does it mean for countries like India?
We’re already seeing some of the tolls, but you’re going to see things like tuberculosis… there are millions of cases of tuberculosis in India. Even more will go undiagnosed, which means that you’re going to get a spread of more tuberculosis in the community. I’m quite concerned about the drop into extreme poverty. We know more people are dropping below the extreme poverty level of $1.90 a day. I do think the government of India’s cash-transfer payments have been very wise — the fact they’ve put the money in the hands of women, they’ve put it in women’s digital mobile wallets, if a woman has a digital wallet on her phone, and they’ve made sure to use the self-help groups, like Jeevika (the Bihar Rural Livelihoods Project), to make sure that the cash-transfer payments get out into the hands of women, particularly in rural areas, who don’t have access to a cellphone. Yes, it’s deeply concerning. I mean, we know from ebola when it hit the four countries in Africa, the four most-affected countries, we had a shadow pandemic of maternal mortality, because women don’t go into the health clinic to deliver their baby, or they’re not welcomed. And so I think you’re going to have a severe rise in maternal mortality in India during this time.
How much of a push, both financial and in terms of manpower, will be needed to regain lost ground?
I think that has to be looked at country by country, but I think we’re seeing that we’re going to have a huge loss in the global economy of $12 trillion, but luckily we’re seeing $18 trillion of stimulus going in, but it’s going to mean making sure that people know where they can still go for health services, where they can still go for universal health coverage. One of the things I think India has going for it is the ASHA (accredited social health activist) workers. The fact that they’ve already been able to go out and very quickly give messages to people in the community about Covid-19, give messages still about clean and safe birth, give messages about, okay, if you’ve got this issue where do you go in the health system, I think that infrastructure that India has built up is going to really benefit the country.
What could delay vaccine supplies? Do you think India’s vaccine goals are too ambitious?
I think a vaccine needs to go through all of the hurdles of good trials so that we make sure that it’s a safe and efficacious vaccine, but I think the pharmaceutical companies are absolutely doing that, and I think you see them moving slowly through phase one, phase two, phase three trials. We just saw a vaccine trial stopped, the
one, because of an adverse event. That’s exactly what needs to happen when you’re trialing a vaccine. So I do think we will get a safe and efficacious one, hopefully early in the new year, 2021, and then the issue will really be distribution. And one of the biggest concerns we have as a foundation, and as a global set of partners, is you don’t want the high-income countries to buy up the first doses. So there’s a model now out from Northeastern University that says that if the high-income countries purchase the first two billion doses you’re going to have double the amount of deaths around the world. So it means we need to make sure that the tech transfer happens quickly to places like Serum Institute in India — our foundation has a great relationship with them — so that Serum can then be able to produce hundreds of millions of doses for the Indian population, and then for the rest of the world.
How was your experience working in India with the vaccine makers?
We’ve had incredibly good relationships with vaccine companies in India, and in particular Serum Institute, and I think it’s because of the vaccines and because of the government’s willingness to look at things like rotavirus — when there was a new rotavirus vaccine out, they made sure it eventually got out to the most remote, rural areas, and that’s why more children are alive, because most children die of pneumonia and diarrhea. So getting the rotavirus vaccine out for diarrhea, getting the pneumonia vaccine out for kids, it has literally saved lives. India has a good vaccine system, so when this vaccine is ready they’ll be able to put it straight through there and again they’ll be able to use the auxiliary nurse midwives to really help with giving the vaccines. Then they can use the ASHAs to get the message out: The vaccine’s here; it’s available; here’s where you go for it. So the system is there. It’s a high-quality system. I’m optimistic that once India gets the vaccine, and Serum is able to produce it, it will get out into the population, and that’s going to make a huge difference in terms of the country being able to get back to work and get back on the economic track that it wants to be on.
How has your experience been working with the government?
We’ve had a very positive experience with the government.