Many Around The World Were Pessimistic About Inequality Even Before Pandemic

Gates: Certainly humility is called for because the damage—whether it’s economic, educational, mental health—is so large. Other than a world war, this is the worst thing that’s happened in over a century. And so we should all say, “Wow, we

didn’t understand about masks; we didn’t understand about asymptomatics.” Even the medical profession. We haven’t taken understanding these different respiratory diseases quite as seriously as we should. So everyone has lessons here.

Yong: I think that one of the things the pandemic has highlighted is the relevance of social interventions. The pandemic has so much widened inequities, both around the world and domestically, between rich and poor. It has disproportionately hit Black and Latinx and Indigenous communities. How are you thinking about those disparities and what needs to be done to address them?

Gates: Yeah, it’s kind of unbelievable that every dimension of inequity has been exacerbated here. Every other year, [our “Goalkeeper’s Report”] has been this positive story of gradual progress—less children dying, less malnutrition, longer life spans. We get to say to the world, “Hey, pay attention to that steady progress.”

This report had to deliver the news that if you only look at COVID deaths, you’re actually missing the scale of the setback. Because it’s also routine immunization, malaria, getting HIV medicines. Things are so disrupted, even gathering the numbers for that was very, very difficult. But we dropped our routine-immunization levels by over 14 percent. There’s going to have to be a stronger equity agenda, hopefully on a global basis, once we get out of this. Thirty-seven million people have been driven into extreme poverty. That’s really just gut-wrenching.

Most of the time when we talk about infectious diseases, our problem is, the world doesn’t pay attention to malaria or TB. Here, because people care so much about getting the [COVID-19] vaccines, they’re actually saying, “Okay, we should maybe be even less generous.” The kind of generosity that historically has helped might even go down.

Yong: Do you see those kinds of inequities also play out in the U.S.? One of my concerns is that the groups that have been disproportionately burdened by this pandemic and by this long-standing history of systemic discrimination will be last in line to receive the vaccine. What work should and can be done to reduce that inequity back home?

Gates: One way to help with that is to have so much volume that you’re not making superhard trade-offs. With our vaccine expertise in the foundation, we’re trying to help with that. If multiple [vaccines] get approved, actually, the volumes could be quite large.

We should look at the risk levels. And based on that, you would say that communities including Blacks and Hispanics would have higher priority. You can come up with what the equitable priority ranking should be, [but] I’m not seeing that sense of gathering the data to come up with those algorithms. It’s kind of bizarre that you have these overoptimistic projections that the vaccine will come soon. When you read the 67-page report about how it’s distributed, it doesn’t actually concretely identify the criteria or how the information is going to be gathered to do the prioritization.

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