This interview has been edited for length and clarity.
Ed Yong: Bill, we last spoke about this topic in 2018, a very different time. How do you feel about the way the pandemic has played out this year?
Bill Gates: Well, sadly, I think the most pessimistic view of how unprepared we were has actually played out, particularly in the United States. With something that can grow exponentially, like infectious disease, a little bit of preparedness makes such a difference. A few countries have distinguished themselves, but most countries have not.
Yong: And looking at how the U.S. has fared, what has surprised you, and where do you see we’ve gone wrong?
WATCH: ATLANTIC STAFF WRITER ED YONG IN CONVERSATION WITH BILL GATES
Gates: The U.S. had a lot of assets going into this. We weren’t ground zero, so the U.S. had more time to get ready. The U.S. has more PCR [polymerase chain reaction] machines than all other countries per capita. We are very blessed with an expensive medical infrastructure. And we have groups like the CDC [Centers for Disease Control and Prevention] and BARDA [the Biomedical Advanced Research and Development Authority]. So the U.S. had done more to get ready than other countries had in advance.
I would have expected us to get the commercial [testing] providers up and going like South Korea or Germany or Australia did. There were so many phone calls about, We have to get diagnostic capacity up and we have to get quick results. I participated in a lot of those calls. And yet, to this day, that’s just a complete mess.
Yong: I think you are one of the few people who has had direct contact with the president and the administration about the matter of pandemic preparedness. What is your assessment of America’s leaders and their response to this pandemic?
Gates: Even though the U.S. didn’t do a very good job, most other countries didn’t. There were a few that had been hit by SARS or MERS that had practice understanding, Oh, wow, diagnosis, contact tracing is super important, so they are among the countries that did the best. So I’d give the U.S., like, a C–.
Once it hit, the first community spread of coronavirus in the United States should have set off such alarms. This notion that the travel ban was some beneficial thing, that’s just not true. And then after the pandemic starts, there hasn’t been any coherence.
Read: How the pandemic defeated America
Now the R&D funding, I will say that’s where the U.S. actually does get the highest grade in the world. We need to complement that with funding the factories and the procurement for the global response, in which the U.S. has been absent so far. But I’m still hopeful that if there’s another supplemental bill, we’ll get about $8 billion for international COVID activities into that.
Yong: Do you think that the pandemic should change the way we think about global health? In this crisis, many of the richest countries have fared appallingly, whereas many poorer ones, Senegal to Vietnam, have actually done really well. Do you think that this should be cause for humility and change in our approach?
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