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Bill Gates: What You Need to Know About COVID-19 Vaccine

Bill Gates, an engineer, businessman, and philanthropist, was attacked by supporters of absurd conspiracy theories claiming to be involved in the creation of the coronavirus. In his blog, the creator of the world's largest private charitable foundation publishes analytical reviews, shares finds, recommends books and speeches. We are publishing a translation of an article about the race to create a vaccine against Covid-19 for the channel “ Rationally on Coronavirus ”.

Humanity has never faced a more urgent task than creating a general immunity to coronavirus.

One of the questions that I have been asked most often lately is when will the world be able to return to normal life as it was before the coronavirus pandemic, for example, in December. Each time I answer the same thing: when we have an almost perfect medicine for the treatment of COVID-19 or when almost all people on the planet will be vaccinated against coronavirus.

The first is unlikely to happen anytime soon. To do this, we need a miracle cure effective in at least 95% of cases. Most drugs are now far from such indicators . They can save quite a few lives, but they are not enough so that we can return to a normal life.

The search for a vaccine remains.

Humanity has never faced a more urgent task than creating a general immunity to coronavirus. Indeed, if we want to return to normal, we need to develop a safe and effective vaccine. We will need to produce billions of doses of the vaccine, deliver them anywhere in the world, and do it as quickly as possible.

And that really sounds scary. Our foundation is the largest vaccine sponsor in the world, and trying to cope with the current situation overshadows everything we have ever worked on. A solution will require a global collaborative effort, still unknown. But I know that we can handle it. We just have no choice.

That's all you need to know about the COVID-19 vaccine race.

The world is working on a vaccine in the shortest time in history


Dr. Anthony Fauci said that, in his opinion, the development of a coronavirus vaccine will take about eighteen months. I agree with him, the spread can be from 9 months to two years.

And although eighteen months may seem like a long time, this will be the minimum time for scientists to create a new vaccine. Development usually takes about five years: you need to create the vaccine itself and test it on animals, and then conduct testing for safety and effectiveness in humans.

Safety and efficacy are the two main characteristics of the new vaccine. Safety- How safe is this vaccine for people? Minor side effects (such as a slight fever or pain at the injection site) may be acceptable, but you are unlikely to want to give the vaccines to people with something that will make them sick.

Efficiency shows how well the vaccine protects against disease. And although I would like to receive a vaccine with 100 percent effectiveness, in reality, many are worse in this parameter. For example, the flu vaccine is about 45 percent effective this year .

To test safety and efficacy, each vaccine undergoes three phases of testing:

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After the vaccine has successfully completed all three phases of the test, you can begin the production cycle and apply for registration with WHO and other government agencies:

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This process works well at normal times, but in the current situation, the standard development times are too long. If we can speed up getting vaccines even for a day, it will have a huge impact on the world both to save lives and reduce the economic damage in the trillions of dollars.

Therefore, vaccine developers are trying to shorten the time:

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In the standard process, key issues are resolved sequentially to reduce financial risks, vaccine development is very expensive. Many candidate vaccines fail, so companies first expect success at one stage before investing in the next.

For COVID-19, funding is not a major concern. Governments and other organizations, including our foundation and a terrific alliance called the Epidemic Preparedness Innovation Coalition , said they were ready to do anything to get the vaccine. This way, scientists can save time by completing several stages of development at the same time. For example, private companies, governments, and our foundation are about to start looking for businesses to produce various potential vaccines. Some enterprises will not be involved in the end, but this is a small price for accelerating production.

Fortunately, shortening the testing time is not the only way to speed up the process, which usually takes five years, to 18 months. Another way that we have resorted to is the simultaneous testing of many approaches.

Dozens of candidate vaccines in development


As of April 9, 115 candidate vaccines against COVID-19 were already in development . I believe that 8-10 of them look especially promising, but our fund will follow everyone so as not to miss others with good characteristics:



The most promising candidates use different approaches to protect the body from COVID-19. To understand them, it is useful to recall how the human immune system works.

When a pathogen enters the body, the immune system responds by producing antibodies. They attach to substances called antigens on the surface of the pathogen and serve as an attack signal to the body. The immune system keeps track of all those who have ever been defeated in order to quickly recognize and destroy the invaders in the future, before they cause the disease.

Vaccines bypass this whole process, teaching the body how to deal with pathogens without disease. The two most common types — the ones you are probably most familiar with — are inactivated and live vaccines. Inactivated vaccines contain killed pathogens, while in live ones they are attenuated (attenuated). Live vaccines are very effective, but often give side effects.

Inactivated and live vaccines are “traditional” approaches. There are a number of candidate vaccines from COVID-19 of both types, and not by chance: they are well known - we understand how to test and produce them.

But their production is time consuming. For each dose of vaccine, a large number of materials, mainly biological, that is, requiring long-term cultivation, are required.

Therefore, I am inspired by two new approaches that are used in some candidates: RNA and DNA vaccines . If one of these new approaches works, we are likely to be able to distribute vaccines around the world much faster. (For the sake of simplicity, I will only talk about RNA vaccines. DNA vaccines differ in the type of genetic material and the method of administration, but are generally similar).

Our fund - both through our own financing, and through CEPI- supported the development of RNA vaccines for the last ten years. We planned to create vaccines for diseases that affect poor countries, such as malaria, and now it looks like one of the most promising options for COVID-19. The first candidate to start human trials was the Moderna RNA vaccine.

Here's how the RNA vaccine works: instead of injecting the pathogen antigen into the body, they give him the genetic code necessary for self-production of the antigen. When antigens appear outside the cells, the immune system attacks them - and learns how to defeat future intruders. In essence, you are turning your body into your own vaccine division.

Since RNA vaccines allow your body to do most of the work, they don’t need a lot of biomaterial, which makes them much faster in production. But it is not yet known for sure whether RNA is a viable basis for vaccines - it is necessary to prove that the vaccine works and creates immunity. This is a bit like the simultaneous development of the computer itself and the programs for it.

So even if the RNA vaccine looks promising, you can not stop there. It is not yet known which vaccine against COVID-19 will be successful, so we must put all our energy into studying the maximum number of approaches to creating a vaccine.

The vaccine probably won't be perfect - and that's fine


Smallpox vaccine is the only disease that has wiped out the face of the earth. Its use is rather traumatic: it leaves a scar on the vaccinated hand. One in three was forced to miss school or work due to side effects. A small but significant number of people have more serious reactions.

The smallpox vaccine was far from perfect, but it did its job. The vaccine COVID-19 may be similar.

An ideal sample would be 100% safe and 100% effective. A single dose would be enough to provide protection for life. It could easily be stored and delivered. I would like the COVID-19 vaccine to have all of these qualities, but given the timing, things will probably be different.

The key priorities, as I mentioned earlier, are security.and vaccine efficacy . Since there is no time for many years of research, it will be necessary to conduct extensive tests in the first phase and make sure that we have enough data on its complete safety.

As for the effectiveness of the vaccine, there is more room for maneuver. It seems to me that 70 percent efficiency will be enough to stop the pandemic. You can even use a vaccine that is 60 percent effective, although in this case local outbreaks can occur. Efficiency below 60 percent is unlikely to create sufficient population immunity to stop the virus.

It will be very difficult to ensure good vaccine performance in the elderly. The older the person, the less effective the vaccine for him. The immune system, like the rest of the body, is aging and slower recognizing and attacking intruders. This is a big problem for the COVID-19 vaccine, as older people are the most vulnerable. We need to make sure that they are protected.

In the case of the shingles vaccine - it is also intended for older people - the solution was to increase the strength of the vaccine. We may do something similar for COVID-19, but this can lead to more side effects.

In addition to the safety and efficacy of vaccines, several other factors must be considered:

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I want to believe that the vaccine, which will be ready in 18 months, will be as close to “ideal” as possible. Even if this does not happen, we will continue to work to improve it. I suspect that the COVID-19 vaccine will be part of routine immunization of newborns.

However, after the vaccine appears, we still have to solve huge problems. Because…

At least 7 billion doses of vaccine needed to be manufactured and distributed.


To stop the pandemic, we need to provide a vaccine for almost all people on the planet. We had never before solved the task of delivering something to all corners of the world. And, as I said earlier, vaccines are especially difficult to produce and store.

Moreover, until we have decided on the type of vaccine, it is difficult to say how we will manufacture and distribute the vaccine. For example, can we use existing factories to produce COVID-19 vaccine?

But we can prepare various types of production in advance. For each type of vaccine, different types of factories are needed, so different preparations will have to be made in order to start making the selected vaccine as soon as possible. It will cost billions of dollars, so governments need to quickly find a funding mechanism. Our foundation is currently working with CEPI, WHO and governments to solve this problem.

Part of the discussion is about who will get the vaccine and when. The reality is that not everyone can get the vaccine at the same time. It will take months — or even years — to create 7 billion doses (or, for example, 14 billion if it is a multi-dose vaccine), and we must begin to distribute them as soon as the first batch is ready.

Most people agree that healthcare providers should take precedence, but who will receive it later? Aged people? Teachers? Workers in key occupations?

I think that low-income countries should be among the first recipients of the vaccine, because people in these places are at greater risk. COVID-19 will spread much faster in poor countries because it is more difficult to maintain physical distance. Many have health problems, making complications more likely, and weak health systems make it difficult to get the help they need. Spreading the vaccine in low-income countries can save millions of lives. Fortunately, we already have an organization with the necessary experience - Gavi, the Vaccination Alliance .

As a rule, the vaccine manufacturer signs agreements with the countries in which their production is located on the priority receipt of vaccines. It is unclear whether this will be the case with COVID-19. I hope we find a way to distribute the vaccine equally throughout the world. WHO and national health organizations will need to develop a distribution plan as soon as we understand exactly what we will work with.

Ultimately, the process will reach a scale enough to provide everyone with the vaccine. And then we can return to normal life and, I hope, take measures so as not to be in a similar situation again.

There is light at the end of the tunnel, even if it is not yet visible. We are taking the right steps to get the vaccine as soon as possible. In the meantime, I urge you to continue to follow the recommendations of your local authorities. Our chances of dealing with a pandemic are directly dependent on each other's security concerns.

Translation: Anton Bely for the telegram channel “ Rationally about Coronavirus ”
Edited by Tatyana Lando and Dmitry Kalupin

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