Bill Gates was talking to President Trump in the Oval Office last month when the conversation turned to the notion of a universal flu vaccine — probably, as Gates recalled in an interview, “the longest conversation about universal flu vaccine that the president’s ever had.”

“You should associate yourself with American innovation. Wouldn’t you love to have the universal flu vaccine be something that really got kicked off and energized by you?” Gates recalled asking Trump.

The idea fired up the president, who Gates described as “super interested.” In a matter of moments, Trump had Scott Gottlieb, the commissioner of the Food and Drug Administration, on speakerphone, asking him about a vaccine that could generate lasting protection against a range of seasonal and animal flu viruses with pandemic potential.

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“Hey, Gates says there’s a universal flu vaccine. Is that crazy?” the philanthropist, bemused, recalled the president asking.

Gates said Gottlieb confessed that while he’d heard there was some good work underway, he wasn’t an expert and would need to look into it. (Gottlieb confirmed that the call took place, but declined to discuss the conversation.)

The flu vaccine discussion. An unexpected job offer from Trump. Some criticism for a previous president. And an explanation from Gates on why he chose global health philanthropy over political spending. A team of journalists from STAT sat down on Friday in Boston for a freewheeling discussion with the head of the Bill and Melinda Gates Foundation — and also got a sense of just how steeped he has become in matters involving vaccines, pandemics and public health.

Here’s what we heard.

Hey, Bill Gates, do you want a new job?

Trump hasn’t named anyone to fill the vacant post of White House science adviser. The last director of the White House Office of Science and Technology Policy, John Holdren, resigned at the end of the Obama administration.

Many in the scientific community are worried about this vacancy. Gates brought it up during his 40-minute meeting with Trump.

“I mentioned: ‘Hey, maybe we should have a science adviser.’”

And?

“He said: Did I want to be the science adviser?”

That’s not the answer Gates was looking for. “That’s not a good use of my time,” Gates recalled telling the president.

Gates admitted he doesn’t know what would have happened if he’d said yes. “I didn’t put him to the test, whether that was a serious thing or not. He probably himself didn’t know if he was serious. It was a friendly thing. He was being friendly.”

The Oval Office, the ides of March

Gates has met three times with Trump since he won the 2016 election. (The two had never met previously.) During the first two meetings, multiple topics — foreign aid, education, vaccines — were on the table. This time, on March 15, the conversation was laser-focused on global health security.

It may be a hard sell at the White House, given that Trump has repeatedly said the United States has for too long been spending too much abroad.

But Gates, who argues that pandemics know no borders, cast his message in a way that he hoped might speak to Trump.

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“One thing’s for sure: No matter what your framework is, even if it’s that human benefits outside the country count for zero, stopping pandemics is a smart thing,” Gates said.

“The capacity to build the tools that would help you be prepared for a big pandemic — the U.S. is really the only country that’s got a broad set of those tools. So even in a totally nationalistic framework, you don’t want lots of Americans to die from flu or smallpox or some new pathogen.”

Speaking of smallpox

The deadly virus appears to weigh on Gates’s mind, even though it was declared eradicated in 1980. (It is still the only human pathogen that mankind has erased from the world.) In a speech Friday in Boston and in his conversation with STAT, Gates several times raised the specter of the potential for a bioterrorism attack using smallpox.

There are only two known caches of smallpox in the world, repositories held at the Centers for Disease Control and Prevention in Atlanta and at a Russian government laboratory in Novosibirsk. Every few years — the last time was in 2014 — the governing body of the World Health Organization debates whether to destroy the remaining stocks, a step that was called for in the original eradication planning. And yet they remain.

Gates had blunt words for the ongoing debate. “That’s a non-issue,” he said flatly.

Even if all existing smallpox viruses were destroyed, its genetic code is known and the virus could be made from scratch, using genetic parts ordered over the internet. In fact, Canadian researchers revealed last year they had done something quite similar, synthesizing a related virus, horsepox.

“There’s too much known,” Gates said, terming the smallpox destruction debate “not a productive discussion.”

“That is not the source of risk,” he said.

About that universal flu vaccine …

The Gates Foundation is offering $12 million in seed money for projects that would help the world develop a universal flu vaccine. Gates said he thinks that when a universal flu vaccine is developed, it will be made in one of the newer vaccine constructs attracting so much research attention these days.

“The RNA, DNA technologies are extremely likely to be where you get the universal flu vaccine,” he said.

He name-checked a few biotechs working in that space: Inovio, Moderna, and CureVac.

As for whether he thinks the seed he’s planted with Trump will take root, Gates said he thinks the president will have to hear encouragement from other sources — the National Security Council, and people like NIH Director Francis Collins and Alex Azar, health and human services secretary — for the idea to get traction.

“There will have to be a variety of voices that come back to him and say: Hey, you may have heard of this topic, here’s a plan that’s concrete and sort of fits within the resources we have,” Gates said. “So the action item is very much on me or the community who care about these things to talk to federal officials, both defense and non-defense.”

Vaccines and Disease X

The Gates Foundation is supporting work — including through the Coalition for Epidemic Preparedness Innovations, CEPI — to develop vaccines to protect against disease threats. But Gates admitted that if something wholly new broke out, there wouldn’t be time to develop and use vaccine. He’d rather have a drug.

“If something’s fast spreading, a vaccine takes too long to be effective,” Gates said. Even once you get inoculated, it takes about two weeks for your immune system to generate a protective response. And with something completely foreign, it might take two shots per person to mount immunity. That’s too long.

“If you can pre-anticipate what the pathogen is, then vaccines could come in and you could do protection, at least of key personnel, in advance. But for the unknown pathogen, you give me a choice between having a vaccine for an unknown pathogen or having an antiviral [drug] — I’ll take the antiviral any day.”

Global health vs. political PACs

The U.S. political landscape seems like a battleground for the ultra-wealthy these days, with loads of billionaire donors (the Koch brothers and Robert and Rebekah Mercer to name just a few) backing the administration and billionaire and liberal activist Tom Steyer openly campaigning for Trump’s impeachment.

Gates and his foundation have always been politically circumspect, approaching each administration, regardless of their political stripe “with an open mind,” he told STAT before the 2016 election.

Given the high stakes and the polarized times, is Gates at all tempted to get political?

In a word, no. When asked, Gates said his foundation’s work has reduced mortality in children under age 5 around the globe from 11 million when it started to about 5 million a year now. Those are the kind of returns he is looking for.

“If there are people who’ve used political lobbying to save that many lives then maybe I missed a trick,” Gates said.

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But about Obama …

On the topic of preparing for pandemics, Gates became animated when it was suggested President Obama might have had a stronger grasp of the issue.

“Come on! Universal flu vaccine?” said Gates, who generally projects even-keeled competence when he speaks. “Pandemic preparedness, during those eight years: What’s your favorite thing that happened? Name it!”

“I mean, seriously!” But Gates’s tone quickly softened: “There’s a lot of reasons to like Obama … and he actually had a science adviser.”

About rising infectious disease threats due to climate change

Asked about concerns that rising temperatures will increase infectious diseases risks, Gates said some claims were “overstated.”

“Although when the world gets warmer, mosquitoes live in more areas, that’s like between now and 2100,” he said. “And the percentage of extra deaths because the mosquitoes live in more areas — that’s the climate change people really reaching for something.”

Gates is concerned about climate change, and he pointed out his foundation is a major funder of energy innovations. But the risk of a pandemic, in his view, is more urgent than the risk of disease spread associated with climate change.

“The problems are much more to agriculture and sea rise. The infectious disease piece just — as you go through the numbers — it just doesn’t bear up.”

One threat that is supposed to worsen with climate change: malaria, a disease that Gates and others are trying to help eradicate. Earlier this month, in fact, he pledged $1 billion in new spending to combat malaria.

“We should get rid of malaria before 2100. If malaria’s still around in 2100, shame on humanity,” he said.

Polio’s protracted swan song

For the last decade or so the Gates Foundation has been a pivotal partner in the polio eradication program. The effort to rid the globe of polio was launched 30 years ago, and though global case counts are at historic lows, the virus continues to defy the world’s best efforts to snuff it out.

Will transmission stop for good in 2018? The normally optimistic Gates was cautious, noting that environmental surveillance in Afghanistan and Pakistan — the last two countries where viruses are thought to be spreading — is still turning up more polioviruses in sewage samples than the program thinks it should be.

“We don’t know that this will be the last year,” Gates said. “We’re serious about ending polio and it’s not easy. It’s not predictable.”

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  • IF Trump goes along with this, I think Gates should give Trump the vaccine. Then Trump should give the vaccine to Gates, then Trump should give it to his beautiful little son, then Ivanka, then to Jared, etc.
    Let’s not forget that, Gates, provided he lives long enough to do it, vaccinates his own wife and kids. Now Gates needs to vaccinate the Council of 13 (12).
    And I do mean the very same vaccine they intend to give to all of us (mankind), not a pic of them receiving a saline vaccine.

    There you go, all the problems of mankind are solved.

    • I won’t take the current flu shot each year, let alone a “universal” flu shot. When did Bill Gates become an immunologist? No? Is he aware that there is no universal immune system? Stick to little electronic gadgets and widgets Bill.
      -RN

  • What we need is AI to discover the microbiome in healthy people then use these norms to compare to diseased states. Then develop bacteriophages to attack the pathogens. there is already an inventory of bacteriophages and we need to add to it.
    Bacteria and viruses can change their protein configurations so they can avoid antibodies. Bacteria also can exchange DNA so the antibiotic resistant bacteria can pass the resistance to other bacteria.
    The microbiome comprises anywhere from 10 to 43 % of humans. Yet we know nothing about that part of us.
    The direction of research must change from the magic pill to discover what cells make up the human organism and how they interact.

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