SPIEGEL: Mr. Gates, experts have been warning against catastrophic pandemics time and again. In 2002, it was severe acute respiratory syndrome (SARS), in 2005 it was bird flu, in 2009 the swine flu. And yet every time, the global catastrophe failed to materialize. Now you are saying that a pandemic could cause 30 million deaths in the next 10 to 15 years. Do you think people are still listening?
Gates: The fact that there was no catastrophic pandemic in recent history does not mean there won't be another one. And we are certainly not prepared for the next pandemic. It is hard to state the probability of a large natural epidemic or an intentionally caused bioterrorism type epidemic. But it is not zero -- so I've been speaking out that we need to do more.
SPIEGEL: In 1918, the Spanish flu virus caused up to 50 million deaths globally. Why do you think that now, almost 100 years later, the world is still unprepared?
Gates: One reason is that people forget. When you say that after World War I there was a pandemic that killed more people than the war itself, most will say: "Wait, are you kidding? I know World War I, but there was no World War 1.5, was there?" But people were traveling around after the war, and that meant the force of infection was much higher. And the problem is that the rate of travel back then was dramatically less than what we have nowadays.
SPIEGEL: What are the other reasons?
Gates: Priorities, for one. I have this very positive view of the world getting better and better. The list of things that could be huge setbacks is not very long: A nuclear war, climate change and epidemics. Today, we take the risk of nuclear war quite seriously, climate change not so much and epidemics least of all. But no single country, not even the United States, is well prepared. And even if one country is doing the right things to protect itself, it has to be a global thing. We need to cooperate globally on epidemic preparedness and prevention in the same way we are cooperating globally to stop people from getting nuclear weapons.
SPIEGEL: One problem with preparing for epidemics is that much of the science involved is dual use: New tools can help protect against viruses, but they can also be weaponized.
Gates: It is good news that science is developing tools for diagnosis, treatment and protection. In 1990, one in 10 children died before the age of five. That's now down to one in 20, and vaccines were the single biggest factor in that. Had it stayed at 10 percent, 122 million more children would have died. The unfortunate news is that science is also making it easier for non-state actors to breed some pathogen that would cause an epidemic. But the kinds of things you want to do to get ready for a natural or a bioterrorist epidemic are almost entirely the same.
SPIEGEL: Having governments prepare is one thing. But will enough people be willing to get vaccinated? Skepticism about vaccination seems to be increasing again, perhaps also because of declining public trust in experts' views.
Gates: If there was an epidemic, that definitely would make people accept vaccines. I wouldn't hope for that, of course, but if you wanted people to love vaccines, an epidemic would remind them how magical they are. We have completely eradicated smallpox; we have almost eradicated polio. That's the miracle of vaccines, which is even greater than that of antibiotics. Vaccines are extremely well tested; their safety is well understood. The false allegations about vaccines causing autism have been disproven. But there are still echoes out there confusing people.
SPIEGEL: "Echoes" sounds a bit like a euphemism given that President Trump himself has repeatedly embraced the idea of vaccines causing autism, even after his inauguration. During the campaign, he met with Andrew Wakefield, the scientist who authored the autism theory using fabricated data. Does this damage public trust in vaccines, and what does it say about Trump's approach to a science- and fact-based approach in general?
Gates: I only had one meeting with Mr. Trump, after he was elected in December, and I had a chance to explain vaccines and how great they are.
SPIEGEL: It seems you have not been very successful. In January, reports emerged that Mr. Trump is planning to have a commission look into the autism theory again, and it seems he wants Robert F. Kennedy, Jr., a notorious vaccine skeptic, to direct it.
Gates: The administration has not yet done anything official on this topic. I think at worst they would have some commission looking into it, which would be too bad, because there really are no open questions about this. But if so, the commission -- assuming it would be a scientific group -- would come back with exactly that.
SPIEGEL: You say you are an optimist, that things get better and better in the long run. Does this make you feel lonely at times?
Gates: The fact is that the "always better" approach is not widely appreciated. I'm not saying there aren't huge problems. But good stuff tends to happen gradually, whereas violence or catastrophes are deemed more newsworthy. If you say to people that there's less violence today than in the past, they would be stunned to hear that. But it's the truth, even though we have awful things happening in Syria or Sudan.