At the Sibos banking conference, the ex-Microsoft CEO and chair of the Bill and Melinda Gates Foundation talked to the Guardian about Ebola and the low chances of a US epidemic

Bill Gates on Ebola and the low risk of the disease in the US: 'Health is very unjust'

The Sibos banking conference in Boston – a yearly gathering of more than 7,500 people in financial services – recorded its biggest audience ever for its closing interview. The lure? Bill Gates, the co-founder of both Microsoft and the Bill and Melinda Gates Foundation.

Using his capitalist bona fides, Gates spoke at Sibos to pitch one of the foundation’s priorities: encouraging the assembled bankers to work together to create better banking systems for the poor in countries like Kenya and Nigeria, where bank branches are rare, payments are usually less than $5, and $20 cellphones are often the preferred tool of banking. The Gates foundation has pledged $50m to fight Ebola in west Africa, including the hot zones of Guinea, Sierra Leone and Liberia.

The money will go to research and funding Ebola care efforts that are both private and public.

The Guardian asked Gates a few questions about the epidemic. An edited version of our conversation is below.

What do you think when you see the focus that’s been put on Ebola, knowing the number of people who die from malaria?

Malaria kills over 500,000 per year for Africa, and that’s come down somewhat with the use of bed nets and artemisinin. It’s a huge priority for our foundation.



So yeah, it is fair to ask why does Ebola deserve this huge response. And a key answer is that Ebola is shutting down the healthcare system. It’s actually shutting down a lot of activity in terms of food getting to people, kids going to school. But let’s just focus on the health system.



More kids are dying of malaria in these three countries now than they were before Ebola came along. In fact, we don’t have very accurate measures coming out of these three countries right now, but almost certainly more people are dying of non-Ebola diseases than are dying of Ebola.



So it would be worth stopping the Ebola epidemic if the only benefit was that it put the health system back in place.



Now, the health systems we have in these three countries weren’t ideal before the epidemic took place. That’s partly why gathering the information and getting the treatment capacity has been so difficult in these three, because even by African standards these three have very poor healthcare systems. Overall, healthcare systems in Africa have been improving a lot over the last decade, but with the civil war and some challenges in these countries, these weren’t as good.



So we need to get to the civil panic that shuts down these healthcare systems. We need to get treatment capacity, people willing to go to treatment centres so that the health system can re-operate again. And you stop Ebola deaths, so the two things go hand in hand.



Then we need to both be on a firmer footing on general health in these three countries and our preparedness for either an Ebola or some other type of outbreak.



What has the foundation chosen to do?

Because infectious diseases are a big area for us, we have a number of ways we’re involved. It’s key to point out that the US government is playing the strongest role in many aspects of this thing. It was Tom Frieden of the CDC who went in August and said that even though the US and we had given money, that seeing the urban impact, that we really all needed to step up.



And it was the president who said let’s get the Department of Defence involved because they’re the ones who can do logistics and get people in and out and get things built.



The tools – like can we have a vaccine that would protect people, the idea of how quickly could we move, which vaccine constructs should we look at it – we and the [National Institutes of Health] are looking at it hard, talking to all the companies, taking in expertise about how you can get things quickly through regulators, thinking about, OK, can we get a vaccine quickly, can we get a therapeutic? ZMapp as a therapeutic worked in the monkey models but there’s a real manufacturing challenge with that. So we’re working a lot on the tools.



We also got involved in the Nigeria case because we have a lot of polio activity there. So we gave the money that created the emergency operations centre and we had some of the polio people come down and staff that emergency operations centre. So we give money, we have staff that is getting involved.



It’s the scale of the US government response – the DoD, Tom speaking out, the president calling on other countries – that I feel is the key reason, though I can’t predict when, that I feel we’re going to be able to get on top of this.



What are your thoughts on seeing the Dallas Ebola case and knowing it exists because we have good Ebola care here in the US in a way that they don’t in Africa?

Health is very unjust. The chance of a poor child dying is 20 times the chance of a child in the United States or the UK dying.



That’s the great inequity that is a top priority of our foundation, to get rid of malaria and a variety of other diseases that would allow there to be health equity and the idea of all lives have equal value – making it look like the world has allocated its resources as though that’s the truth.



The likelihood of people getting Ebola in the US is extremely low, because we know how to quarantine people. Even if you get the disease, the kinds of things we can do in terms of maintaining your body, you’re better off to be here than in the three affected countries.

