How the pandemic will shape the near future | Bill Gates

Chris Anderson: Welcome, Bill Gates.

譯者: Lilian Chiu 審譯者: Helen Chang

克里斯·安德森：歡迎，比爾·蓋茲。

Bill Gates: Thank you.

比爾·蓋茲：謝謝。

CA: Alright. It's great to have you here, Bill.

克：比爾，很高興你能來。

You know, we had a TED conversation about three months ago

大約三個月前， 我們在 TED 對談上

談過這次疫情，

about this pandemic,

and back then, I think fewer than -- I think that was the end of March --

當時，我想只有不到—— 我想應該是三月底——

那時，美國的死亡人數 還不到一千人，

back then, fewer than 1,000 people in the US had died

and fewer than 20,000 worldwide.

全世界還不到兩萬人。

I mean, the numbers now are, like, 128,000 dead in the US

現在美國的死亡人數 是十二萬八千人，

and more than half a million worldwide,

全世界則是超過五十萬人，

in three months.

才短短三個月。才短短三個月。

In three months.

今年下半年，你認為 可能會是怎樣的狀況？

What is your diagnosis of what is possible for the rest of this year?

You look at a lot of models.

你研究很多模型。

What do you think best- and worst-case scenarios might be?

依你所見，最好 和最糟的情況會是什麼？

BG: Well, the range of scenarios, sadly, is quite large,

比：不幸的是， 可能的情況範圍非常大，

including that, as we get into the fall,

包括有可能等到進入秋天時，

we could have death rates that rival the worst of what we had

我們的死亡率會追上

至今死亡率最高的四月期間。

in the April time period.

If you get a lot of young people infected,

若有許多年輕人受到感染，最終，

eventually, they will infect old people again,

他們會再次傳染給老人，

and so you'll get into the nursing homes,

會進入到安養中心、遊民收容所，

the homeless shelters,

有許多人因疫情而死的地方。

the places where we've had a lot of our deaths.

The innovation track, which probably we'll touch on --

我們等下可能會 概略談到創新軌跡——

diagnostics, therapeutics, vaccines --

診斷、治療法、疫苗——

there's good progress there,

那裡有很好的進展，

but nothing that would fundamentally alter the fact

但都無法從根本上改變一個事實：

that this fall in the United States could be quite bad,

今年秋天美國的狀況可能會很糟，

and that's worse than I would have expected a month ago,

比我在一個月前預期的更糟，

the degree to which we're back at high mobility,

我們又回到了高移動性，

not wearing masks,

不戴口罩，

and now the virus actually has gotten into a lot of cities

現在病毒已經大舉入侵許多

以前沒有病毒的城市裡，

that it hadn't been in before in a significant way,

so it's going to be a challenge.

所以這會是個困難的挑戰。

There's no case where we get much below the current death rate,

絕對不可能遠低於目前的死亡率，

which is about 500 deaths a day,

而目前是一天五百人死亡。

but there's a significant risk we'd go back up

但有極大的風險 死亡率會再次升高，

to the even 2,000 a day that we had before,

升至以前曾經發生過的 一天兩千人死亡，

because we don't have the distancing,

因為我們沒有保持距離，

the behavior change,

行為改變的程度

to the degree that we had in April and May.

沒有像四月、五月那樣。

And we know this virus is somewhat seasonal,

我們知道這種病毒 某種程度上是季節性的，

so that the force of infection,

所以感染力

both through temperature, humidity, more time indoors,

受到溫度、濕度、 待在室內時間變長的影響，

will be worse as we get into the fall.

在進入秋天時會更強。

CA: So there are scenarios where in the US,

克：所以美國有種可能情況是， 如果依據這些數字向前推斷，

like, if you extrapolate those numbers forward,

we end up with, what,

我們最後可能會有 超過二十五萬人死亡，

more than a quarter of a million deaths, perchance,

even this year if we're not careful,

如果今年我們不小心謹慎，

and worldwide, I guess the death toll could, by the end of the year,

到了年底全世界的死亡人數

be well into the millions, with an "s."

可能會達「數」百萬。

Is there evidence that the hotter temperatures of the summer

有沒有證據顯示

夏天的高溫對我們真的有幫助？

actually have been helping us?

BG: They're not absolutely sure,

比：沒有絕對確定，但，肯定的是

but certainly, the IHME model definitely wanted to use the season,

健康指標和評估研究所的模型 肯定會想要使用

季節，包括溫度和濕度，

including temperature and humidity,

to try and explain why May wasn't worse than it was.

來試圖解釋為什麼 五月的狀況沒有更糟糕。

And so as we came out and the mobility numbers got higher,

所以，當我們走出來， 移動力數字又更高，

the models expected more infections and deaths to come out of that,

模型就預期會有更多人

因此被感染、死亡，

and the model kept wanting to say,

而模型一直要表示：

"But I need to use this seasonality

「但我得要用這種季節性

來配合說明為什麼五月沒有更糟，

to match why May wasn't worse,

why June wasn't worse than it was."

為什麼六月沒有更糟。」

And we see in the Southern Hemisphere,

我們發現，在南半球，

you know, Brazil,

比如巴西，

which is the opposite season,

季節和我們相反，

now all of South America is having a huge epidemic.

現在整個南美洲的疫情都很嚴重。

South Africa is having a very fast-growing epidemic.

南非的疫情惡化非常快速。

Fortunately, Australia and New Zealand,

幸運的是，澳洲和紐西蘭， 南半球最後的國家，

the last countries in the Southern Hemisphere,

are at really tiny case counts,

感染案例還很少，

and so although they have to keep knocking it down,

雖然它們必須要持續不斷對抗，

they're talking about, "Oh, we have 10 cases,

他們談的是：「喔，新增十個案例，

that's a big deal, let's go get rid of that."

好嚴重，我們得擺脫這個情況。」

So they're one of these amazing countries that got the numbers so low

它們是少數幾個厲害國家， 能把數據壓到很低，

that test, quarantine and trace

低到檢測、隔離、追蹤

is working to get them, keep them at very near zero.

對它們是有用的， 能讓案例數接近零。

CA: Aided perhaps a bit by being easier to isolate

克：也許比較容易隔離 也是有幫助的，

and by less density, less population density.

且人口密度比較低。

But nonetheless, smart policies down there.

但無論如何，他們都有睿智的政策。

BG: Yeah, everything is so exponential

比：是的，一切都是指數增減，

that a little bit of good work goes a long way.

做得好一點，就有很長遠的影響。

It's not a linear game.

這不是線性的賽局。

You know, contact tracing, if you have the number of cases we have in the US,

要知道，若要追蹤接觸者， 以我們美國的病例數，

it's super important to do,

是非常重要必須要做的，

but it won't get you back down to zero.

但也不可能讓回到零確診。

It'll help you be down,

可以協助減少案例，

but it's too overwhelming.

但數字太大了。

CA: OK, so in May and June in the US,

克：在美國，五月和六月時，

the numbers were slightly better than some of the models predicted,

數字比一些模型預測的要好些，

and it's hypothesized that that might be partly because of the warmer weather.

假設可能的原因之一 是天氣比較溫暖。

現在我們所見的狀況，你是否會說

Now we're seeing, really, would you describe it

as really quite alarming upticks in case rates in the US?

美國確診數增加的情況已經告急？

BG: That's right, it's --

比：是的，是——

In, say, the New York area,

比如，在紐約地區，

the cases continue to go down somewhat,

確診數持續某種程度地下降，

but in other parts of the country,

但在美國其他地方，

primarily the South right now,

現在主要是南部，

you have increases that are offsetting that,

增加的人數足以將之抵消；

and you have testing-positive rates in young people

且年輕人檢測出陽性反應的比率

that are actually higher than what we saw even in some of the tougher areas.

比我們在受災嚴重的地方

所見到的比率還要高。

And so, clearly, younger people have come out of mobility

所以，很顯然，年輕人的移動力

more than older people have increased their mobility,

大於老年人的，

so the age structure is right now very young,

所以目前感染者的年齡結構很年輕。

but because of multigenerational households,

但因為有多代同堂的家庭，

people work in nursing care homes,

有人在安養中心工作，

unfortunately, that will work its way back,

不幸的是，還會走上回頭路，

both the time lag and the transmission,

時間延遲以及傳播 都會回到老人身上，

back up into the elderly,

will start to push the death rate back up,

這就會讓死亡率再次升高。

which, it is down --

目前死亡率已經下降——

way down from 2,000 to around 500 right now.

從兩千人大大下降到 目前約五百人。

CA: And is that partly because there's a three-week lag

克：有部分是因為案例數

between case numbers and fatality numbers?

和死亡人數之間有三星期的延遲嗎？

And also, perhaps, partly because

也可能有部分是因為

there have been some effective interventions,

過去有一些有效的干預手段，

and we're actually seeing the possibility

讓我們真的能看見整體死亡率

that the overall fatality rate is actually falling a bit

有下降一些的可能性，

now that we've gained some extra knowledge?

因為我們已經有更多額外知識了？

BG: Yeah, certainly your fatality rate is always lower

比：是的，在沒有負載過重時，

死亡率一定會比較低。

when you're not overloaded.

And so Italy, when they were overloaded,

以義大利為例，他們在超載時，

Spain, even New York at the start,

還有西班牙，紐約最初的時候，

certainly China,

中國肯定也是，

there you weren't even able to provide the basics,

在那種時候，甚至無法 提供基本的東西，

the oxygen and things.

比如氧氣等等。

A study that our foundation funded in the UK

我們在英國成立的基金會 做了一項研究，

found the only thing other than remdesivir

發現除了瑞德西韋之外，

that is a proven therapeutic,

只有一種藥物被證明有療效，

which is the dexamethasone,

就是地塞米松，

that for serious patients,

對重病的病人，

is about a 20 percent death reduction,

死亡率可以減少約兩成。

and there's still quite a pipeline of those things.

離充分供應這兩種藥物還很遠。

You know, hydroxychloroquine never established positive data,

而羥氯奎寧從未有正面數據，

so that's pretty much done.

大概就這些了。

There's still a few trials ongoing,

還有一些試驗在進行中，

but the list of things being tried,

但所有嘗試過的藥物，

including, eventually, the monoclonal antibodies,

包括最終也拿來測試的單株抗體，

we will have some additional tools for the fall.

讓我們在秋天會有 一些額外的工具可以用。

And so when you talk about death rates,

所以，談到死亡率，

the good news is, some innovation we already have,

好消息是，我們已經有一些創新，

and we'll have more, even in the fall.

甚至秋天還會有更多。

We should start to have monoclonal antibodies,

我們應該會開始有單株抗體，

which is the single therapeutic that I'm most excited about.

這是最讓我感到興奮的療法。

CA: I'll actually ask you to tell me a bit more about that in one sec,

克：我其實等下就要問你這件事，

但我們先把死亡率的拼圖拼起來，

but just putting the pieces together on death rates:

so in a well-functioning health system,

在運作良好的健康體系中，

so take the US when places aren't overcrowded,

比如美國醫院沒有過載的時候，

what do you think

以你的看法，目前，

the current fatality numbers are, approximately, going forward,

概略的死亡人數是否一直維持是

like as a percentage of total cases?

總案例數的一個比例？

Are we below one percent, perhaps?

我們也許在 1% 以下？

BG: If you found every case, yes,

比：若所有的案例 都找出來了，是的，

you're well below one percent.

一定低於 1%。

People argue, you know, 0.4, 0.5.

有人主張是 0.4、0.5。

By the time you bring in the never symptomatics,

如果你把無症狀感染者也納入，

it probably is below 0.5,

可能會低於 0.5，

那是好消息。

and that's good news.

This disease could have been a five-percent disease.

這種疾病有可能是 死亡率 5% 的疾病。

The transmission dynamics of this disease

這種疾病的傳播動態

are more difficult than even the experts predicted.

比專家所預測都還要更困難。

The amount of presymptomatic and never symptomatic spread

症狀前個案和無症狀個案 造成散播的情況，

and the fact that it's not coughing,

以及這種疾病並不像咳嗽，

where you would kind of notice, "Hey, I'm coughing" --

讓你注意到「嘿，我在咳嗽」——

most respiratory diseases make you cough.

它不像大部分的呼吸道 疾病會讓你咳嗽。

This one, in its early stages, it's not coughing,

這種疾病在初期時並不會咳嗽，

it's singing, laughing, talking,

是你在唱歌、說笑的時候，

actually, still, particularly for the super-spreaders,

特別是身上有非常大量 病毒的超級傳播者，

people with very high viral loads,

causes that spread,

造成病毒散播，這點十分新奇，

and that's pretty novel,

and so even the experts have to say, "Wow, this caught us by surprise."

就連專家也說： 「哇，出乎我們意料之外。」

The amount of asymptomatic spread

無症狀散播的量很大，

and the fact that there's not a coughing element

且又沒有咳嗽元素，

is not a major piece like the flu or TB.

讓它完全不像流感或結核病。

CA: Yeah, that is devilish cunning by the virus.

克：是的，那正是 這種病毒的狡詐之處。

I mean, how much is that nonsymptomatic transmission

無症狀感染者造成的傳播

佔了總傳播的多少百分比？

as a percentage of total transmission?

I've heard numbers it could be as much as half of all transmissions

我聽過的數字是， 總傳播數中有多達半數

基本上是症狀前造成的。

are basically presymptomatic.

BG: Yeah, if you count presymptomatics,

比：是的，如果症狀前也算的話，

then most of the studies show that's like at 40 percent,

大部分的研究顯示，約為四成，

and we also have never symptomatics.

還有些人始終都沒有出現症狀。

The amount of virus you get in your upper respiratory area

在上呼吸道區域的病毒量

is somewhat disconnected.

某種程度是不相關的。

Some people will have a lot here and very little in their lungs,

有些人在上面這裡有許多病毒， 但在肺部中卻很少，

and what you get in your lungs causes the really bad symptoms --

真正造成嚴重症狀的 是肺部中的病毒——

and other organs, but mostly the lungs --

還有其他的器官， 不過主要是肺部——

and so that's when you seek treatment.

那時你才會去尋求治療。

And so the worst case in terms of spreading

所以，在散播方面最糟糕的情況

is somebody who's got a lot in the upper respiratory tract

就是有人在上呼吸道有很多病毒，

but almost none in their lungs,

但肺部幾乎沒有，

so they're not care-seeking.

所以他們不會去尋求照護。

CA: Right.

克：是的。所以， 如果把從來沒有症狀的個案

And so if you add in the never symptomatic

to the presymptomatic,

和症狀前個案加在一起，

do you get above 50 percent of the transmission

總傳播當中是否會有超過五成 來自沒有症狀的個案？

is actually from nonsymptomatic people?

BG: Yeah, transmission is harder to measure.

比：傳播是很難測量的。

You know, we see certain hotspots and things,

要知道，我們看到某些熱點，

but that's a huge question with the vaccine:

但疫苗有一個大問題：

Will it, besides avoiding you getting sick,

疫苗測試是要知道 除了讓你不生病，

which is what the trial will test,

will it also stop you from being a transmitter?

是否還讓你不傳播？

CA: So that vaccine,

克：疫苗是個很重要的問題， 我們要來談談它。

it's such an important question, let's come on to that.

但在此之前，先談談 在過去幾個月，

But before we go there,

any other surprises in the last couple months

是否有驚人新發現，

that we've learned about this virus

that really impact how we should respond to it?

真會影響我們因應病毒的方式？

BG: We're still not able to characterize who the super-spreaders are

比：我們還無法找出超級傳播者

in terms of what that profile is,

有什麼樣的特徵， 且可能永遠找不到。

and we may never.

That may just be quite random.

那可能是很隨機的。

If you could identify them,

如果你能辨識出他們，

they're responsible for the majority of transmission,

大部分的傳播都是他們造成的，

a few people who have very high viral loads.

那些有非常高病毒量的少數人。

But sadly, we haven't figured that out.

但很可惜，我們還沒搞懂這一塊。

This mode of transmission,

傳播的模式，

if you're in a room and nobody talks,

若你在一間房間中，沒有人說話，

there's way less transmission.

傳播就會少很多。

That's partly why, although planes can transmit,

這可以部分說明 為什麼飛機雖然可以傳播，

it's less than you would expect just in terms of time proximity measures,

就時間相鄰度測量來說， 實際情況卻比預期少很多，

because unlike, say, a choir or a restaurant,

因為在飛機上不像在合唱團或者餐廳，

you're not exhaling in loud talking

你呼出的氣體不會像在大聲說話那樣，

quite as much as in other indoor environments.

比較像是在其他室內環境那樣。

CA: Hmm.

克：嗯，對於有人 上飛機卻拒絕戴口罩，

What do you think about the ethics of someone who would go on a plane

在倫理面上，你有什麼的看法？

and refuse to wear a mask?

BG: If they own the plane, that would be fine.

克：如果那架飛機 是你的，那沒關係。

If there's other people on the plane,

如果機上有其他人，

that would be endangering those other people.

那就是在危害其他人。

CA: Early on in the pandemic,

克：在疫情初期，世界衛生組織

the WHO did not advise that people wear masks.

並不建議大家戴口罩。

They were worried about taking them away from frontline medical providers.

他們擔心會搶走前線 醫療服務提供者的口罩。

In retrospect, was that a terrible mistake that they made?

現在回頭看，他們是否犯了大錯？

BG: Yes.

比：是的。

All the experts feel bad that the value of masks --

所有專家都感覺很糟，

口罩的價值——

which ties back somewhat to the asymptomatics;

這和無症狀感染者 在某種程度上有關，

if people were very symptomatic,

如果大家的症狀很明顯，

like an Ebola,

像伊波拉那樣，

then you know it and you isolate,

你會知道誰被感染，就能做隔離，

and so you don't have a need for a masklike thing.

就不會需要像口罩這樣的東西。

The value of masks,

口罩的價值，

the fact that the medical masks was a different supply chain

醫療口罩的供應鏈

than the normal masks,

和一般口罩不同，

the fact you could scale up the normal masks so well,

你可以把一般口罩的規模做大，

the fact that it would stop that presymptomatic,

就可以阻止症狀前感染，

never symptomatic transmission,

也不會發生有症狀的感染。

it's a mistake.

那是個錯誤，

But it's not a conspiracy.

但那不是陰謀。

It's something that, we now know more.

只是我們現在知道得更多。

And even now, our error bars on the benefit of masks

就連現在，口罩益處的誤差線 都比我們願意承認的還要高，

are higher than we'd like to admit,

but it's a significant benefit.

但益處很顯著。

CA: Alright, I'm going to come in with some questions

克：好，我帶來一些社群成員的問題。

from the community.

Let's pull them up there.

把問題放上來。

Jim Pitofsky, "Do you think reopening efforts in the US have been premature,

吉姆·皮托夫斯基：

「你認為美國重新開放是否過早？

and if so, how far should the US go to responsibly confront this pandemic?"

如果是，你認為美國若要負起責任 對抗疫情，應該做到什麼程度？」

BG: Well, the question of how you make trade-offs

比：問題在於權衡取捨，

between the benefits, say, of going to school

像是去學校上學的好處，

versus the risk of people getting sick because they go to school,

對比去學校就得冒感染的風險。

those are very tough questions

那些問題很難取捨，

that I don't think any single person can say,

我不認為有任何一個人能說：

"I will tell you how to make all these trade-offs."

「我能教你如何權衡取捨。」

The understanding of where you have transmission,

要了解傳播在哪裡發生，

and the fact that young people do get infected

且年輕人確實會被感染，

and are part of the multigenerational transmission chain,

他們也是多代傳播鏈的一部分，

we should get that out.

這資訊應該要傳出去。

If you just look at the health aspect,

如果只看健康面向，

we have opened up too liberally.

我們的開放就太寬鬆了。

Now, opening up in terms of mental health

從心理健康方面來看開放，

and seeking normal health things like vaccines or other care,

以及尋求正常的健康相關事物，

比如疫苗或其他照護，

there are benefits.

是有益處的。

I think some of our opening up has created more risk than benefit.

我認為我們有些開放措施

造成的風險比益處高。

Opening the bars up as quickly as they did,

那麼快就開放酒吧，

you know, is that critical for mental health?

那對心理健康有這麼必要嗎？

Maybe not.

也許沒有。

So I don't think we've been as tasteful about opening up

我不認為我們對於 開放的判斷做得很好，

as I'm sure, as we study it,

我相信，

當我們去研究，

that we'll realize some things we shouldn't have opened up as fast.

會發現

有些開放措施不該這麼快。

But then you have something like school,

但，又還有學校要考量，

where even sitting here today,

就連今天坐在這裡，

the exact plan, say, for inner-city schools for the fall,

確切的計畫，比如，

內都市（貧民區）秋季學校計畫，

I wouldn't have a black-and-white view

對涉及到的相關權衡取捨，

on the relative trade-offs involved there.

我也沒有黑白分明的看法。

There are huge benefits to letting those kids go to school,

讓那些孩子去上學 的確有很大的益處，

and how do you weigh the risk?

而你要如何評估風險？

If you're in a city without many cases,

如果你所處的城市 沒有許多確診個案，

I would say probably the benefit is there.

我會說，可能是有益處的。

Now that means that you could get surprised.

你有可能會沒意料到。

The cases could show up, and then you'd have to change that,

個案可能會出現， 接著你就得改變，

which is not easy.

這並不容易。

But I think around the US,

但我認為，在美國，

there will be places where that won't be a good trade-off.

會有某些地方，

這樣的權衡不甚理想。

So almost any dimension of inequity,

幾乎不平等的每一個維度，

this disease has made worse:

都被這種疾病變得更糟糕：

job type, internet connection,

工作類型、網路連線、

ability of your school to do online learning.

學校做線上學習的能力。

White-collar workers,

白領階級的工作者，

people are embarrassed to admit it,

大家不好意思承認，

some of them are more productive

當中有些人的生產力比較高，

and enjoying the flexibility that the at-home thing has created,

且能夠享受在家工作帶來的彈性，

and that feels terrible

而當你知道很多人在許多層面上

when you know lots of people are suffering in many ways,

受苦時，那感覺糟透了，

including their kids not going to school.

包括他們的孩子無法去上學。

CA: Indeed. Let's have the next question.

克：的確。來看下一個問題。

[Nathalie Munyampenda] "For us in Rwanda,

「對我們盧安達的人， 早期的政策干預造成了不同。

early policy interventions have made the difference.

此時，你會建議美國 做什麼樣的政策干預？」

At this point, what policy interventions do you suggest for the US now?"

Bill, I dream of the day where you are appointed

比爾，我夢想有一天你會被指派 擔任新型冠狀病毒沙皇，

the coronavirus czar

with authority to actually speak to the public.

有權真正對大眾發言。

What would you do?

你會怎麼做？

BG: Well, the innovation tools

比：嗯，

創新工具

are where I and the foundation probably has the most expertise.

可能是我和基金會最擅長的地方。

Clearly, some of the policies on opening up have been too generous,

顯然，有一些開放政策太大方了，

but I think everybody

但我認為人人

could engage in that.

都能參與其中。

We need leadership

我們需要領導人承認

in terms of admitting that we've still got a huge problem here

我們的問題仍然很大，

and not turning that into almost a political thing

且不要把它轉變成政治的東西：

of, "Oh, isn't it brilliant what we did?"

「喔，我們做得很棒不是嗎？」

No, it's not brilliant,

不，並不棒，但，

but there's many people, including the experts --

有許多人，包括專家——

there's a lot they didn't understand,

他們還有很多不了解的，

and everybody wishes a week earlier whatever action they took,

大家都希望，不論採取什麼行動，

they'd taken that a week earlier.

他們都能早一週行動。

The innovation tools,

至於創新工具，

that's where the foundation's work

基金會在這方面針對抗體、疫苗

on antibodies, vaccines,

做努力，

we have deep expertise,

我們在此有很深的專業，

and it's outside of the private sector,

且是在民營部門之外，

and so we have kind of a neutral ability to work with all the governments

所以我們中立，

能和所有政府及公司合作。

and the companies to pick.

Particularly when you're doing break-even products,

特別是當你在做不賠不賺的 產品時，誰能得到資源？

which one should get the resources?

There's no market signal for that.

那可沒有市場訊號可以參考。

Experts have to say, "OK, this antibody deserves the manufacturing.

專家會說：「好，這種抗體 應該要生產製造。

This vaccine deserves the manufacturing,"

這種疫苗應該要生產製造。」

because we have very limited manufacturing for both of those things,

因為生產力有限， 我們無法兩樣都生產，

and it'll be cross-company, which never happens in the normal case,

必須要跨公司合作，

這在平時是不可能的——

where one company invents it

一家公司發明，

and then you're using the manufacturing plants of many companies

交由多家公司的工廠

to get maximum scale of the best choice.

以最大的規模生產那選出的最佳產品。

So I would be coordinating those things,

我會協調這些事，

but we need a leader who keeps us up to date,

但我們需要領導人 提供我們最新的資訊。

is realistic

他得要切實，

and shows us the right behavior,

以身作則讓我們看怎樣做是對的，

as well as driving the innovation track.

同時引導創新軌跡。

CA: I mean, you have to yourself be a master diplomat

克：你自己必須有純熟的外交技巧

in how you talk about this stuff.

才能談論這些事情；

So I appreciate, almost, the discomfort here.

因此我很感激你的不憚煩勞。

But I mean, you talk regularly with Anthony Fauci,

意思是，你常和安東尼·弗契博士談，

who is a wise voice on this by most people's opinion.

大部分人認為他在這方面很明智，

But to what extent is he just hamstrung?

但他受到多大程度的限制？

He's not allowed to play the full role

他不被允許好好扮演

他在這個情況中可以扮演的角色。

that he could play in this circumstance.

BG: Dr. Fauci has emerged where he was allowed to have some airtime,

比：如今的情況是 弗契博士被允許可上電視廣播。

and even though he was stating things that are realistic,

雖然他說的內容都很實際，

his prestige has stuck.

他的威信卻被卡住了。

He can speak out in that way.

他能用那種方式發聲。

Typically, the CDC would be the primary voice here.

通常疾病管制與預防中心 (CDC) 是主要的發言中心。

It's not absolutely necessary,

未必非得如此，

but in previous health crises,

但過去的健康危機

you let the experts inside the CDC

會讓 CDC 內部的專家出來發聲。

be that voice.

They're trained to do these things,

他們受的訓練就是要做這些，所以，

and so it is a bit unusual here how much we've had to rely on Fauci

我們這麼仰賴弗契而不是 CDC，

as opposed to the CDC.

這點是有點不尋常。

It should be Fauci, who's a brilliant researcher,

因為弗契是個出色的研究者，

so experienced, particularly in vaccines.

經歷豐富，特別是在疫苗方面。

In some ways, he has become, taking the broad advice

在某些層面上，他已經 變成接受廣大的建議，

that's the epidemiology advice

也就是流行病學的建議，

and explaining it in the right way,

且用正確的方式做解釋，

where he'll admit,

他會承認：「好，

"OK, we may have a rebound here,

疫情在這裡可能會反彈，

and this is why we need to behave that way."

因此我們得要那麼做。」

But it's fantastic that his voice has been allowed to come through.

到底，允許他的發言 傳得出來是很棒的事。

CA: Sometimes.

克：「有時」傳得出來。

Let's have the next question.

我們來看看下一個問題。

Nina Gregory, "How are you and your foundation

妮娜·葛雷哥利：

「倘若你和你的基金會 找到可用的疫苗，

addressing the ethical questions about which countries get the vaccine first,

要如何處理哪個國家 先拿到疫苗的倫理問題？」

assuming you find one?"

And maybe, Bill, use this as a moment

比爾，也許可以順便談談

to just talk about where the quest for the vaccine is

疫苗發展的進度，

and what are just some of the key things we should all be thinking about

以及當我們在追蹤這方面的新聞時

as we track the news on this.

應該要思考哪些關鍵。

比：有三種疫苗，

BG: There's three vaccines that are,

如果可行，會是最早的疫苗：

if they work, are the earliest:

the Moderna, which unfortunately, won't scale very easily,

Moderna 公司的，

遺憾的是規模很不容易做大，

so if that works, it'll be mostly a US-targeted thing;

若它能用，可能主要會以美國為目標；

then you have the AstraZeneca, which comes from Oxford;

還有牛津的阿斯特捷利康藥廠；

and the Johnson and Johnson.

還有嬌生公司。

Those are the three early ones.

這三種是最早的。

And we have animal data

我們有動物資料，

that looks potentially good but not definitive,

看似潛力不錯，

但並非最佳，

particularly will it work in the elderly,

特別是無法確定 對老年人是否有用，

and we'll have human data over the next several months.

在接下來幾個月 就會有人體實驗資料。

Those three will be gated by the safety and efficacy trial.

這三種疫苗

會由安全及功效試驗來把關。

That is, we'll be able to manufacture those,

也就是說，我們能生產它們，

although not as much as we want.

但並不是想要多少就生產多少。

We'll be able to manufacture those before the end of the year.

在年底之前我們就能生產它們。

至於第三階段是否會成功，

Whether the Phase 3 will succeed

and whether it'll complete before the end of the year,

在年底前是否會完成，

I wouldn't be that optimistic about.

我就沒那麼樂觀了。

Phase 3 is where you need to really look at all the safety profile

第三階段必須要研究 所有的安全數據圖表

and efficacy,

以及功效，但那些會開始進行。

but those will get started.

And then there's four or five vaccines that use different approaches

接著還有四、五種疫苗 用的是不同的方法，

that are maybe three or four months behind that:

時間上落後三、四個月：

Novavax, Sanofi, Merck.

來自 Novavax、賽諾菲、 默克這幾間公司。

And so we're funding factory capacity for a lot of these --

我們針對很多這些疫苗，

資助工廠的生產能力——

some complex negotiations are taking place right now on this --

目前有一些和這方面

相關的複雜協商正在進行中——

to get factories that will be dedicated to the poorer countries,

要找到願意投入協助 較貧窮國家的廠商，

what's called low- and middle-income.

所謂的中低收入。

And the very scalable constructs

而能夠做大的構想，

that include AstraZeneca and Johnson and Johnson,

包括阿斯特捷利康製藥及嬌生公司，

we'll focus on those,

我們會專注在那些不昂貴的疫苗，

the ones that are inexpensive

and you can build a single factory to make 600 million doses.

且只要單一工廠 就可以生產出六億劑。

So a number of the vaccine constructs

所以有不少疫苗的構想

are potential.

都有潛力。

I don't see anything before the end of the year.

我不認為在年底前會出來，

That's really the best case,

那真的會是最佳的情況。

and it's down to a few constructs now,

其他只剩下少數幾個構想，

which, typically, you have high failure rates.

這些通常失敗率會很高。

CA: Bill, is it the case

克：比爾，是不是如果 你和你的基金會沒有參與，

that if you and your foundation weren't in the picture here

that market dynamics would likely lead to a situation

市場動態就很可能會導致

where, as soon as a promising vaccine candidate emerged,

當前景看好的候選疫苗出現時，

the richer countries would basically snap up, gobble up

較富裕的國家基本上就會掃光

all available initial supply --

所有最初可以取得的疫苗供應——

it just takes a while to manufacture these,

生產出那些就要花些時間，

and there would be nothing for the poorer countries --

而較貧窮的國家什麼都搶不到。

but that what, effectively, you're doing

但你實際上在做的事，

by giving manufacturing guarantees and capability

是把生產保證以及生產能力

to some of these candidates,

給予一些候選疫苗，

you're making it possible that at least some of the early vaccine units

因此有可能

至少最初生產出來的疫苗

will go to poorer countries?

有一部分可以給較貧窮的國家，

Is that correct?

是這樣嗎？

BG: Well, it's not just us, but yes,

比：不只是我們，但沒錯，

we're in the central role there,

我們在此扮演了核心角色，

along with a group we created called CEPI, Coalition for Epidemic Preparedness,

還有我們成立的團體 CEPI，

也就是流行病預防創新聯盟，

and the European leaders agree with this.

以及歐洲領導人都認同這一點。

Now we have the expertise to look at each of the constructs

我們有專門技術， 可以研究每一種構想，

and say, "OK, where is there a factory in the world

並說：「好，世界上哪裡有工廠

that has capacity that can build that?

有能力可以做到它？

Which one should we put the early money into?

我們應該最先把錢投入到哪間工廠？

What should the milestones be

到了什麼里程碑時

where we'll shift the money over to a different one?"

要把錢轉到不同的地方？」

Because the kind of private sector people

因為真正了解狀況的私領域人員，

who really understand that stuff,

some of them work for us,

當中有些為我們工作，

and we're a trusted party on these things,

在這些事情上， 我們是受信任的一方，

we get to coordinate a lot of it, particularly that manufacturing piece.

我們可以做很多協調，

特別是在生產製造的部分。

Usually, you'd expect the US to think of this as a global problem

通常，你會預期美國

會把這個問題視為 全球的問題並介入。

and be involved.

So far, no activity on that front has taken place.

截至目前為止

還沒發生任何那方面的活動。

I am talking to people in the Congress and the Administration

我和國會以及政府的人交涉，

about when the next relief bill comes along

也許可以在下一個抒困法案

that maybe one percent of that could go for the tools

將其中的 1% 撥給 這些協助全世界的工具。

to help the entire world.

And so it's possible,

所以是有可能的，

但很遺憾，

but it's unfortunate,

and the vacuum here,

在這種真空狀態下，

the world is not that used to,

世界並不熟悉，

and a lot of people are stepping in, including our foundation,

有很多人介入， 包括我們的基金會，

to try and have a strategy,

試圖想出策略，

including for the poorer countries,

將貧窮的國家納入，

who will suffer a high percentage of the deaths and negative effects,

這些國家的死亡率會很高，

負面效應會很大，

including their health systems being overwhelmed.

它們的健康系統可能無法招架。

Most of the deaths will be in developing countries,

儘管我們已經看到歐美 有大量的死亡案例，

despite the huge deaths we've seen in Europe and the US.

但大部分的死亡案例 仍會發生在開發中國家。

CA: I mean, I wish I could be a fly on the wall

克：我真希望能暗中偷聽

and hearing you and Melinda talk about this,

聽你和梅琳達談這些。

because of all of the ethical ... "crimes," let's say,

因為那些應該要做得更好的領導人，

所犯的這些，姑且說是道德「犯罪」，

executed by leaders who should know better,

I mean, it's one thing to not model mask-wearing,

我的意思是，不以身作則 戴口罩是一回事，

but to not play a role in helping the world

但在面臨共同敵人時

卻不扮演協助世界的角色，

when faced with a common enemy,

respond as one humanity,

不像是個「人」來回應，

and instead ...

反而……

you know, catalyze a really unseemly scramble between nations

催化國家間發生不該發生的爭奪，

to fight for vaccines, for example.

比如，搶疫苗。

That just seems -- surely, history is going to judge that harshly.

那似乎——

歷史肯定會嚴厲地評斷這件事。

That is just sickening.

那實在讓人作噁。

Isn't it? Am I missing something?

不是嗎？我有漏掉什麼嗎？

BG: Well, it's not quite as black-and-white as that.

比：嗯，

並沒有那麼黑白分明。

The US has put more money out

美國拿出很多錢

to fund the basic research on these vaccines

來資助這些疫苗的基礎研究，

than any country by far,

目前拿出的錢比任何國家都更多，

and that research is not restricted.

且沒限制那些研究。

There's not, like, some royalty that says, "Hey, if you take our money,

並不是，比如要某種權利金： 「嘿，如果你拿了我們的錢，

you have to pay the US a royalty."

你就得支付美國權利金。」

They do, to the degree they fund research,

在資助研究方面， 他們確實是為所有人而做；

it's for everybody.

To the degree they fund factories, it's just for the US.

在資助工廠方面， 則是為了美國而做。

The thing that makes this tough is that in every other global health problem,

這件事之所以很難搞，是因為 在所有其他全球健康問題上，

the US totally leads smallpox eradication,

像是美國完全主導滅絕天花，

the US is totally the leader on polio eradication,

美國領導消滅小兒麻痺症，

with key partners -- CDC, WHO, Rotary, UNICEF, our foundation.

攜手重要的合作夥伴——

CDC、世界衛生組織、扶輪社、

聯合國兒童基金會、我們的基金會。

So the world -- and on HIV,

所以世界——還有愛滋病，

under President Bush's leadership, but it was very bipartisan,

在布希總統的領導和兩黨的支持下，

this thing called PEPFAR was unbelievable.

愛滋病緊急救援計劃 簡直是不可思議，

That has saved tens of millions of lives.

拯救了數千萬條生命。

And so it's that the world always expected the US

所以，世界一直都會期望美國

to at least be at the head of the table,

至少要在會議桌上引領，

financially, strategy, OK, how do you get these factories for the world,

財務上、策略上，

好，你要如何讓這些 工廠為全世界生產，

even if it's just to avoid the infection coming back to the US

就算只是為了避免感染再回到美國，

or to have the global economy working,

或者讓全球經濟能運作，

which is good for US jobs

在美國以外有需求，

to have demand outside the US.

對美國的就業也有利。

And so the world is kind of --

所以全世界有點——

you know, there's all this uncertainty about which thing will work,

究竟什麼能行得通， 都充滿了不確定性，

and there's this, "OK, who's in charge here?"

有這種「好，這裡是誰主導？」

And so the worst thing, the withdrawal from WHO,

所以，最糟糕的事， 離開世界衛生組織，

that is a difficulty that hopefully will get remedied

希望這個難題

還能在將來某個時點補救回來，

at some point,

because we need that coordination

因為我們需要透過世界衛生組織協調。

through WHO.

CA: Let's take another question.

克：我們再來看另一個問題。

Ali Kashani, "Are there any particularly successful models

阿里·卡沙尼：「在處理疫情上，

of handling the pandemic that you have seen around the world?"

你看到世界上有什麼 特別成功的模型嗎？」

BG: Well, it's fascinating that, besides early action,

比：很棒的是， 除了超前部署之外，

there are definitely things where you take people who have tested positive

還有其他的，比如針對 檢測結果為陽性的人

and you monitor their pulse ox,

做脈搏血氧監控，

which is the oxygen saturation level in their blood,

也就是他們血液中的氧氣飽和度，

which is a very cheap detector,

這種偵測器非常便宜，

and then you know to get them to the hospitals fairly early.

你很早就會知道要送他們就醫。

Weirdly, patients don't know things are about to get severe.

奇怪的是，病人並不知道 狀況會開始變嚴重。

It's an interesting physiological reason that I won't get into.

我不在這裡深入討論 這背後有趣的生理原因。

And so Germany has quite a low case fatality rate

德國的死亡率很低，

that they've done through that type of monitoring.

他們就是靠那種監控辦到的。

And then, of course, once you get into facilities,

接著，當然，一旦你進入醫療場所，

we've learned that the ventilator, actually, although extremely well-meaning,

我們發現，呼吸器其實

本意雖然很好，

was actually overused and used in the wrong mode

但其實在早期被過度使用，

且使用的模式錯誤，

in those early days.

所以健康——

So the health -- the doctors are way smarter about treatment today.

現今的醫生在治療上聰明很多。

Most of that, I would say, is global.

我會說，這大部分都是全球性的。

Using this pulse ox as an early indicator,

用脈搏血氧來當作初期的指標，

that'll probably catch on broadly,

可能會廣為流行起來，

but Germany was a pioneer there.

但德國是這方面的先鋒。

And now, of course, dexamethasone -- fortunately, it's cheap, it's oral,

現在，當然，地塞米松——

幸運的是它很便宜且是口服的，

we can ramp up manufacture.

我們可以增加生產。

That'll go global as well.

那也會是全球性的。

CA: Bill, I want to ask you something about

克：比爾，我想要請問

what it's been like for you personally through this whole process.

你個人在這整個過程中的感受。

因為奇怪的是，

Because, weirdly, even though your passion and good intent on this topic

雖然你對這個主題的熱情及好意，

seems completely bloody obvious to anyone who has spent a moment with you,

只要是和你相處過的人

都能非常明顯知道；

there are these crazy conspiracy theories out there about you.

但外頭還是有些 和你有關的瘋狂陰謀論。

I just checked in with a company called Zignal

我才和 Zignal 公司聯繫，

that monitors social media spaces.

他們做的是監控社群媒體空間。

They say that, to date, I think on Facebook alone,

他們說，至今，我想光是臉書，

more than four million posts have taken place

就有超過四百萬篇貼文

that associate you with some kind of conspiracy theory around the virus.

和你在這次病毒事件中的陰謀論有關。

I read that there was a poll that more than 40 percent of Republicans

我讀到有一則民意調查，

有四成以上的共和黨員

believe that the vaccine that you would roll out

相信你要推出的疫苗

would somehow plant a microchip in people to track their location.

會以某種方式將微晶片植入人體 以追蹤他們的所在。

I mean, I can't even believe that poll number.

我實在無法相信那調查的數字。

And then some people are taking this seriously enough,

有些人還非常嚴肅看待此事，

and some of them have even been recirculated on "Fox News" and so forth,

在福斯新聞等地方還不斷重覆播放，

some people are taking this seriously enough

有些人很認真看待此事，

to make really quite horrible threats and so forth.

認真到會做出很可怕的威脅等等。

You seem to do a good job sort of shrugging this off,

你似乎能完全不在意這些事，

but really, like, who else has ever been in this position?

但，誰遇過這種事情？

How are you managing this?

你怎麼處理這種狀況？

What on earth world are we in

這是個怎樣的世界，

that this kind of misinformation can be out there?

讓這麼錯誤的資訊能到處傳？

What can we do to help correct it?

我們要如何協助改正它？

BG: I'm not sure.

比：我不確定。

And it's a new thing

以前沒有過這種情況，

that there's conspiracy theories.

出現這些陰謀論。

I mean, Microsoft had its share of controversy,

微軟有它的爭議性，

but at least that related to the real world, you know?

但至少是和真實世界有關。

Did Windows crash more than it should?

Windows 當機的次數是否過高？

We definitely had antitrust problems.

我們絕對有反壟斷的問題。

But at least I knew what that was.

但至少我知道那是什麼。

When this emerged, I have to say,

陰謀論出現時，

my instinct was to joke about it.

我的直覺就是笑笑過去即可。

People have said that's really inappropriate,

大家說那樣並不妥當，

because this is a very serious thing.

因為這是非常嚴肅的事。

It is going to make people less willing to take a vaccine.

會讓人比較不願意去接種疫苗。

And, of course, once we have that vaccine,

當然，一旦我們有了疫苗，

it'll be like masks,

就會像口罩一樣，

where getting lots of people,

讓許多人，

particularly when it's a transmission-blocking vaccine,

特別是對能阻擋傳播的疫苗，

there's this huge community benefit

若能讓疫苗被廣為使用，

to widespread adoption of that vaccine.

對社會有很大的益處。

So I am caught a little bit,

所以我有點陷入兩難，

unsure of what to say or do,

不確定該說、該做什麼，

because the conspiracy piece is a new thing for me,

因為對我來說，陰謀論是種新東西。

and what do you say

你要說什麼

that doesn't give credence to the thing?

才不會讓它變得可信？

The fact that a "Fox News" commentator, Laura Ingraham,

福斯新聞的時事評論者

勞拉·英格拉漢姆說 我要在人體植入微晶片；

was saying this stuff about me microchipping people,

that survey isn't that surprising because that's what they heard

如果人們在電視上聽到這些，

那民調結果並不意外。

on the TV.

It's wild.

很荒唐。

And people are clearly seeking simpler explanations

很顯然大家寧可尋求比較簡單的解釋，

than going and studying virology.

而不願去研究病毒學。

CA: I mean,

克：我的意思是，

TED is nonpolitical,

TED 無關政治，

but we believe in the truth.

但我們相信真相。

I would say this:

我會說：

Laura Ingraham, you owe Bill Gates an apology and a retraction.

勞拉·英格拉漢姆，你欠比爾·蓋茲 一個道歉且應該把話收回。

You do.

真的。

And anyone who's watching this

現在在看的觀眾，

who thinks for a minute that this man is involved in some kind of conspiracy,

如果你有一絲絲認為 這個人會涉及陰謀，

you want your head examined.

最好去檢查你的大腦。你瘋了。

You are crazy.

Enough of us know Bill over many years

我們有很多人都認識比爾許多年，

and have seen the passion and engagement in this to know

也見識到他在此的熱情和投入，

我們知道的足以確定你瘋了。

that you are crazy.

So get over it,

所以快想開吧，

and let's look at the actual problem of solving this pandemic.

我們來研究真正的問題： 如何解決這次疫情。

Honestly.

這是說真的。

If anyone in the chat here has a suggestion,

聊天室裡有沒有人可以建議一下，

a positive suggestion for how you can,

關於怎麼做的正面建議，

how do you get rid of conspiracies,

要怎麼擺脫陰謀論？

because they feed on each other.

因為他們彼此互相助長。

Now, "Oh, well I would say that, because I'm part of the conspiracy,"

「喔，我會那樣說是因為 我也是陰謀的一部分」之類的。

or whatever.

我們要如何回到

Like, how do we get back to a world

資訊可信的世界？

where information can be trusted?

We have to do better on it.

我們在這方面得做得更好。

Are there any other questions out there from the community?

還有其他來自社群的問題嗎？

Aria Bendix from New York City:

紐約市的艾莉亞·班迪克斯：

"What are your personal recommendations for those who want to reduce

「對於在這個確診數漸增的環境中

their risk of infection amid an uptick in cases?"

想要減低感染風險的人， 你個人有什麼建議？」

BG: Well, it's great if you have a job

比：很好的情況是，如果你的工作

可以在家做，

that you can stay at your house and do it through digital meetings,

透過數位會議來進行，

and even some of your social activities,

甚至做些社交活動，

you know, I do video calls with lots of friends.

我和很多朋友用視訊通話。

I have friends in Europe that, who knows when I'll see them,

我有些朋友在歐洲，天知道 我何時才會再見到他們，

but we schedule regular calls to talk.

但我們會安排定期視訊會議來交談。

If you stay fairly isolated,

如果你能處在很隔離的狀態，

you don't run much risk,

你就不會有什麼風險，

and it's when you're getting together with lots of other people,

是當你和很多人在一起時，

either through work or socialization,

不論是工作或社交，

that drives that risk,

那才會造成風險；

and particularly in these communities where you have increased cases,

特別是在確診個案數 增加的社區中，

even though it's not going to be mandated,

雖然這不是強制命令，

hopefully, the mobility numbers will show people responding

希望流動率數字會顯示 大家有做出因應，

and minimizing those kind of out-of-the-house contacts.

並將那些屋外的接觸

降到最低。

CA: Bill, I wonder if I could just ask you

克：比爾，不知道我能否問你 一點關於慈善事業的問題。

just a little bit about philanthropy.

Obviously, your foundation has played a huge role in this,

很顯然，你的基金會 在此扮演重要角色，

but philanthropy more generally.

不過整體來說是慈善事業。

You know, you've started this Giving Pledge movement,

你發起了「捐贈誓言」運動，

recruited all these billionaires

招募了許多億萬富翁

who have pledged to give away half their net worth

誓言在死前或死後要捐出

他們的一半淨值。

before or after their death.

But it's really hard to do.

但那真的很難。

It's really hard to give away that much money.

很難捐出這麼多錢。

You yourself, I think,

我認為，你自己， 從「捐贈誓言」開始之後——

since The Giving Pledge was started --

多久了？十年左右？ 我不太確定時間——

what? 10 years ago or something, I'm not sure when --

but your own net worth, I think, has doubled since that period

但你自己的淨值，我想， 已經比那時增加了一倍，

despite being the world's leading philanthropist.

儘管你是世界上帶頭的慈善家。

Is it just fundamentally hard to give away money effectively

基本上要把錢有效地捐出去

讓世界變更好是很困難的？

to make the world better?

Or should the world's donors,

或者，世界上的捐贈者，

and especially the world's really rich donors,

特別是真的很有錢的捐贈者， 應該要開始承諾一個時間表，

start to almost commit to a schedule,

like, "Here's a percentage of my net worth each year

比如「這是我每年淨值的一個百分比，

that, as I get older,

隨著我年齡漸增，可能還會提升。

maybe that goes up.

If I'm to take this seriously,

如果我認真看待此事，

I have to give away -- somehow, I've got to find a way

我必須要找到某種方式 有效益地做捐贈。」

of doing that effectively."

Is that an unfair and crazy question?

這個問題會很不公平且瘋狂嗎？

BG: Well, it'd be great to up the rate,

比：如果能把比率提高是很好，

and our goal, both as the Gates Foundation or through The Giving Pledge,

我們的目標，透過蓋茲基金會 或捐贈誓言想達到的目標，

is to help people find causes they connect to.

是協助大家找到 他們能有所連結的理念。

People give through passion.

大家是透過熱情來付出的。

Yes, numbers are important,

是的，數字很重要，

but there's so many causes out there.

但，外頭有好多理念。

The way you're going to pick is you see somebody who's sick,

你挑選目標的方式是， 你看到某人生病，

you see somebody who's not getting social services.

你看到某人無法得到社會服務，

You see something that helps reduce racism.

你看到某種能協助 減少種族主義的方式。

And you're very passionate, and so you give to that.

你非常有熱情， 所以會為那些事去捐贈。

And, of course,

當然，有些慈善捐贈最後沒有用。

some philanthropic gifts won't work out.

We do need to up the ambition level of philanthropists.

我們確實需要提高慈善家的企圖心。

Now, collaborative philanthropy

合作性質的慈善事業，

that you're helping to facilitate through Audacious,

透過「大膽計畫」來貢獻心力，

there's four or five other groups that are getting philanthropists together,

有另外四、五個團體在將 慈善家集結起來，那很棒，

that is fantastic,

因為他們能彼此學習，

because then they learn from each other,

they get confidence from each other,

他們能從彼此身上得到信心，

they feel like, "Hey, I put in x, and the four other people put money in,

他們覺得：「嘿，我投入 x，

另外四個人投入金錢，

so I'm getting more impact,"

所以影響會比較大。」

and hopefully, it can be made fun for them even when they find out,

希望，就算當他們發現某些捐贈

並沒有預期的效果， 他們仍然能樂在其中，

OK, that particular gift didn't work out that well,

but let's keep going.

繼續投入。

So philanthropy, yes,

所以，慈善事業，是的，

I would like to see the rate go up,

我希望能看到比率上升，

and people who do get going,

對於開始動身的人，

it is fun,

這很有趣，很讓人滿足，

it's fulfilling,

you pick which of the family members are partnered in doing it.

你可以選要和哪個家人 攜手一起做這件事。

In my case, Melinda and I love doing this stuff together,

就我來說，我和梅琳達 很喜歡一起做這些事，

learning together.

一起學習。

Some families, it will even involve the kids in the activities.

在某些家庭中， 甚至孩子也參與活動。

Sometimes the kids are pushing.

有時是孩子在推動。

When you have lots of money,

若你有很多錢，

you still think of a million dollars as a lot of money,

仍然會認為一百萬美金是一大筆錢；

but if you have billions,

但如果你有幾十億美金， 你應該要捐贈出幾億美金。

you should be giving hundreds of millions.

So it's kind of charming that, in terms of your personal expenditure,

蠻迷人的一點在於， 就你的個人花費來說，

you stay at the level you were at before.

你和以前沒有什麼不同。

That's societally quite appropriate.

在社會層面上是妥當的。

But on your giving, you need to scale up

但就你的捐贈來說， 你得要增加規模，

or else it will be your will,

要不然它就會變成你的遺囑，

and you won't get to shape it and enjoy it quite that same way.

你就無法控制它， 無法用同樣的方式來享受它。

And so without --

所以若沒有——

we don't want to mandate it,

我們不想強制規定它，

but yes, both you and I want to inspire philanthropists

但，是的，

你我都想要鼓勵慈善家

to see that passion, to see those opportunities

看見那些熱忱、看見那些機會，

significantly faster than in the past,

且要比過去更快。

because whether it's race or disease, or all the other social ills,

因為不論種族、疾病 或其他社會弊端，

the innovation of what philanthropy can go to and do quickly

慈善事業能快速地創新，

that, if it works, government can come in behind it and scale it up,

如果行得通，

政府能支持並把規模做大。

God knows we need solutions,

天知道我們很需要解決方案，

we need that kind of hope and progress

我們需要希望和進展，

that expectations are high

期望很高，

that will solve very tough problems.

希望能解決非常困難的問題。

CA: I mean, most philanthropists, even the best of them,

克：大部分的慈善家， 就連最好的慈善家，

find it hard to give away more than about a percent of their net worth every year,

都很難每年捐出他們淨值的 1%，

and yet the world's richest often have access

但，世界上最有錢的人

通常能取得很好的投資機會。

to great investment opportunities.

Many of them are gaining wealth at seven to 10 percent plus per year.

當中有許多人的財富 每年能增加 7 到 10%。

Isn't it the case that to have a real chance

不就是這種情況，真的有機會 能把一半財富捐出來？

of giving away half your fortune,

at some point you have to plan to give away five, six, seven, eight,

在某些時點，你得要計畫每年捐出

你淨值的 5%、6%、 7%、8%、10%？

10 percent of your net worth annually?

And that is, isn't that the logic of what should be happening?

這樣子的邏輯不是很合理嗎？

BG: Yeah, there are people like Chuck Feeney,

比：有像查克·費尼這樣的人，

who set a good example and gave away all of his money.

樹立好榜樣，

捐出他所有的錢。

Even Melinda and I are talking about, should we up the rate that we give at?

就連梅琳達和我也在談，

是否要提高我們捐贈的比率？

As you say, we've been very lucky on the investment side

如你所言，在投資面上透過各種方式，

through a variety of things.

我們一直很幸運。

Tech fortunes in general have done well,

總體來說，科技業的財富表現很好，

even this year,

就連今年也是，

which is one of those great contrasts

和世界上發生的狀況

是很大的對比。

in what's going on in the world.

And I do think there's an expectation that we should speed up,

我確實認為大家預期我們要加速，

and there's a reason to speed up,

是有應該加速的理由。

and government is going to miss a lot of needs.

很多的需求政府照顧不到。

Yes, there's tons of government money out there,

沒錯，外頭有一堆政府的錢，

but helping it be spent well,

但要協助善用它們，

helping find places it's not stepping up,

協助找到還沒有得到幫助的地方。

and if people are willing to give to the developing world,

如果大家願意捐給開發中世界，

they don't have governments

那裡的政府無法印製

that can print checks for 15 percent of GDP,

等同 15% 國民所得的紓困支票，

and so the suffering there broadly, just the economic stuff alone,

所以單就經濟層面來說 就已經讓廣大的人民很苦，

put aside the pandemic,

更不用說疫情了，

is tragic.

很不幸。

It's about a five-year setback

對這些國家而言，

in terms of these countries moving forward,

向前的發展倒退了五年，

and in a few cases, it's tough enough that the very stability of the country

在少數例子中，艱困到

連國家的穩定度都成了問題。

is in question.

CA: Well, Bill,

克：嗯，比爾，

I'm in awe of what you and Melinda have done.

我很敬佩你和梅琳達所做的。

You walk this narrow path

你們走在這條狹路上，

of trying to juggle so many different things,

試圖改變這麼多事物，

and the amount of time that you dedicate to the betterment of the world at large,

你投入讓整個世界變更好的時間

and definitely the amount of money

以及金錢，

and the amount of passion you put into it --

還有你投入的熱情，真的很不簡單。

I mean, it's pretty awesome,

and I'm really grateful to you for spending this time with us now.

我很感激你能抽空和我們討論。

Thank you so much,

非常謝謝你，

and honestly, the rest of this year,

老實說，今年剩下的日子， 會比以往更需要你的技能和資源。

your skills and resources are going to be needed more than ever,

so good luck.

所以，祝好運。

BG: Well, thanks.

比：謝謝。我樂在其中，而且很樂觀。

It's fun work and I'm optimistic, so thanks, Chris.

謝謝，克里斯。