Melinda Gates Lays Out Her Biggest Concern for the Next Phase of the COVID-19 Pandemic

From 2018-2019, the Bill and Melinda Gates Foundation gave more money to the World Health Organization than any entity except the U.S. government.

With President Donald Trump cutting ties to the international health agency in the midst of the COVID-19 pandemic, the Gates Foundation’s work has come into sharper relief than ever. Co-chair Bill Gates announced at the Global Vaccine Summit on June 4 that it will give $1.6 billion over five years to the Vaccine Alliance (GAVI), to help ensure that people around the world have access to vaccines, regardless of income. The Gates Foundation in 1999 pledged $750 million to help establish GAVI, and the organization has since vaccinated more than 760 million children in underserved areas.

Ahead of the June 4 pledge event, TIME spoke with Gates Foundation co-chair Melinda Gates about equitable solutions to COVID-19, the need for optimism in times of anxiety and what will happen to the WHO.

TIME: The scale of anti-racism protests we’re seeing right now is incredible. How does this moment relate to your work in health equity?

Gates: What happened to George Floyd was brutal and horrible and should never happen to anyone, anywhere. This is a moment of reckoning in the United States. We all need to really pause during this time and learn as best we can from it. Even before we saw this senseless death, COVID had already started to show us gaps and structural problems in our country. We are seeing black men die at a disproportionate rate. We know the way out of COVID-19 will be a vaccine, and it needs to go out equitably.

How do you make sure that happens?

You make sure the vaccine doesn’t go to the highest bidder. GAVI uses a pooled set of resources from governments and private citizens, so you can make sure that when you go to purchase the vaccine, you purchase it in bulk at low prices. We’ve gotten the delivery system, over 20 years, really set up appropriately. This pledging event means governments around the world will step up in global cooperation to all say, ‘We care about this vaccine getting out equitably,’ [since their contributions will help GAVI secure and distribute doses when they become available].

The first people that need this vaccine are the 60 million health care workers around the world. They deserve to get it before anybody else. Then you start tiering.

Who needs it after health care workers?

In the U.S., that would be black people next, quite honestly, and many other people of color. They are having disproportionate effects from COVID-19. From there, people with underlying health conditions, and then people who are older. Those are the ones who all need it first. We also need to think about essential workers who are keeping our grocery stores open for us so we can buy food, or who are making sure that food moves through the warehouses.

When do you think most people will get vaccinated?

We’re probably 18 months out from that.

Do you have concerns about how a Trump Administration—if Trump is still President at the time—will distribute the vaccine?

We’re all concerned that the vaccine not go to the highest bidder. There are some signs that early doses may get bought up, and I think that would be a shame for the entire world. It’s important for world leaders to step up and lock arms and say, ‘This is about everybody, whether you live in India, or Tanzania, or Switzerland.’

How will the U.S. pulling out of the WHO affect the organization’s work?
The WHO is not a perfect institution. No institution is perfect. But the middle of a pandemic is the last moment you should be making changes or pulling out. WHO was set up to deal with pandemics like this, to deal with things like smallpox, to deal with things like polio. The U.S government is the largest funder of the WHO. Nobody can replace the funding the U.S was putting into the WHO.

This decision will touch everything at the WHO. I worry deeply about polio. I’m worried deeply about measles. I’m worried about Ebola.

If we didn’t think we were global, COVID has certainly pointed it out to us. The United States was a founding member of the WHO after World War II because we saw how important it was. To be going back on something that we know will help all of us, that’s just senseless. It’s another thing to do a postmortem when this crisis is over and say, ‘Hey, we need some structural changes to WHO, or we need different governance,’ but not in the middle of a pandemic. You just don’t do that.

Has the global health community ever faced a challenge like COVID-19?

No. The Spanish influenza in 1918, I guess you could say. But we weren’t traveling on planes the way we are now.

The vaccine-creation challenge is also unprecedented, both in terms of the speed of development and the number of doses. The world has never created 7 billion doses of a vaccine in this short amount of time. The good thing is the world is actually more coordinated than I think many people realize, and that’s lucky.

What gives you hope right now?

I have pictures here, where I’m sitting in my office, of moms I’ve met all over the developing world who have told me about the lengths they go to get their kids vaccines. They walk 15 kilometers in the heat, they’re carrying their baby on their back. These moms know the difference that vaccines make in their kids’ lives. When I think about them, they give me so much hope, even when I see some of the pushback on vaccines here in the United States.

The other thing that gives me hope is this next generation. I’m seeing the way they talk about race. They’re willing to stand up and listen, they’re willing to go march in the streets and say, ‘This isn’t right.’ That gives me a lot of hope.

This interview has been condensed and lightly edited for clarity.