“Nobody, I would say, gets an A on this one,” said the cofounder of the Bill & Melinda Gates Foundation and former CEO of Microsoft during an event with the Lowy Institute, an Australian think tank, on Monday.

Gates pointed to a few successes in the developed world. Australia and several other countries “did population-scale diagnostics early on and had quarantine policies associated with that,” Gates said. He added that such early actions kept infection rates low, preventing hospitals from getting overloaded with patients, and thus helped lower death rates. The World Health Organization puts Australia’s COVID death toll at almost 17,000, compared with 1.1 million COVID deaths in the U.S.

Gates credited the U.S. for its early funding of COVID vaccines, which “accelerated the availability of both mRNA and non-mRNA vaccines” that could “cut the death rate by 70%” in those over age 60 or those with immunodeficiency.  

The former Microsoft CEO also shared his views on China, which has rapidly pivoted away from tough COVID-zero policies amid a record surge in COVID cases.

Gates admitted that “we’ll never know the true death numbers” coming out of China. Chinese officials estimate that 60,000 people died from COVID-related issues between mid-December and mid-January, but that is likely still an undercount of the outbreak’s death toll. A model from U.K. research firm Airfinity estimates that over 900,000 people have died of COVID since Dec. 1.

But Gates noted that China entered its outbreak with “some level of vaccination,” which will lower the death toll compared with earlier outbreaks in developed countries. “They’ll have about a third of the death rate of the rich countries, including the U.S.,” Gates predicted. (If China’s per capita death rate were one-third that of the U.S.’s current mortality rate, the country will end up with a total death toll of 1.56 million.)

Gates said that China “should have jumped on vaccines, particularly for the elderly, much faster, and that would have allowed them to open up somewhat sooner than they did.” In late November, Chinese health officials estimated that only 40% of those over 80 had received the boosters necessary to protect against new COVID variants. 

However, the head of the Gates Foundation suggested that countries needed regular exercises to prepare for future pandemics. “Sadly, epidemics come along so rarely that it’s easy to be incompetent,” he said.