In 2015, Bill Gates wrote an article in the New England Journal of Medicine detailing the threat of “the next epidemic.” He warned of an airborne pathogen that would spread through global travel routes, spark panic, overwhelm the supply of medical commodities, set off a technological race with death, drastically reduce global wealth and fill millions of graves.
This was intended as an alarm. Most wealthy nations reached instead for the snooze button. Now Gates has written a book, “How to Prevent the Next Pandemic,” laying out a plea and a plan for how the world can avoid repeating that mistake.
I’ve been engaged with Gates on these issues since soon after the Ebola outbreak of the mid-2010s. (The Bill & Melinda Gates Foundation is a funder of ONE, an organization fighting to end global poverty and disease, where I spend part of my professional life.)
Gates’s book is, first of all, a tribute to the enduring power of the political columnist. Gates first conceived an interest in global health in 1997 after reading a column by Nicholas D. Kristof in the New York Times detailing the problem of diarrheal illness, which caused the needless deaths of about 3 million children each year. Gates then went to William H. Foege, former director of the Centers for Disease Control and Prevention, who gave him 81 textbooks and articles on the topic of communicable diseases. “I read them as fast as I could and asked for more,” Gates writes.
In some ways, Gates’s book serves as a summary of this education and a graduate course in epidemiology. The material is simplified but not simplistic. Anyone who reads it will end up with a basic grounding in the science of global health.
But the book is also politically well-timed. President Biden’s budget for fiscal 2023 proposes nearly $82 billion over five years for the Department of Health and Human Services “to prevent, detect and respond to emerging biological catastrophes.” Gates’s book is one of the first major efforts to fill out how that money might best be spent.
One of the advantages of being Gates is to have a panoramic view of the pandemic we’re still experiencing. What countries have done well?
South Korea, Gates told me during a recent sit-down, was “super aggressive” on contact tracing, eventually reducing new infections to zero and achieving a low death rate. But the method it used — accessing people’s cellphone records to see whom they’d been in contact with — would probably have been less welcome in the United States.
Japan, Gates said, is the “king of masks” — and has been since the 1918 flu. Israel managed to secure early access to vaccines and “got coverage up quickly.” And Australia did early testing right, making full use of its PCR testing capacity.
But the United States? A mixed picture. The creation of effective vaccines in the course of a year was a world-historic accomplishment. This was achieved, Gates said, because government officials “wrote large checks to the pharmaceutical companies,” allowing them to invest in speculative technologies without needing to justify the risk to investors.
Yet in his book, Gates calls the Trump administration’s initial reaction to covid-19 “disastrous.” Political officials played down the pandemic and gave terrible advice to citizens. “Therapeutics came later than we expected,” according to Gates, and diagnostics were a problem. The CDC had never practiced “taking the country’s PCR capacity, which is the highest in the world, and rationally allocating that against people who wanted to be tested.”
Gates offers a variety of proposals to improve on this — to invest in health innovation, ensure earlier detection of pathogens, encourage the creation of new vaccines and treatments, and close the health gap between rich and poor countries. But his signature idea is called GERM: Global Epidemic Response and Mobilization.
Do you know how, in many pandemic movies, there is a team of highly trained scientists who arrive in hazmat suits to respond to outbreaks? They don’t really exist. During the Obama administration, when then-Ebola czar Ron Klain asked the U.S. military to play this role, it agreed to fly personnel into West Africa. But it refused to transport blood samples because it had never trained for that mission, Gates said.
GERM is designed to fill such a role. Gates would locate about 3,000 health professionals — experts in epidemiology, genetics, vaccine development, logistics, computer modeling and communication — at the World Health Organization. They would wake up each day with the question: “What can we do to be better prepared for the next pandemic?” And they would constantly rehearse the worst possibilities. “To me,” Gates said, “practice is everything.”
It’s not easy to stay prepared for a relatively rare event. But it is not moral or responsible to stay unprepared for one of the most likely existential threats to humankind.