Preventable Pandemics

In 2015, Microsoft founder Bill Gates predicted a COVID-19-like contagion. He warned that nations lacked preparation, and that the disease might cause 30 million deaths and trillions of dollars of economic damage. Few listened then, but many listen now. Clearly and cogently, Gates explains pathogens and their spread. He provides an actionable blueprint for preventing future pandemics that proves practical, affordable and necessary.

New Pathogens

Most pathogens transfer from animals to humans, as COVID-19 likely did. Some do no harm, while others, such as AIDS, kill millions. An outbreak is local and becomes an epidemic when it spreads throughout a region. A pandemic means a pathogen crosses continents.

Outbreaks are inevitable, but pandemics are optional.

Larry Brilliant

In today’s interconnected world, an outbreak in a city that infects 100 people by the third day of a month can infect everyone in the world by the end of that month. 

Preparedness

Most governments lacked preparedness. With foresight and vigilance, a coordinated international effort and funding for global public health, the world can avert pandemics, including coronaviruses and the flu.

America’s failure to test people at anything near the level that other nations achieved is among the biggest mistakes any country has made during the pandemic.Bill Gates

This demands more comprehensive vaccines, improved detection, testing and treatments for those who contract a pathogen and faster regulatory approvals of vaccines and drugs.

Lessons

Nations that detected COVID-19 early – such as Vietnam, New Zealand and South Korea – introduced widespread testing and tracking and suffered dramatically fewer deaths than countries that fumbled their responses.

The United States offers negative lessons: mixed messages, poor dissemination of information, political infighting and a lack of leadership. A dearth of testing and no capacity to track the virus’s spread left Americans especially vulnerable.

Global Pandemic Unit

Disease management requires a “Global Epidemic Response and Mobilization” (“GERM”) team of several thousand full-time experts seeking to identify outbreaks and prevent them from becoming pandemics. Currently, no such organization exists. Rich nations must fund it.

Early Detection

COVID-19 exposed the world’s inadequate capacity for disease surveillance. Infected people don’t always become sufficiently ill to feel they must visit a doctor. Americans with the flu, for example, usually wait it out, leaving too few samples available for sequencing. 

Active surveillance means health care workers, teachers, scientists, and others look for signs of potential outbreaks, note student absences, investigate mortality, monitor wastewater for viruses, test people for infection and sequence the genomes of viruses they detect.

Governments and funders should back innovative ways to test mass numbers of people in a short time.Bill Gates

Antigen tests for COVID-19 you can perform at home give remarkably accurate results in 15 minutes . Comprehensive and free access to tests is a must.

Help People Help Themselves

Masking, social distancing, lockdowns and closing businesses help prevent pandemics. Upon detecting an outbreak, governments should overreact. More than a century of evidence shows that when they do, their citizens fare much better than those of governments that don’t.

Governments should consider the cost-benefit outcomes of interventions. School closures, for example, likely fail the cost-benefit analysis because kids proved largely immune to serious harm and remote learning generally failed.

If everyone would just wear masks, How to Prevent the Next Pandemic would be a very short book.Bill Gates

Masking, social distancing and remote work all but eliminated flu. Proper masking provided virtually perfect protection at the cost of a few pennies and steamed-up glasses.

Introduce Treatments Quickly

In summer 2020, physicians began treating COVID-19 patients with dexamethasone. This may have saved more than a million lives, but associated risks limited its use to the most severe cases. In late 2020, the antiviral treatment mAbs gained approval for emergency use, and has proved highly effective in reducing the severity of COVID-19 variants.

Paxlovid provided greater protection when a patient received it soon after showing symptoms. Scientists must develop these types of treatments faster, after which mass global production and distribution must follow. Drugs should arrive as pills or nasal sprays for effective self-administration.

Better Vaccines

The vaccines that Americans received don’t inject small amounts of a virus to produce an immune response, as ordinary vaccines do. They instruct cells to produce antibodies that match “spikes” and trip your immune system to respond to the virus.

The fact that scientists were able to create multiple successful COVID-19 vaccines is itself unusual in the history of disease. The fact that they did it in a year is miraculous.Bill Gates

Vaccine development far eclipses drug development in scope, cost and complexity. The ROI calculus for developing vaccines doesn’t work. Global cooperation and investment must incentivize the development, manufacture, preservation, distribution and administration of what amounts to billions of doses.

Simulations and Drills

Governments run too few drills, exercises and simulations, to study the impact of outbreaks. These exercises reveal gaps in services, leadership or communications that could prove deadly during an outbreak.

There is no biological reason why the next pathogen couldn’t be far more lethal.Bill Gates

Almost invariably, Gates laments, officials ignore the insights these drills provide.

Prevention

Poor and middle-income countries, where millions die annually from preventable or treatable conditions, need health care assistance – including helping them manufacture and administer generic versions of vaccines.

Nations must cooperate to develop and mass manufacture more robust treatments and vaccines.

We need outbreak strategies that are as clear, rigorous and thorough as the world’s best military strategy.Bill Gates

Scientists and health care workers need databases of shared information. Governments must enhance lab safety and fund a global GERM team.

Big Picture Philanthropy

Gates is a big-picture philanthropist; his access to unlimited information and his own genius for synthesis results in Gates assessing impossible problems and offering practical solutions in concise, clear language that no experienced reader associates with tech CEOs. Gates offers detailed overviews and specific examples that render comprehensible world-shattering events that have defied comprehension. He offers advice aimed at governments, and calls on his readers to take action.

Bill Gates also wrote How to Avoid a Climate Disaster and The Road Ahead.