Opinion | Bill Gates’ new pandemic book presents a prayer and a plan

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In 2015, Bill Gates wrote an article in the New England Journal of Medicine describing the threat of “the next epidemic.” He warned of an airborne pathogen that would spread through global travel routes, create panic, overwhelm the supply of medical raw materials, set in motion a technological race to the death, drastically reduce global wealth and fill millions of graves.

This was intended as an alarm. Most affluent nations instead reached out for the snooze button. Now Gates has written a book, “How to Prevent the Next Pandemic,” which presents a prayer and a plan for how the world can avoid repeating the mistake.

I’ve been engaging with Gates on these issues since shortly after the Ebola outbreak in the mid-2010s. (The Bill & Melinda Gates Foundation is funded by ONE, an organization that fights to stop global poverty and disease, where I spend part of my professional life.)

Gates’ book is first and foremost a tribute to the enduring power of the political columnist. Gates first became interested in global health in 1997 after reading a column by Nicholas D. Kristof in the New York Times describing the problem of diarrheal diseases, which caused unnecessary deaths to 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 subject of communicable diseases. “I read them as fast as I could and asked for more,” Gates writes.

In some ways, Gates’ book serves as a summary of this education and a master’s course in epidemiology. The material is simplified, but not simplified. Anyone who reads it will end up with a fundamental grounding in the science of global health.

But the book is also politically well-timed. President Biden’s budget for fiscal year 2023 proposes nearly $ 82 billion over five years to the Department of Health and Human Services “to prevent, detect and respond to new biological disasters.” Gates’ book is one of the first major efforts to fill in how this money can best be spent.

One of the benefits of being Gates is having panoramic views of the pandemic we are still experiencing. Which countries have done well?

South Korea, Gates told me during a recent sit-down, was “super aggressive” in terms of contact tracking, eventually reducing new infections to zero and achieving a low death rate. But the method it used – to access people’s cell phone records to see who they’ve been in contact with – would probably have been less welcome in the United States.

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Japan, Gates said, is “the king of worms” – and has been since the flu in 1918. Israel managed to secure early access to vaccines and “gained rapid coverage.” And Australia tested right early on and made full use of its PCR testing capabilities.

But the United States? A mixed image. The creation of effective vaccines over the course of a year was a world-historic achievement. This was achieved, Gates said, because officials “wrote big checks to the pharmaceutical companies,” allowing them to invest in speculative technologies without having to justify the risk to investors.

Yet in his book, Gates calls the Trump administration’s initial reaction to covid-19 a “disaster.” Political officials downplayed the pandemic and gave terrible advice to the citizens. “Therapeutics came later than we expected,” according to Gates, and diagnostics was a problem. The CDC had never practiced “taking the country’s PCR capacity, which is the highest in the world, and rationally distributing it to people who wanted to be tested.”

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Gates offers a number of suggestions to improve this – investing in health innovation, ensuring earlier detection of pathogens, encouraging the creation of new vaccines and treatments, and closing 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 react to outbreaks? They do not really exist. During the Obama administration, when then-Ebola Tsar Ron Klain asked the U.S. military to play this role, it agreed to fly personnel into West Africa. But it refused to carry blood samples because it had never trained for that mission, Gates said.

GERM is designed to fill such a role. Gates would find 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 every day with the question, “What can we do to be better prepared for the next pandemic?” And they would constantly practice the worst options. “For me,” Gates said, “exercise is everything.”

It is not easy to be prepared for a relatively rare event. But it is not moral or responsible to remain unprepared for one of the most likely existential threats to humanity.

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