This was intended as an alarm. Instead, most rich nations turned to the snooze button. Now Gates has written a book, “How to Prevent the Next Pandemic,” in which he lays out a plea and a plan for how the world can avoid repeating that mistake.
I have been engaged with Gates on these issues since shortly after the Ebola outbreak in the mid-2010s. (The Bill & Melinda Gates Foundation is a sponsor of ONE, an organization fighting to end global poverty and disease, where spend part of my professional life).
Gates’s 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 detailing the problem of diarrheal diseases, which cause the unnecessary deaths of an estimated 3 million children each year. Gates then turned to William H. Foege, former director of the Centers for Disease Control and Prevention, who presented him with 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 a way, 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 foundation in the science of global health.
But the book is also politically timely. President Biden’s fiscal year 2023 budget 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 determine how that money could best be spent.
One of the advantages of being Gates is having a panoramic view of the pandemic that we are still experiencing. Which countries have done well?
South Korea, Gates told me during a recent meeting, was “super aggressive” in contact tracing, eventually cutting new infections to zero and achieving a low death rate. But the method he used — accessing people’s cell phone records to see who they had been in contact with — would likely 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 “gained coverage quickly.” And Australia got the early tests right, making the most of its PCR testing capacity.
But the United States? A mixed image. The creation of effective vaccines in the course of a year was a world-historical achievement. This was achieved, Gates said, because government officials “wrote big checks to drug companies,” allowing them to invest in speculative technologies without having to justify the risk to investors.
In his book, however, Gates calls the Trump administration’s initial reaction to COVID-19 “disastrous.” Political officials downplayed the pandemic and gave citizens lousy advice. “Therapeutics came later than we expected,” according to Gates, and diagnoses were a problem. The CDC had never practiced “taking the country’s PCR capacity, which is the highest in the world, and allocating it rationally to people who wanted to get tested.”
Gates offers a variety of proposals to improve this: invest in health innovation, ensure early 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.
You know how, in many pandemic movies, there’s a team of highly trained scientists who arrive in hazmat suits to respond to outbreaks? They really don’t exist. During the Obama administration, when then-Ebola czar Ron Klain asked the US military to play this role, he agreed to send personnel to West Africa. But he refused to transport blood samples because he had never trained for such a mission, Gates said.
GERM is designed to play that role. Gates would place some 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 constantly rehearsed 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 neither moral nor responsible to be unprepared for one of the most likely existential threats to humanity.