Bill Gates believes that the next big threat to humanity will come from missiles, not microbes.
Gates spends a lot of time talking about global health, but if you listen carefully, you’ll notice that he almost never offers policy recommendations. Now, at the tail end of the Ebola epidemic, Gates is speaking up about how he thinks we should prepare for a future epidemic that’s even more deadly–and more costly.
Consider this: a global epidemic of a deadly flu virus would reduce global wealth by $3 trillion, not to mention the huge loss of life that would also occur. Flu is much more transmissible than Ebola; if a Spanish flu-like epidemic was unleashed, by day 263 there would be over 30 million dead, according to Gates.
The countries of Sierra Leone, Guinea, and Liberia are losing 12% of their GDP in 2015 due to the Ebola epidemic. If the epidemic was global and cost that much in every country, the world would lose over $7 trillion.
“The problem wasn’t that there was a system that didn’t work well enough [with Ebola], the problem was that there wasn’t a system at all,” Gates said at this year’s TED conference.
When Ebola emerged in the latest outbreak, epidemiologists weren’t tracking its spread. Case reports came in on paper, and there were no medical teams preparing people for how to react. There was no one to even look at treatment approaches and diagnostics.
“We could have taken the blood of survivors, processed it, and put the plasma back into people to protect them. We didn’t,” said Gates.
In a paper just published in the New England Journal of Medicine, Gates discusses lessons from Ebola, and what we should do next.
First, Gates says that we need to strengthen public health systems around the world, including labs, critical care and primary care facilities, and surveillance. One reason why Ebola spread in certain communities is because of a lack of strong primary care systems–which could have found infected people earlier–in those places.
So what would a disease surveillance system look like? Gates proposes systems that are tied to national public health laboratories, to ensure constant monitoring. Data from routine surveillance, he says, should be open to the public. This would require the creation of a data system that allows workers to quickly enter info on disease cases, and then share that data instantaneously to other organizations. Computer models and satellite images could then help predict what the spread of the disease would look like.
Ebola spread fast partially because of a lack of trained medical personnel on the ground. Gates believes that, ideally, countries should have people on hand that are ready to tackle an epidemic immediately, including managers for emergency operations centers, experts in things like surveillance and epidemiology, and community leaders who can provide information to locals.
“We need a medical reserve corps, with people who already have he training and background” he said. “We need to do simulations–germ games, not war games–so that we see where the holes are.”
In order to get people and supplies to where they need to go in case of an epidemic, there has to be adequate transportation–specifically, says Gates, with help from militaries, which can coordinate logistics and fly people in and out of disaster zones. Goods, like tents, bleach, air conditioning, and medical supplies, also need to be on hand in large quantities. Humanitarian agencies and militaries can help with that.
Gates also calls for treatments to be made available quickly to volunteers, health workers, and other important workers on the ground. And, of course, he advocates for better medical technology: faster diagnostic tests (he mentions one in development that can take biological samples and spit out a diagnosis in 20 minutes), more effective drugs, and vaccines.
There have been vaccine candidates available for more than 10 years, explained Seth Berkly, a medical epidemiologist and CEO of the GAVI Alliance, at TED. It’s just that the people who need them have little money, so drug companies had no incentive to do research. It’s only out of a misguided fear,”said Berkeley, that anything has been done at all.
That means we need to provide better incentives and subsidies for vaccine development–and do a better job of figuring out which diseases are actually the most threatening, building labs, better investigation capabilities, and repositories of potential disease-fighting agents.
On stage, Berkly brought out two Ebola vaccines that have recently gone into clinical trials. It’s a start. Next time (yes, there will be a next time), we’ll hopefully get to this point a lot sooner.