The next outbreak we're not ready

When I was kid, the disaster we worried about most was a nuclear war, That’s why we had a barrel like this down in our basement filled with cans of food and water, when a nuclear attack came, we were supposed to go downstairs, hunker down, eat out of that barrel,

Today the greatest risk of global catastrophe doesn’t look like this, instead, it looks like this, if anything kills over 10 million people in a next few decades, it’s most likely to be a highly infectious virus rather than a war, not missiles but microbes, now part of the reason for this is that we’ve invested a huge amount in nuclear deterrents, but we’ve actually invested a very little in a system to stop an epidemic, we are not ready for the next epidemic, let’s look at EBOLA, I’m sure all of you read about it in the newspaper, lots of tough challenges I followed it carefully through the case analysis tools we used to track polio eradication, as you look at what went on, the problem wasn’t that there was a system that didn’t work well enough, the problem was that we didn’t have a system at all, in fact there are some pretty obvious key missing pieces, we didn’t have a group of epidemiologists ready to go, who would have gone and seen what the disease was, seen how far it had spread, the case reports came in on paper was very delayed before they were put online and they were extremely inaccurate, we didn’t have a medical team ready to go, we didn’t have a way to prepare people, now Medison Sonfrontier did a great job orchestrating volunteers, but even so, we were far slower than we should’ve been getting the thousands of workers into these countries, and a large epidemic would require us to have hundreds of thousands of workers，

there’s no one there to look at the treatment approaches, no one to look at the diagnostics, no one to figure out what tool should be used, as an example, we could’ve taken the blood of survivors, processed it, put that plasma back in people to protect them, but that was never tried

So there was a lot that was missing, and these things are really a global failure, the WHO is founded to monitor the epidemics, but not to do these things I’ve talked about, now the movies is quite different, there’s a group of handsome epidemiologists ready to go, they move in, they save the day, but that’s just purely hollywood, the failure to prepare could allow the next epidemic to be dramatically more devastating than EBOLA, let’s look at the progression of EBOLA over this year, about 10,000 people died, and nearly all are in the 3 west african countries, there’re 3 reasons why it didn’t spread more, the first is that there was a lot of heroic work by the health workers, they found people and they prevented more infections, the second is the nature of the virus, EBOLA is not spread through the air, by the time you’re contagious. most people are so sick that they’re bedridden, third, it didn’t get into many urban areas now it was just a luck, If it got into a lot more urban areas the case numbers would have been much larger, so next time we might not be so lucky, ah, you can have a virus where people feel well enough, while infectious, that they get on the plane or they go to a market, the source of the virus could be a natural epidemic like EBOLA or could be a bioterrorism, and so there are things that we literally make things thousand times worse, in fact let’s look at a model of a virus spread through the air like the Spanish flu back in 1918, so here’s what would happen, it was spread throughout the world very very quickly, and you can see there’s over 30 million people died from that epidemic, so this is a serious problem we should be concerned, but in fact, we can build a really good response system, we have the benefits of all the science and technology that we talk about here, we’ve got the cellphones to get the information from the public and get the information out to them, we have the satellite maps where can see where people are and where they’re moving, we have the advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that Ah pathogen, so we can have the tools but those tools need to be put into an overall global health system and we need preparedness, the best lessons I think on how to get prepared are again what we do for war, for soldiers we have full-time waiting to go, we have reserves can scale us up to larger numbers, and NATO has a mobile unit that can deploy very rapidly，NATO does a lot of war games to check if people well trained - do they understand about the fuel and logistics and the same radio frequencies so they’re absolutely ready to go, so those of the kinds of things we need to deal with the epidemic, what are the key pieces, Ah first is we need the strong health systems in poor countries, Ah that’s where mothers can give birth safely, kids can get all the vaccines but also where we see the outbreak very early on

We need the medical reserve corp, lots of people’ve got the training and background who are ready to go with the expertise, and then we need to pair those medical people with the military taking the advantage of the military’s ability to move fast, do the logistics and secure the areas, we need to do simulations, germ games not war games, we will see where the holes are, the last time the germ game was done in the united states was back in 2001 and it didn’t go so well, so far the score is: germs 1, people 0, finally, we need lots of advanced R&D in areas of vaccines and diagnostics, there are some big breakthoughs like the Adeno-associated virus that could work very very quickly

Now I don’t have an exact budget for what this would cost, but i’m quite sure it’s very modest compared to the potential harm, the world bank estimates that if we have a world-wide flu epidemic, global wealth would go down by over 3 trillion dollars, and we’d have millions and millions of deaths, these invesments offer signifcant benefits beyond just being ready for the epidemic, Ah the primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe, so I think this should absolutely be a priority, there’s no need to panic we don’t have to hoard cans of spaghetti or go down into the basement but we need to get going, because time is not on our side

In fact there’s one positive thing that can come out of EBOLA epidemic, it’s that it can serve as an early warning, a wake-up call to get ready, if we start now, we can be ready for the next epidemic, thank you.