When I was a
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 the nuclear attack came, we
were supposed to go downstairs, hunker down, and 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 the 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 very
little in a system to stop an epidemic.
We're 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 use to
track polio eradication.
And 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's
some pretty obvious key missing pieces.
We didn't have a group of epidemiologists ready to go,
who would have gone, seen what the disease was, seen how
far it had spread.
The case
reports came in on paper. It 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 of preparing people.
Now, Médecins
Sans Frontières did a great job orchestrating
volunteers. But even so, we were far slower than we
should have been getting the thousands of workers into
these countries.
And a large
epidemic would require us to have hundreds of thousands
of workers.
There was no
one there to look at treatment approaches. No one to
look at the diagnostics. No one to figure out what tools
should be used. As an example, we could have taken the
blood of survivors, processed it, and 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 funded to
monitor epidemics, but not to do these things I talked
about. Now, in the movies it's quite different.
There's a
group of handsome epidemiologists ready to go, they move
in, they save the day, but that's just pure 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 were in the three West
African countries.
There's three
reasons why it didn't spread more.
-
The
first is that there was a lot of heroic work by
the health workers. They found the people and
they prevented more infections.
-
The
second is the nature of the virus. Ebola does
not spread through the air. And by the time
you're contagious, most people are so sick that
they're bedridden.
-
Third, it didn't get into many urban areas. And
that was just luck. If it had gotten into a lot
more urban areas, the case numbers would have
been much larger.
So next time,
we might not be so lucky.
You can have
a virus where people feel well enough while they're
infectious that they get on a plane or they go to a
market. The source of the virus could be a natural
epidemic like Ebola, or it could be bioterrorism.
So there are
things that would literally make things a 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 would spread throughout the world
very, very quickly.
And you can
see 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
cell phones to get information from the public and
get information out to them.
We have
satellite maps where we can see where people are and
where they're moving.
We have
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
pathogen.
So we can
have 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 that can
scale us up to large numbers.
NATO has a
mobile unit that can deploy very rapidly.
NATO does a
lot of war games to check,
Are people well trained?
Do
they understand about fuel and logistics and the same
radio frequencies?
So they are
absolutely ready to go. So those are the kinds of things
we need to deal with an epidemic.
What are the key pieces? First, we need strong health
systems in poor countries. That's where mothers can give
birth safely, kids can get all their vaccines.
But, also
where we'll see the outbreak very early on.
We need a
medical reserve corps: lots of people who'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 advantage of the military's ability to move fast,
do logistics and secure areas.
We need to do
simulations, germ games, not war games, so that we see
where the holes are.
The last time
a 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 breakthroughs, 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 worldwide flu epidemic, global wealth will go
down by over three trillion dollars and we'd have
millions and millions of deaths...
These
investments offer significant benefits beyond just being
ready for the epidemic.
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, if there's one positive thing that can come out
of the 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...
