When I was a kid, the disaster we worried aboutmost was a nuclear war. That’s why we had a barrel like this down our basement,filled with cans of food and water. When the nuclear attack came, we supposedto go downstairs, hunker down, and eat out of that barrel. Today the greatestrisk of global catastrophe, doesn’t look this. Instead, it looks like this. Ifanything kills over 10 million people in the next few decades, it’s most liketo be a highly infective virus, rather than a war. Not missiles but microbes.Now, part of reason for this is that we’ve invested a huge amount in nucleardeterrents. But we’ve invested 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 aboutit in the newspaper, lots of tough challenges. I followed it carefully throughthe case analysis tools we use to track polio eradication. And as you look at whatwent on, the problem wasn’t that there was a system that didn’t work wellenough, the problem was that we didn’t have a system at all.
In fact there’s some pretty obvious key missingpieces. We didn’t have a group of epidemiologists ready to go, who would havegone, seen what the disease was, seen how far it had spread. The case reportcame in on paper. It was very delayed before they were put online, and theywere extremely inaccurate. We didn’t have a medical team ready to go. We didn’thave a way of preparing people. Now Medicins Sans Frontieres did a great joborchestrating volunteers. But even so, we were far slower than we should havebeen getting the thousands of works into these countries. And a large epidemicwould require us to have hundreds of thousands of workers. There was no onethere to look at treatment approaches, no one to look at the diagnostics, noone to figure out what tools should be used. As an example, we could have takenthe blood of survivors , processed it, and put that plasma back in people toprotect them. but that was never tried.
So, there was a lot that was missing. And thesethings are really a global failure. The WHO is founded to monitor epidemics,but not to do these things I talked about. Now, in the movies it’s quitedifferent. There’s a group of handsome epidemiologists ready to go, they movein, they save the day, but that just pure Hollywood. The failure to preparecould allow the next epidemic to be dramatically more devastating than Ebola.
Let’ look at the progression of Ebola over thisyear. About 10 thousand people died and nearly all were in the three WestAfrican countries.
There’s three reasons why it didn’t spread more.The first is that there were a lot of heroic work by the heal workers. Theyfound the people and they prevented more infections. The second is the natureof the virus. Ebola dose not spread through the air. And by the time you’recontagious, most people are so sick that they’re bedridden. Third, it didn’tget into many urban areas. And that was just luck. If it had gotten into a lotmore 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 enoughwhile they’re infectious that they get on a plane or they go to a market. Thesource of the virous could be a natural epidemic like Ebola, or it could bebioterrorism. So there are things that would literally make things a thousand timesworse. In fact, let’s look at a model of a virus spread through the air, likethe Spanish Flu back in 1918. So here’s what would happen: It would spreadthroughout the world very, very quickly. And you can see over 30 million peopledied from that epidemic. So this is a serious problem we should be concerned.
But we can build a really good response system. We havethe benefits of all the science and technology that we talk about here. We’vegot cellphones to get information from the public and get information out tothem. We can have satellite maps where we can see where people are and wherethey are moving. We have advances in biology that should dramatically change theturnaround time to look at a pathogen and be able to make drugs and vaccinesthat fit for that pathogen. So we can have tools, but those tools need to beput into an overall global health system. And we need preparedness. The bestlessons, 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 largenumbers. NATO has a mobile unit that can deploy very rapidly. NATO dose a lot ofwar gamed to check, are people well trained? Do they understand about fuels andlogistics, and the same radio frequencies? So they are absolutely ready to go. Sothose 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 reservecorps: lots of people who’ve got the training and background who are ready togo, with the expertise. And then we need to pair those medical people with themilitary taking the advantage of military’s ability to move fast, do logistics andsecure areas.????? We need to dosimulations, germ games, not war games, so that we can see where the holes are.The last time a germ game was done in the United States was back in 2001 and itdidn’t go so well. So far the score is germs:1, people:0. Finally, we need lotsof advanced R&D in areas of vaccines and diagnostics. There are some big breakthroughs,like the Adeno-associated virus that would work very, very quickly. Now I don’thave an exact budget for what this would cost, but I’m sure it’s very modestcompared to the potential harm. The World Bank estimates that if we have aworldwide flu epidemic, global wealth will go down by over three trillion dollarsand we’d have millions and millions of deaths. These investments offersignificant benefits beyond just being ready for the epidemic. The primary healthcare,the R&D, those things would reduce global health equity and make the worldmore 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 hoardcans 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 thatcan come out of Ebola epidemic, it’s that it can serve as an early warning, awake-up call, to get ready. If we start now, we can be ready for the nextepidemic.
Thank you.
