Reviews | Bill Gates’ new book on the pandemic presents a plea and a plan
It was intended as an alarm. Most wealthy countries have opted for the snooze button instead. Now Gates has written a book, “How to Prevent the Next Pandemic,” laying out a plea and plan for how the world can avoid repeating this mistake.
I was engaged with Gates on these issues shortly after the Ebola outbreak of the mid-2010s. (The Bill & Melinda Gates Foundation is one of the funders of ONE, an organization fighting to end the poverty and disease in the world, where I spend part of my professional life.)
Gates’ book is above all 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 disease, which has caused the needless deaths of approximately 3 million children every year. year. Gates then approached William H. Foege, former director of the Centers for Disease Control and Prevention, who gave him 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 some ways, Gates’ book serves as a summary of that education and a graduate course in epidemiology. The hardware is simplified but not simplistic. Anyone who reads it will end up with a basic education in global health science.
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 disasters.” Gates’ book is one of the first major efforts to figure out how that money might best be spent.
One of the perks of being Gates is getting a bird’s-eye view of the pandemic we’re still living through. Which countries have done well?
South Korea, Gates told me in a recent encounter, was “super aggressive” on contact tracing, eventually reducing new infections to zero and achieving a low death rate. But the method used – accessing people’s cellphone records to see who they had been in contact with – would probably have been less well received in the United States.
Japan, Gates said, is the “king of masks” — and has been since the 1918 flu. Israel managed to secure rapid access to vaccines and “rapidly increased coverage.” And Australia has done the first tests well, making full use of its PCR testing capacity.
But the United States? A mixed picture. The creation of effective vaccines within a year was a world historic achievement. This was achieved, Gates said, because government officials “wrote big checks to pharmaceutical companies,” allowing them to invest in speculative technologies without having to justify the risk to investors.
Yet in his book, Gates calls the Trump administration’s initial response to covid-19 “disastrous”. Politicians downplayed the pandemic and gave dire advice to citizens. “Therapeutics came later than expected,” Gates said, and diagnoses were a problem. The CDC had never practiced “taking the nation’s PCR capacity, which is the highest in the world, and allocating it rationally to people who wanted to be tested.”
Gates offers a variety of proposals to improve this – investing in health innovation, ensuring earlier detection of pathogens, encouraging the creation of new vaccines and treatments, and closing the health gap between rich and poor countries. But his flagship idea is called GERM: Global Epidemic Response and Mobilization.
Do you know how in many pandemic movies there is a team of highly trained scientists who arrive in hazmat suits to respond to outbreaks? They don’t really exist. Under the Obama administration, when Ron Klain, then Ebola czar, asked the US military to play this role, it agreed to send personnel by plane to West Africa. But he refused to carry blood samples because he had never trained for the mission, Gates said.
GERM is designed to fulfill such a role. Gates would locate about 3,000 medical professionals — experts in epidemiology, genetics, vaccine development, logistics, computer modeling and communications — at the World Health Organization. They woke up every day with the question, “What can we do to be better prepared for the next pandemic?” And they would constantly repeat 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.