The next epidemic. It will come, and we are not prepared.

Video: TED – Ideas Worth Spreading

Translation: Leonardo Silva. Review: Fernando Gonçalves

Passionate about technology, a shrewd businessman, and today a philanthropist sponsoring various projects in the areas of health and education, Bill Gates changed the world by leading the astounding success of Microsoft.

Videographer:

Full translation of Bill Gates' TED talk:

As children, the catastrophe that worried us most was a nuclear war. That's why we had a barrel like this in our basement, full of cans of food and water. When a nuclear attack occurred, we were supposed to go to the basement, crouch down, and eat what was in the barrel.

Today, the greatest risk of global catastrophe isn't like that. Actually, it is like that. If something kills more than 10 million people in the next few decades, it's more likely to be a highly contagious virus than a war. Not missiles, but microorganisms. Well, one of the reasons for this is that we've invested heavily in anti-nuclear strategies, but very little in a system to stop an epidemic. We are not prepared for the next epidemic.

Let's look at Ebola. Surely you've all read about it in the newspapers; many difficult challenges. I followed the situation carefully with case analysis tools, the same ones we used to track the eradication of polio. And, if we analyze what happened, the issue wasn't that there was a system that didn't work very well. The issue is that we didn't have a system at all. In fact, there are some important and quite obvious variables missing.

We didn't have a group of epidemiologists ready to act, who would have gone, seen what the disease was, seen how far it had spread. Case reports arrived on paper. It took a long time for them to be put online, and they were extremely inaccurate. We didn't have a medical team ready to act. We didn't have a way to prepare people. Well, Doctors Without Borders did a great job organizing volunteers. Even so, we were much slower than we should have been in getting thousands of professionals to those countries. And a major epidemic would require hundreds of thousands of professionals. There was no one there to check treatment approaches, to assess the diagnostic process, to see what tools should be used. For example, we could have collected blood from survivors, processed that blood, and used the plasma to immunize other people, but that was never tried.

So, a lot was missing. Things like that are truly a global failure. The WHO is funded to monitor epidemics, not to do these things. Well, in the movies, it's quite different. There's a group of wonderful epidemiologists ready to act, and they go, they solve the problem, but that's pure Hollywood production.

A failure to prepare could allow a future epidemic to be drastically more devastating than Ebola. Let's look at the progression of Ebola over this year. About 10 people died, and almost all of them were in three West African countries. There are three reasons why the virus didn't spread further. The first is that there was a great deal of heroic work by healthcare professionals. They found people and prevented further infections. The second is the nature of the virus. Ebola is not airborne, and when it is in the contagious stage, most patients become so ill that they are bedridden. The third is that it didn't enter many urban areas, and that was simply by luck. If it had entered many more urban areas, the number of cases would have been much higher.

So, next time, we might not be so lucky. There could be a virus that leaves the patient seemingly well at the contagious stage, to the point where they can travel by plane or go to the market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So, there are things that could make things literally a thousand times worse.

In fact, let's look at a model of an airborne virus, like the Spanish flu in 1918. Let's see what would happen: it would spread around the world very, very quickly. We can see that more than 30 million people would die from the epidemic. So, this is a serious problem, we should be concerned, but in fact, we can create a very good response system. We have the advantage of all the science and technology we've talked about here. We have cell phones to collect information from people and disseminate information to them. We have satellite maps where we can see where people are and where they are going. We have advances in biology that would drastically change the response time for analyzing a pathogen and being able to create vaccines and medications compatible with it. We may have the tools, but they need to be placed within a comprehensive global health system, and we need preparation.

I think the best lessons on how to prepare are, once again, what we do for war. Soldiers are prepared to act at any moment. We have reservists who can represent us in large numbers. NATO (North Atlantic Treaty Organization) has a mobile unit that can go into action very quickly and conducts various war tests to find out: are the people trained? Do they understand fuel, logistics, and the same radio frequencies? Then they are fully ready to act. These are the kinds of things we need to deal with in an epidemic.

What are the key pieces? First, we need strong health systems in poor countries, where mothers can give birth safely and children have access to all vaccines, but where we will also see the outbreak very early on. We need a medical corps on standby: many trained and experienced people are needed, ready to act, with expertise. And we need to combine these health professionals with the military, leveraging the military's ability to move quickly, handle logistics, and secure areas. We need to conduct simulations, germ tests, not war tests, to see where the flaws are. The last time such a test was conducted in the US was in 2001, and the result wasn't very good. So far, the result is: germs, 1; people, 0. Finally, we need a lot of advanced R&D in the area of ​​vaccination and diagnostics. There are some great discoveries, such as the adeno-associated virus, that could act very quickly.

I don't know exactly how much that would cost in terms of budget, but I'm sure it would be quite modest compared to the potential damage. The World Bank estimates that if we have a global flu epidemic, global wealth will fall by more than $3 trillion and we would have millions and millions of deaths. These investments offer significant benefits that go beyond just epidemic preparedness. Basic healthcare, R&D, things like that would reduce global health inequality and make the world fairer and safer.

So I think this should definitely be a priority. There's no need to panic. We don't need to hoard cans of spaghetti or stay in basements, but we need to hurry, because time is not on our side.

In fact, if there is anything positive about the Ebola epidemic, it is that it can serve as a signal, a warning, for us to prepare. If we start now, perhaps we will be prepared for the next epidemic.

Thank you.