WEBVTT

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When I was a kid, the disaster we
worried about most was a nuclear war.

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That's why we had a barrel
like this down in our basement,

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filled with cans of food and water.

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When the nuclear attack came,

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we were supposed to go downstairs,
hunker down, and eat out of that barrel.

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Today the greatest risk of global
catastrophe doesn't look like this.

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Instead, it looks like this.

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If anything kills over 10 million
people in the next few decades,

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it's most likely to be a highly
infectious virus rather than a war.

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Not missiles, but microbes. Now,
part of the reason for this is that

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we've invested a huge
amount in nuclear deterrents.

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But we've actually invested very
little in a system to stop an epidemic.

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We're not ready for the next epidemic.

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Let's look at Ebola. I'm sure all
of you read about it in the newspaper,

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lots of tough challenges. I followed it
carefully through the case analysis tools

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we use to track polio eradication.

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And as you look at what went on,

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the problem wasn't that there was a
system that didn't work well enough,

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the problem was that we
didn't have a system at all.

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In fact, there's some pretty
obvious key missing pieces.

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We didn't have a group of epidemiologists
ready to go, who would have gone,

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seen what the disease was,
seen how far it had spread.

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The case reports came in on paper.

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It was very delayed before they were put
online and they were extremely inaccurate.

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We didn't have a medical team ready to go.

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We didn't have a way of preparing people.

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Now, Médecins Sans Frontières did
a great job orchestrating volunteers.

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But even so, we were far
slower than we should have been

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getting the thousands
of workers into these countries.

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And a large epidemic would require us
to have hundreds of thousands of workers.

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There was no one there to look
at treatment approaches.

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No one to look at the diagnostics.

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No one to figure out
what tools should be used.

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As an example, we could have
taken the blood of survivors,

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processed it, and put that plasma
back in people to protect them.

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But that was never tried.
So there was a lot that was missing.

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And these things are
really a global failure.

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The WHO is funded to monitor epidemics,
but not to do these things I talked about.

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Now, in the movies it's quite different.

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There's a group of handsome
epidemiologists ready to go,

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they move in, they save the day,
but that's just pure Hollywood.

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The failure to prepare
could allow the next epidemic

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to be dramatically more
devastating than Ebola

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Let's look at the progression
of Ebola over this year.

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About 10,000 people died,

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and nearly all were in the
three West African countries.

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There's three reasons
why it didn't spread more.

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The first is that there was a lot
of heroic work by the health workers.

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They found the people and they
prevented more infections.

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The second is the nature of the virus.

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Ebola does not spread through the air.

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And by the time you're contagious, most
people are so sick that they're bedridden.

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Third, it didn't get
into many urban areas.

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And that was just luck. If it had
gotten into a lot more urban areas,

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the case numbers would
have been much larger.

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So next time, we might not be so lucky.

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You can have a virus where people feel
well enough while they're infectious

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that they get on a plane
or they go to a market.

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The source of the virus could
be a natural epidemic like Ebola,

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or it could be bioterrorism.

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So there are things that would literally
make things a thousand times worse.

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In fact, let's look at a model
of a virus spread through the air,

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like the Spanish Flu back in 1918.

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So here's what would happen:

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It would spread throughout
the world very, very quickly.

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And you can see over 30 million
people died from that epidemic.

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So this is a serious problem.
We should be concerned.

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But in fact, we can build
a really good response system.

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We have the benefits of all the science
and technology that we talk about here.

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We've got cell phones

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to get information from the public
and get information out to them.

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We have satellite maps where we can see
where people are and where they're moving.

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We have advances in biology

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that should dramatically change
the turnaround time to look at a pathogen

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and be able to make drugs and vaccines
that fit for that pathogen.

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So we can have tools,

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but those tools need to be put into
an overall global health system.

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And we need preparedness. The best
lessons, I think, on how to get prepared

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are again, what we do for war.

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For soldiers, we have
full-time, waiting to go.

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We have reserves that can
scale us up to large numbers.

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NATO has a mobile unit
that can deploy very rapidly.

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NATO does a lot of war games
to check, are people well trained?

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Do they understand about fuel and
logistics and the same radio frequencies?

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So they are absolutely ready to go.

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So those are the kinds of things
we need to deal with an epidemic.

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What are the key pieces?

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First, we need strong health
systems in poor countries.

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That's where mothers can give birth
safely, kids can get all their vaccines.

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But, also where we'll see
the outbreak very early on.

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We need a medical reserve corps:

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lots of people who've got
the training and background

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who are ready to go, with the expertise.

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And then we need to pair those
medical people with the military.

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taking advantage of the military's
ability to move fast, do logistics

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and secure areas.
We need to do simulations,

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germ games, not war games,
so that we see where the holes are.

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The last time a germ game
was done in the United States

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was back in 2001,
and it didn't go so well.

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So far the score is germs: 1, people: 0.

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Finally, we need lots of advanced R&D
in areas of vaccines and diagnostics.

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There are some big breakthroughs,
like the Adeno-associated virus,

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that could work very, very quickly.

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Now I don't have an exact
budget for what this would cost,

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but I'm quite sure it's very modest
compared to the potential harm.

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The World Bank estimates that if
we have a worldwide flu epidemic,

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global wealth will go down
by over three trillion dollars

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and we'd have millions
and millions of deaths.

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These investments offer
significant benefits

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beyond just being ready for the epidemic.

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The primary healthcare, the R&D, those
things would reduce global health equity

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and make the world more
just as well as more safe.

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So I think this should
absolutely be a priority.

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There's no need to panic.

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We don't have to hoard cans of spaghetti
or go down into the basement.

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But we need to get going,
because time is not on our side.

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In fact, if there's one positive thing
that can come out of the Ebola epidemic,

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it's that it can serve as an early
warning, a wake-up call, to get ready.

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If we start now, we can be
ready for the next epidemic.

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Thank you. (Applause)