The next outbreak? We’re not ready | Bill Gates | TED

The threat

• Gates recalls worrying about nuclear war as a kid, with a barrel of food and water in the basement.
• Today, if anything kills over 10 million people in the next few decades, it is most likely to be a highly infectious virus — not missiles, but microbes.
• We have invested hugely in nuclear deterrents but very little in a system to stop an epidemic.

What Ebola revealed

• Gates followed Ebola through the case analysis tools used to track polio eradication.
• The problem was not a system that didn't work well enough — there was no system at all.
• Missing pieces: no epidemiologists ready to go, no medical team, case reports on paper that were delayed and extremely inaccurate.
• Médecins Sans Frontières did a great job orchestrating volunteers, but a large epidemic would require hundreds of thousands of workers.
• No one looked at treatment approaches or diagnostics; using survivors' plasma was never tried.
• The WHO is funded to monitor epidemics, not to do these response tasks.

Why Ebola wasn't worse

• About 10,000 people died, nearly all in three West African countries.
• Three reasons it didn't spread more: heroic health workers, the virus doesn't spread through the air and contagious people are bedridden, and it didn't reach many urban areas — that was just luck.
• A future virus could let people feel well enough while infectious to get on a plane or go to a market.
• The source could be a natural epidemic or bioterrorism.
• A virus spread through the air, like the 1918 Spanish Flu, killed over 30 million people.

How to prepare

• We have the tools: cell phones for information, satellite maps to see movement, and advances in biology to speed up drugs and vaccines.
• Lessons from war preparation: full-time soldiers, reserves, NATO's rapid mobile unit, and war games to test readiness.
• Key pieces: strong health systems in poor countries, a medical reserve corps, pairing medical people with the military, germ games instead of war games, and advanced R&D in vaccines and diagnostics.
• The last U.S. germ game was in 2001 and didn't go well — the score is germs: 1, people: 0.
• The Adeno-associated virus is one breakthrough that could work very quickly.

Cost and stakes

• No exact budget, but the cost is very modest compared to the potential harm.
• The World Bank estimates a worldwide flu epidemic would cut global wealth by over three trillion dollars with millions of deaths.
• These investments also reduce global health equity gaps and make the world more just and more safe.
• No need to panic, but we need to get going — Ebola can serve as an early warning, a wake-up call.