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When I was a kid,

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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

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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

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rather than a war.

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Not missiles, but microbes.

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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.

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I'm sure all of you read about it 
in the newspaper,

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lots of tough challenges.

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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

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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.

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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,

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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.

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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.

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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.

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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

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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,

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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.

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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,

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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.

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(Applause)