The next outbreak? We’re not ready

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

was a nuclear war.

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

filled with food and water.

When the nuclear attack came,

we were supposed to go downstairs,

hunker down, and eat out of that barrel.

Today the greatest risk
of global catastrophe

doesn't look like this.

Instead, it looks like this.

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

it's most likely to be
a highly infectious virus

rather than a war.

Not missles, but microbes.

Now part of the reason for this

is that we've invested a huge amount
in nuclear deterrants.

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

We're not ready for the next epidemic.

Let's look at Ebola.

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

lots of touch challenges.

I followed it carefully through
the case analysis tools we use

to track polio eradication.

And as you look at what went on,

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

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

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

We didn't have a group of epidemiologists
ready to go

who would have gone,
seen what the disease was,

seen how far it had spread.

The case reports came in on paper.

It was very delayed before they
were put online

and they were extremely inaccurate.

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

We didn't have a way of preparing people.

Now Médecins Sans Frontières did a
great job orchestrating volunteers.

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

getting the thousands of workers
into these countries.

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

of workers.

There was no one there to look
at treatment approaches.

No one to look at the diagnostics.

No one to figure out what tools
should be used.

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

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

But that was never tried.

So there was a lot that was missing.

And these things are really
a global failure.

The WHO is funded to monitor epidemics,

but not to do these things I talked about.

Now in the movies, it's quiet different.

There's a group of
handsome epidemiologists

ready to go, they move in,
they save the day.

But that's just pure Hollywood.

The failure to prepare could allow
the next epidemic

to be dramatically more devastating
than Ebola.

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

About 10,000 people died,

and nearly all were in the three
West African countries.

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

The first is that there was
a lot of heroic work

by the health workers.

They found the people and they
prevented more infections.

The second is the nature of the virus.

Ebola does not spread through the air.

And by the time you're contagious,
most people are so sick

that they're bedridden.

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

And that was just luck.

If it had gotten into a lot more
urban areas,

the case numbers would have
been much larger.

So next time, we may not be so lucky.

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

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

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

or it could be bioterrorism.

And so there are things that would
literally make things

a thousand times worse.

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

like the Spanish Flu back in 1918.

So here's what would happen:

it would spread throughout the world
very, very quickly.

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

So this is a seriousl problem.

We should be concerned.

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

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

We've got cell phones to get information
from the public

and get information out to them.

We have satellite maps where we can see
where we can see where people are

and where they're moving.

We have advances in biology
that should dramatically change

the turnaround time to look at a pathogen

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

So we can have tools, but those tools
need to be put into

an overall global health system.

And we need preparedness.

The best lessons, I think, on how
to get prepared

are, again, what we do for war.

For soldiers, we have them full-time,
ready to go.

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

NATO has a mobile unit
that can deploy very rapidly.

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

Do they understand about fuel
and logistics

and the same radio frequencies?"

So they are absolutely ready to go.

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

What are the key pieces?

First, we need strong health systems
for countries.

That's where mothers can give birth safely,

kids can get all their vaccines.

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

We need a medical reserve corps:

lots of people who've got the training
and background

who are ready to go, with the expertise.

And then we need to pair those
medical people

with the military,

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

and secure areas.

We need to do simulations: germs games,
not war games,

so that we see where the holes are.

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

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

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

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

There are some big breakthroughs,
like