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When I was a kid, the disaster
we worried about most
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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,
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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 missles, 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 deterrants.
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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 we use
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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
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to have hundreds of thousands of workers.
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There was noone 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,
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but not to do these things I talked about.
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Now in the movies, it's quiet different.
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There's a group of
handsome epidemiologists
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ready to go, they move in,
they save the day.
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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
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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
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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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And so there are things that would
literally make things
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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 seriousl 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 to get
information from the public
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and get information out to them.
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We have satellite maps where
we can see where people are
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and where they're moving.
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We have advances in biology
that should dramatically change
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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, but those tools
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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,
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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 would go down
by over 3 trillion dollars
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and we'd have millions
and millions of deaths.
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These investments offer
significant benefits beyond just
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being ready for the epidemic.
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The primary healthcare, the R&D,
those things would reduce
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global health equity
and make the world more just
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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 horde cans of spaghetti
or go down into the basement.
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But we need to get going,
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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 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)