In season 3 of the TV show “24”—a show I really liked—a terrorist intentionally releases a pathogen in Los Angeles. Word gets to practically every government entity in no time. The hotel where the release took place is immediately sealed off. A computer modeling genius figures out not only how the disease will spread, but how quickly news of the disease will get around and (the best part) how bad traffic will get as people flee the city. I remember watching those episodes and thinking, “Wow, that government sure knew how to prepare.” It made for great TV, and of course we could all sleep better at night if things really worked that way.
“Many organizations work hard to respond to a major outbreak, but their efforts largely depend on volunteers.”
But they don’t. Although there are many organizations that work hard to respond to a major outbreak, their efforts largely depend on volunteers. Regional and national response teams are understaffed and underfunded, and none of them has a mandate from the international community to work globally. The only organization that sort of has that mandate, the World Health Organization (WHO), has very little funding and almost no personnel dedicated to pandemics, relying instead on the mostly volunteer Global Outbreak Alert and Response Network (GOARN). There is no organization with the size, scope, resources and responsibility that are essential for detecting and responding to outbreaks and preventing them from becoming pandemics.
Let’s consider the sequence of events that are involved in an effective response to an outbreak. Sick people have to go to a clinic and the health workers there have to diagnose them properly. Those cases must get reported up the chain, and an analyst has to notice an unusual cluster of cases with similar suspicious symptoms or test results. A microbiologist must get samples of the pathogen and determine whether it’s something we’ve seen before. A geneticist may need to map its genome. Epidemiologists have to understand how transmissible and severe the disease is. Community leaders need to get, and share, accurate information. Quarantines might need to be put in place and enforced. Scientists need to get cracking on diagnostic tests, treatments and vaccines. And, just as firefighters run drills when they’re not putting out a blaze, all of these groups need to have practiced, testing the system to find the weak spots and fix them.
Bits and pieces of what you’d want in a monitor-and-respond system exist. I’ve met people who have dedicated their lives to this work, and many put their lives on the line for it. But Covid did not happen because there were too few smart, compassionate people trying to prevent it. Covid happened because the world hasn’t created an environment in which smart, compassionate people can make the most of their skills as part of a strong, well-prepared system.
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What we need is a well-funded global organization with enough full-time experts in all the necessary areas, the credibility and authority that come with being a public institution, and a clear remit to focus on preventing pandemics. I call it the GERM—Global Epidemic Response and Mobilization—team, and the job of its people should be to wake up every day asking themselves the same questions: “Is the world ready for the next outbreak? What can we do to be better prepared?” They should be fully paid, regularly drilled and prepared to mount a coordinated response to the next threat of a pandemic. The GERM team should have the ability to declare a pandemic and work with national governments and the World Bank to raise money for the response very quickly.
My back-of-the-napkin estimate is that GERM would need about 3,000 full-time employees. Their skills should run the gamut: epidemiology, genetics, drug and vaccine development, data systems, diplomacy, rapid response, logistics, computer modeling and communications. GERM should be managed by the WHO, the only group that can give it global credibility, and it should have a diverse workforce, with a decentralized staff working in many places around the world. To get the best staff possible, GERM should have a special personnel system different from what most U.N. agencies have. Most of the team would be based at individual countries’ national public health institutes, though some would sit in the WHO’s regional offices and at its headquarters in Geneva.
When there’s a potential pandemic looming, the world needs expert analysis of early data points that can confirm the threat. GERM’s data scientists would build a system for monitoring reports of clusters of suspicious cases. Its epidemiologists would monitor reports from national governments and work with WHO colleagues to identify anything that looks like an outbreak. Its product-development experts would advise governments and companies on the highest-priority drugs and vaccines. GERMers who understand computer modeling would coordinate the work of modelers around the world. And the team would take the lead on creating and coordinating common responses, such as how and when to implement border closures and recommend mask use.
Diplomacy will inevitably be part of the job. After all, national and local leaders are the ones who understand the unique conditions in their country, who speak every local language, who know the key players, and to whom the public looks for leadership. People from GERM would have to work closely with them, making it clear that their job is to support, not supplant, local expertise. If GERM becomes—or even appears to be—something imposed from the outside, some countries will reject its recommendations.
For countries that need additional support, GERM should fund or loan public health experts who would participate in this global pandemic-prevention network. They would train and drill together to keep their skills sharp, and they would stay ready to respond locally or globally when they’re needed. Countries with greater need and a high risk of outbreaks would bring in more GERM team members from the network and host them to build local expertise in infectious diseases. Regardless of where they’re assigned, these GERMers would have a dual identity: They’d be part of the national detection-and-response system and also part of GERM’s rapid response.
Finally, the GERM team should be responsible for testing the world’s monitor-and-respond system to find the weak spots. They would develop a checklist for pandemic preparedness, similar to the ones that airplane pilots follow before every takeoff and many surgeons now go through during an operation. And just as militaries do complex exercises where they simulate different conditions and see how well they respond, the GERM team would organize outbreak response exercises. Not war games, but germ games.
“I put the cost of running the GERM team in the neighborhood of $1 billion a year.”
I put the cost of running the GERM team in the neighborhood of $1 billion a year, to cover salaries for 3,000 people plus equipment, travel and other expenses. To put that number in perspective, $1 billion a year is less than 0.1% of the world’s annual spending on defense. Given that it would be an insurance policy against a tragedy that could cost the world trillions of dollars, as Covid has, and also help drive down the human and financial burden caused by other diseases, a billion dollars a year would be a bargain. Don’t think of this spending as charity or even traditional development assistance. Just like defense spending, it would be part of every nation’s responsibility to ensure the safety and security of its citizens.
—This essay is adapted from Mr. Gates’s new book “How to Prevent the Next Pandemic,” which will be published on May 3 by Knopf.
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