Five years ago Microsoft founder Bill Gates hoped that the Ebola epidemic of 2013 would be the wake-up call that triggered mobilization towards preparedness. In his April 2015 TED Talk Gates said,
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 missiles, but microbes.
Such prediction becomes credible when we compare efforts at preparing for war vs. efforts at preparing to fighting epidemics.
… we’ve invested a huge amount in nuclear deterrents. But we’ve actually invested very little in a system to stop an epidemic. We’re not ready for the next epidemic.
Preparedness for war entails reserves that can be called into action, mobile units that can be deployed where conflicts arise, and on-going assessments of logistics. Such preparedness does not exist in public health systems.
An effective public health system needs not only trained and flexible boots on the ground, but also coordinated scientific and technological support, as Bill Gates suggested.
But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talk 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 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.
In his 2015 talk Bill Gates was speaking from the world’s experience with the Ebola epidemic that started in 2013. Ebola was contained by 2016. Except for isolated cases elsewhere, the Ebola epidemic mostly affected populations in West Africa.
Even more difficult to contain without effective public health systems in place are pandemics, which unlike epidemics spread rapidly globally. Epidemiologists estimated deaths from two recent pandemics: the 1968 Hong Kong Flu caused one million deaths worldwide and 100,000 in the U.S., and the 2009 Swine Flu 575,400 deaths worldwide and 12,469 in the U.S.
Today we are suffering through COVID-19, not a strain of influenza, but a coronavirus in the same family as SARS (Severe Acute Respiratory Syndrome, first emerged in 2002, deaths worldwide 813, fatality rate 9.5%), and MERS (Middle East Respiratory Syndrome, first emerged in 2012, deaths 858, fatality rate 34%).
Preparedness for COVID-19 is minimal in most countries. In the U.S. there is scarcity of tests and protective gear, insufficient hospital beds, inadequate logistics for keeping grocery shelves stocked, no plan to quickly move school aged children from crowded brick and mortar facilities to small groups or on-line instruction. We are left with lockdowns that will result in massive economic and social disruptions.
Effective public health structures that defend populations against disease cost money. However, such public structures are not built by government throwing money at schemes like Medicare for everyone or universal health care. They are built by intelligent research and development, flexible logistics for people and equipment, absence of excessive red tape, and ample market competition that brings costs down.
Also, the costs of effective health structures must be compared to economic upheavals incurred by lockdowns and absences from work as we are seeing with COVID-19. As Bill Gates said,
I don’t have an exact budget for what this would cost, but I’m quite sure it’s very modest compared to the potential harm.
Today we are seeing the harm brought about by unpreparedness. Hopefully after COVID-19 is past, we will see determination towards preparedness.