We can make COVID-19 the last pandemic

In the year 6 CE, a fire devastated Rome. In response, Emperor Augustus did something that had never been done before in the history of the Empire. He created a permanent team of firefighters who used buckets just like this one. Augustus understood that individuals alone can't protect themselves from fires. They need help from the community. When one person's house is on fire, that creates a risk for everyone else's homes.

And so what we've had these last few years is like a horrific global fire. The COVID pandemic has killed millions and upended economies, and we want to stop that from happening again. COVID, it's hard to overstate how awful it's been. It's increased the health inequities between the rich and the poor. Survival depended partly on your income, your race, the neighborhood you lived in. And so we should seize this opportunity to create a world where everyone has a chance to live a healthy and productive life. Also a life free from the fear of the next COVID-19.

When I was on this stage in 2015, I was one of many people who said we weren't ready and we needed to get ready. We didn't. The speech actually was watched by a lot of people. But 90 percent of the views were after it was too late.

So now I hope the need is clear. And of course, we've learned a lot. During this pandemic, a lot of things worked well, a lot of things didn't work well. And so we have all that knowledge to build a prevention system.

COVID-19 can be the last pandemic if we take the right steps. So how, what are these steps? Well, let's go back and look at what the Romans did. Think about how, over time, we've gotten good at preventing big fires. Fire prevention is kind of this pervasive thing. It's well funded. It's well understood. If an alarm went off right now, everyone here would know we're supposed to calmly gather, go out and wait instructions. We'd know that help would be on the way because we have lots of trained firefighters who practice. The United States alone has 370,000 full-time firefighters, even more than I guessed that number would be. We also have access to water. The United States, for example, has almost nine million fire hydrants. And so that type of investment, that type of practice, that type of system is what we need to stop pandemics.

Now, often in movies, we'll have pandemics. And I'm always impressed with what takes place. Let's look at an example of this rapid response.

Well, that's quite impressive. We don't need the music, but otherwise we saw exactly what should happen. An outbreak’s detected. Very quickly, literally within days, doctors are dispatched. They have a helicopter to get into exactly ground zero. They go in there, and they’ve got the right tools. And this is what should happen when an outbreak is spotted.

But we don't have that team, we don't have those resources. And if an outbreak took place in a low-income country, it could be literally months before we started to orchestrate those resources.

So despite what you see in movies, there is no group of experts standing by to prevent this disaster. So we have to create a new team. I believe we should create what I call the GERM team. Germ stands for Global Epidemic Response and Mobilization. This group is full-time. Their only priority is pandemic prevention. It's made up of a diverse set of specialists with a lot of different realms of expertise: epidemiologists, data scientists, logistics experts. And it's not just scientific and medical knowledge. They also have to have communication and diplomacy skills. The cost of this team is significant. It's over a billion a year to support the 3,000 people who would be on this team. And its mission is to stop outbreaks before they become pandemics. The work would be coordinated by the WHO. They'd be present in many locations around the world, stationed in public health agencies. They'd work closely with the national teams, depending on the income level. They'd have more in the lower-income countries. You know, for example, we could have GERM members say an epidemiologist, working out of the Africa CDC office in Abuja. And a very important thing is that like firefighters, a GERM team would do drills. When you want to have quick response, when you want to make sure you have all the pieces there and you can move very quickly, practice is key. That's how you make sure everyone knows what to do.

Now, this team, there could be periods where there's no risky outbreak and they can keep their skills strong by working on some of the other infectious diseases, but that would be a second priority. They would work with countries to strengthen their health systems. The health systems are the front line. You need to know if, say, a lot of people show up with a new kind of cough, that’s when GERM needs to look into it and say, is this an outbreak? Is there a new pathogen here? What is the sequence of that? And so for all of this, the first 100 days are key. Viruses spread exponentially. And so if you get in there when the infection rate is fairly small, you can actually stop the spread.

You know, in this epidemic, if we'd been able to stop it within 100 days, we would have saved over 98 percent of the lives. Now, we did have countries that did a good job. Australia is an example. They orchestrated diagnostic capacity. They came up with distancing policies and quarantine policies. And so their overall death rate per capita will be well less than a 10th of other countries. But we did not, as a world, contain it. And that's what we have to do next time.

When COVID struck, we were almost like Rome before they had fire buckets and firefighters. We didn't have the people, the systems or the tools we need. Now, with the right investments, we can have a whole new generation of tools, better diagnostics, therapeutics and vaccines. A good example in the diagnostic area is this little machine, this is called the Lumira. We can have these all over the world that can test for any number of diseases. It’s a 10th as expensive as PCR, it’s absolutely as accurate, and it’s simple. So it can be used anywhere. We need other R&D investments. One that I'm very excited about is the idea of a drug that you inhale that blocks you from getting infected. It can be pathogen-independent and trigger your immune system so that you'll be protected. A lot of the tools, the diagnostic tools and those infection-blocking tools are important because they can be staged in advance. Now, we also need vaccines, but we want to stop the outbreak before we have to do a global vaccination campaign. And so vaccines can play a couple of different roles, but not the primary role. We have to invest in more than just that.

When we look at vaccines, they were the miracle of this epidemic. They saved millions of lives, but they can be far better. We need to invent easier-to-deliver vaccines that are just a patch you put on your arm or something that you inhale. We need vaccines that actually block infections. In this case, there were lots of breakthrough infections. We need vaccines that are broad spectrum, so they work against most of the emerging variants, which we did not have this time. And we also need factories that are standing by so we can build enough vaccines for the entire world within six months and achieve far better equity. The vaccines can also do something that would be super helpful, which is to help us eradicate entire families of viruses. Innovative new vaccines used properly could get rid of the flu family, the coronavirus family. And there's a huge burden of those, even in non-pandemic years, and if we get rid of it, it can never cause a pandemic.

So I'm talking about investments in three broad areas: Disease monitoring, that's GERM. The R and D tools that are far better. And finally, and the most expensive, is improved health systems. This won't be cheap, but it'll save lives. And even it'll save money in the long run. It's like an insurance policy.

The cost to prevent the next pandemic will be tens of billions of dollars. But let's compare that to what we just went through. The IMF estimates that COVID has cost nearly 14 trillion dollars. And so we need to spend billions in order to save trillions. And here's the best part of this. Even when we're not having an outbreak, these investments like the Lumira, those new vaccines, they will make people healthier. They'll shrink the gap, the health equity gap, which is gigantic, between rich and poor countries. For example, we can detect more HIV cases and do a better job of treatment. We can reduce deaths from malaria. We can get more people high-quality care. And so this is not just a downer about how to stop things from getting worse, but also a chance to make things better.

If we take the right steps, we can make COVID-19 the last pandemic, and we can build a healthier, more equitable world for everyone.

(Applause) Helen Walters: Thank you so much. I have a few follow-up questions and one is really about the formal status of GERM. So you mentioned this would cost a billion dollars, you mentioned it comes through the WHO, but exactly who's running this, how does this work, how do we make this happen?

BG: Well, GERM does not exist. It's a proposal I'm putting forward that hopefully over the next year, while the pain of the pandemic is still clear in people's minds, will get a global consensus. The rich-world governments will have to step up like they do with all the aid things and come up with that money. The way the personnel systems works, so that it's under WHO, but a really top-notch team, there will be a lot of debate about how to do that well. So, you know, I'm putting it forward and hopefully within the next year we'll get that consensus.

HW: Who do you need to pick that up next?

BG: Well, it's really the rich-world governments. The WHO has this big yearly meeting, the World Health Assembly, and at some point somebody will put forward a resolution and we'll see if the extra resources can be put in for that. After World War II, we did a lot. You know, we created the United Nations, we talked a lot about war. So I'd be stunned, although, you know, so far the action has been less than I would have expected, I'd be stunned if we don't go forward with something pretty close to what I'm laying out there.

HW: This has been pretty personal for you. You know, the anti-vaxxers are out there, they are loud, and this has become personal. I just wanted to ask, like, how are you managing that?

BG: Well, it's kind of weird.

Now, our foundation, the Gates Foundation, is very involved in vaccines, the invention of new vaccines, funding vaccines. And we're very proud that through joint efforts like GAVI, that saved tens of millions of lives. So it's somewhat ironic to have somebody turn around and say, no, you know, we're using vaccines to kill people or to make money or, you know, we started the pandemic, even some strange things like, that I somehow want to track, you know, the location of individuals because I'm so deeply desirous to know where everybody is.

I'm not sure what I'm going to do with that information.

You know, does this turn into something where, you know, there's constantly crazy people showing up? Who knows? But, you know, hopefully, as the pandemic calms down, people are more rational about, hey, vaccines are a miracle and there's a lot more we can do.

HW: So the future is in our hands in the present.

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