How to prevent the next pandemic (ENG)

After two years of pandemic, Bill Gates delivers a book that in about three hundred pages can serve as both a warning and a handbook for the future. How to prevent the next pandemic, published on 3 May by the Allen Lane publishing house, has been the talk of the town since its release. The Coronavirus pandemic, in fact, has not yet died out and continues to plague governments around the world with its social, political, health and economic implications, but Mr. Gates is already looking to the future, trying to find an answer to the existential question that also gives this book its title ‘How can we prevent the next pandemic?

The Microsoft founder is firmly convinced – and personally, after reading his book, I find myself agreeing with him – that by learning from the current pandemic and implementing a series of strategies for the future, we can avoid the outbreak of a global health crisis like the one caused by Covid-19.

Based on the shared views of the world’s leading experts and his own experience fighting deadly diseases through the Gates Foundation, in How to prevent the next pandemic Bill Gates clearly and convincingly sets out the importance of being better prepared for the spread of new viruses.

The book consists of nine chapters plus an Introduction and an Afterword, the core of which revolves around the idea that while epidemics are inevitable, pandemics are optional. The world, therefore, in Gates’ thinking should not live in fear of the next pandemic, but should make the right investments for the benefit of all, with a view to making Covid-19 the last pandemic ever.

As many will recall, Bill and Melinda Gates have been committed to fighting the virus from the earliest days, collaborating with experts inside and outside the Gates Foundation who have been fighting infectious diseases for decades. This commitment inevitably led Mr. Gates to reflect on many factors in the pandemic response that could have been faster and more efficient.

Starting with the fact that respiratory viruses, including influenza and coronaviruses, are particularly dangerous because they spread very quickly, Bill Gates explains that the likelihood of a pandemic striking the world is steadily increasing; partly because human beings with urbanisation are encroaching on countless natural habitats and, as a result, interacting with animals more often, creating the conditions that allow a disease to pass from animal to human. In addition to this, another key point to consider is the lack of technical preparedness that all countries around the world have generally shown in responding to the virus. Back in 2015, during a speech at the TED conference entitled “The next epidemic? We’re not ready”, Gates had emphasised the importance of planning for all kinds of scenarios – from vaccine research to the training of health workers – to prevent the outbreak of increasingly dangerous viruses. Reflecting this importance, How to Prevent the Next Pandemic sets out how governments, scientists, companies and individuals can build a system capable of containing the inevitable outbreaks so that they do not turn into pandemics. Specifically, each chapter of the book explains a different step to take in order to be ready, and together, all these steps form a plan to eliminate future pandemics and reduce the likelihood that society will have to go through another Covid-19.

The first chapter traces the importance of learning from the pandemic caused by Covid-19. The starting point is swift action. It is no coincidence that many of the countries that experienced low excess mortality – Australia, Vietnam, New Zealand, South Korea – at the start of the pandemic quickly tested a large portion of the population, abruptly isolated individuals who tested positive and those who had been exposed to the virus, and put in place a plan to track, monitor, and manage cases that crossed their borders. Of course, Gates explains, just as some countries show us what to do and how to act, others show us the opposite. Not everyone did the right thing. Some people refused to wear a mask or vaccinate. Some politicians have denied the seriousness of the disease and avoided implementing the necessary closures to stop the spread of the virus.

Another fundamental point, repeatedly emphasised by the author, is that investing in innovation today will pay off in the future. In this regard, in the second chapter Gates emphasises the importance of putting in place a global body of experts whose task is to study how to respond to diseases that could kill thousands of people. Simply put, the world has never before invested in the mechanisms needed to prevent future pandemics and now is the time to do so.

Today, there are many organisations working to respond to pandemics, the best known being the Global Outbreak Alert and Response Network (GOARN) which does heroic work but does not have the personnel, funds or global mandate to deal with any threat.

What Bill Gates therefore advocates is the creation of a permanent organisation of experts, fully paid and prepared to organise, at any time, a coordinated response to any dangerous outbreak. Mr. Gates proposes to call this group GERM – Global Epidemic Response and Mobilisation – and to fill it with experts from all over the world with a wide range of expertise (epidemiology, genetics, diplomacy, logistics, computer models, communication, etc.) who, when not actively working in the field, are based in the public health agencies of individual countries, in the regional offices of the WHO, and at the headquarters in Geneva.

Several times throughout the book, Gates explains how the most important job of this team would be to help run epidemic response exercises to see if the world is ready for the next big pandemic. However, GERM’s impact would not be limited to stopping pandemics, the group would also improve overall health worldwide, especially in poorer countries.

Another important part of prevention is to study and constantly monitor the spread of different viruses. Indeed, with the right investment and preparation, we will be able to rapidly test large numbers of people during an epidemic in the future. A rapid and efficient response is inevitably linked to the development of digital data collection systems so that public health offices can keep abreast of the situation in their communities, as well as the ability of governments around the world to establish working relationships with infectious disease experts from both the public and private sectors.

In the fourth chapter, the author explores an issue that has plagued countless countries and governments over the past two pandemic years: the need to teach and help people to protect themselves and others. The most useful way we can all do our part is through so-called ‘non-pharmaceutical inventions’ – NPIs – (masks, sanitisers, lockdowns, etc.). The irony of NPIs is that the more useful and effective they are, the easier they are to criticise. However, as our recent past shows, lockdowns – for example – have allowed the world’s economies to recover faster, simply by forcing people to stay indoors and thus saving lives. Of course, not everything that governments have implemented during the current pandemic has been right, nor will it be necessary in the future to repeat every single action taken in the fight against Covid-19. In particular, Gates focuses on the closure of schools, emphasising that schools will not need to be closed for extended periods of time in the future, especially if the world community is able to provide vaccines for everyone within six months.

However, what works for one place or country does not necessarily work for another. Lockdowns are a clear example of this disparity. As explained by the author, social distancing and lockdowns work more for wealthier countries and neighbourhoods; this is because wealthier people tend to work jobs that do not require them to travel and go out to work and because they can afford to stay indoors. Consequently, just as it is important to develop and implement the study of new vaccines, new tests for infectious diseases, and new treatments, it is equally important to work on the inequalities that afflict the global community and that, consequently, slow down the fight against future pandemics. Both locally and globally. A further recurring theme of the book is that the global community does not have to choose between preventing future pandemics or implementing global health: these are in fact mutually reinforcing. The greatest medical breakthrough of this pandemic – and one of the most important in recent decades – was the creation of vaccines against Covid-19. One study found that in the first year they saved more than 1 million lives and prevented 10 million hospitalisations in the US alone. The creation and distribution of the vaccines has been quite rapid, yet there are a number of problems that need to be solved before the next potential pandemic arrives, such as the huge disparity between those who have been vaccinated and those who have not. It is important to remember that the speed with which the vaccines against Covid-19 were implemented depends largely on a matter of ‘luck’. In fact, coronaviruses had already caused two previous outbreaks (SARS and MERS), allowing scientists to learn a great deal about the structure of the virus. In particular, the scientific community – before 2020 – had already identified Covid’s characteristic spike protein – the crown-like spikes of the virus of which countless images have been disseminated – as a potential target for vaccines, so when it came time to create new vaccines, scientists suddenly realised which part of the virus was most vulnerable to attack. In the next outbreak,’ Mr Gates warns us, ‘we might not be so lucky. It could be caused by a virus that scientists have not yet studied.

That is why, according to the author, the global community must adopt a serious plan for the development, production and distribution of new vaccines to prevent another pandemic. However, it is good to keep in mind the difficulty and especially the high costs of such processes. Production alone is a huge challenge: to avoid the inequalities we have seen in Covid-19, the world will have to be able to produce enough vaccines for everyone on the planet within six months of the discovery of a new pathogen (around 8 billion doses for a single-dose vaccine and 16 billion for a two-dose version). To do this, Bill Gates proposes – in chapter six – a four-step plan, starting with accelerating the invention of new vaccines.

All this inevitably requires a lot of practice. ‘Practice, practice, practice’, not surprisingly, is how the author wanted to call the next chapter, in which he advocates a series of simulation plans for the future that will help the global community prevent future pandemics from breaking out. So, just as countless governments spend millions on military exercises, so too should they in the future invest in health exercises that will make us all better prepared should another virus spread. Such exercises will not only be useful in preventing further pandemics, but will also help governments to be prepared in the event of a bioterrorist attack (which is the deliberate use of biological agents – such as viruses, bacteria or toxins – in actions against public safety). The very possibility of a bioterrorism attack is one of the reasons why governments around the world should invest more money in research, study and prevention of diseases that can ‘go global’. Inevitably, investments of public money – as well as the ability to cope with crises – are easier and more possible in richer countries, which greatly contributes to widening inequalities between developed and undeveloped or developing countries. In this regard, Mr. Gates proposes for the immediate future to start decreasing the gaps between rich and poor countries, especially in the area of public health since “where we live and how much money we have determines the chances we have of dying young or becoming wealthy adults”. Narrowing the gaps between wealthier and poorer countries not only helps to eliminate inequities in health and healthcare, but also helps to prevent the spread of new pandemics. Thus, both rich and poor countries benefit.

In conclusion, Bill Gates reminds us that investing public money in planning and preventing new pandemics will make people healthier, save lives and reduce the health gap between rich and poor, even when the world is not actually facing an active epidemic. How to prevent the next pandemic is therefore a handbook, an opportunity not only to prevent things from getting worse, but also to make them better. “We must not give up,” says Mr Gates, “living in perpetual fear of another global catastrophe. But we must be aware of this possibility and be willing to do something about it. I hope the world seizes this moment and invests in the necessary steps to make Covid-19 the last pandemic’.

Personally, I found reading this book extremely interesting, but above all enlightening. Reading How to prevent the next pandemic made me realise how many things are often taken for granted nowadays, especially for people like me who live in developed countries. From the distribution of vaccines to the possibility of finding sanitary devices or swabs, everything is easier if we just leave the house and walk a few metres to find a pharmacy. The Covid-19 pandemic affected every country in the world without distinction, but the ability of governments to respond to it was inevitably related to the type of country (rich or poor, developed or underdeveloped). I believe, therefore, that reading this handbook – as it should be read – can be extremely useful, both for individuals and for governments themselves.

Francesca Teresi

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