On How to Prevent the Next Pandemic

This is the transcript of my video posted on Youtube. If you like it, go check out my video there!

Hey everyone what’s up! I hope you’ve been well, mostly importantly, staying healthy. Today I wanna share with you a new book from Bill Gates, on How to Prevent the Next Pandemic. In 2015, Bill Gates presented a TED talk saying that us human beings, are not ready for a pandemic. Unfortunately, that video didn’t gain any traction until a real one happened.

This book discusses a wide spectrum of things in a timely manner, specifically around how we could do a better job at detecting outbreaks early, helping people protect themselves, finding new treatments, developing, manufacturing and delivering new vaccines, and separately, how we could setup a dedicated team in the future, that answers for the call, “how to prevent the next pandemic”. We’ll gonna walk through some of the highlights in this book, and hopefully from this video you can learn something you didn’t know.

First of all, let’s recap on the lifecycle of a pandemic and get clear on some terminologies. COVID started as an outbreak. An outbreak is a disease spikes in a local area, and then it goes to epidemic, when an outbreak spreads more broadly within a country or region, and ultimately becomes a pandemic, that goes global and affects more than one continent. Matter of fact, there’re hundreds of outbreaks of infectious diseases every year, and some of them can cause catastrophes, such as COVID, or HIV/AIDS, or smallpox, which existed more than 3000 years and got eradicated by 1980s.

Now let’s break them down into individual steps and see the challenges and action items in each of them.

The first step during the outbreak phase is to detect it early. But the challenging part is that the world woefully underinvests in disease surveillance. Especially in low- and middle-income countries, there’s no precise data, that could indicate when and why people died. It might take years for someone’s birth or death to be counted in the government record, if it ever gets counted at all.

Another challenge that also goes beyond the outbreak phase, is about testing. Testing is still costly in both time and money. Initially we had PCR test, where your samples are taken from saliva or nostrils, and then is taken to a lab to run on a special machinery that tests if its genome matches the virus. It’s pretty accurate and only takes a few hours but the downside is that when there’s a large backlog of samples to run, like when it’s during COVID, it usually takes days before you can get the result, and because that it runs a specially designed machine, it’s impractical to run everywhere in the world. And timing is important during an outbreak because we need to quickly identify the groups of people to perform quarantine and isolation.

Later we had the antigen test, which is a little bit less accurate, but not egregiously so. However, it has huge upsides. First of all, it doesn’t need to be run a machine, and you can do it at home using a test kit, and it usually just takes less than half an hour to get the result.

Ultimately, we need diagnostic tools that are accurate, accessible for many people around the world, and quick to produce results that feed into the public health system. To achieve this, we need to invest in all elements of a robust health system that make it possible to detect diseases, as well as treat them, especially in low- and middle- income countries. We also need to double down on testing, to be able to test mass numbers of people in a short time, and high-volume, with low-cost ones that work for everybody.

After an outbreak happens, it’s important for people to protect themselves. This is where NPI comes to have great impact, which stands for “Non-pharmaceutical interventions”. Actions like quarantine, lockdowns, even border closures, are the most effective tools during an early stage of an outbreak. Like Dr Fauci says, “if you’re overreacting, you’re probably doing the right thing.”

But the irony of NPI is that, the better they work, the easier it is for people to blame the ones who put them in place. Because you would never be able to know how things would turn out if otherwise without NPIs, thus making them all seem unnecessary. Also, there’s no universal way of NPI that works equally well everywhere. Some of the actions like border closures is a hammer that needs to be wielded carefully, because it has a great implication on the society and economics, as we all say, “the cure cannot be worse than the problem”.

Other ways including social distancing, and wearing masks are less intrusive, but great ways to flatten the curve. It’s just mind-blowing how cheap and effective masks are, yet in the beginning of the pandemic, there’s a constant missing value of masks especially in the United States, which is probably one of the biggest mistakes made during the pandemic.

Now moving on, it took COVID very short time to become a pandemic, and one of the things that turned things around is without doubt, the vaccines. In December 2019, nobody knew what COVID was, but it took scientists only a year to create safe and effective vaccines for the virus, and in total less than 18 months to reach to almost half of the global population. Compared to that, Measles took us 30+ years, and it both took around 80 years to identify Polio and whooping cough and immunizing 50 percent of the world’s population.

To understand how this happened, we need to know how a vaccine gets developed, tested, manufactured and delivered. Now, there’re so many challenges in each step, taking the regulation process for example, a vaccine needs to go through a rigorous process to make sure they’re safe and effective, including pre-clinical trials, then phase 1 that tests the safety and dose selection, phase 2 that tests a small group efficacy, phase 3 with large group efficacy, and then commercial licensing. In parallel, from a manufacturing perspective, we also need to go all the way from small-scale production of clinical trial material, manufacturing scale-up, and large-scale manufacturing. Before COVID, the fastest a vaccine that had ever been made was 4 years. But for several COVID vaccines, this was made happen because we combined the clinical trials like phase 2 and 3, with emergency licensing, and at the same time, manufacturing development and scale-up began immediately once a vaccine tests effective.

But this doesn’t mean that it couldn’t have been faster and better. We need to invest more in innovations to make vaccines more effective and even universal, meaning that one can protect you against possibly all respiratory diseases. We also need to coordinate manufacturers and expand production and make sure that they are delivered to every corner of the world.

It’s hard to go through all of action items from this books because pandemic, or more broadly, epidemiology is such a complex subject, that involves so many aspects, and topics like economics, politics, human ethics, business, medicines, etc. But one big theme, or vision of this book is to call for assembling a dedicated team to get us more prepared, or even to prevent the next pandemic. Bill Gates called it the “GERM” team, that stands for “Global Epidemic Response and Mobilization” team, and its 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?” Now, you can read in this book on how this team looks like and how it potentially operates, but to help you understand why we need this sort of dedicated team, is to look at out how we so commonly have firefighters all over the world. We know the urgency of having a team of firefighters because we know, once a place catches fire, its neighborhood is in danger. And we’ve also recognized that individual families and businesses aren’t solely responsible for protecting themselves. We need help from the communities. And fire doesn’t spread across the entire country, but disease does. We would also need to constantly practices drills or exercises, and the GERM team will be responsible for distilling the findings from it, measuring the preparedness, recording the action items and eventually helping close the gaps and make sure they are put into practice.

There’re so many interesting and concerning topics we didn’t go through, such as inequity and disparity of health resources between rich and low income countries. Hundreds of millions of people were pushed into extreme poverty and vaccines are distributed drastically unequally.

Another interesting topic is about how the pandemic has changed the world’s course of digitalization. Comment below and let me know how new innovations have changed your work and life.

Some last words, as much as COVID had put such a negative impact on all our lives, WHO estimates that between 80,000 and 180,000 health and care workers have died from COVID-19 in the period between January 2020 to May 2021. They are extraordinary people and this is such a tragic loss. We need to take action so that we don’t have to go through this again.