Bill Gates: How Can We Prevent The Next Global Health Epidemic? Entrepreneur and philanthropist Bill Gates stresses our dire need for a system that can take on the challenges of the next global health epidemic.

How Can We Prevent The Next Global Health Epidemic?

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GUY RAZ, HOST:

And what Seth's talking about kind of makes sense if you think about it, right? Like, that ideas can spread like viruses except that viruses are things that, of course, we don't want to spread.

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UNIDENTIFIED MAN #1: It is the worst Ebola outbreak in history, and it continues to wreak havoc across West Africa.

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UNIDENTIFIED MAN #2: The mountain has reached crisis point.

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UNIDENTIFIED WOMAN: Most of those who get it will die through uncontrollable bleeding.

RAZ: So this was the summer of 2014.

BILL GATES: Everybody who thinks about global health spent July and August of that year wondering why is this form of Ebola spreading so fast?

RAZ: This is Bill Gates, who, of course, does a lot of work on global health.

GATES: At first, we weren't sure how it was spreading.

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UNIDENTIFIED MAN #3: The relief group Doctors without Borders says the epidemic is so out of control they can no longer send teams to new outbreak sites.

RAZ: At the time, it seemed like Ebola could become a major pandemic. And there were a lot of questions about whether humans actually had the capacity to contain it.

GATES: The dynamics, once we got into urban areas - should you quarantine, should you not quarantine the health professionals who are getting sick?

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UNIDENTIFIED MAN #1: The numbers are rising, even health workers not immune.

GATES: How much will that capacity stay in place?

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UNIDENTIFIED WOMAN: Africa could see over 1 million cases by January. Now Ebola has already killed...

GATES: And so everything seemed to fall apart there.

RAZ: You probably remember all of that. The summer of fear, the news coverage that continued well into the fall. But you may not remember how it all stopped.

GATES: By December, it was clear that there was less geographic spread, and you could see some positive news.

RAZ: Even though 10,000 people died from Ebola, it never became millions. And that's because gradually, health workers managed to contain it. And that was a part of it, but Bill Gates says the other part? It was luck.

GATES: So this is not like a measles or a flu where a significant percentage of everybody in the population would be infected.

RAZ: To catch Ebola, you literally had to come into contact with the bodily fluids of an infected person, and only then from a really sick infected person. So it's not actually that easy to catch. But next time, Bill Gates says, the next pandemic could be airborne. It could spread faster, and it could be harder to detect, which means -

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GATES: We're not ready for the next epidemic.

RAZ: Bill Gates picks up this idea on the TED stage.

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GATES: Let's look at the progression of Ebola. The problem wasn't that there was a system that didn't work well enough. The problem was that we didn't have a system at all. We didn't have a group of epidemiologists ready to go who would've gone, seen what the disease was, seen how far it had spread. The case reports came in on paper. It was very delayed before they were put online, and they were extremely inaccurate. We didn't have a medical team ready to go. We were far slower than we should have been getting the thousands of workers into these countries, and a large epidemic would require us to have hundreds of thousands of workers. There was no one there to look at treatment approaches, no one to figure out what tools should be used. The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola. You can have a virus where people feel well enough while they're infectious that they get on a plane or they go to a market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. And so there are things that would literally make things a thousand times worse.

RAZ: Why do you think we're not ready for the next epidemic? I mean, is it a lack of ability, or is it just a lack of will?

GATES: We're underinvested in both the risk of a natural epidemic and the risk of an intentionally caused bioterrorism epidemic. And yet the United States government actually spends more on these issues than all other governments put together. Even so, every report that comes out - after SARS and H1N1, their reports call on governments to do more, but things that have a low probability of happening but a very high cost, it's always very tricky who's supposed to invest to get ready for those things.

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GATES: But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talked 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. So we can have tools, but those tools need to be put into an overall global health system. Now what are the key pieces? First is we need strong health systems in poor countries. That's where mothers can give birth safely, kids can get all their vaccines, but also where we'll see the outbreak very early on. We need a medical reserve corps, lots of people who have got the training and background who are ready to go with the expertise. And then we need to pair those medical people with the military, taking advantage of the military's ability to move fast and secure areas. We need to do simulations, germ games, not war games so that we see were the holes are. Finally, we need lots of advanced R and D in areas of vaccines and diagnostics. There are some big breakthroughs that could work very, very quickly -

RAZ: How long do we have before we can put these tools into place? Like, you know, have a system to actually stop an epidemic before it spreads out of control?

GATES: Well, eventually we'll have some type of extreme surveillance where you're taking biological samples from people who are traveling around and doing full sequencing of saliva, blood, feces, and trying to understand what's out there and catch it at a very early stage, so eventually having a super effective digital immune system for the world. Hopefully that would catch something at a very early stage. Also, our technology to very quickly make new vaccines or other protective constructs - over the next 10 years that stuff is getting a lot better. So we should hope that we take it more seriously, we should hope that nothing bad happens in the next 10 years, and then we will be better equipped to deal with a natural epidemic.

RAZ: Bill Gates. He heads the Bill and Melinda Gates Foundation. You can see his talk on Ebola as well as others he's given at TED.com. Our show today? Ideas about how things spread.

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