WASHINGTON – “Of all the things that could kill more than 10 million people around the world,” writes philanthropist Bill Gates in The New England Journal of Medicine, “the most likely is an epidemic stemming from either natural causes or bioterrorism.”
Beginning with this blunt and clinical assessment, we are given a detailed picture of the specter that haunts Gates’ nightmares: the emergence of a highly-infectious virus that would spawn global panic, overwhelm the supply of medical commodities, set off a desperate technological race against death, reduce global wealth by trillions of dollars and fill millions of graves.
The genetic mutation that would lead to this outcome is not likely to occur tomorrow. It is likely to occur as tomorrows gather into decades. The Spanish flu of 1918 infected about a third of the world’s population and caused 50 million deaths. The AIDS virus kills slowly and spreads without obvious symptoms. About 40 million people have died from AIDS.
Like others in his field, Gates describes the Ebola outbreak as “a wake-up call.” Liberia has demonstrated (remarkably, heroically) that the goal of zero new infections is achievable. Sierra Leone, however, is still seeing transmissions occur from unsafe burial practices.
But this killer, even after taking about 10,000 victims, is not the mass murderer Gates is warning against. Ebola is spread through bodily fluids by people who are highly symptomatic – mainly putting families and caregivers at risk.
What Gates calls “the next epidemic” is likely to be an airborne virus. Modern travel would hasten the globalization of death. After the Ebola crisis, we know one thing with complete certainty: The world would be utterly unprepared for an outbreak 100 times as large.
The first and foundational layer of pandemic preparedness is the disease surveillance system in developing countries. During a recent trip, I visited Tanzania’s national lab, which provides test results for 200 health sites and tracks infectious diseases such as measles, rubella, HIV/AIDS and flu. The lab is in the process of upgrading – allowing it to test for Ebola rather than sending samples to Nairobi (which would cut potentially vital days off the process). The facility would not exist without funding from the President’s Emergency Plan for AIDS Relief and the World Bank, as well as the training of technicians by the Centers for Disease Control and Prevention.
The next time a politician sneers at “foreign aid,” substitute the words “disease surveillance” and see if his or her statement still makes sense. Many developing countries lack even the minimal capability to identify outbreaks before they become epidemics. Filling those gaps is one of the goals of President Obama’s essential Global Health Security Agenda, designed to strengthen surveillance capacity in 30 countries comprising 4 billion people.
The second layer of preparedness is emergency response – the ability, on a moment’s notice, to provide mass logistics and command-and-control amid chaos. This is a very rare global capability – currently possessed by the U.S. military, NATO and pretty much no one else.
The urgent questions are how and where such a capacity might be created. The United Nations and the World Health Organization won’t be ready anytime soon.
All this raises questions of leadership and governance. If the worst happens, would anyone be in charge? The day before the next epidemic, this will seem a secondary matter. The day after, there will be no other issue.
Michael Gerson is a columnist for The Washington Post. Reach him by email at michaelgerson@washpost.com. © 2015 The Washington Post Writers Group.
