The next outbreak? We're not ready

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When I was a kid,

the disaster we worried about most

was a nuclear war.

That's why we had a barrel like this

down in our basement,

filled with cans of food and water.

When the nuclear attack came,

we were supposed to go downstairs,

hunker down, and eat out of that barrel.

Today the greatest risk

of global catastrophe

doesn't look like this.

Instead, it looks like this.

If anything kills over 10 million people

in the next few decades,

it's most likely to be

a highly infectious virus

rather than a war.

Not missiles, but microbes.

Now, part of the reason for this is that

we've invested a huge amount

in nuclear deterrents.

But we've actually invested very little

in a system to stop an epidemic.

We're not ready for the next epidemic.

Let's look at Ebola.

I'm sure all of you read about it

in the newspaper,

lots of tough challenges.

I followed it carefully

through the case analysis tools

we use to track polio eradication.

And as you look at what went on,

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.

In fact, there's some pretty obvious

key missing pieces.

We didn't have a group of epidemiologists

ready to go, who would have 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 didn't have a way of preparing people.

Now, Médecins Sans Frontières

did a great job orchestrating volunteers.

But even so, 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 look at the diagnostics.

No one to figure out

what tools should be used.

As an example, we could have

taken the blood of survivors,

processed it, and put that plasma

back in people to protect them.

But that was never tried.

So there was a lot that was missing.

And these things

are really a global failure.

The WHO is funded to monitor epidemics,

but not to do these things I talked about.

Now, in the movies it's quite different.

There's a group of handsome

epidemiologists ready to go,

they move in, they save the day,

but that's just pure Hollywood.

The failure to prepare

could allow the next epidemic

to be dramatically

more devastating than Ebola

Let's look at the progression

of Ebola over this year.

About 10,000 people died,

and nearly all were in the three

West African countries.

There's three reasons why

it didn't spread more.

The first is that there was a lot

of heroic work by the health workers.

They found the people and they

prevented more infections.

The second is the nature of the virus.

Ebola does not spread through the air.

And by the time you're contagious,

most people are so sick

that they're bedridden.

Third, it didn't get

into many urban areas.

And that was just luck.

If it had gotten into a lot

more urban areas,

the case numbers

would have been much larger.

So next time, we might not be so lucky.

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.

So there are things that would literally

make things a thousand times worse.

In fact, let's look at a model

of a virus spread through the air,

like the Spanish Flu back in 1918.

So here's what would happen:

It would spread throughout the world

very, very quickly.

And you can see over 30 million people

died from that epidemic.

So this is a serious problem.

We should be concerned.

But in fact, we can build

a really good response system.

We have the benefits of all the science

and technology that we talk 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

that fit for that pathogen.

So we can have tools,

but those tools need to be put

into an overall global health system.

And we need preparedness.

The best lessons, I think,

on how to get prepared

are again, what we do for war.

For soldiers, we have full-time,

waiting to go.

We have reserves that can scale

us up to large numbers.

NATO has a mobile unit

that can deploy very rapidly.

NATO does a lot of war games

to check, are people well trained?

Do they understand

about fuel and logistics

and the same radio frequencies?

So they are absolutely ready to go.

So those are the kinds of things

we need to deal with an epidemic.

What are the key pieces?

First, 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've 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, do logistics

and secure areas.

We need to do simulations,

germ games, not war games,

so that we see where the holes are.

The last time a germ game

was done in the United States

was back in 2001,

and it didn't go so well.

So far the score is germs: 1, people: 0.

Finally, we need lots of advanced R&D

in areas of vaccines and diagnostics.

There are some big breakthroughs,

like the Adeno-associated virus,

that could work very, very quickly.

Now I don't have an exact budget

for what this would cost,

but I'm quite sure it's very modest

compared to the potential harm.

The World Bank estimates that

if we have a worldwide flu epidemic,

global wealth will go down

by over three trillion dollars

and we'd have millions

and millions of deaths.

These investments

offer significant benefits

beyond just being ready for the epidemic.

The primary healthcare, the R&D,

those things would reduce

global health equity

and make the world more just

as well as more safe.

So I think this should absolutely

be a priority.

There's no need to panic.

We don't have to hoard cans of spaghetti

or go down into the basement.

But we need to get going,

because time is not on our side.

In fact, if there's one positive thing

that can come out of the Ebola epidemic,

it's that it can serve as an early

warning, a wake-up call, to get ready.

If we start now, we can be ready

for the next epidemic.

Thank you.

(Applause)