It’s not too soon to start thinking about the next pandemic
January 27, 2021
Co-chair, Bill & Melinda Gates Foundation
The last twelve months have been a year unlike any other. The novel coronavirus pandemic has cost lives, sickened millions, and thrust the global economy into a devastating recession. Given how completely COVID-19 has upended lives around the globe, Melinda and I decided to write this year’s Annual Letter about one subject: the pandemic. In this excerpt, I talk about why preparing for the next pandemic is an essential part of recovering from this one.
One of the questions I get asked the most is when I think the world will get back to normal. I understand why. We all want to return to the way things were before COVID-19. But there’s one area where I hope we never go back: our complacency about pandemics.
The unfortunate reality is that COVID-19 might not be the last pandemic. We don’t know when the next one will strike, or whether it will be a flu, a coronavirus, or some new disease we’ve never seen before. But what we do know is that we can’t afford to be caught flat-footed again. The threat of the next pandemic will always be hanging over our heads—unless the world takes steps to prevent it.
The good news is that we can get ahead of infectious disease outbreaks. Although the world failed to prepare for COVID-19 in many ways, we’re still benefiting from actions taken in response to past outbreaks. For example, the Ebola epidemic made it clear that we needed to accelerate the development of new vaccines. So, our foundation partnered with governments and other funders to create the Coalition for Epidemic Preparedness Innovations. CEPI helped fund a number of COVID-19 candidates—including the Moderna and Oxford AstraZeneca vaccines—and is deeply involved in the vaccine equity work that Melinda wrote about.
To prevent the hardship of this last year from happening again, pandemic preparedness must be taken as seriously as we take the threat of war. The world needs to double down on investments in R & D and organizations like CEPI that have proven invaluable with COVID-19. We also need to build brand-new capabilities that don’t exist yet.
Stopping the next pandemic will require spending tens of billions of dollars per year—a big investment, but remember that the COVID-19 pandemic is estimated to cost the world $28 trillion. The world needs to spend billions to save trillions (and prevent millions of deaths). I think of this as the best and most cost-efficient insurance policy the world could buy.
The bulk of this investment needs to come from rich countries. Low- and middle-income countries and foundations like ours have a role to play, but governments from high-income nations need to lead the charge here because the benefits for them are so huge. If you live in a rich country, it’s in your best interest for your government to go big on pandemic preparedness around the world. Melinda wrote that COVID-19 anywhere is threat to health everywhere; the same is true of the next potential pandemic. The tools and systems created to stop pathogens in their tracks need to span the globe, including in low- and middle-income countries.
To start, governments need to continue investing in the scientific tools that are getting us through this current pandemic—even after COVID-19 is behind us. New breakthroughs will give us a leg up the next time a new disease emerges. It took months to get enough testing capacity for COVID-19 in the United States. But it’s possible to build up diagnostics that can be deployed very quickly. By the next pandemic, I’m hopeful we’ll have what I call mega-diagnostic platforms, which could test as much as 20 percent of the global population every week.
A lab technician inserts a swab into a COVID-19 rapid test machine. (Angus Mordant/Getty Images)
I’m confident that we will have better treatments next time, too. One of the most promising COVID-19 therapeutics is monoclonal antibodies. If a patient gets them early enough, you can potentially reduce the death rate by as much as 80 percent.
Our foundation has funded research into monoclonal antibodies as a potential treatment for flu and malaria for over a decade. These antibodies can be used to treat any number of diseases. The downside is that they’re time-consuming to develop and manufacture. It will likely take another five years of perfecting the technology before we can quickly churn them out in response to new pathogens.https://www.linkedin.com/embeds/publishingEmbed.html?articleId=7111880597653066148
I also expect we’ll see huge advances over the next five years in our ability to develop new vaccines—in large part due to the success of mRNA vaccines for COVID-19. I wrote about this at length in my Year in Review, but the short version is that mRNA vaccines are a new type of vaccine that deliver instructions to teach your body to fight off a pathogen. Although our foundation has been funding research into this new platform since 2014, no mRNA vaccine had been approved for use before last month. This pandemic has massively sped up the platform’s development process.
Just as I think we’ll see huge improvements in diagnostics and monoclonal antibodies, I predict that mRNA vaccines will become faster to develop, easier to scale, and more stable to store over the next five to ten years. That would be a huge breakthrough, both for future pandemics and for other global health challenges. mRNA vaccines are a promising platform for diseases like HIV, tuberculosis, and malaria. The R&D progress made as a result of COVID-19 might one day give us the tools we need to finally end these deadly diseases.
When it comes to preventing pandemics, scientific tools alone aren’t enough. The world also needs field-based capabilities that constantly monitor for troubling pathogens and can be spun up as soon as they’re needed. There is still a lot to be figured out in terms of specifics, including where these capabilities would be housed and how exactly they’d be structured. But here is my broad thinking:
First, we need to spot disease outbreaks as soon as they happen, wherever they happen. That will require a global alert system, which we don’t have at large scale today. The backbone of this system would be diagnostic testing. Let’s say you’re a nurse at a rural health clinic. You notice that more patients are showing up with coughs than you’d expect for this time of year, or maybe even that more people are dying than normal. So, you test for common pathogens. If none of them test positive, your sample is sent elsewhere to get sequenced for further investigation.
Workers assemble COVID-19 testing kits at the Incas Diagnostics lab in Kumasi, Ghana.
If your sample turns out to be some super infectious—or entirely new—pathogen, a group of infectious disease first responders springs into action. Think of this corps as a pandemic fire squad. Just like firefighters, they’re fully trained professionals who are ready to respond to potential crises at a moment’s notice. When they aren’t actively responding to an outbreak, they keep their skills sharp by working on diseases like malaria and polio. I estimate that we need somewhere around 3,000 responders throughout the world.
To learn how to best use these first responders, the world needs to regularly run germ games—simulations that let us practice, analyze, and improve how we respond to disease outbreaks, just as war games let the military prepare for real-life warfare. Speed matters in a pandemic. The faster you act, the faster you cut off exponential growth of the virus. Places that had recent experiences with respiratory outbreaks—such as Taiwan with SARS and South Korea with MERS—responded to COVID-19 more quickly than other places because they already knew what to do. Running simulations will make sure everyone is ready to act quickly next time.
Ultimately, the thing that makes me the most optimistic that we’ll be ready next time is also the simplest: The world now understands how seriously we should take pandemics. No one needs to be convinced that an infectious disease could kill millions of people or shut down the global economy. The pain of this past year will be seared into people’s thinking for a generation. I am hopeful that we’ll see broad support for efforts that make sure we never have to experience this hardship again. We’re already seeing new pandemic preparedness strategies emerge, including from this year’s UK-led G7, and I expect to see more in the months and years to come.
The world wasn’t ready for the COVID-19 pandemic. I think next time will be different.
Read our full Annual Letter at gatesletter.com.