Five years ago this week -- March 18, 2015, to be exact -- Bill Gates was on a mission. 

Right about now, Gates is looking awfully prescient. Because on that single day:

  • Gates posted a blog on his GatesNotes website: "We're Not Ready for the Next Epidemic."
  • He ran an op-ed in the New York Times: "How to Fight the Next Epidemic"
  • He published an article in the New England Journal of Medicine (.pdf link): "Gates B. The next epidemic -- lessons from Ebola."     
  • And he went across the border from Seattle to Vancouver to give a TED talk. Title: "The next outbreak? We're not ready."

In every message that day, Gates hit the same theme, over and over: We will likely face a big viral epidemic, and we are not ready for it. For example, here's how he started his TED talk:

"When I was a kid, the disaster we worried about most was a nuclear war. 

...

Today ... 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." 

Gates isn't a doctor. But he's perhaps the most successful philanthropist in the world and has donated billions of dollars for public health (including $100 million for coronavirus research starting in January, long before most Americans or the U.S. government took it seriously).

It also seems like Gates got things right in 2015, so people are interested in his take now.

Last week, Gates, answered 31 questions about about the pandemic during a Reddit AMA session. He then posted a slightly edited (and better formatted) version of his Q&A on GatesNotes.

Of course, you can read his full transcript. But there are a few key points well worth pulling out and highlighting.

1.    How we got here: 'There was almost no funding.'

To start, Gates says the biggest reason why we weren't prepared to deal with this crisis this year wasn't that the pandemic was a surprise, but instead that we simply didn't dedicate resources to being prepared.

"No one could predict what the chance of a new virus emerging was," Gates wrote. "However we did know it would happen at some point either with a flu or some other respiratory virus. There was almost no funding." 

2.    What we should do now: Testing and social distancing.

Next, Gates said basically what we've heard experts say about the best way to persevere.

"[G]o along with the 'shut down' approach in your community so that the infection rate drops dramatically," he said, despite the significant "economic damage" it will bring.

He added later that he thinks that if the world's richest countries do his, "within 2-3 months [they] should have avoided high levels of infection." (In answer to another question, Gates gave a slightly different prediction: six to 10 weeks, provided that countries do a good job with 'testing and 'shut down.'"

The danger will be even greater in the developing world, Gates wrote, where social distancing is harder and "hospital capacity is much lower."

3.    Afterward: Learn the lessons, and make the investments.

In the end, it all comes back to the same thing Gates was talking about five years ago: Taking these kinds of threats seriously, and being willing to invest in fighting them the way we would invest in fighting a shooting war with a foreign country.

Because even once this crisis is resolved, there's no reason to think it won't happen again.

"The TED talk I did in 2015 talked about this," Gates said. "We need to have the ability to scale up diagnostics, drugs and vaccines very rapidly. The technologies exist to do this well if the right investments are made. ...  [T]hat needs to be funded at higher level to have the standby manufacturing capacity for the world."

Published on: Mar 21, 2020
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