To prevent next pandemic, Bill Gates wants world leaders to fund global health team
In his new book, he says the key ideas are the team, improving testing, speeding vaccine and treatment development, and shoring up health systems
The Seattle Times
SEATTLE — To Bill Gates, it's obvious world leaders will fund a global health team to prevent the next pandemic.
"We're just not that irrational," the billionaire philanthropist and self-proclaimed data nerd said of the alternative.
Gates' pitch: a Global Epidemic Response and Mobilization team — or GERM, humorously, for short.
In a video interview from the Kirkland offices of his private investment firm, he said that for an estimated $1 billion a year, with the U.S. likely chipping in $250 million, the team would be "the best bargain you'll ever see."
"More Americans died in [the pandemic] than Americans died in all the wars put together," Gates said. "This thing was, you know, superbad." Compared to the cost of addressing climate change or opioid abuse, for example, "the sums involved here are actually pretty modest."
Gates' proposed team is a key idea in his book "How to Prevent the Next Pandemic," which was published in May with the intention of prompting debate — not just about GERM, but also about improving testing, speeding vaccine and treatment development, and shoring up health systems worldwide.
Yet Gates — whose fortune and foundation, co-chaired with ex-wife Melinda French Gates, give him an outsized influence on public health — said discussion about the team "has started out a little bit slower than I expected."
Pandemic prevention is "not a huge topic in the Congress, or even in the executive branch, right at the moment," he said.
Gates' book arrived at an odd time in the arc of COVID-19. New coronavirus variants have been spreading fast but are less lethal. And many people have shed their masks and sense of urgency to beat back the virus, instead turning their attention to other issues: the war in Ukraine, U.S. Supreme Court rulings, Jan. 6 hearings.
World leaders, too, are not showing the sense of urgency about the pandemic some would like.
"Incrementalism and realism have lately become the de facto watchwords of the global response to the COVID-19 pandemic," Carolyn Reynolds, of the Pandemic Action Network, and J. Stephen Morrison, of the Center for Strategic and International Studies, wrote in a June article. "Pandemic fatigue has rapidly become entrenched in Washington and capitals around the world."
Reynolds and Morrison say there's a bright spot: G-20 countries, with the world's largest economies, have agreed to create a fund for pandemic prevention, preparedness and response. But current commitments of about $1 billion, including $15 million from the Bill & Melinda Gates Foundation, fall $9 billion short of the annual goal.
Speaking on the late June day the World Bank approved the pandemic fund, Gates noted few details have emerged about what specifically it will be used for. Conceivably, he said, part of the money could go toward creating a global team like GERM.
Others have proposed a similar idea. As Gates envisions it, GERM would consist of about 3,000 experts, managed by the World Health Organization, whose full-time job would be to watch out for disease outbreaks, quickly respond and stop them from turning into global catastrophes. He likens these experts to professional firefighters — constantly alert and ready to spring into action.
Such a team could have made a big difference with COVID, he said. "If there had been just a slightly quicker response, the number of countries affected would have been dramatically less."
Gates could arguably fund GERM in its entirety. But he doesn't intend to, apart from a small amount of startup money, because of what he sees as a question of legitimacy.
He said if the team is going to tell countries that their lack of pandemic preparation is putting the masses at risk, for example, the team must be funded primarily by governments — not philanthropy.
Scott Dowell, a Gates Foundation deputy director who has been overseeing much of the organization's pandemic preparedness work, elaborated: "What we don't want to do is have people think: 'Oh, this is something that the Gates Foundation is going to fund, or that is going to be imposed from Seattle.'"
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Gates, whose $50 billion foundation of nearly 1,800 employees has promoted agendas on everything from education to family planning to disease eradication, has long been praised and criticized for his impact on the world. The criticism has morphed into wild conspiracy theories during the pandemic: one is that Gates is plotting to control the global health system; another, that he is surveilling people with microchips in vaccines. (He has also been criticized for his long relationship with sex offender Jeffrey Epstein.)
"I've decided that the best way forward is to just keep doing the work," Gates writes in his book.
Accordingly, the foundation is moving ahead in its effort to get GERM off the ground.
Dowell said he and Valerie Nkamgang Bemo, another foundation deputy director, have spent the past six months in a "listening phase."
Some of the global public health leaders they've talked to have said, "That's nuts, that can't possibly work that way," Dowell recalled.
Some like the idea of a professional force based within their country that coordinates with professional responders and international authorities, Dowell said, but bristled at the prospect of a group of outsiders "sweeping in and taking over our country's public health response."
The team would be largely decentralized, with staffers around the world, but Gates noted that some poor countries, like Somalia and the Democratic Republic of Congo, have limited disease-fighting capacity, so "you're going to have to be able to fly in."
The foundation, helped by a small group of outside leaders at the Centers for Disease Control and Prevention, among other organizations, is now moving into a "design phase" to flesh out a detailed plan and get more feedback, Dowell said.
If things stay on track, he added, they might be able to get the team funded in a dozen or so countries by fall.
"I don't know that we'll hit that deadline," Gates said, however. "You know, without the Ukraine war, maybe we would."
Aside from the annual $1 billion for GERM, a huge amount of funding would be needed to carry out Gates' scientific research and development wish list.
He lays out a host of possibilities in his book. Among them: fostering innovative ways to rapidly test massive numbers of people, creating "libraries" of drug compounds that can be quickly scanned to see if they're effective against new viruses, and developing "universal" vaccines that prime the body to fight viruses that don't yet exist.
As with GERM, Gates said he believes the funding will eventually materialize, pandemic fatigue or otherwise.
"People were probably fatigued with World War II," he said, but it's a government's job to protect its citizens.
Pandemic prevention is not foreign aid, he stressed, and is in the self-interest of all countries. Plus, he said, the National Institutes of Health is sure to fund some of the research — as are China, Japan and various European countries.
An ardent believer in industry whose foundation opposed waiving COVID vaccine patent protections before shifting course, Gates said the market potential for vaccines will also stimulate private investment.
Some of the scientific research on Gates' wish list could happen in Seattle, which is home to a wealth of infectious disease experts.
Gates mentioned Dr. Christopher Murray, head of the University of Washington's Institute for Health Metrics and Evaluation, whose COVID forecasting models are widely cited nationwide; computational biologist Trevor Bedford of the Fred Hutchinson Cancer Research Center, whose work on the Seattle Flu Study helped track the progress of COVID; and a UW program bringing together public health leaders in Africa.
The Seattle-based global health nonprofit PATH also played a crucial role in changing the direction of the Gates Foundation in the 1990s, he recalled. At a meeting convened by PATH, Gates first learned that improved health led people to have fewer children. Focused largely on reproductive health at the time, the foundation turned to working on eradicating diseases.
The foundation's COVID work has taken it in a new direction; until the pandemic its disease work focused on those that afflict poor countries without lucrative vaccine and treatment markets. The foundation has contributed more than $2 billion so far to its pandemic response, and more is coming. Citing COVID and other crises, the foundation this week announced it is increasing its payout by 50%, to $9 billion annually.
Looking ahead, Gates warns in his book, "We have to be careful not to get caught fighting the last war."
He said the next pandemic could come from anywhere, though he speculates Africa is a contender because climate change and population growth may thrust humans and animals together in a way that gives rise to disease. While COVID is most dangerous for older people, a new pandemic could disproportionately affect the young — and who's to say what the fatality rate will be.
"Whenever something emerges, it can be far worse than what we went through this time," Gates said.
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