How the world can respond to the outbreak
Bill Gates
In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is an excellent case in point. The world needs to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.
The long-term challenge-improving our ability to respond to outbreaks-isn’t new. Global health experts have been saying for years that another pandemic rivalling the speed and severity of the 1918 influenza epidemic wasn’t a matter of if but when.
In the past week, Covid-19 has started to behave a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume that it will be until we know otherwise.
There are two reasons that Covid-19 is such a threat. First, it can kill healthy adults in addition to elderly people with existing health problems. The data so far suggests that the virus has a case fatality risk around 1 per cent; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6 per cent) and the 1918 influenza pandemic (2 per cent).
Second, Covid-19 is transmitted quite efficiently. The average infected person spreads the disease to two or three others. That’s an exponential rate of increase. There is also strong evidence that it can be transmitted by people who are just mildly ill or not even showing symptoms yet. This means Covid-19 will be much harder to contain than Middle East Respiratory Syndrome or Severe Acute Respiratory Syndrome (Sars), which were only spread by those showing symptoms and were much less efficiently transmitted. In fact, Covid-19 has already caused 10 times as many cases as Sars in just a quarter of the time.
The good news is that national, state, and local governments and public health agencies can take steps over the next few weeks to slow the spread of Covid-19. For example, in addition to helping their own citizens respond, donor governments should help low- and middle-income countries prepare for this pandemic.
The health systems in many of these countries are already stretched thin, and a pathogen like coronavirus can quickly overwhelm them.
And poorer countries have little political or economic leverage, given wealthier countries’ natural desire to put their own people first.
By helping countries in Africa and South Asia get ready now, we can save lives and also slow the global circulation of the virus. (A significant portion of the commitment Melinda and I recently made to help kickstart the global response to Covid-19-which could total up to $100 million-is focused particularly on developing countries.)
The world also needs to accelerate work on treatments and vaccines for Covid-19. Scientists were able to sequence the genome of the virus and develop several promising vaccine candidates in a matter of days, and the Coalition for Epidemic Preparedness Innovations is already preparing up to eight promising vaccine candidates for clinical trials. If one or more of these vaccines proves safe and effective in animal models, they could be ready for larger-scale trials as early as June.
But we also need to make larger systemic changes so we can respond more efficiently and effectively when the next epidemic arrives.
It’s essential to help low- and middle-income countries strengthen their primary health care systems. When you build a health clinic, you’re also creating part of the infrastructure for fighting epidemics. Trained health care workers not only deliver vaccines; they can also monitor disease patterns, serving as part of the early warning systems that will alert the world to potential outbreaks.
The world also needs to invest in disease surveillance, including a case database that is instantly accessible to the relevant organisations and rules that require countries to share their information. Governments should have access to lists of trained personnel, from local leaders to global experts, who are prepared to deal with an epidemic immediately, as well as lists of supplies to be stockpiled or redirected in an emergency.
In addition, we need to build a system that can develop safe and effective vaccines and antivirals, get them approved, and deliver billions of doses within a few months of the discovery of a fast-moving pathogen. That’s a tough challenge that presents technical, diplomatic, and budgetary obstacles, as well as demanding partnership between the public and private sectors. But all these obstacles can be overcome.
Governments and industry will need to come to an agreement: During a pandemic, vaccines and antivirals won’t simply be sold to the highest bidder. They’ll be available and affordable for people who are at the heart of the outbreak and in greatest need.
Not only is this the right thing to do, it’s also the right strategy for short-circuiting transmission and preventing future pandemics.
These are the actions that leaders should be taking now. There is no time to waste.