Hard questions about the next epidemic

Normally when I post here on TGN, give a speech, or write an op-ed, I’m out to share good news about how the world is getting better. But last month I made an exception. In a TED talk, an op-ed in the New York Times, and a longer paper in the New England Journal of Medicine, I wanted to highlight a sobering fact: The world is not prepared to handle a major epidemic. I shared a few thoughts about what it might take to get ready, based on lessons from the Ebola epidemic in West Africa.

I was curious to hear people’s feedback on my suggestions, so it was great to meet in Berlin with a group of health experts from governments, non-profits, and pharmaceutical companies, and then with U.S. senators in Washington, D.C. In this post, I want to share a few of the things I heard.

There is general agreement that this is a big challenge. Everyone I talked to, politicians and technical experts alike, felt strongly that the world isn’t doing enough to prepare. There is also broad agreement about what to do: we need to create a global alert and response system for epidemics.

As we got into the details, though, we ran into some tough issues.

For example, I argued that in a severe epidemic, the military has to play a role. It’s the only group that can quickly move large numbers of people and equipment in and out of an affected area. But in my conversations in D.C., it became clear that the U.S. military is not chartered for this work and doesn’t prepare for it, which meant that in West Africa they were learning on the fly.

In addition, what happens when there’s an outbreak in a region where people see the army—whether it’s domestic or foreign—as the bad guy? Some NGO leaders and health workers worry that being associated with armed forces could put them in harm’s way by making them a target.

This is one of the toughest issues that came up and it deserves more discussion. At a minimum I think we need a diverse set of military groups from different countries ready to help. And we can take steps to make it clear that troops are on a humanitarian mission, for example by running simulations in different countries so citizens can see what they’re up to.

Another big topic was drug trials. In an epidemic you want to develop and test new treatments very quickly. But how do you make that happen when the usual drug-approval process takes years? Should there be an emergency regulator who decides which drugs to test, how to test them quickly, and whether to deploy one? Should (and can) they indemnify whoever is producing the drug to protect them from lawsuits?

All these conversations raised a larger issue that is fascinating to me: How should the world get ready for rare, potentially cataclysmic events? When an epidemic strikes, we will want the best health and logistics experts ready to spring into action. But which group has the budget to maintain that kind of spare capacity? Even more importantly, how do we get brilliant people to sit around waiting for an event that has a small chance of occurring in any given year?

The closest analogy I can think of is the military, where troops might go years at a time without seeing combat. They use training exercises and war games to stay sharp. I think we should be doing something similar—germ games—for epidemics.

What happens next? Even though the experts mostly agree on the broad strokes of what should be done, I don’t know whether the world will choose to put meaningful resources into this effort. But I am hopeful that it will happen. The group I joined in Berlin is providing input to German Chancellor Angela Merkel and the G7 group of wealthy countries as they think about how they can help solve this problem. Creating a global plan would help more nations see how they can contribute and hopefully draw them in. The United Nations and WHO are also looking at various steps that could improve their ability to respond. And at the Gates Foundation we’re talking about how we might be able to assist.

It is great to see this issue rising up the global agenda. The world isn’t ready yet for a serious epidemic, but I think we have a good chance to make real progress in the next few months.