9:59:59.000,9:59:59.000 When I was a kid, the disaster[br]we worried about most 9:59:59.000,9:59:59.000 was a nuclear war. 9:59:59.000,9:59:59.000 That's why we had a barrel like this[br]down in our basement, 9:59:59.000,9:59:59.000 filled with food and water. 9:59:59.000,9:59:59.000 When the nuclear attack came, 9:59:59.000,9:59:59.000 we were supposed to go downstairs, 9:59:59.000,9:59:59.000 hunker down, and eat out of that barrel. 9:59:59.000,9:59:59.000 Today the greatest risk [br]of global catastrophe[br] 9:59:59.000,9:59:59.000 doesn't look like this. 9:59:59.000,9:59:59.000 Instead, it looks like this. 9:59:59.000,9:59:59.000 If anything kills over 10 million people[br]in the next few decades, 9:59:59.000,9:59:59.000 it's most likely to be [br]a highly infectious virus 9:59:59.000,9:59:59.000 rather than a war. 9:59:59.000,9:59:59.000 Not missles, but microbes. 9:59:59.000,9:59:59.000 Now part of the reason for this[br] 9:59:59.000,9:59:59.000 is that we've invested a huge amount[br]in nuclear deterrants. 9:59:59.000,9:59:59.000 But we've actually invested very little [br]in a system to stop an epidemic. 9:59:59.000,9:59:59.000 We're not ready for the next epidemic. 9:59:59.000,9:59:59.000 Let's look at Ebola. 9:59:59.000,9:59:59.000 I'm sure all of you read about [br]it in the newspaper, 9:59:59.000,9:59:59.000 lots of touch challenges. 9:59:59.000,9:59:59.000 I followed it carefully through [br]the case analysis tools we use 9:59:59.000,9:59:59.000 to track polio eradication. 9:59:59.000,9:59:59.000 And as you look at what went on, 9:59:59.000,9:59:59.000 the problem wasn't that there was[br]a system that didn't work well enough, 9:59:59.000,9:59:59.000 the problem was that we didn't have[br]a system at all. 9:59:59.000,9:59:59.000 In fact, there's some pretty obvious[br]key missing pieces. 9:59:59.000,9:59:59.000 We didn't have a group of epidemiologists[br]ready to go 9:59:59.000,9:59:59.000 who would have gone, [br]seen what the disease was, 9:59:59.000,9:59:59.000 seen how far it had spread. 9:59:59.000,9:59:59.000 The case reports came in on paper. 9:59:59.000,9:59:59.000 It was very delayed before they[br]were put online 9:59:59.000,9:59:59.000 and they were extremely inaccurate. 9:59:59.000,9:59:59.000 We didn't have a medical team ready to go. 9:59:59.000,9:59:59.000 We didn't have a way of preparing people. 9:59:59.000,9:59:59.000 Now Médecins Sans Frontières did a [br]great job orchestrating volunteers. 9:59:59.000,9:59:59.000 But even so, we were far slower[br]than we should have been 9:59:59.000,9:59:59.000 getting the thousands of workers[br]into these countries. 9:59:59.000,9:59:59.000 And a large epidemic would require[br]us to have hundreds of thousands 9:59:59.000,9:59:59.000 of workers. 9:59:59.000,9:59:59.000 There was no one there to look[br]at treatment approaches. 9:59:59.000,9:59:59.000 No one to look at the diagnostics. 9:59:59.000,9:59:59.000 No one to figure out what tools[br]should be used. 9:59:59.000,9:59:59.000 As an example, we could have taken[br]the blood of survivors, 9:59:59.000,9:59:59.000 processed it, and put that plasma[br]back in people to protect them. 9:59:59.000,9:59:59.000 But that was never tried. 9:59:59.000,9:59:59.000 So there was a lot that was missing. 9:59:59.000,9:59:59.000 And these things are really [br]a global failure. 9:59:59.000,9:59:59.000 The WHO is funded to monitor epidemics, 9:59:59.000,9:59:59.000 but not to do these things I talked about. 9:59:59.000,9:59:59.000 Now in the movies, it's quiet different. 9:59:59.000,9:59:59.000 There's a group of [br]handsome epidemiologists 9:59:59.000,9:59:59.000 ready to go, they move in, [br]they save the day. 9:59:59.000,9:59:59.000 But that's just pure Hollywood. 9:59:59.000,9:59:59.000 The failure to prepare could allow[br]the next epidemic 9:59:59.000,9:59:59.000 to be dramatically more devastating[br]than Ebola. 9:59:59.000,9:59:59.000 Let's look at the progression of Ebola[br]over this year. 9:59:59.000,9:59:59.000 About 10,000 people died, [br] 9:59:59.000,9:59:59.000 and nearly all were in the three[br]West African countries. 9:59:59.000,9:59:59.000 There's three reasons why[br]it didn't spread more. 9:59:59.000,9:59:59.000 The first is that there was [br]a lot of heroic work 9:59:59.000,9:59:59.000 by the health workers. 9:59:59.000,9:59:59.000 They found the people and they [br]prevented more infections. 9:59:59.000,9:59:59.000 The second is the nature of the virus. 9:59:59.000,9:59:59.000 Ebola does not spread through the air. 9:59:59.000,9:59:59.000 And by the time you're contagious,[br]most people are so sick 9:59:59.000,9:59:59.000 that they're bedridden. 9:59:59.000,9:59:59.000 Third, it didn't get into many urban areas. 9:59:59.000,9:59:59.000 And that was just luck. 9:59:59.000,9:59:59.000 If it had gotten into a lot more[br]urban areas, 9:59:59.000,9:59:59.000 the case numbers would have [br]been much larger. 9:59:59.000,9:59:59.000 So next time, we may not be so lucky. 9:59:59.000,9:59:59.000 You can have a virus where people [br]feel well enough while they're infectious, 9:59:59.000,9:59:59.000 they get on a plane or they go to a market. 9:59:59.000,9:59:59.000 The source of the virus could be [br]a natural epidemic like Ebola, 9:59:59.000,9:59:59.000 or it could be bioterrorism. 9:59:59.000,9:59:59.000 And so there are things that would[br]literally make things [br] 9:59:59.000,9:59:59.000 a thousand times worse. 9:59:59.000,9:59:59.000 In fact, let's look at a model[br]of a virus spread through the air, 9:59:59.000,9:59:59.000 like the Spanish Flu back in 1918. 9:59:59.000,9:59:59.000 So here's what would happen: 9:59:59.000,9:59:59.000 it would spread throughout the world[br]very, very quickly. 9:59:59.000,9:59:59.000 And you can see, over 30 million people[br]died from that epidemic. 9:59:59.000,9:59:59.000 So this is a seriousl problem. 9:59:59.000,9:59:59.000 We should be concerned. 9:59:59.000,9:59:59.000 But in fact, we can build a really good[br]response system. 9:59:59.000,9:59:59.000 We have the benefits of all the science[br]and technology that we talked about here. 9:59:59.000,9:59:59.000 We've got cell phones to get information[br]from the public 9:59:59.000,9:59:59.000 and get information out to them. 9:59:59.000,9:59:59.000 We have satellite maps where we can see[br]where we can see where people are 9:59:59.000,9:59:59.000 and where they're moving. 9:59:59.000,9:59:59.000 We have advances in biology[br]that should dramatically change 9:59:59.000,9:59:59.000 the turnaround time to look at a pathogen 9:59:59.000,9:59:59.000 and be able to make drugs and vaccines[br]that fit for that pathogen. 9:59:59.000,9:59:59.000 So we can have tools, but those tools[br]need to be put into 9:59:59.000,9:59:59.000 an overall global health system. 9:59:59.000,9:59:59.000 And we need preparedness. 9:59:59.000,9:59:59.000 The best lessons, I think, on how [br]to get prepared 9:59:59.000,9:59:59.000 are, again, what we do for war. 9:59:59.000,9:59:59.000 For soldiers, we have them full-time,[br]ready to go. 9:59:59.000,9:59:59.000 We have reserves that can scale us up[br]to large numbers. 9:59:59.000,9:59:59.000 NATO has a mobile unit [br]that can deploy very rapidly. 9:59:59.000,9:59:59.000 NATO does a lot of war games to check, [br]"Are people well trained? 9:59:59.000,9:59:59.000 Do they understand about fuel[br]and logistics 9:59:59.000,9:59:59.000 and the same radio frequencies?" 9:59:59.000,9:59:59.000 So they are absolutely ready to go. 9:59:59.000,9:59:59.000 So those are the kinds of things[br]we need to deal with an epidemic. 9:59:59.000,9:59:59.000 What are the key pieces? 9:59:59.000,9:59:59.000 First, we need strong health systems[br]for countries. 9:59:59.000,9:59:59.000 That's where mothers can give birth safely, 9:59:59.000,9:59:59.000 kids can get all their vaccines. 9:59:59.000,9:59:59.000 But, also where we'll see[br]the outbreak very early on. 9:59:59.000,9:59:59.000 We need a medical reserve corps: 9:59:59.000,9:59:59.000 lots of people who've got the training[br]and background 9:59:59.000,9:59:59.000 who are ready to go, with the expertise. 9:59:59.000,9:59:59.000 And then we need to pair those[br]medical people 9:59:59.000,9:59:59.000 with the military, 9:59:59.000,9:59:59.000 taking advantage of the military's ability[br]to move fast, do logistics 9:59:59.000,9:59:59.000 and secure areas. 9:59:59.000,9:59:59.000 We need to do simulations: germs games,[br]not war games, 9:59:59.000,9:59:59.000 so that we see where the holes are. 9:59:59.000,9:59:59.000 The last time a germ game was done[br]in the United States 9:59:59.000,9:59:59.000 was back in 2001, and it didn't go so well. 9:59:59.000,9:59:59.000 So far the score is germs: 1, people: 0.