1
99:59:59,999 --> 99:59:59,999
When I was a kid, the disaster
we worried about most

2
99:59:59,999 --> 99:59:59,999
was a nuclear war.

3
99:59:59,999 --> 99:59:59,999
That's why we had a barrel like this
down in our basement,

4
99:59:59,999 --> 99:59:59,999
filled with food and water.

5
99:59:59,999 --> 99:59:59,999
When the nuclear attack came,

6
99:59:59,999 --> 99:59:59,999
we were supposed to go downstairs,

7
99:59:59,999 --> 99:59:59,999
hunker down, and eat out of that barrel.

8
99:59:59,999 --> 99:59:59,999
Today the greatest risk 
of global catastrophe


9
99:59:59,999 --> 99:59:59,999
doesn't look like this.

10
99:59:59,999 --> 99:59:59,999
Instead, it looks like this.

11
99:59:59,999 --> 99:59:59,999
If anything kills over 10 million people
in the next few decades,

12
99:59:59,999 --> 99:59:59,999
it's most likely to be 
a highly infectious virus

13
99:59:59,999 --> 99:59:59,999
rather than a war.

14
99:59:59,999 --> 99:59:59,999
Not missles, but microbes.

15
99:59:59,999 --> 99:59:59,999
Now part of the reason for this


16
99:59:59,999 --> 99:59:59,999
is that we've invested a huge amount
in nuclear deterrants.

17
99:59:59,999 --> 99:59:59,999
But we've actually invested very little 
in a system to stop an epidemic.

18
99:59:59,999 --> 99:59:59,999
We're not ready for the next epidemic.

19
99:59:59,999 --> 99:59:59,999
Let's look at Ebola.

20
99:59:59,999 --> 99:59:59,999
I'm sure all of you read about 
it in the newspaper,

21
99:59:59,999 --> 99:59:59,999
lots of touch challenges.

22
99:59:59,999 --> 99:59:59,999
I followed it carefully through 
the case analysis tools we use

23
99:59:59,999 --> 99:59:59,999
to track polio eradication.

24
99:59:59,999 --> 99:59:59,999
And as you look at what went on,

25
99:59:59,999 --> 99:59:59,999
the problem wasn't that there was
a system that didn't work well enough,

26
99:59:59,999 --> 99:59:59,999
the problem was that we didn't have
a system at all.

27
99:59:59,999 --> 99:59:59,999
In fact, there's some pretty obvious
key missing pieces.

28
99:59:59,999 --> 99:59:59,999
We didn't have a group of epidemiologists
ready to go

29
99:59:59,999 --> 99:59:59,999
who would have gone, 
seen what the disease was,

30
99:59:59,999 --> 99:59:59,999
seen how far it had spread.

31
99:59:59,999 --> 99:59:59,999
The case reports came in on paper.

32
99:59:59,999 --> 99:59:59,999
It was very delayed before they
were put online

33
99:59:59,999 --> 99:59:59,999
and they were extremely inaccurate.

34
99:59:59,999 --> 99:59:59,999
We didn't have a medical team ready to go.

35
99:59:59,999 --> 99:59:59,999
We didn't have a way of preparing people.

36
99:59:59,999 --> 99:59:59,999
Now Médecins Sans Frontières did a 
great job orchestrating volunteers.

37
99:59:59,999 --> 99:59:59,999
But even so, we were far slower
than we should have been

38
99:59:59,999 --> 99:59:59,999
getting the thousands of workers
into these countries.

39
99:59:59,999 --> 99:59:59,999
And a large epidemic would require
us to have hundreds of thousands

40
99:59:59,999 --> 99:59:59,999
of workers.

41
99:59:59,999 --> 99:59:59,999
There was no one there to look
at treatment approaches.

42
99:59:59,999 --> 99:59:59,999
No one to look at the diagnostics.

43
99:59:59,999 --> 99:59:59,999
No one to figure out what tools
should be used.

44
99:59:59,999 --> 99:59:59,999
As an example, we could have taken
the blood of survivors,

45
99:59:59,999 --> 99:59:59,999
processed it, and put that plasma
back in people to protect them.

46
99:59:59,999 --> 99:59:59,999
But that was never tried.

47
99:59:59,999 --> 99:59:59,999
So there was a lot that was missing.

48
99:59:59,999 --> 99:59:59,999
And these things are really 
a global failure.

49
99:59:59,999 --> 99:59:59,999
The WHO is funded to monitor epidemics,

50
99:59:59,999 --> 99:59:59,999
but not to do these things I talked about.

51
99:59:59,999 --> 99:59:59,999
Now in the movies, it's quiet different.

52
99:59:59,999 --> 99:59:59,999
There's a group of 
handsome epidemiologists

53
99:59:59,999 --> 99:59:59,999
ready to go, they move in, 
they save the day.

54
99:59:59,999 --> 99:59:59,999
But that's just pure Hollywood.

55
99:59:59,999 --> 99:59:59,999
The failure to prepare could allow
the next epidemic

56
99:59:59,999 --> 99:59:59,999
to be dramatically more devastating
than Ebola.

57
99:59:59,999 --> 99:59:59,999
Let's look at the progression of Ebola
over this year.

58
99:59:59,999 --> 99:59:59,999
About 10,000 people died, 


59
99:59:59,999 --> 99:59:59,999
and nearly all were in the three
West African countries.

60
99:59:59,999 --> 99:59:59,999
There's three reasons why
it didn't spread more.

61
99:59:59,999 --> 99:59:59,999
The first is that there was 
a lot of heroic work

62
99:59:59,999 --> 99:59:59,999
by the health workers.

63
99:59:59,999 --> 99:59:59,999
They found the people and they 
prevented more infections.

64
99:59:59,999 --> 99:59:59,999
The second is the nature of the virus.

65
99:59:59,999 --> 99:59:59,999
Ebola does not spread through the air.

66
99:59:59,999 --> 99:59:59,999
And by the time you're contagious,
most people are so sick

67
99:59:59,999 --> 99:59:59,999
that they're bedridden.

68
99:59:59,999 --> 99:59:59,999
Third, it didn't get into many urban areas.

69
99:59:59,999 --> 99:59:59,999
And that was just luck.

70
99:59:59,999 --> 99:59:59,999
If it had gotten into a lot more
urban areas,

71
99:59:59,999 --> 99:59:59,999
the case numbers would have 
been much larger.

72
99:59:59,999 --> 99:59:59,999
So next time, we may not be so lucky.

73
99:59:59,999 --> 99:59:59,999
You can have a virus where people 
feel well enough while they're infectious,

74
99:59:59,999 --> 99:59:59,999
they get on a plane or they go to a market.

75
99:59:59,999 --> 99:59:59,999
The source of the virus could be 
a natural epidemic like Ebola,

76
99:59:59,999 --> 99:59:59,999
or it could be bioterrorism.

77
99:59:59,999 --> 99:59:59,999
And so there are things that would
literally make things 


78
99:59:59,999 --> 99:59:59,999
a thousand times worse.

79
99:59:59,999 --> 99:59:59,999
In fact, let's look at a model
of a virus spread through the air,

80
99:59:59,999 --> 99:59:59,999
like the Spanish Flu back in 1918.

81
99:59:59,999 --> 99:59:59,999
So here's what would happen:

82
99:59:59,999 --> 99:59:59,999
it would spread throughout the world
very, very quickly.

83
99:59:59,999 --> 99:59:59,999
And you can see, over 30 million people
died from that epidemic.

84
99:59:59,999 --> 99:59:59,999
So this is a seriousl problem.

85
99:59:59,999 --> 99:59:59,999
We should be concerned.

86
99:59:59,999 --> 99:59:59,999
But in fact, we can build a really good
response system.

87
99:59:59,999 --> 99:59:59,999
We have the benefits of all the science
and technology that we talked about here.

88
99:59:59,999 --> 99:59:59,999
We've got cell phones to get information
from the public

89
99:59:59,999 --> 99:59:59,999
and get information out to them.

90
99:59:59,999 --> 99:59:59,999
We have satellite maps where we can see
where we can see where people are

91
99:59:59,999 --> 99:59:59,999
and where they're moving.

92
99:59:59,999 --> 99:59:59,999
We have advances in biology
that should dramatically change

93
99:59:59,999 --> 99:59:59,999
the turnaround time to look at a pathogen

94
99:59:59,999 --> 99:59:59,999
and be able to make drugs and vaccines
that fit for that pathogen.

95
99:59:59,999 --> 99:59:59,999
So we can have tools, but those tools
need to be put into

96
99:59:59,999 --> 99:59:59,999
an overall global health system.

97
99:59:59,999 --> 99:59:59,999
And we need preparedness.

98
99:59:59,999 --> 99:59:59,999
The best lessons, I think, on how 
to get prepared

99
99:59:59,999 --> 99:59:59,999
are, again, what we do for war.

100
99:59:59,999 --> 99:59:59,999
For soldiers, we have them full-time,
ready to go.

101
99:59:59,999 --> 99:59:59,999
We have reserves that can scale us up
to large numbers.

102
99:59:59,999 --> 99:59:59,999
NATO has a mobile unit 
that can deploy very rapidly.

103
99:59:59,999 --> 99:59:59,999
NATO does a lot of war games to check, 
"Are people well trained?

104
99:59:59,999 --> 99:59:59,999
Do they understand about fuel
and logistics

105
99:59:59,999 --> 99:59:59,999
and the same radio frequencies?"

106
99:59:59,999 --> 99:59:59,999
So they are absolutely ready to go.

107
99:59:59,999 --> 99:59:59,999
So those are the kinds of things
we need to deal with an epidemic.

108
99:59:59,999 --> 99:59:59,999
What are the key pieces?

109
99:59:59,999 --> 99:59:59,999
First, we need strong health systems
for countries.

110
99:59:59,999 --> 99:59:59,999
That's where mothers can give birth safely,

111
99:59:59,999 --> 99:59:59,999
kids can get all their vaccines.

112
99:59:59,999 --> 99:59:59,999
But, also where we'll see
the outbreak very early on.

113
99:59:59,999 --> 99:59:59,999
We need a medical reserve corps:

114
99:59:59,999 --> 99:59:59,999
lots of people who've got the training
and background

115
99:59:59,999 --> 99:59:59,999
who are ready to go, with the expertise.

116
99:59:59,999 --> 99:59:59,999
And then we need to pair those
medical people

117
99:59:59,999 --> 99:59:59,999
with the military,

118
99:59:59,999 --> 99:59:59,999
taking advantage of the military's ability
to move fast, do logistics

119
99:59:59,999 --> 99:59:59,999
and secure areas.

120
99:59:59,999 --> 99:59:59,999
We need to do simulations: germs games,
not war games,

121
99:59:59,999 --> 99:59:59,999
so that we see where the holes are.

122
99:59:59,999 --> 99:59:59,999
The last time a germ game was done
in the United States

123
99:59:59,999 --> 99:59:59,999
was back in 2001, and it didn't go so well.

124
99:59:59,999 --> 99:59:59,999
So far the score is germs: 1, people: 0.

125
99:59:59,999 --> 99:59:59,999
Finally, we need lots of advanced R&D
in areas of vaccines and diagnostics.

126
99:59:59,999 --> 99:59:59,999
There are some big breakthroughs, 
like the Adeno-associated virus,

127
99:59:59,999 --> 99:59:59,999
that could work very, very quickly.

128
99:59:59,999 --> 99:59:59,999
Now I don't have an exact budget
for what this would cost,


129
99:59:59,999 --> 99:59:59,999
but I'm quite sure that it's very modest
compared to the potential harm.

130
99:59:59,999 --> 99:59:59,999
The World Bank estimates that 
if we have a worldwide flu epidemic,

131
99:59:59,999 --> 99:59:59,999
global wealth would go down
by over 3 trillion dollars.

132
99:59:59,999 --> 99:59:59,999
We'd have millions and millions of deaths.

133
99:59:59,999 --> 99:59:59,999
These investments offer 
significant benefits beyond just

134
99:59:59,999 --> 99:59:59,999
being ready for an epidemic.

135
99:59:59,999 --> 99:59:59,999
The primary healthcare, the R&D,
those things


136
99:59:59,999 --> 99:59:59,999
would reduce global health equity
and make the world more just,

137
99:59:59,999 --> 99:59:59,999
as well as more safe.

138
99:59:59,999 --> 99:59:59,999
So I think this should absolutely
be a priority.

139
99:59:59,999 --> 99:59:59,999
There's no need to panic.

140
99:59:59,999 --> 99:59:59,999
We don't have