0:00:05.504,0:00:07.398
When I was a kid,

0:00:07.398,0:00:10.959
the disaster we worried about most [br]was a nuclear war.

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That's why we had a barrel like this[br]down in our basement,

0:00:15.085,0:00:17.656
filled with cans of food and water.

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When the nuclear attack came,

0:00:19.901,0:00:24.637
we were supposed to go downstairs,[br]hunker down, and eat out of that barrel.

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Today the greatest risk [br]of global catastrophe

0:00:29.597,0:00:32.457
doesn't look like this.

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Instead, it looks like this.

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If anything kills over 10 million people[br]in the next few decades,

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it's most likely to be [br]a highly infectious virus

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rather than a war.

0:00:47.792,0:00:51.679
Not missles, but microbes.

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Now part of the reason for this is that[br]

0:00:53.878,0:00:58.081
we've invested a huge amount[br]in nuclear deterrants.

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But we've actually invested very little [br]in a system to stop an epidemic.

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We're not ready for the next epidemic.

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Let's look at Ebola.

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I'm sure all of you read about it [br]in the newspaper,

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lots of tough challenges.

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I followed it carefully [br]through the case analysis tools

0:01:18.876,0:01:23.721
we use to track polio eradication.

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And as you look at what went on,

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the problem wasn't that there was a system[br]that didn't work well enough,

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the problem was that we [br]didn't have a system at all.

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In fact, there's some pretty obvious[br]key missing pieces.

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We didn't have a group of epidemiologists [br]ready to go who would have gone,

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seen what the disease was,[br]seen how far it had spread.

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The case reports came in on paper.

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It was very delayed[br]before they were put online

0:01:52.808,0:01:54.782
and they were extremely inaccurate.

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We didn't have a medical team ready to go.

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We didn't have a way of preparing people.

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Now, Médecins Sans Frontières [br]did a great job orchestrating volunteers.

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But even so, we were far slower[br]than we should have been

0:02:08.880,0:02:12.022
getting the thousands of workers[br]into these countries.

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And a large epidemic would require us[br]to have hundreds of thousands of workers.

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There was no one there [br]to look at treatment approaches.

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No one to look at the diagnostics.

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No one to figure out [br]what tools should be used.

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As an example, we could have [br]taken the blood of survivors,

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processed it, and put that plasma[br]back in people to protect them.

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But that was never tried.

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So there was a lot that was missing.

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And these things [br]are really a global failure.

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The WHO is funded to monitor epidemics,[br]but not to do these things I talked about.

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Now in the movies, it's quiet different.

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There's a group of handsome[br]epidemiologists ready to go,

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they move in, they save the day,[br]but that's just pure Hollywood.

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The failure to prepare [br]could allow the next epidemic

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to be dramatically [br]more devastating than Ebola

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Let's look at the progression [br]of Ebola over this year.

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About 10,000 people died, [br]

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and nearly all were in the three[br]West African countries.

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There's three reasons why[br]it didn't spread more.

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The first is that there was a lot [br]of heroic work by the health workers.

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They found the people and they [br]prevented more infections.

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The second is the nature of the virus.

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Ebola does not spread through the air.

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And by the time you're contagious,

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most people are so sick [br]that they're bedridden.

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Third, it didn't get[br]into many urban areas.

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And that was just luck.

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If it had gotten into a lot [br]more urban areas,

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the case numbers [br]would have been much larger.

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So next time, we might not be so lucky.

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You can have a virus where people [br]feel well enough while they're infectious,

0:04:14.530,0:04:17.842
that they get on a plane[br]or they go to a market.

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The source of the virus could be [br]a natural epidemic like Ebola,

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or it could be bioterrorism.

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So there are things that would literally[br]make things a thousand times worse.

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In fact, let's look at a model[br]of a virus spread through the air,

0:04:33.475,0:04:37.070
like the Spanish Flu back in 1918.

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So here's what would happen:

0:04:39.560,0:04:43.558
it would spread throughout the world[br]very, very quickly.

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And you can see, over 30 million people[br]died from that epidemic.

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So this is a serious problem.

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We should be concerned.

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But in fact, we can build[br]a really good response system.

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We have the benefits of all the science[br]and technology that we talk about here.

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We've got cell phones

0:05:02.883,0:05:06.140
to get information from the public [br]and get information out to them.

0:05:06.140,0:05:10.319
We have satellite maps where we can see[br]where people are and where they're moving.

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We have advances in biology

0:05:12.627,0:05:16.453
that should dramatically change [br]the turnaround time to look at a pathogen

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and be able to make drugs and vaccines[br]that fit for that pathogen.

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So we can have tools, but those tools[br]

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need to be put into an overall[br]global health system.

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And we need preparedness.

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The best lessons, I think, [br]on how to get prepared

0:05:32.257,0:05:34.758
are again, what we do for war.

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For soldiers, we have full-time,[br]waiting to go.

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We have reserves that can scale [br]us up to large numbers.

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NATO has a mobile unit [br]that can deploy very rapidly.

0:05:46.005,0:05:49.455
NATO does a lot of war games [br]to check, are people well trained?

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Do they understand [br]about fuel and logistics

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and the same radio frequencies?

0:05:54.241,0:05:56.779
So they are absolutely ready to go.

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So those are the kinds of things[br]we need to deal with an epidemic.

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What are the key pieces?

0:06:03.301,0:06:08.591
First, we need strong health systems[br]in poor countries.

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That's where mothers [br]can give birth safely,

0:06:11.778,0:06:13.295
kids can get all their vaccines.

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But, also where we'll see [br]the outbreak very early on.

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We need a medical reserve corps:

0:06:19.935,0:06:22.501
lots of people who've got [br]the training and background

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who are ready to go, with the expertise.

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And then we need to pair those[br]medical people with the military.

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taking advantage of the military's ability[br]to move fast, do logistics

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and secure areas.

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We need to do simulations,

0:06:39.129,0:06:43.927
germ games, not war games,[br]so that we see where the holes are.

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The last time a germ game [br]was done in the United States

0:06:46.723,0:06:50.443
was back in 2001, [br]and it didn't go so well.

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So far the score is germs: 1, people: 0.

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Finally, we need lots of advanced R&D[br]in areas of vaccines and diagnostics.

0:07:01.609,0:07:05.246
There are some big breakthroughs, [br]like the Adeno-associated virus,

0:07:05.246,0:07:09.229
that could work very, very quickly.

0:07:09.229,0:07:12.599
Now I don't have an exact budget[br]for what this would cost,

0:07:12.599,0:07:17.095
but I'm quite sure it's very modest[br]compared to the potential harm.

0:07:17.095,0:07:21.740
The World Bank estimates that [br]if we have a worldwide flu epidemic,

0:07:21.740,0:07:25.465
global wealth would go down[br]by over 3 trillion dollars

0:07:25.465,0:07:29.332
and we'd have millions[br]and millions of deaths.

0:07:29.332,0:07:32.317
These investments [br]offer significant benefits

0:07:32.317,0:07:34.518
beyond just being ready for the epidemic.

0:07:34.518,0:07:36.982
The primary healthcare, the R&D,

0:07:36.982,0:07:39.812
those things would reduce [br]global health equity

0:07:39.812,0:07:43.502
and make the world more just [br]as well as more safe.

0:07:43.502,0:07:46.864
So I think this should absolutely[br]be a priority.

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There's no need to panic.

0:07:48.980,0:07:53.469
We don't have to hoard cans of spaghetti[br]or go down into the basement.

0:07:53.469,0:07:57.309
But we need to get going,[br]because time is not on our side.

0:07:57.309,0:08:03.524
In fact, if there's one positive thing[br]that can come out of the Ebola epidemic,

0:08:03.524,0:08:09.330
it's that it can serve as an early [br]warning, a wake-up call, to get ready.

0:08:09.330,0:08:14.978
If we start now, we can be ready [br]for the next epidemic.

0:08:14.978,0:08:16.574
Thank you.

0:08:16.574,0:08:19.868
(Applause)