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June 1, 2015

What scares Bill Gates: Pandemic flu

Daily Briefing

What keeps Bill Gates up at night? The billionaire philanthropist and entrepreneur tells Vox's Ezra Klein the biggest threat to humanity is another global disease pandemic—and the world is not prepared.

Gates notes that disease pandemics have been fatal on a large scale before: the Spanish Flu of 1918 killed approximately 65 million people, matching the death toll of World War II.

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A vulnerable world

When Gates had researchers model the effect of a Spanish Flu-like illness on the modern world, the results shocked him. Even with advances in modern medicine, they predicted a similar disease would kill 33 million people in 250 days.

"Within 60 days it's basically in all urban centers around the entire globe," Gates says, adding, "That didn't happen with the Spanish Flu."

His researchers found that about 50 times more people travel internationally today than they did in 1918. As a result, diseases spread faster and are more difficult to track.

"If you look at the H1N1 flu in 2009, it had spread around the world before we even knew it existed," says Ron Klain, who President Obama appointed as America's "Ebola Czar." He adds that the world's bumpy experience fighting Ebola—which is relatively easy to contain compared with other pathogens—should be a wake-up call.

Pandemic flu "would be much more contagious than Ebola," Klain warns. "The people who are contagious may not have visible symptoms. It could break out in a highly populous country that sends thousands of travelers a day to the [United States]."

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Building infrastructure

CDC director Thomas Frieden says the best way to guard against future outbreaks is to invest in basic public health infrastructure—especially in the developing world. "That means laboratories for finding specimens, getting them tested, and discovering what's spreading," Frieden explains. "It means field epidemiologists. It means emergency operation centers."

According to Frieden, such investments only cost approximately a dollar per person per year. "It doesn't cost nearly as much as building a fancy hospital in your capital," Frieden says. The larger challenge to improving the world's response to disease outbreaks may be political.

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For example, "Guinea did not want to declare an Ebola epidemic because in terms of investors and travel, it's a death sentence," Gates points out. Some countries might also be too weak to respond to outbreaks because of internal strife or unstable governments.

As a result, international bodies such as the World Health Organization (WHO) are critical to responding to outbreaks, Vox's Klein says. But "WHO is underpowered for the problems it's meant to solve," Klein concludes.

That is why Gates urges more resources and more preparation to respond to infectious disease outbreaks. During the Ebola outbreak, "where was the equivalent of the military reserve" to respond to the Ebola outbreak, Gates asks. "What are the quarantine rules? It was completely ad hoc."

Klain agrees. "This is the hole in the global system," he says (Klein, Vox, 5/27).

The takeaway: Bill Gates warns that a global disease pandemic could kill 33 million people in 250 days—and that the world is not prepared for such an outbreak.

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