How to prevent the next pandemic - Bill Gates

Reading notes on some of the chapters.

Notes from each chapter

Learn from COVID

Some mistakes

• Federal agencies refused to share data
• Persons responsible did not have training inn epidemiology
• Not enough testing, not fast enough
• Lacks information sharing

Create a pandemic prevention team

There should be a global expert team to help preventing the pandemic: they should be responsible for

• surveillance of potential disease outbreaks, sound the alert when necessary;
• creation and sharing of data system and data on cases
• standardising policy making and training
• evaluation of the capacity of individual countries
• coordination of personnels

However it is difficult even for all countries to reach an agreement, and secure the funds. There is no one organisation that is able to join forces from all parties. Organisations depend on volunteers. WHO lacks funds, experts who are specialised in pandemic research, and relies on the free global response networks.

A team, GERM (Global Epidemic Response and Mobilisation) should be established. The main task should be disease surveillance and modeling; rather than treating patients.

Get better at detecting outbreaks early

Disease surveillance

Passive surveillance: healthcare workers report cases that use healthcare services (e.g. clinic, hospital) to public health authorities.

Active surveillance: workers go to communities to find potential patients that have not been to clinics or hospitals due to inconvenience, or mild symptoms.

When there are many cases (clusters), the signal might be picked up by a computer algorithm, and alerts sent to healthcare workers so that they pay more attention.

In some countries, personnels other than healthcare workers (e.g. teachers, post office staff) might also participate in disease surveillance. In addition, some virus can be detected in the environment such as waste water (e.g. polio, illeagal drug).

Birth and death

In LMIC (low and middle income countries), there are higher percentage of unrecorded births ad deaths. Some of them carry out census every other year - no real time data. Some data are also lack information such as cause of death. Without knowing causes of death (such as diarrhea), it is impossible to prevent the disease.

Post-mortem (autopsy) can be unattainable, especially in LMIC. It could also be undesirable for families who have lost their loved ones - procedures are very invasive. Nevertheless, alternatives exist, such as minimally invasive autopsy technologies like MRI and MRI guided fine-needle biopsy.

Help people protect themselves right away

The effect of NPI (non-pharmaceutical intervention, such as masks and lockdown) is difficult to quantify; yet it is a very important measure.

Paradox: NPI is effective -> reduced cases -> people think NPI is not necessary

Lockdown can slow down spread, yet it has a huge impact on economy, especially for LMIC.

Contact tracing

• not a new technology; used for smallpox, Ebola, AIDS.
• not widely applicable: some countries do it better than others. Need more trust from people towards public health agencies.
• smartphone apps, not very useful: limited by users

Good ventilation system

• viruses survive in air, but for different length of time

Social distance

• 6 inch isn’t a magic distance
• depends on circumstances: indoor/outdoor

Find new treatment fast, get readyy to make vaccines

Infodemic

(these two chapters are highly technical, and they deserve a separate note)

Practice, practice, practice

Disaster simulation and drill

Drill: assume a city is at risk of a disease that has epidemic potential

• how to develop diagnostic tests and large-scale manufacturing and distribution
• government, timely and comprehensive information dissemination
• management of quarantine
• set up system for case reporting

Close the health gap between rich and poor countries

The impact is different among different groups.

Vaccination distribution is highly imbalanced; yet it is only one of the many aspects where inequality exists, and not even the most unequal.

Make and fund a plan for preventing pandemics

Make and provide better tools

Invest in better vaccine, treatment, diagnosis

Testing and approval process

Finding new treatment and vaccine

• create a large database for anti-virus chemicals, open to all
• AI and software to speed-up development

GERM

Public health agencies are under-funded, this is true for all levels: state/county, country and international organizations (WHO).

Improve disease surveillance

Improve census, birth and death in LMIC; then expand into sequencing pathogens, environmental monitoring.

Aggregate disease surveillance systems internationally, and provide real-time data

Improve health system

Rebuild the system after Covid, invest more in healthcare, more staff

Spend more on basic prevention for all and early diagnosis, rather than in-hospital treatment for severe cases

Management, clear tasks and responsibility