Health: World must prepare for a disastrous epidemic that could kill over 30 million people - Bill Gates warns

people wearing masks after an outbreak in Brazil

February 24, 2017

Bill Gates is a smart guy who knows something about global health. So when he gives a grave warning about a potential catastrophe, it's a good idea to listen. Yesterday, at the Munich Security Conference in Germany, the man who tops the Forbes richest person in the world list and is co-chair of the Bill and Melinda Gates Foundation said:

Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year. And they say there is a reasonable probability the world will experience such an outbreak in the next 10 to 15 years.

Notice that this was at a security conference and not a health meeting. Therefore, he could have focused on some other issue such as nuclear weapons or climate change. But Gates chose to focus on infectious disease threats (whether starting naturally or used as a bioterrorist weapon) for a good reason. Our society is in need of a good wake-up call and a slap in the face.

Our society is woefully underprepared for a bad pandemic. This was obvious in 2009 when I and Shawn Brown, Ph.D., director of public health applications at the Pittsburgh Supercomputing Center (PSC), were embedded in the Department of Health and Human Services (HHS) to use our computational models to help with the national response to the H1N1 influenza pandemic. People in HHS were working very hard each day to mobilize the national response.

However, the external resistance that they encountered was troubling. Many external parties put their own individual or business interests in front of national security and were reluctant to share information. Some of the general public questioned whether the pandemic existed and even raised a number of conspiracy theories. Fortunately, the virus was not as harmful as initially thought and the world was spared real disaster. Was the H1N1 pandemic a wake-up call for society? Not really.

Microsoft CEO, Bill Gates

Maybe a slower-progressing epidemic that resulted in more deaths and disability would do the trick? After the H1N1 pandemic ran its course, more attention focused on the continuing epidemics of methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant bacteria.

The Centers for Disease Control and Prevention (CDC), with efforts led by John Jernigan, M.D., M.S., and Rachel Slayton, Ph.D., and other public health agencies have been working to combat the MRSA epidemic with healthcare facilities and researchers such as our RHEA (Regional Healthcare Analyst) computational modeling team that includes Susan Huang, M.D., M.P.H., of the University of California, Irvine, Sarah Bartsch, M.P.H., of the Johns Hopkins Bloomberg School of Public Health (JHSPH), Dr. Brown, Kim Wong, Ph.D., of the University of Pittsburgh Center for Simulation and Modeling, and Loren Miller, M.D., and Jamie McKinnell, M.D., of UCLA.

Has the MRSA epidemic, which is still continuing, prompted all the major changes in infection control and antibiotic development necessary to combat a pandemic? Again, no. While some advances have been made, lack of resources for infection control practice and research remains a challenge, antibiotic overuse has continued and relatively few antibiotics are under development. As I have stated previously, this continues to be a crisis, as our society may eventually run out of antibiotics that work against bacteria.

Surely, then, an epidemic in which the pathogen is highly and rapidly fatal would spur people to more action. Well, it did result in a new version of the song "Do They Know It's Christmas?"...but, to sound like a broken record, no, it did not deliver the needed kick in the behind. The 2014-2016 Ebola outbreaks in West Africa involved a virus that killed around half the people it infected.

Seemingly suddenly, Ebola jumped into the headlines (even though it had been around for years) when the number of deaths in Liberia, Sierra Leone and Guinea surged, raising concerns that the pathogen may spread elsewhere, including the U.S. Suddenly, people were saying, "Quick, we need a vaccine," without giving the world much lead time to deliver and prepare accordingly, as stated in our Lancet piece.

I recall during the Paul G. Allen Family Foundation Ebola Innovation Summit seeing many people around the room who had not even heard of Ebola a year prior, saying that we needed to eliminate this disease, naively underestimating the effort required to do so. As I tried to explain to a founder of a major dot-com at the meeting, creating a successful website is not the same as combating an infectious disease. Fortunately for the rest of the world, the Ebola epidemic eventually subsided without any vaccines or new technologies. As Gates mentioned during his Munich speech, "we would be wise to consider the social and economic turmoil that might ensue if something like Ebola made its way into urban centers."

How much did the activity around the Ebola outbreaks change the world? The refrain: not nearly enough. As David Peters, M.D., Dr.P.H., chair of international health at JHSPH, explains in the following video, many major systems problems in West Africa contributing to the Ebola epidemic still remain and could easily lead to future epidemics:

Indeed, many health systems around the world remain broken. For example, our HERMES Logistics computational modeling team, coordinated by Leila Haidari, M.P.H., and working with Raja Rao at the Bill and Melinda Gates Foundation, has found that numerous countries have major problems in their vaccine supply chains that could benefit from significant redesign. Even if the proper technology, such as vaccines and medications, is available during an epidemic, effective and efficient supply chains and health systems would be necessary to get them to where they need to go.

Progress has occurred with vaccine supply chains but not as much in other types of supply chains and other aspects of health systems. As before, the Ebola outbreaks resulted in some changes but not nearly enough.