We Are Not Properly Preparing For The Next Pandemic

 The following op-ed is by Bill Gates in The New York Times:

Imagine there’s a small fire in your kitchen. Your fire alarm goes off, warning everyone nearby about the danger. Someone calls 911. You try to put the fire out yourself — maybe you even have a fire extinguisher under the sink. If that doesn’t work, you know how to safely evacuate. By the time you get outside, the fire truck is already pulling up. Firefighters use the hydrant in front of your house to extinguish the flames before any of your neighbors’ homes are ever at risk of catching fire.

We need to prepare to fight disease outbreaks just as we prepare to fight fires. If it is left to burn out of control, a fire poses a threat not only to one home, but to an entire community. The same is true for infectious diseases, except on a much bigger scale. As we know all too well from Covid, an outbreak in one town can quickly spread across an entire country and then around the world.

When the World Health Organization first described Covid-19 as a pandemic just over three years ago, it marked the culmination of a collective failure to prepare for pandemics despite many warnings. And I worry that we’re making ‌‌those same mistakes again. The world hasn’t done as much to get ready for the next pandemic as I’d hoped. But ‌‌it’s not too late to stop history from repeating itself. The world needs a well-funded system that is ready to spring into action at a moment’s notice when danger emerges. ‌We need a fire department for pandemics.

I’m optimistic about a network that the W.H.O. and its partners are building called the Global Health Emergency Corps. This network of the world’s top health emergency leaders will work together to get ready for the next ‌‌pandemic. Just as firefighters run drills to practice responding to a fire, the Emergency Corps plans to run drills to practice for outbreaks. The exercises will make sure that everyone — governments, health care providers, emergency health workers — knows what to do when a potential outbreak emerges.

One of the corps’ most important jobs will be to ‌‌take quick action to stop the spread of a pathogen. The speed of action requires countries to have large-scale testing capabilities that identify potential threats early. Environmental surveillance like sewage testing is key, since many pathogens show up in human waste. If a sewage sample comes back positive, a rapid response team would deploy to the affected area to find people who might be infected, implement a response plan‌‌ and kick off the necessary community education about what to look for and how to stay protected.

As C‌ovid-19 demonstrated, a pandemic is a trillion-dollar problem, and mitigating this challenge should not depend on volunteers. We need a corps of professionals from every country and region, and the world needs to find a way to compensate them for the time they spend preparing for and responding to transnational threats. They must be able to deploy teams of professionals on standby to help control outbreaks where they start.

To be successful, the Emergency Corps must build on existing networks of experts and be led by people like the heads of national public health agencies and their leads for epidemic response. ‌It’s difficult ‌‌for any one country to stop a disease from spreading on its own — many of the most meaningful actions require‌‌ coordination from the highest levels of government. The world needs to prepare for a multiple-alarm fire — the type of fire response that requires different units and departments. These kinds of blazes are rare, but when they happen, there’s no time to waste. Local responders need to know they can count on a surge of well-trained firefighters who will work seamlessly together. They can’t arrive on the scene only to discover that their hoses don’t fit on the closest hydrant or that they have a completely different approach from the other units. The Emergency Corps will make sure countries and health systems are coordinated in advance of an emergency, so that everything runs smoothly during times of crisis.

This is where practice makes perfect. By running drills and simulations, the corps will uncover the areas where ‌countries and leaders are not ready and help us fix them now. ‌It’s important to practice for lots of different types of pathogens, too. Human respiratory diseases are a huge concern, because they can go global so quickly. (Just look at how fast Covid spread.) But they are far from the only threat. What if the next pandemic-potential pathogen spreads through surface droplets? Or if it is sexually transmitted like H.I.V.? What if it’s the result of bioterrorism? Each scenario requires a different response, and the Emergency Corps can help the world get ready for all of them.

We can’t afford to get caught flat-footed again. The world must take action now to make sure Covid-19 becomes the last pandemic, and one of the biggest moves we can make is to support the world’s principal health experts — the W.H.O. — and invest in the Global Health Emergency Corps so it can live up to its full potential.

This will require two things: First, public health leaders from all countries need to participate. The next ‌pandemic could emerge anywhere, and so the Emergency Corps must have expertise from every corner of the globe, including from national disease and research agencies like the C.D.C. and the N.I.H. in the United States. Second, we need wealthier countries to step up and provide funding to make this a reality.

‌‌I believe the W.H.O. remains our best tool for helping countries stop disease outbreaks, and the Global Health Emergency Corps will represent massive progress toward a pandemic-free future. The ‌question ‌‌is whether we have the foresight to invest in that future now before it’s too late.

Inflation Reduction Act Will Help Control Climate Change

One of the provisions of the Inflation Reduction Act, currently being considered in the U.S. Senate, will do several things in addition to reducing inflation. One of those things is to fight global climate change.

Here is what Bill Gates thinks of that provision in the IRA: 

Turn on the evening news and it immediately becomes clear that Americans are experiencing the effects of climate change. Extreme heat and drought are affecting tens of millions of people, as floods and wildfires ravage communities from Appalachia to California. In the coming days, Congress has the opportunity to face down the climate crisis while strengthening our country’s energy security, creating opportunities for businesses and improving the lives of Americans. We can’t afford to miss it.

The Inflation Reduction Act of 2022 may be the single most important piece of climate legislation in American history. It represents our best chance to build an energy future that is cleaner, cheaper and more secure. Senators Chuck Schumer of New York and Joe Manchin of West Virginia deserve a lot of credit for reaching this agreement, as do countless others. Many business leaders and activists I’ve gotten to know through Breakthrough Energy, the climate organization I founded in 2015 to accelerate the clean energy transition, have worked relentlessly for decades for this moment. But although it appears the legislation will pass, success is not guaranteed, so it’s critical to keep pushing for it. Let me explain why.

Many of the technologies we’ll need to reach net-zero emissions don’t exist, are in early stages of development or are still too expensive to scale up. At the same time, more mature technologies like solar, wind and electric vehicles must be deployed more quickly in more places. Through new and expanded tax credits and a long-term approach, this bill would ensure that critical climate solutions have sustained support to develop into new industries.

These incentives would also provide the private sector with the confidence to invest for the long term. This legislation would begin to transform the parts of our economy that are hardest to decarbonize, like manufacturing, which we must do to reach net-zero emissions. As many Americans face summer blackouts, power shortages and high electricity bills, these measures would help build a modern, reliable power grid so all can have access to affordable, abundant and clean energy.

With those incentives and investments, this bill would catalyze a new era of American innovation. The ability of America’s universities and industries to innovate remains second to none, yet the country risks falling behind as other countries race to build their own clean energy economies. This legislation would help turn American energy innovations into American energy industries and unlock huge economic opportunities in the energy market. If it becomes law, few nations would have the capacity for producing homegrown clean energy like the United States. America could quickly become a leader in the deployment of clean energy at the scale required.

American businesses are ready for this change. I’ve spoken with corporate leaders who are eager for our government to act. Many have made big climate pledges and invested significant amounts in clean energy, both because they care about making good on their promises and because it’s good business. Even more businesses are waiting on the sidelines for a strong signal from government that clean industries are a solid long-term investment. Passing the Inflation Reduction Act would send that message and enable private capital to supercharge our clean energy future with even greater confidence.

With President Biden’s signature, this legislation would jump-start and support clean energy industries that could create millions of jobs, many in communities that have been built by fossil fuels. In fact, many of the most promising technologies in the clean energy economy will require similar skills and expertise possessed by today’s coal, oil and gas workers. This will help ensure a fair transition.

Solving climate change is perhaps the hardest challenge humanity has ever faced. It will require fundamentally transforming how we power our communities, move goods, build things, heat and cool buildings and grow food — basically how we do everything. We need to do it rapidly with a cohesive and coherent plan if we want to avoid the worst effects of climate change.

The country has an opportunity to set an example by offering a vision of what’s possible — and then by making it happen. By passing this legislation, Congress would mark a moment when, despite the many challenges facing the nation, lawmakers in Washington acted with ambition and foresight to build a cleaner, healthier, and more prosperous future. Let’s get it done.

Gates Says Pandemic Therapies Must Be Developed Faster

The following is just part of a guest op-ed in The New York Times by Bill Gates. He has a point. We need to be able to develop therapeutic treatments faster when hit by a pandemic. He writes:

Today, drug discovery still relies on a mixture of good science and good luck. Unfortunately, when an outbreak appears to be headed toward a pandemic, there’s no time to count on luck. The next time we’re faced with a contagion, scientists will need to develop treatments as fast as possible, much faster than they did for Covid.

So let’s suppose we’re in that situation: There’s a new virus that looks like it could go global, and we need a treatment. How will scientists go about making an antiviral?

The first step is to map the virus’s genetic code and figure out which proteins are most important to it. These essential proteins are known as the “targets,” and the search for a treatment essentially boils down to defeating the virus by finding things that will keep the targets from working the way they should.

Until the 1980s, researchers trying to identify promising compounds had to rely on slow trial and error to identify the right ones. Today, using 3-D modeling and robotic machines that run thousands of experiments at a time, companies can test millions of compounds in a matter of weeks — a task that would otherwise take a team of humans years to complete.

Once a promising compound is identified, the scientific teams will analyze it to determine whether it’s worth further exploration. Once they’ve found a good candidate, they will typically spend several years in the “preclinical” phase, studying it to determine whether it is safe and triggers the desired response. The first studies will be done in animals. (Finding the right animal is not easy. Researchers have a saying: “Mice lie, monkeys exaggerate and ferrets are weasels.”)

If all goes well in the preclinical phase, the drug will move into the riskiest and most expensive part of the process: clinical trials in humans. With permission from a government regulator — in the United States, it’s the Food and Drug Administration — scientists will start a small trial involving a few dozen healthy adult volunteers. They will be looking to see whether the drug causes any adverse effects and to zero in on a dosage that’s high enough to be beneficial but not so high that it makes the patient sick.

Assuming all goes well once again, it will move on to larger and larger trials. Finally, after three phases, if they believe the drug is safe and effective, the scientists will go back to the regulatory agency and apply for approval. Then — assuming they get the green light — it’s time to start manufacturing.

At this point, a team of chemists will work on finding a consistent way to produce the key part of the drug, known as the “active ingredient.” Then, the scientific team will address the next big question: How to make sure it actually reaches everyone who needs it. Not at all an easy problem to solve.

As you can see, drug development is a complex and labor-intensive science, and each step is fraught with scientific and logistical obstacles — but we need to accelerate the process. The faster researchers are able to produce safe, effective drugs for quick-spreading pathogens like Covid, the more lives will be saved and the more we can reduce the burden on health care systems. Fortunately, there are ways to speed up and streamline the process without sacrificing safety.

One of the keys to ensuring that health care workers have better treatment options in the next big outbreak than they did for Covid will be investing in large libraries of drug compounds that researchers can quickly scan to see whether existing therapies work against new pathogens. Some of these libraries exist already, but the world needs more. We need libraries that cover many types of drugs, but the most promising, in my view, are those known as pan-family and broad-spectrum therapies — either antibodies or drugs that can treat a wide range of viral infections, especially those that are likely to cause a pandemic.

Researchers could also find better ways of activating what’s known as “innate immunity,” which is the part of your immune system that kicks in just minutes or hours after it detects any foreign invader — it’s your body’s first line of defense. By boosting your innate immune response, a drug could help your body stop an infection before it takes hold.

To deliver on these promising approaches, the world needs to invest more into understanding how various dangerous pathogens interact with our cells. Scientists are working on ways to mimic these interactions so that they can quickly figure out which drugs might work in an outbreak.

A few years ago, I saw a demonstration of a “lung on a chip,” an experimental device you could hold in your hand that operated just like a lung, allowing researchers to study how different drugs, pathogens and human cells affect one another. With advances in artificial intelligence and machine learning, it’s now possible to use computers to identify weak spots on pathogens that we already know about, and we’ll be able to do the same when new pathogens arise. These technologies are also speeding up the search for new compounds that will attack those weak spots.

With adequate funding, various groups could take the most promising new compounds through Phase 1 studies even before there’s an epidemic, or at least have several leads that can be turned into a product quickly once we know what the target looks like.

In short, although therapeutics didn’t rescue us from Covid, they hold a lot of promise for saving lives and preventing future outbreaks from crippling health systems. But to make the most of that promise, the world needs to invest in the research and systems we’ll need to find treatments much faster. That’s why my foundation has supported a therapeutics accelerator at Duke University, but broader initiatives will be necessary to make lasting change. This will require substantial investment to bring together academia, industry and the latest software tools. But if we succeed, the next time the world faces an outbreak, we’ll save millions more lives.

Concern Over Coronavirus Grows In Spite Of Trump Lies

This chart is from the Morning Consult Poll -- done most recently between February 24th and 26th of a national sample of 2,000 adults, with a 2 point margin of error. The sample size and margin of error for the three previous polls are the same.

Donald Trump has told Americans that there's nothing to worry about, because his administration has taken steps to keep the Coronavirus out of the United States. But he has also said that the virus will magically disappear as soon and hot weather arrives. And last Friday night, he told a South Carolina crowd of supporters that the Coronavirus is a hoax (perpetrated by Democrats to damage his chance of re-election). In other words, he's just telling whatever lie he thinks will make him look good.

But the public doesn't need lies -- not for something as serious as a possible pandemic. It needs the truth. Sadly, truth is not something Trump does. Most people know Trump is dishonest, and they don't trust him to tell them the truth about this virus. That's probably a big reason why the concern is growing over the Coronavirus. Note on the chart above that concern over the virus is growing -- from 52% near the end of January to 69% a month later.

Fortunately, there are people willing to tell Americans the truth. One of them is Bill Gates. He and his wife have donated $100 million to fight this virus. Here's part of what he had to say in The New England Journal of Medicine:

In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

The long-term challenge — improving our ability to respond to outbreaks — isn’t new. Global health experts have been saying for years that another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when. The Bill and Melinda Gates Foundation has committed substantial resources in recent years to helping the world prepare for such a scenario.

Now we also face an immediate crisis. In the past week, Covid-19 has started behaving a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume it will be until we know otherwise.

There are two reasons that Covid-19 is such a threat. First, it can kill healthy adults in addition to elderly people with existing health problems. The data so far suggest that the virus has a case fatality risk around 1%; this rate would make it many times more severe than typical seasonal influenza, putting it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).

Second, Covid-19 is transmitted quite efficiently. The average infected person spreads the disease to two or three others — an exponential rate of increase. There is also strong evidence that it can be transmitted by people who are just mildly ill or even presymptomatic. That means Covid-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people. In fact, Covid-19 has already caused 10 times as many cases as SARS in a quarter of the time.

National, state, and local governments and public health agencies can take steps over the next few weeks to slow the virus’s spread. For example, in addition to helping their own citizens respond, donor governments can help low- and middle-income countries (LMICs) prepare for this pandemic. Many LMIC health systems are already stretched thin, and a pathogen like the coronavirus can quickly overwhelm them. And poorer countries have little political or economic leverage, given wealthier countries’ natural desire to put their own people first.

By helping African and South Asian countries get ready now, we can save lives and slow the global circulation of the virus. (A substantial portion of the commitment Melinda and I recently made to help kickstart the global response to Covid-19 — which could total up to $100 million — is focused on LMICs.)

The world also needs to accelerate work on treatments and vaccines for Covid-19. Scientists sequenced the genome of the virus and developed several promising vaccine candidates in a matter of days, and the Coalition for Epidemic Preparedness Innovations is already preparing up to eight promising vaccine candidates for clinical trials. If some of these vaccines prove safe and effective in animal models, they could be ready for larger-scale trials as early as June. Drug discovery can also be accelerated by drawing on libraries of compounds that have already been tested for safety and by applying new screening techniques, including machine learning, to identify antivirals that could be ready for large-scale clinical trials within weeks.

All these steps would help address the current crisis. But we also need to make larger systemic changes so we can respond more efficiently and effectively when the next epidemic arrives.

You can go here to read what long-term changes he believes is necessary to prevent future outbreaks.