Book review: Voluble criticism notwithstanding, 'How To Prevent The Next Pandemic' makes some important points

Bill Gates' 'How to Prevent the Next Pandemic' came out in May 2022.

Microsoft co-founder Bill Gates is co-chair of the Bill & Melinda Gates Foundation, where he has spent more than 20 years working on global health and development issues, including pandemic prevention, disease eradication, and problems concerning water, sanitation, and hygiene.

His latest book, How to Prevent the Next Pandemic came out in May 2022, just as Covid cases worldwide were dipping.

A bit of context

Infectious diseases have been “something of an obsession” for Gates. AIDS and other silent epidemics such as malaria and tuberculosis have been the focus of the Gates Foundation’s global work for some time now. Gates writes in the book that the Ebola outbreak of 2014 came as a wake-up call of sorts. It brought to the fore glaring gaps in the world’s pandemic-preparedness. This got him thinking, and in 2015, Gates published a paper in The New England Journal of Medicine. It pointed out how unprepared the world was and laid out what it would take to get ready. This was also the theme of his TED talk, ‘The Next Epidemic? We’re Not Ready’. It included an animation showing 30 million people dying from a flu as infectious as the 1918 one.

Covid-19 struck much later. But the world was still not prepared. Interestingly, 95 percent of the 43 million views of his TED talk came only after the pandemic started.

It is inevitable that diseases will continue to spread, but they need not become global disasters. “Outbreaks are inevitable, but pandemics are optional”, Gates quotes eminent epidemiologist Dr Larry Brilliant. This is also the premise upon which he builds his master plan—wherein governments, scientists, companies, and individuals can build a system that will contain inevitable outbreaks so they don’t become pandemics.

“This is an opportunity to learn from our mistakes and ensure that no one ever has to live through another disaster like COVID," Gates writes in the book. "But we can be even more ambitious than that: We can work toward a world where everyone has a chance at a healthy and productive life. The opposite of complacency isn’t fear. It’s action.”

Key takeaways from the book

Covid-19 has had a long, unfettered run—taking lives, wrecking livelihoods, and upending economies. Gates’ word of caution—let’s not get too complacent—is relevant now.

- There is much to learn from the last two years, especially from the wrong steps and flawed measures that worsened outcomes in many countries. A robust monitor-and-response system could have made a big difference.

“We don’t need to surrender to living in perpetual fear of another global catastrophe. But we do need to remain aware of the possibility and be willing to do something about it. The fact that we now understand the threat like never before should inspire the world to take action— to invest billions now so we won’t lose millions of lives and trillions of dollars in the future,” Gates writes.

- Gates envisages a World Health Organization (WHO)-managed global corps of around 3,000 experts that can mount a coordinated response to the next threat of a pandemic. They will play a crucial role in disease surveillance, coordinating the immediate response, advising on research agenda, and finding weak spots in systems. Running the GERM—Global Epidemic Response and Mobilization—team, as he calls it, would cost $1 billion a year. “That is less than one one-thousandth of the world’s annual spending on defense”, he puts that number in perspective.

- Gates goes on to discuss getting better at detecting outbreaks early, accelerating vaccine trials and approvals, stepping up research on broad-spectrum therapies, running full-scale exercises to test readiness for the next major outbreak, the change Covid has brought about in our digital future, and so on. He also points out that it’s not just natural pathogens that we need to worry about. Governments should get serious about fighting the danger of bioterrorism too.

“Climate change and pandemics—including the possibility of an attack by bioterrorists—are the most likely existential threats for humans. Fortunately, there are opportunities to make major progress on both of them in the next decade… Over the next decade, if governments expand their investments in research and adopt evidence-based policies, we can develop most of the tools we need to keep an outbreak from turning into a disaster. The amount of money required for pandemic preparedness is far less than what it will take to avoid a climate disaster,” Gates writes.

Postscript

Since the book came out, it has received some flak. Part of the reason is Gates own (changing) stance on lifesaving medicines and intellectual property rights for Covid vaccines—terms like vaccine apartheid have been used in connection with him.

Yet the flak should not take away from the merit of the book.

New results emerge only from new conversations. And that’s what the book attempts to do—it opens an avenue for newer conversations around pandemic threats, rooted in past lessons as well as future uncertainties.

Gates has access to some of the world’s best scientific minds and finest research insights, and he makes ample use of them to support his arguments. There is copious data too, blended well with the narrative to keep it simple.

As he courses along in easy prose—drawing country-specific examples and anecdotes—it’s not just a looming threat that gets highlighted. He shares deep insights on epidemics in general, the unpredictable tenor of pathogen spread, intricacies and challenges of vaccine production and distribution, regulatory hurdles, the unequal balance between rich and poor countries, and so on.

Gates is an ardent technophile and that drives the optimism around many of his proposals. Some may seem overly ambitious too, but he believes they can be achieved if governments, funders, and private industry make the right choices and investments. After all, “the opposite of complacency isn’t fear. It’s action”. And we don’t have a plausible reason to disagree.

As Gates writes: “Most of all, don’t let the world forget how awful COVID was. Do whatever you can to keep pandemics on the agenda—locally, nationally, internationally—so we can break the cycle of panic and neglect that makes them the most important thing in the world for a time, until we forget about them and go back to our daily lives.”