How to prevent the next.., p.25
How to Prevent the Next Pandemic, page 25
Cold chain: The process of keeping a vaccine at the right temperature as it travels from the factory where it is made to the place where it is being administered.
Contact tracing: The process of identifying people who came into contact with someone who was infected with a certain disease.
COVAX: The global effort to get COVID vaccines out to low- and middle-income countries, co-led by CEPI, Gavi, and the WHO.
Effectiveness, efficacy: The measure of how well a vaccine or drug works. In the medical field, efficacy refers to performance in a clinical trial, and effectiveness refers to performance in the real world. For the sake of simplicity, in this book I’ve used effectiveness to refer to both.
Gavi, the Vaccine Alliance: A nonprofit created in 2000 to encourage manufacturers to lower vaccine prices for the poorest countries in return for long-term, high-volume, and predictable demand from those countries. Formerly known as the Global Alliance for Vaccines and Immunization.
Genome, genomic sequencing: The genome is the genetic code of an organism. All living things have genomes, and every genome is unique. Sequencing a pathogen’s genome is the process of figuring out the order in which its genetic information appears.
GERM: The Global Epidemic Response and Mobilization team. A proposed global organization responsible for detecting and responding to outbreaks and preventing them from becoming pandemics.
Global Fund: Officially the Global Fund to Fight AIDS, TB, and Malaria, a nonprofit partnership designed to end the epidemics of those three diseases.
IHME: The Institute for Health Metrics and Evaluation, a research organization based at the University of Washington that develops evidence to guide decisions about public health.
Monoclonal antibodies (mAbs): A form of treatment for some diseases. These are antibodies that have been isolated from a patient’s blood or designed in a lab and then cloned billions of times to create a treatment for someone who has been infected.
mRNA (messenger RNA): Genetic material that carries the directions for making certain proteins to the factories in your cells where the proteins will be assembled. Vaccines that use mRNA work by introducing genetic code that teaches your cells to make shapes that match certain shapes on a given virus, triggering your immune system to produce antibodies against that virus.
Nonpharmaceutical interventions (NPIs): Policies and tools that reduce the spread of an infectious disease without the use of vaccines or drugs. Common NPIs include masks, social distancing, quarantines, business and school closures, travel restrictions, and contact tracing.
PCR test: Polymerase chain reaction, the current gold standard in disease diagnostics.
SCAN: The Seattle Coronavirus Assessment Network, which along with the Seattle Flu Study was set up to learn more about how a respiratory disease spreads through a community.
WHO: The World Health Organization, a division of the United Nations responsible for international public health.
ACKNOWLEDGMENTS
I want to thank all of the staff, trustees, grantees, and partners of the Bill & Melinda Gates Foundation who worked tirelessly to help out during COVID. I’m inspired by your passion and commitment. Melinda and I are lucky to work with such a talented group of people.
Writing this book was like trying to hit a moving target, as new information came in almost daily. So it took a team effort to stay on top of the latest data and analysis. I’m grateful to everyone who helped me complete How to Prevent the Next Pandemic.
I have written each of my books with one or more writing and research partners. For this book, as he did on my previous one, Josh Daniel devoted his considerable skill to helping me explain complicated topics simply and clearly. Josh and his colleagues Paul Nevin and Casey Selwyn made a fantastic trio who conducted in-depth research, synthesized ideas from experts across many fields, and helped me clarify my thinking. I appreciate their advice and admire their hard work.
For this book, I benefited from the insights of many people at the foundation, including Mark Suzman, Trevor Mundel, Chris Elias, Gargee Ghosh, Anita Zaidi, Scott Dowell, Dan Wattendorf, Lynda Stuart, Orin Levine, David Blazes, Keith Klugman, and Susan Byrnes. They joined brainstorming sessions and reviewed drafts while balancing the rest of their demanding jobs during a pandemic. Many others at the foundation provided expert input, research, and feedback on drafts, including Hari Menon, Oumar Seydi, Zhi-Jie Zheng, Natalie Africa, Mary Aikenhead, Jennifer Alcorn, Valerie Nkamgang Bemo, Adrien de Chaisemartin, Jeff Chertack, Chris Culver, Emily Dansereau, Peter Dull, Ken Duncan, Emilio Emini, Mike Famulare, Michael Galway, Allan Golston, Vishal Gujadhur, Dan Hartman, Vivian Hsu, Hao Hu, Emily Inslee, Carl Kirkwood, Dennis Lee, Murray Lumpkin, Barbara Mahon, Helen Matzger, Georgina Murphy, Rob Nabors, Natalie Revelle, David Robinson, Torey de Rozario, Tanya Shewchuk, Duncan Steele, Katherine Tan, Brad Tytel, David Vaughn, Philip Welkhoff, Edward Wenger, Jay Wenger, Greg Widmyer, and Brad Wilken. And the foundation’s communications and advocacy teams not only contributed research but will carry this work forward, helping me translate the ideas in this book into concrete changes that leave the world more prepared to deal with the next major outbreak.
Thoughtful reviews of early passages and drafts came from Anthony Fauci, David Morens, Tom Frieden, Bill Foege, Seth Berkley, Larry Brilliant, Sheila Gulati, and Brad Smith.
I also want to thank the many people at Gates Ventures who helped make this book possible.
Larry Cohen provided leadership and vision that are both essential and rare. I appreciate his calm demeanor, wise guidance, and dedication to the work we do together.
Niranjan Bose gave me expert advice and helped me get many technical details right. Becky Bartlein and the rest of the Exemplars in Global Health team helped me flesh out details on why some countries did so much better than others.
Alex Reid thoughtfully drove the communications team that was responsible for ensuring the successful launch of the book. Joanna Fuller was instrumental in helping me with all the details of the story of the Seattle Flu Study and SCAN.
Andy Cook led the online strategy work that brought the book out online on my website, social channels, and beyond.
Ian Saunders did a masterful job leading the creative team that helped bring the book to market.
Meghan Groob offered sound editorial advice, particularly on the Afterword. Anu Horsman led the creative process for the visual content of the book. Jen Krajicek worked behind the scenes to manage its production. Brent Christofferson oversaw the production of the visual assets with charts from Beyond Words and illustrations from Jono Hey. John Murphy helped me identify and learn about many of the heroes of the COVID fight.
Greg Martinez and Jennie Lyman help me stay up-to-date on where technology is headed, work that informed the Afterword in particular.
Gregg Eskenazi and Laura Ayers negotiated contracts and secured permissions from dozens of sources featured in this book.
Many others played an important role in the creation and release of this book, including Katie Rupp, Kerry McNellis, Mara MacLean, Naomi Zukor, Cailin Wyatt, Chloe Johnson, Tyler Hughes, Margaret Holsinger, Josh Friedman, Ada Arinze, Darya Fenton, Emily Warden, Zephira Davis, Khiota Therrien, Abbey Loos, K.J. Sherman, Lisa Bishop, Tony Hoelscher, Bob Regan, Chelsea Katzenberg, Jayson Wilkinson, Maheen Sahoo, Kim McGee, Sebastian Majewski, Pia Dierking, Hermes Arriola, Anna Dahlquist, Sean Williams, Bradley Castaneda, Jacqueline Smith, Camille Balsamo-Gillis, and David Sanger.
And I want to thank the rest of the incredible team at Gates Ventures: Aubree Bogdonovich, Hillary Bounds, Patrick Brannelly, Gretchen Burk, Maren Claassen, Matt Clement, Quinn Cornelius, Alexandra Crosby, Prarthna Desai, Jen Kidwell Drake, Sarah Fosmo, Lindsey Funari, Nathaniel Gerth, Jonah Goldman, Andrea Vargas Guerra, Rodi Guidero, Rob Guth, Rowan Hussein, Jeffrey Huston, Gloria Ikilezi, Farhad Imam, Tricia Jester, Lauren Jiloty, Goutham Kandru, Sarah Kester, Liesel Kiel, Meredith Kimball, Jen Langston, Siobhan Lazenby, Anne Liu, Mike Maguire, Kristina Malzbender, Amelia Mayberry, Caitlin McHugh, Emma McHugh, Angelina Meadows, Joe Michaels, Craig Miller, Ray Minchew, Valerie Morones, Henry Moyers, Dillon Mydland, Kyle Nettelbladt, Bridgette O’Connor, Patrick Owens, Dreanna Perkins, Mukta Phatak, David Vogt Phillips, Tony Pound, Shirley Prasad, Zahra Radjavi, Kate Reizner, Chelsea Roberts, Brian Sanders, Bennett Sherry, Kevin Smallwood, Steve Springmeyer, Aishwarya Sukumar, Jordan-Tate Thomas, Alicia Thompson, Caroline Tilden, Rikki Vincent, Courtney Voigt, William Wang, Stephanie Williams, Sunrise Swanson Williams, Tyler Wilson, Sydney Yang, Jamal Yearwood, and Mariah Young.
A special thank-you to the human resources teams at both Gates Ventures and the Gates Foundation for all they’ve done during COVID to maintain a strong culture while putting everyone’s health and safety first.
Chris Murray and the rest of the team at the Institute for Health Metrics and Evaluation assisted with research, modeling, and analysis that informed my thinking as well as many of the charts and statistics in this book.
Max Roser’s site Our World in Data is an invaluable resource, and I turned to it countless times while writing this book.
This book would not have been possible without the tireless support of my editor, Robert Gottlieb at Knopf. His guidance helped us keep the book clear and reader-friendly. Katherine Hourigan masterfully managed the entire process, helping us stay on track under a tight (self-imposed) deadline. And I want to thank everyone else at Penguin Random House who supported this book: Reagan Arthur, Maya Mavjee, Anne Achenbaum, Andy Hughes, Ellen Feldman, Mike Collica, Chris Gillespie, Erinn Hartman, Jessica Purcell, Julianne Clancy, Amy Hagedorn, Laura Keefe, Suzanne Smith, Serena Lehman, and Kate Hughes.
Warren Buffett’s incredibly generous support for the Gates Foundation, a pledge he first made in 2006, has allowed us to expand and deepen our work around the world. I’m honored by his commitment and feel fortunate to call him my friend.
I’ve learned a great deal from Melinda since that day we met in 1987. I’m deeply proud of the family we raised together and the foundation we created together.
Finally, I want to thank Jenn, Rory, and Phoebe. The year in which I wrote this book was an incredibly difficult one for the world and, personally, for our family. I am grateful for their constant support and love. Nothing means more to me than being their dad.
NOTES
Introduction
The Chinese government had taken: Hien Lau et al., “The Positive Impact of Lockdown in Wuhan on Containing the COVID-19 Outbreak in China,” Journal of Travel Medicine 27, no. 3 (April 2020).
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Nick reported that diarrhea was killing: Nicholas D. Kristof, “For Third World, Water Is Still a Deadly Drink,” New York Times, Jan. 9, 1997.
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Photo: From The New York Times. © 1997 The New York Times Company. All rights reserved. Used under license.
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One of the most influential: World Bank, World Development Report 1993, https://elibrary.worldbank.org.
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There were 1.5 million new cases: World Health Organization (WHO), “Number of New HIV Infections,” https://www.who.int.
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It struck Madagascar in 2017: “Managing Epidemics: Key Facts About Major Deadly Diseases,” WHO, 2018, https://who.int.
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Figure: Endemic killers. Source: Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Global Burden of Disease Study 2019, https://healthdata.org.
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In 2000, these diseases killed: Institute for Health Metrics and Evaluation, GBD Compare, https://vizhub.healthdata.org/gbd-compare/.
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Photo: Eye Ubiquitous/Universal Images Group via Getty Images.
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Photo: Fototeca Storica Nazionale via Getty Images.
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In 2019, before COVID, tourists: Our World in Data, “Tourism,” https://www.ourworldindata.org.
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By that July: “2014–2016 Ebola Outbreak in West Africa,” Centers for Disease Control and Prevention (CDC), https://www.cdc.gov.
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Photo: Enrico Dagnino/Paris Match via Getty Images.
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In 2021, the White House announced: Seth Borenstein, “Science Chief Wants Next Pandemic Vaccine Ready in 100 Days,” Associated Press, June 2, 2021.
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Every year, influenza alone: WHO, “Global Influenza Strategy 2019–2030,” https://www.who.int.
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Chapter 1. Learn from COVID
Figure: The true toll of COVID. Estimated number of global excess deaths include official count of COVID-19 deaths, additional estimated COVID-19 deaths, and deaths from all causes attributed to complications stemming from the pandemic through December 2021. Source: Institute for Health Metrics and Evaluation (IHME) at the University of Washington (2021).
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Toward the end of 2021: Our World in Data, “Estimated Cumulative Excess Deaths Per 100,000 People During COVID-19,” https://ourworldindata.org/.
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Figure: Containing COVID in Vietnam. New cases per day (seven-day rolling average). Source: “Emerging COVID-19 Success Story: Vietnam’s Commitment to Containment,” Exemplars in Global Health program, https://www.exemplars.health (published March 2021; accessed Jan. 2022). Using data extracted from Hannah Ritchie et al., “Coronavirus Pandemic (COVID-19)” (2020), published online at OurWorldInData.org, https://ourworldindata.org/coronavirus.
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Its rate of excess deaths: Our World in Data, “Estimated Cumulative Excess Deaths per 100,000 People During COVID-19,” https://ourworldindata.org.
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IHME’s data also suggests: T. J. Bollyky et al., “Pandemic Preparedness and COVID-19: An Exploratory Analysis of Infection and Fatality Rates, and Contextual Factors Associated with Preparedness in 177 Countries, from January 1, 2020, to September 30, 2021,” The Lancet, in press.
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Uganda and its neighbors: Prosper Behumbiize, “Electronic COVID-19 Point of Entry Screening and Travel Pass DHIS2 Implementation at Ugandan Borders,” https://community.dhis2.org.
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Photo: Sally Hayden/SOPA Images/LightRocket via Getty Images.
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Photo: The Gates Notes, LLC/Ryan Lobo.
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To protect her family: “7 Unsung Heroes of the Pandemic,” Gates Notes, https://gatesnotes.com.
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Around the world, health care workers: WHO, “Health and Care Worker Deaths During COVID-19,” https://www.who.int.
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And expecting perfection: This account of David Sencer’s experience is based on this interview: Victoria Harden (interviewer) and David Sencer (interviewee), CDC, “SENCER, DAVID J.,” The Global Health Chronicles, https://globalhealthchronicles.org/ (accessed Dec. 28, 2021).
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In total, GBS cases occurred: Kenrad E. Nelson, “Invited Commentary: Influenza Vaccine and Guillain-Barré Syndrome—Is There a Risk?,” American Journal of Epidemiology 175, no. 11 (June 1, 2012): 1129–32.
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In 2021 alone, they accounted for: UNICEF, “COVID-19 Vaccine Market Dashboard,” https://www.unicef.org; and data provided by Linksbridge.
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But as the late educator and physician: Hans Rosling, Ten Reasons We’re Wrong About the World—and Why Things Are Better Than You Think (Flatiron Books, 2018).
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Chapter 2. Create a pandemic prevention team
In the year 6 CE: Michael Ng, “Cohorts of Vigiles,” in The Encyclopedia of the Roman Army (2015): 122–276.
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In America, there were volunteer groups: Merrimack Fire, Rescue, and EMS, “The History of Firefighting,” https://www.merrimacknh.gov/about-fire-rescue.
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There are now about: U.S. Bureau of Labor Statistics, “Occupational Employment and Wages, May 2020,” https://www.bls.gov/; National Fire Protection Association, “U.S. Fire Department Profile 2018,” https://www.nfpa.org.
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For nearly 800 years: Thatching Info, “Thatching in the City of London,” https://www.thatchinginfo.com/.
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