Not Preparing for the Next Pandemic

A terrific commentary (Bill Gates, NEJM 2018; 378: 2057-60) explains how we are NOT preparing for the next pandemic and what we should be doing and why.

Key points:

  • There has been incredible progress in many areas of global health and infectious diseases.  In fact, “child mortality has decreased by more than 50% since 1990.”  HIV is no longer “a certain death sentence” and there has been progress with malaria.
  • Yet, “there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime.”  Some recent events have alerted us to this risk, including swine flu in 2009, Ebola in 2014 as well as recent MERS (Middle East respiratory syndrome) and SARS (severe acute respiratory syndrome).
  • “We need better tools, an early detection system, and a global response system.”
  • “A simulation by the Institute for Disease Modeling shows what would happen if a highly contagious and lethal airborne pathogen, like the 1918 influenza, were to appear today.  Nearly 33 million people worldwide would die in just 6 months.” (see below)
  • Vaccine development holds some promise to protect against many pathogens.  One step to help with vaccines has been a public-private venture, Coalition for Epidemic Preparedness Innovations (CEPI).
  • Vaccines alone are not enough as they take time to stimulate immunity and often not enough people receive them.  “So we need to invest in other approaches, such as antiviral drugs and antibody therapies that can be stockpiled.”

My take (borrowed): “”If it were a military weapon [threat], the response would be to de everything possible to develop countermeasures.  In the case of biologic threats, that sense of urgency is lacking.  But the world needs to prepare for pandemics in the same serious way.”

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