Tess Pennington - The Coronavirus Preparedness Handbook: How to Protect Your Home, School, Workplace, and Community from a Deadly Pandemic (Covid-19)

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Copyright 2020 by Tess Pennington

Bill Gates article on page 213 First published in The New England Journal of Medicine, Feb 28, 2020

Copyright 2020, Massachusetts Medical Society, reprinted with permission

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Contents

Responding to COVID-19 A Once-in-a-Century Pandemic?

By Bill Gates

First published in The New England Journal of Medicine, Feb 28, 2020 Copyright 2020, Massachusetts Medical Society, reprinted with permission

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 isnt 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 weve been worried about. I hope its 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 viruss 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.

Its essential to help LMICs strengthen their primary health care systems. When you build a health clinic, youre also creating part of the infrastructure for fighting epidemics. Trained health care workers not only deliver vaccines; they can also monitor disease patterns, serving as part of the early warning systems that alert the world to potential outbreaks.

We also need to invest in disease surveillance, including a case database that is instantly accessible to relevant organizations, and rules requiring countries to share information. Governments should have access to lists of trained personnel, from local leaders to global experts, who are prepared to deal with an epidemic immediately, as well as lists of supplies to be stockpiled or redirected in an emergency.

In addition, we need to build a system that can develop safe, effective vaccines and antivirals, get them approved, and deliver billions of doses within a few months after the discovery of a fast-moving pathogen. Thats a tough challenge that presents technical, diplomatic, and budgetary obstacles, as well as demanding partnership between the public and private sectors. But all these obstacles can be overcome.

One of the main technical challenges for vaccines is to improve on the old ways of manufacturing proteins, which are too slow for responding to an epidemic. We need to develop platforms that are predictably safe, so regulatory reviews can happen quickly, and that make it easy for manufacturers to produce doses at low cost on a massive scale. For antivirals, we need an organized system to screen existing treatments and candidate molecules in a swift and standardized manner.