"[P]andemic preparedness must be taken as seriously as we take the threat of war."
That's according to the Bill and Melinda Gates Foundation's annual letter published Wednesday.
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Although the Covid pandemic is still raging, the billionaire philanthropist has ideas about how the world can better address the next pandemic.
Gates, whose foundation has committed $1.75 billion in the fight against Covid to date, wrote that the world needs to be spending tens of billions of dollars each year on pandemic preparedness.
"I think of this as the best and most cost-efficient insurance policy the world could buy," he said.
Here are strategies that Gates believes will help future outbreaks:
At the start of the pandemic, the United States lagged behind many countries in terms of diagnostic testing capacity.
"By the next pandemic, I'm hopeful we'll have what I call mega-diagnostic platforms, which could test as much as 20% of the global population every week," Gates wrote. (In the past, Gates has discussed the need for more efficient tests, like at-home rapid tests.)
In addition to testing, Gates pointed to promising therapeutic treatments, such as monoclonal antibodies, which have been shown to be effective at reducing the risk of death and hospitalization from Covid. Monoclonal antibodies are laboratory-produced molecules that mimic the immune system's ability to fight off harmful antigens such as viruses, according to the Food and Drug Administration.
The success of messenger RNA vaccines (both the Pfizer and Morderna Covid vaccines are RNA) is another reason to be hopeful. They "essentially turn your body into its own vaccine manufacturing unit," Gates wrote in an April 2020 blog post. And RNA vaccines are more versatile and can be manufactured more easily and faster than conventional vaccines.
The efficiency of RNA vaccines will only increase: "I predict that mRNA vaccines will become faster to develop, easier to scale, and more stable to store over the next five to ten years," Gates said in the foundation's annual letter. "That would be a huge breakthrough, both for future pandemics and for other global health challenges."
In early December, Gates said that there needs to be a team of 3,000 infectious disease experts whose job it is to spot and quickly address a pandemic when it arises.
"Think of this corps as a pandemic fire squad," Gates wrote in the letter. "Just like firefighters, they're fully trained professionals who are ready to respond to potential crises at a moment's notice."
"When they aren't actively responding to an outbreak, they keep their skills sharp by working on diseases like malaria and polio," Gates said.
There should also be a large scale "global alert system" that healthcare workers can use to log patient data, identify trends and ultimately pick up on a pandemic sooner, he added. (Smaller decentralized systems for spotting infectious disease outbreaks exist. For example, last year, the Canadian startup BlueDot used its artificial intelligence platform to pick up on a cluster of pneumonia cases in Wuhan, China before the pandemic was declared.)
In order to stay prepared, Gates suggested worldwide "germ games," which are organized and sophisticated "simulations that let [experts] practice, analyze, and improve how we respond to disease outbreaks, just as war games let the military prepare for real-life warfare," Gates said.
Before the pandemic, the United States did not have ample experience handling respiratory outbreaks, which is one of the reasons the country's response was delayed and fragmented. Simulations could help train and prepare the groups of infectious disease experts.
"Speed matters in a pandemic," Gates said. "The faster you act, the faster you cut off exponential growth of the virus."