Bill and Melinda Gates write their annual letter to . . . well, the world, really, and make a sensible recommendation that has one glaring problem that they don’t address.
To prevent the hardship of this last year from happening again, pandemic preparedness must be taken as seriously as we take the threat of war. The world needs to double down on investments in R&D and organizations like CEPI that have proven invaluable with COVID-19. We also need to build brand-new capabilities that don’t exist yet . . .
First, we need to spot disease outbreaks as soon as they happen, wherever they happen. That will require a global alert system, which we don’t have at large scale today. The backbone of this system would be diagnostic testing. Let’s say you’re a nurse at a rural health clinic. You notice that more patients are showing up with coughs than you’d expect for this time of year, or maybe even that more people are dying than normal. So, you test for common pathogens. If none of them test positive, your sample is sent elsewhere to get sequenced for further investigation.
If your sample turns out to be some super infectious—or entirely new—pathogen, a group of infectious disease first responders springs into action. Think of this corps as a pandemic fire squad. 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. I estimate that we need somewhere around 3,000 responders throughout the world.
We more or less already have a global alert system in place, just not at the “large scale” that the Gates envision. The problem with the SARS-CoV-2 pandemic wasn’t really that we didn’t have enough well-trained doctors looking for answers when an unusually high patients showed up with coughs. The problem was that those doctors tried to pull the alarm, and the government authorities above them kept shutting down the alarm until it was too late.
Chinese doctors were collecting samples and identifying the presence of a previously unknown virus strain by late December. By December 27, 2019, Zhang Jixian, director of the respiratory and critical-care-medicine department of Hubei Provincial Hospital of Integrated Chinese and Western Medicine, sent a report declaring the discovery of a new “viral disease, probably infectious,” to the district-level center for disease control and prevention. By December 30, Dr. Li Wenliang sent a message to a group of other doctors warning them about a possible outbreak of an illness that resembled severe acute respiratory syndrome (SARS), urging them to take protective measures against infection.
All of those parts of the Chinese medical system worked fine!
No, the biggest problem in this pandemic is that once the virus was discovered, local and national health authorities in China did not want to admit to the world that they had a serious problem on their hands, and did everything they could to cover up and downplay the extent of the threat.
On the last day of 2019, the Wuhan Municipal Health Commission declared, “The investigation so far has not found any obvious human-to-human transmission and no medical staff infection.” This was the opposite of the belief of the doctors working on patients in Wuhan, and two doctors were already suspected of contracting the virus.
The next day, “after several batches of genome sequence results had been returned to hospitals and submitted to health authorities, an employee of one genomics company received a phone call from an official at the Hubei Provincial Health Commission, ordering the company to stop testing samples from Wuhan related to the new disease and destroy all existing samples.”
According to a New York Times study of cellphone data from China, 175,000 people left Wuhan that day. On January 3, “China’s National Health Commission, the nation’s top health authority, ordered institutions not to publish any information related to the unknown disease, and ordered labs to transfer any samples they had to designated testing institutions, or to destroy them.”
The Chinese government didn’t even contact the World Health Organization until three weeks after the first reported cases. Until January 19, the Chinese National Health Commission was insisting the virus “still preventable and controllable.” The WHO, following China’s lead, echoed their assessment, concluding, “Not enough is known to draw definitive conclusions about how it is transmitted, the clinical features of the disease, the extent to which it has spread, or its source, which remains unknown.” The virus had been spreading for six weeks, and was in at least five countries by then.
The “global alert system” that Bill and Melinda Gates envision will only work if national governments are willing to be honest with themselves, to their citizens, and to the world about the potential threat of a new virus. Totalitarian and authoritarian regimes are much less honest with their publics and the world about their problems, lest it undermine public faith in their dear leader. Autocratic strongmen will choose just about any option other than admitting, “We’ve got a problem that is too big for us to solve by ourselves.”
The Gates’ proposed “global alert system” would probably do a good job at ensuring the world is quickly informed about novel contagious diseases in free societies. But those societies are already the ones most likely to quickly sound the alarm.