In the year 6 CE, a fire devastated Rome. In response, Emperor Augustus did something
that had never been done before in the history of the Empire. He created a permanent
team of firefighters who used buckets just like this one. Augustus understood that individuals alone
can't protect themselves from fires. They need help from the community. When one person's house is on fire, that creates a risk
for everyone else's homes. And so what we've had these last few years
is like a horrific global fire. The COVID pandemic has killed millions
and upended economies, and we want to stop that
from happening again. COVID, it's hard to overstate
how awful it's been. It's increased the health inequities
between the rich and the poor. Survival depended partly
on your income, your race, the neighborhood you lived in. And so we should seize this opportunity to create a world
where everyone has a chance to live a healthy and productive life. Also a life free from the fear
of the next COVID-19. When I was on this stage in 2015, I was one of many people who said we weren't ready
and we needed to get ready.

We didn't. The speech actually was watched
by a lot of people. But 90 percent of the views
were after it was too late. (Laughter) So now I hope the need is clear. And of course, we've learned a lot. During this pandemic, a lot of things worked well,
a lot of things didn't work well. And so we have all that knowledge
to build a prevention system. COVID-19 can be the last pandemic
if we take the right steps. So how, what are these steps? Well, let's go back
and look at what the Romans did. Think about how, over time,
we've gotten good at preventing big fires. Fire prevention is kind of
this pervasive thing. It's well funded. It's well understood. If an alarm went off right now, everyone here would know
we're supposed to calmly gather, go out and wait instructions.

We'd know that help would be on the way because we have lots of trained
firefighters who practice. The United States alone has 370,000
full-time firefighters, even more than I guessed
that number would be. We also have access to water. The United States, for example,
has almost nine million fire hydrants. And so that type of investment,
that type of practice, that type of system
is what we need to stop pandemics. Now, often in movies,
we'll have pandemics. And I'm always impressed
with what takes place. Let's look at an example
of this rapid response. [Motaba River Valley, Zaire] (Helicopter rotors whirring) Well, that's quite impressive. We don't need the music, but otherwise we saw
exactly what should happen. An outbreak’s detected. Very quickly, literally within days, doctors are dispatched. They have a helicopter
to get into exactly ground zero. They go in there,
and they’ve got the right tools. And this is what should happen
when an outbreak is spotted. But we don't have that team,
we don't have those resources. And if an outbreak took place
in a low-income country, it could be literally months before we started to orchestrate
those resources.

So despite what you see in movies, there is no group of experts
standing by to prevent this disaster. So we have to create a new team. I believe we should create
what I call the GERM team. Germ stands for Global Epidemic
Response and Mobilization. This group is full-time. Their only priority
is pandemic prevention. It's made up of a diverse
set of specialists with a lot of different
realms of expertise: epidemiologists, data scientists, logistics experts. And it's not just scientific
and medical knowledge. They also have to have communication
and diplomacy skills. The cost of this team is significant. It's over a billion a year to support the 3,000 people
who would be on this team. And its mission is to stop outbreaks
before they become pandemics. The work would be coordinated by the WHO. They'd be present in many
locations around the world, stationed in public health agencies.

They'd work closely
with the national teams, depending on the income level. They'd have more
in the lower-income countries. You know, for example,
we could have GERM members say an epidemiologist, working
out of the Africa CDC office in Abuja. And a very important thing
is that like firefighters, a GERM team would do drills. When you want to have quick response, when you want to make sure
you have all the pieces there and you can move very quickly,
practice is key. That's how you make sure
everyone knows what to do. Now, this team, there could be periods
where there's no risky outbreak and they can keep their skills strong by working on some
of the other infectious diseases, but that would be a second priority. They would work with countries
to strengthen their health systems.

The health systems are the front line. You need to know if, say, a lot of people show up
with a new kind of cough, that’s when GERM needs to look into it
and say, is this an outbreak? Is there a new pathogen here? What is the sequence of that? And so for all of this,
the first 100 days are key. Viruses spread exponentially. And so if you get in there
when the infection rate is fairly small, you can actually stop the spread. You know, in this epidemic, if we'd been able to stop it
within 100 days, we would have saved
over 98 percent of the lives. Now, we did have countries
that did a good job. Australia is an example. They orchestrated diagnostic capacity. They came up with distancing policies
and quarantine policies. And so their overall death rate
per capita will be well less than a 10th of other countries. But we did not, as a world, contain it. And that's what we have to do next time. When COVID struck,
we were almost like Rome before they had
fire buckets and firefighters. We didn't have the people,
the systems or the tools we need.

Now, with the right investments, we can have a whole new
generation of tools, better diagnostics,
therapeutics and vaccines. A good example in the diagnostic area
is this little machine, this is called the Lumira. We can have these all over the world
that can test for any number of diseases. It’s a 10th as expensive as PCR, it’s absolutely as accurate,
and it’s simple. So it can be used anywhere. We need other R&D investments. One that I'm very excited
about is the idea of a drug that you inhale that blocks you
from getting infected. It can be pathogen-independent
and trigger your immune system so that you'll be protected. A lot of the tools, the diagnostic tools and those infection-blocking
tools are important because they can be staged in advance.

Now, we also need vaccines, but we want to stop the outbreak before we have to do
a global vaccination campaign. And so vaccines can play
a couple of different roles, but not the primary role. We have to invest in more than just that. When we look at vaccines,
they were the miracle of this epidemic. They saved millions of lives,
but they can be far better. We need to invent
easier-to-deliver vaccines that are just a patch you put on your arm or something that you inhale. We need vaccines that actually
block infections. In this case, there were lots
of breakthrough infections. We need vaccines that are broad spectrum, so they work against most
of the emerging variants, which we did not have this time.

And we also need factories
that are standing by so we can build enough vaccines
for the entire world within six months and achieve far better equity. The vaccines can also do something
that would be super helpful, which is to help us eradicate
entire families of viruses. Innovative new vaccines used properly
could get rid of the flu family, the coronavirus family. And there's a huge burden of those, even in non-pandemic years, and if we get rid of it,
it can never cause a pandemic. So I'm talking about investments
in three broad areas: Disease monitoring, that's GERM.

The R and D tools that are far better. And finally, and the most expensive,
is improved health systems. This won't be cheap, but it'll save lives. And even it'll save money in the long run. It's like an insurance policy. The cost to prevent the next pandemic
will be tens of billions of dollars. But let's compare that
to what we just went through. The IMF estimates that COVID
has cost nearly 14 trillion dollars. And so we need to spend billions
in order to save trillions.

And here's the best part of this. Even when we're not having an outbreak,
these investments like the Lumira, those new vaccines, they will make people healthier. They'll shrink the gap,
the health equity gap, which is gigantic,
between rich and poor countries. For example, we can detect more HIV cases
and do a better job of treatment. We can reduce deaths from malaria. We can get more people high-quality care. And so this is not just a downer about how to stop things
from getting worse, but also a chance to make things better. If we take the right steps, we can make COVID-19 the last pandemic, and we can build a healthier,
more equitable world for everyone.

Thank you. (Applause) Helen Walters: Thank you so much. I have a few follow-up questions and one is really
about the formal status of GERM. So you mentioned this would
cost a billion dollars, you mentioned it comes through the WHO, but exactly who's running this,
how does this work, how do we make this happen? BG: Well, GERM does not exist. It's a proposal I'm putting forward
that hopefully over the next year, while the pain of the pandemic
is still clear in people's minds, will get a global consensus. The rich-world governments
will have to step up like they do with all the aid things
and come up with that money. The way the personnel systems works,
so that it's under WHO, but a really top-notch team, there will be a lot of debate
about how to do that well. So, you know, I'm putting it forward and hopefully within the next year
we'll get that consensus.

HW: Who do you need to pick that up next? BG: Well, it's really
the rich-world governments. The WHO has this big yearly meeting,
the World Health Assembly, and at some point somebody
will put forward a resolution and we'll see if the extra resources
can be put in for that. After World War II, we did a lot. You know, we created the United Nations,
we talked a lot about war. So I'd be stunned, although, you know, so far the action has been less
than I would have expected, I'd be stunned if we don't go forward
with something pretty close to what I'm laying out there.

HW: This has been pretty personal for you. You know, the anti-vaxxers
are out there, they are loud, and this has become personal. I just wanted to ask, like,
how are you managing that? BG: Well, it's kind of weird. (Laughter) (Applause) Now, our foundation, the Gates Foundation,
is very involved in vaccines, the invention of new vaccines,
funding vaccines. And we're very proud that through
joint efforts like GAVI, that saved tens of millions of lives. So it's somewhat ironic to have somebody
turn around and say, no, you know, we're using vaccines to kill people
or to make money or, you know, we started the pandemic, even some strange things like,
that I somehow want to track, you know, the location of individuals because I'm so deeply desirous
to know where everybody is. (Laughter) I'm not sure what I'm going to do
with that information. (Laughter) You know, does this turn into
something where, you know, there's constantly
crazy people showing up? Who knows? But, you know, hopefully,
as the pandemic calms down, people are more rational about, hey, vaccines are a miracle
and there's a lot more we can do.

HW: So the future is
in our hands in the present. Bill Gates, thank you
so much for being here. BG: Thank you. (Applause).



Please enter your comment!
Please enter your name here