Many will have heard Bill Gates’s 2015 call to arms urging world leaders to prepare for a major pandemic. But scientists and epidemiologists have been making similar, more detailed warnings for years. These include Dr Jonathan Quick, who wrote The End of Epidemics, subtitled The looming threat to humanity and how to stop it (Scribe UK, £19), in 2018. It is a clear, concise and compelling analysis of the danger.
The fear that drove Dr Quick to write the book was Bill Gates’s prediction that a global outbreak like the 1918 influenza pandemic that killed 50-100 million people would happen again and that in the first 200 days it could kill 33 million. Bank of America argued that a severe pandemic could claim more than 300 million lives and reduce global GDP by between 5% and 10%. Yet such a pandemic is not inevitable. Quick sets out seven actions that could prevent it.
While Spanish flu was the most deadly pandemic of the last 100 years, Quick charts 13 others, including two coronaviruses (Sars and Mers), two Ebola outbreaks and HIV/Aids. So pandemics are not rare. What’s more, “75% of new human infectious diseases have originated in animals, the majority in wildlife”, he says. “Somewhere out there, a dangerous virus is boiling up in the bloodstream of a bird, bat, monkey or pig preparing to jump to a human being”. Why aren’t we doing more to prevent this turning into a global catastrophe? “Fear... denial, complacency, dithering and financial self-interest”, all of which characterised the early phases of Aids, Sars and Ebola.
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WHO needs a strong leader
The same pandemics provide hard-learned lessons for dealing with or preventing future ones. The first requirement is leadership. Quick attributes the eradication of smallpox, which killed 300-500 million in the last century, to the determination of a single-minded physician. The decisiveness of one head of the World Health Organisation (WHO) contained Sars. The next requirement is strong national health systems and robust international agencies that learn from their mistakes, respond speedily and involve the private sector, charities and international expertise. In addition to the direct human cost, “major epidemics can shred routine health care”. In Africa’s 2014-2016 Ebola outbreak, this killed as many people as the disease.
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Third is “active prevention, constant readiness” to stop killer diseases before they spread. Prevention includes understanding the risks from modern factory farming as well as from bushmeat, thereby identifying and anticipating the development of infections. Vaccines, meanwhile, are not a panacea. There is no proven vaccine for every threat. “Too many vaccines aren’t affordable and production methods are antiquated – most are grown in chicken eggs, which takes months.” As for stopping the spread of a pandemic, “social distancing is never popular, but it works”.
Trustworthy and timely communication is crucial too. “In the face of an epidemic, terror, blame, rumours and conspiracy theories, distrust of authorities and panic can take hold simultaneously.” For the media, fuelling fear increases readership, but people want the truth. Social media is a double-edged sword. It spreads scepticism about vaccines, for example, but helps with the fifth requirement: mobilising public opinion and business leaders.
The price of prevention
Innovation goes well beyond vaccines, the holy grail for which is a universal one that protects against all types of flu. Gene modification can help control mosquitoes, “the most dangerous creatures on earth for humans, infecting nearly 700 million people each year and killing more than a million”. Low-cost rapid tests for a wide range of pathogens, a global early-warning system based on thorough data analysis (“major epidemics are more or less predictable”) and mapping the genes of half a million potential viral enemies are all needed as “the pace of innovations is not even close to keeping pace with the accelerating risk of infectious disease outbreaks”. Collaboration and leadership is required; “WHO is the only organisation able to carry out such a task”.
Finally, preventing pandemics is surprisingly cheap. “The equivalent of just $1 for every person on the planet per year ($7.5bn annually) will save lives and pay for itself.” This is a tiny fraction of what we spend cleaning up after global diseases, yet funding rises when pandemics are in the news and falls thereafter. When the WHO was required to cut $1bn from its budget in 2008, the pandemic response department was dissolved, slowing its ability to respond to Ebola. Quick estimates a payback ratio for monetary savings relative to the cost of preventative spending of 10.2 in a catastrophic economic scenario and 3.4 in a mild one.
Quick’s analysis has stood the test of the Covid-19 pandemic well. The economic cost is clearly far greater than was expected relative to the number of infections and deaths. That the developed world, notably Italy, New York and the UK, has been the worst affected may spur it into action and forestall a far more deadly air-borne pandemic. Or is the lesson of history that the lessons of history are never learned?
