The Economist May 7th 2022 77
CulturePreventingdiseasesThe GERM of a good idea
F
irst, the climate. Next, plagues. Bill
Gates’s career-switch from entrepre-
neur and philanthropist to crusading au-
thor is developing nicely. It is just over a
year since he published “How to Avoid a
Climate Disaster”. Now he sets out to ex-
plain “How to Prevent the Next Pandemic”.
Both books consider what might be
described as human-created natural disas-
ters. Some disasters—hurricanes, earth-
quakes, tsunamis—are purely natural. The
best people can do when dealing with
these is to anticipate them through things
like warning systems, planning codes and
reinforced buildings. Others, such as war,
have human causes. They may sometimes
have a natural trigger, such as a drought
that sets populations on the move. But hu-
man beings inflict the damage.
Climate change and epidemics are half-
way between these extremes. They are
caused by people interacting with nature—
in one case by altering the atmosphere’s
chemical make-up, in the other through
actions ranging from inadequate disposal
of sewage to international jet travel and
sexual activity. As Larry Brilliant, one of the
epidemiologists who helped to eradicatesmallpox, observes, “Outbreaks are inev-
itable [the nature part of the equation] but
pandemics are optional [the human part].”
And that provides an opening for the sort
of techno-optimistic approach that Mr
Gates loves.
One pandemic that might have been op-
tional had it been spotted early enough—
aids—has been in his cross-hairs for years,
as part of the activity of the foundation he
runs jointly with his ex-wife Melinda
French Gates. aidshas killed some 36mpeople, most of them since it came to the
attention of medical science in 1981. Yet
subsequent analysis has shown it had been
spreading in Africa for decades. A better
early-warning system could have picked it
up in the 1950s, rather than the 1980s,
allowing it to be tackled much earlier.
Sexually transmitted infections,
though, spread slowly. Airborne ones
spread fast—particularly in an era of mass
international travel. Early detection is vi-
tal, and is the first item on Mr Gates’s list of
things to accomplish. Others include help-
ing people protect themselves; finding
new treatments; and developing vaccines.
And practice drills: he is big on the idea
that, just as military forces drill and earth-
quake-response teams drill, so should
those tasked with combating pandemics.
But who should those people be? That is
the nub of the book. Armed forces and
civil-defence teams are national responsi-
bilities. But pathogens know no borders,
and governments, in any case, are curious-
ly uninterested in contingency planning
for new diseases. While covid-19 remains
fresh in people’s minds, Mr Gates sees an
opportunity to correct this.
He suggests creating a global “fire bri-
gade” of 3,000 experts scattered around the
world, recruited for skills ranging from
epidemiology and genetics, through drug
and vaccine development and computer
modelling, to diplomacy. This outfit,
which would probably work under the aus-
pices of the World Health Organisation,
would remain on permanent standby, rea-
dy to respond to any detected outbreak.A founder of Microsoft wants to reboot the world’s response to pandemics→Alsointhissection
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81 Johnson: Dangling participlesHow to Prevent the Next Pandemic.
By Bill Gates. Knopf; 304 pages; $28.
Allen Lane; £25