Bill Gates’s Pandemic Prevention Plan Has a China-Sized Blind Spot

In his now famous March 2015 TED talk, which has more than 40 million views online, Microsoft co-founder Bill Gates pleaded with the world to start preparing for the next infectious disease outbreak “because time is not on our side.” In many ways, Gates’s remarks were prescient, such as noting the next outbreak could be “a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market.” In his just-published book, How to Prevent the Next Pandemic, Gates taps into his public health expertise to identify lessons learned from the world’s dysfunctional response to the spread of COVID-19. Gates urges Washington to act decisively while the impact of COVID-19 is still fresh in our minds, lest complacency take over. However, the book’s recollections of the pandemic’s early days are quite selective, which prevents Gates from recognizing that political failures are at least as dangerous as scientific ones when governments are scrambling to stop an outbreak. Specifically, Gates fails to reckon with the Chinese government’s deliberate obstruction, obfuscation, and outright deception regarding COVID-19 during the first pivotal weeks of the crisis.

How to Prevent the Next Pandemic, Bill Gates, Knopf, 304 pp., $28, May 2022

Gates’s dedication to and credibility in the public health sector are unquestionable. Since 2000, the Bill & Melinda Gates Foundation has spent over $53 billion on public health initiatives. The organization initially focused on reducing mortality rates among children under 5 years old who were dying from diarrhea and pneumonia. Twenty years later, the mortality rate has been cut in half. The foundation is also the third-largest donor to the World Health Organization (WHO), spending $584 million in 2020 and 2021 to support a global program to eliminate polio.

Gates’s name is also synonymous with technological innovation, with him having co-founded Microsoft in 1975 with Paul Allen. Advancing innovation and technology in public health is an important element of Gates’s new book. He applauds scientists for developing multiple vaccines for a novel virus in about a year—an astonishing achievement considering the previous record was four years. Gates contends that scientists, after the next outbreak, should try to develop a vaccine in six months and develop infection-blocking drugs. He rightly focuses on the challenges of delivering vaccines to low-income countries and writes that we should develop vaccines that can be inhaled or taken as a pill, which would drastically simplify distribution by reducing the need for cold storage. While much of this may sound fanciful, we should recall that at the beginning of the COVID-19 pandemic, leading public health experts said it was “ridiculously optimistic” for the U.S. government to promise a vaccine within 12 to 18 months.

The central thesis of Gates’s book is that we can prevent the next pandemic by creating a global rapid-response organization that can stop the spread of the next lethal pathogen during the first pivotal weeks following its emergence.

Specifically, Gates recommends that the international community create a global epidemic response and mobilization (GERM) team—a permanent 3,000-person organization made up of experts in epidemiology, data science, logistics, communications, and other disciplines.

Gates estimates that GERM would cost $1 billion a year and says it should be funded by the governments of wealthy and some middle-income nations, which have the most to lose economically from a pandemic. In a new TED talk in April, Gates said, “We need to spend billions in order to save trillions.” He’s right about the magnitude of potential losses. The International Monetary Fund estimates that the COVID-19 pandemic will cost the global economy more than $12.5 trillion through 2024. Gates hopes his GERM concept will be adopted over the next year. The WHO would manage the team, and it could be created by a resolution at the World Health Assembly, the WHO member states’ annual meeting, which is convening this month in Geneva.

The GERM team, Gates writes, would develop “a checklist for pandemic preparedness, similar to the ones that airplane pilots follow before every takeoff and many surgeons now go through during an operation.” The GERM team’s most important role would be to run outbreak response exercises. “Just as militaries do complex exercises where they simulate different conditions and see how well they respond, the GERM team would organize outbreak response exercises,” Gates writes. “Not war games, but germ games.” He explains that “in most countries, these exercises can be run by national public health institutions, emergency operations centers, and military leaders,” with the GERM team “acting as an advisor and reviewer. For low-income countries, the world will have to bring in resources to help out.”

GERM’s mission would be to detect and stop outbreaks before they became pandemics. Once it spots a new outbreak, “GERM should have the ability to declare an outbreak and work with national governments and the World Bank to raise money for the response very quickly.” The organization “would take the lead on creating and coordinating common responses, such as how and when to implement border closures and recommend mask use.” Correctly, Gates observes that the measures necessary to prepare for naturally occurring threats also apply to preventing bioterrorism.

Where Gates begins to run into trouble is his unexamined assumption that national governments will give up control at pivotal moments to an international organization. The genesis of the COVID-19 pandemic teaches us that those governments may even insist there is no threat to address. In his book, Gates never mentions that Chinese leaders spent one month denying there was an outbreak at all.

On Jan. 30, 2020, WHO Director-General Tedros Adhanom Ghebreyesus declared COVID-19 a public health emergency of international concern. Gates heralds this announcement in the book but does not address what we now know about how China obstructed an effective response. For example, on Jan. 1, 2020, local officials in Wuhan, the center of the COVID-19 outbreak, censored eight whistleblowers for “rumor-mongering.” Their only crime was warning fellow medical professionals in late December 2019 of a novel virus outbreak.

China also delayed for a week the release of the virus’s genome, which is necessary to develop diagnostics and vaccines. An Associated Press investigation highlighted that “Chinese government labs only released the genome after another lab published it ahead of authorities on a virologist website on Jan. 11.” Beijing also withheld other crucial information from WHO officials throughout much of January 2020. The AP found that “China stalled for at least two weeks more on providing WHO with detailed data on patients and cases.”

The Chinese Communist Party has a history of obstructing reports of viral outbreaks. In 2003, then-WHO Director-General Gro Harlem Brundtland criticized Beijing’s response to the SARS outbreak, noting experts would have been able to help had they been called earlier. “Next time something strange and new comes anywhere in the world, let us come in as quickly as possible,” she said. Yet letting in foreign observers is rarely what governments want to do when their reputations are on the line.

He remains blind to the intensely political nature of public health decisions, fixating instead on technical solutions.

In making the case for GERM, Gates compares the organization to a global fire department, noting that “a pandemic is the equivalent of a fire that starts in one building and within weeks is burning in every country in the world.” In keeping with the analogy, China’s leaders stood outside a burning building in January 2020 and denied it was on fire. The fire eventually became too obvious, but by then the neighborhood was ablaze.

Disease surveillance is a consistent theme in Gates’s book, which includes an entire chapter titled “Get Better at Detecting Outbreaks Early.” Gates explains that “the world’s disparate disease surveillance systems need to be integrated so that public health officials can rapidly detect emerging and circulating respiratory viruses no matter where they emerge.” His approach to disease surveillance draws from his experiences in low-income countries that report outbreaks quickly and ask for assistance, and the GERM team is indeed a useful concept for addressing outbreaks in these countries. However, it does not hold up to scrutiny when compared with China’s actions to hide the COVID-19 outbreak. Beijing did not acknowledge the seriousness of the outbreak until late January 2020, despite evidence in late December 2019 that the new virus was similar to the one that caused the 2003 SARS outbreak.

Neither in the book nor during subsequent media appearances does Gates address this fairly obvious problem. He remains blind to the intensely political nature of public health decisions, fixating instead on technical solutions. Many of his prescriptions are valid and useful, but none are sufficient to prevent the next pandemic.

Without a full reckoning of what happened in the early days of this pandemic, the world will be doomed to repeat the devastation next time around.