I. Bill Gates is an optimist
... Hell, he can measure them getting better. Child mortality has fallen by half since 1990. To him, optimism is simply realism.
...
"Look at the death chart of the 20th century," he says, because he's the kind of guy that looks at death charts. "I think everybody would say there must be a spike for World War I. Sure enough, there it is, like 25 million. And there must be a big spike for World War II, and there it is, it's like 65 million. But then you'll see this other spike that is as large as World War II right after World War I, and most people, would say, 'What was that?'"
"Well, that was the Spanish flu."
II. The most predictable threat in the history of the human race
...
In a 1990 paper on "The Anthropology of Infectious Disease," Marcia Inhorn and Peter Brown estimated that infectious diseases "have likely claimed more lives than all wars, noninfectious diseases, and natural disasters put together." Infectious diseases are our oldest, deadliest foe.
And they remain so today. "In a good year, flu kills over 10,000 Americans," says Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. "In a bad year, it kills over five times that. If we have a pandemic, it will be much worse. People think the H1N1 flu wasn’t so bad. But more than 1,000 American kids died from H1N1!"
III. The "luck" of the Ebola outbreak
...
Ebola, Klain thinks, shows how unprepared the world was for a disease that it's known about for decades and that, comparatively speaking, spreads pretty slowly. A person infected with Ebola can be expected to pass the disease on to two people, barring effective countermeasures (epidemiologists call this the "reproduction number"). Two is not that high, as these things go. The SARS virus had a reproduction number of four. Measles has a reproduction number of 18.
IV. How human beings have helped infectious disease
... But then he used it to look into how a disease that acted like the Spanish flu of 1918 would work in today's world.
The results were shocking, even to Gates. "Within 60 days it's basically in all urban centers around the entire globe," he says. "That didn't happen with the Spanish flu."
V. Underdeveloped health systems threaten developed countries
...
According to the World Health Organization, the United States spends more than $8,000 per person, per year, on health care. Eritrea spends less than $20. Traditionally, Americans thinks of that as Eritrea's problem. But if a highly infectious, highly lethal new disease presents in Eritrea, and the world is slow to learn about it, then it will quickly become America's problem.
This is, of course, what happened with Ebola. If it had made its first appearance in the United States, it likely would have been caught, and contained, quickly. But as my colleague Julia Belluz wrote, the countries where the 2014 outbreak began "happen to be three of the poorest in the world, and it took them at least three months to even realize they were harboring an Ebola outbreak." By the time Ebola was recognized, it was already out of control — and so, for the first time, it made its way to American shores.
VI. "Are we sure [the WHO] can do better next time? No."
... The first is countries that don't want to admit they need international help because they don't want to admit they have a problem in the first place.
... The second is countries that can't admit international help, either because the state is too weak and fragmented to effectively coordinate with international actors or because the state is hostile to the organizations that would need to come in and offer relief.
... The third problem is that no one really trusts the efficacy of the international institutions that would most naturally coordinate the response.
