Can Anyone Out-Plan a Pandemic?
Bill Gates has a strategy to save the world from the next infectious threat. He’s not the first.
In this, the season of Bill Gates’s atonement, the billionaire is willing to acknowledge that things don’t always turn out as they should have, and that—at least in some cases—that’s on him. There was the high-profile divorce from his wife of 27 years, Melinda French Gates (“definitely a sad thing,” he said); allegations of an affair and inappropriate flirting at work (“false, recycled rumors,” a spokesperson insisted); and his association with the convicted sex offender Jeffrey Epstein (a “big mistake” on a whole list of them).
But Gates is not one to dwell on the painful past, particularly when that past conflicts with his arduously cultivated image as the world’s preeminent techno-savior. Bill Gates is a doer. And a fixer. And the thing he’s most focused on now is how he can help save the world from the next pandemic. After all, he’s seen for himself that no one man—not even a president, not even an innovator, not even a billionaire—was able to stave off this one.
I recently met with Gates, whose foundation has long preoccupied itself with global public-health initiatives, to talk about what he might do differently next time, and what we can learn from the hell of the past two years. His obsession with the subject is honorable, but I had to notice that his approach felt a little, well, predictable. Gates bets big on futuristic biotech—a library stocked with millions of antiviral drugs, for example, and machines that can test 150,000 samples a day for multiple pathogens. But the major building blocks for his plan are decades old: He wants better disease surveillance; more drugs to treat the infected; and enough shots to vaccinate as many people as possible, as quickly as possible. How should we prevent the next pandemic? By doing the things we try to do already—only better.
Much of the world’s response to the coronavirus—and America’s response in particular—has been, to put it lightly, a mess. It’s telling of our sorry situation that Gates’s grandest ambitions are simply to do the most basic things right—to have a real plan and stick to it. But while one big lesson of the pandemic has been how badly plans are needed, another has been how easily even the best ones fail.
I spoke with Gates at the Washington, D.C. Four Seasons hotel, in a windowless basement conference room at a table lined with empty chairs and unopened water bottles. Gates was on a multicity promotional tour for How to Prevent the Next Pandemic, a book that lays out in 215 pages his vision for avoiding future catastrophic global illness. A few notable points: Governments should encourage innovation, cut red tape, and agree to manufacture game-changing global-health tools. Everyone in the world should have access to good primary health care. One chapter focuses on organization; each country should appoint a pandemic czar, it says, while the whole world creates a full-time pandemic-prevention organization called “the GERM (Global Epidemic Response and Mobilization) team.” The next chapter focuses on improving disease surveillance, another on practicing the world’s response through simulated outbreaks, and so on.
The book is in fact Gates’s second about averting an existential global crisis in just as many years. His first world-saving manifesto, How to Avoid a Climate Disaster, came out in February 2021. Although saving all of humanity is indeed a grand mission, Gates’s choice to do so by way of a $19 hardcover is somewhat quaint, if not outright confusing. He is one of the world’s richest human beings. He takes private meetings with prime ministers and presidents, and pours money into projects that tackle—among other things—education, tobacco control, nutrition, maternal health, and a slate of diseases. (Disclosure: The Bill & Melinda Gates Foundation also has supported some Atlantic events and projects.) What good does a book do?
Gates sipped from a can of Diet Coke while he listened to this question. Then he failed to answer me at great length, instead going on an extended jag about the good his foundation and wealth have done. With How to Prevent the Next Pandemic, he said finally, “I thought I had an opportunity to be somewhat educational and frame in a fairly straightforward way what things would make it very, very different next time.” He told me that he hoped his writing would help readers understand complicated issues in a nonpartisan way. (A book, it’s worth noting, is also one way to attempt to shift public focus from questions about your failed marriage, or alleged impropriety at work, or friendship with a sexual predator.)
I asked Gates whether many parts of his pandemic-prevention scheme weren’t already embedded in preexisting plans. He didn’t deny it, but argued that new inventions and research would pave an easier path to success this time around. We have mRNA vaccines, he told me; we have Gavi, the Vaccine Alliance, which helps poor countries buy immunizations (and has received more than $4 billion from the Gates Foundation); and crucially, “we have a much better understanding of why people die.”
Gates is, in this way, an optimist. To believe that you need only a plan rests on an assumption that humans are rational creatures who have roughly the same values and priorities as you do, and—even more improbable—that humans are inclined to follow plans of any kind. After all, when Gates laid out a strategy for solving climate change last year, he was boldly going where world leaders had gone many, many times before without success. The United Nations has held no fewer than 26 annual climate-change conferences. The world committed to the Kyoto Protocol in 1997, but failed to meet its goals. The Paris Agreement is seven years old, and the UN itself says we’re falling short. But Gates told me that the plan he offered in How to Avoid a Climate Disaster has already done some good for the planet. “I feel like the book played a strong role in getting the dialogue onto the only way to square the circle, which is through innovation,” he said. In the meantime, Gates is pursuing a billionaire’s more traditional channels of persuasion: access to other people in power. “I have an ongoing conversation with Joe Manchin about climate-related things,” he told me. “You know, the tax credits that may or may not make it into some reconciliation bill.”
Like the world’s unmet climate goals, the graveyard of unfollowed pandemic plans is dispiriting. Gates’s new book cites a report published by the International Health Regulations Review Committee after the 2009 swine-flu outbreak, which “prophetically” concluded that the world was not ready for a pandemic—but its advice went unheeded. By March 2020, the Trump administration was lagging severely behind on many steps of a 2016 pandemic plan from the National Security Council and utterly flouting others. Before Joe Biden took office, he released yet another pandemic plan that included a promise to “ensure equity throughout the vaccination process” and make shots widely available for free; in reality, Black and Hispanic Americans didn’t receive vaccines as quickly as their white peers, and uninsured people might need to pay out of pocket for future doses.
Gates assured me that this time, the plans would be followed. “I don’t think either party is for pandemic death” in the U.S., he said, and global health is much cheaper than other world-saving projects. Gates writes in his book that the GERM team could run on a cool $1 billion a year, while the improvements the team would recommend to individual governments would cost a total of $15 billion to $20 billion a year over a decade, for the whole world. Compare that with the Green New Deal, which would probably cost Americans between $10 trillion and $93 trillion.
After so much death and suffering over the past two-plus years, Gates told me, “it would be so weird, so—you know—irrational, not to fund something.” The choice seemed so obvious, he said, that he’d been worried, while writing the book, that people would tell him, “Well, Bill, of course, we all know that. You didn’t need to write that down.” He figured that by the time the book came out, his plan, or something like it, would already be in motion.
Now he’s less confident, especially since Russia began its war on Ukraine. If fuel and fertilizer become harder to find, and inflation continues, and national budgets become too bloated with defense spending, and powerful people become distracted, then “that creates the risk, along with the polarization we’ve got, that maybe we won’t fund pandemics, which is stunning,” he said. “I’m mostly optimistic, but governments doing the right things is, you know—it’s a challenge. And the level of discussion about preparing for the next pandemic is less than I would have expected.”
But like any master planner, Gates has a contingency. The last chapter of How to Prevent the Next Pandemic, a book that is effectively a giant plan with lots of context, is called “Make—and fund—a plan for preventing pandemics.” A plan for making a plan: Now, who wouldn’t get on board with that?
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