Future pandemic prevention plans must focus on Africa, says Bill Gates

Half of the risk of the emergence of the next pandemic comes from Africa, according to Bill Gates, who says a new global organisation must be created to face down future pandemic threats after the havoc of Covid-19.

Speaking to promote his new book, How to Prevent the Next Pandemic, Gates, the founder of Microsoft and a billionaire philanthropist, said that the continent must be a focus of efforts to ward off the next devastating disease.

“50% of the risk of an emergence comes off of the continent of Africa, where you have lots of humans interacting with animal species. That’s what we saw with HIV and Ebola. Of course, with the flu and both SARS-CoV-1 and SARS-CoV-2, it came out of Asia, so we have to be ready for it to emerge anywhere. But the quicker we see it, the better,” said Gates, who co-chairs the Bill & Melinda Gates Foundation.

In a bid to monitor future pandemic risks, Gates uses his book to call for the creation of GERM (Global Epidemic Response and Mobilization), “a full-time, paid team whose entire job is to prevent pandemics”. He estimated that GERM, which he would cost around $1bn a year, would need about 3,000 full-time employees with expertise in epidemiology, genetics, drug and vaccine development, data systems, diplomacy, rapid response, logistics, computer modelling and communications. The team should be decentralised, with many staff based at individual countries’ national public health institutes, he said, and will also work closely with WHO colleagues on threat monitoring. 

Gates said that setting up the new team, which he says should be managed by the World Health Organization, could be the quickest and most effective way to track future pandemic threats.  

“I think while this is still in our mind, that’s when we really ought to have the debate…we should design a system that’ll work not just for this one, but for the future threats as well,” said Gates.

“To me, in a way, because GERM is so cheap compared to the cost of this pandemic, it feels pretty obvious that we should do it. But it’s not very often we add something at the global level. The WHO’s responsibility has not included having a significant full-time pandemic team.”

Gates said that such a team could bring a collaborative approach to research, data collection and analysis, and cast a spotlight on the global health inequities that give rise to pandemics.

“The world doesn’t have global government, we work through these UN organisations, including the WHO, and the process of adding a new capacity at that level and making sure that it’s well funded and well-run takes time. I think it’s important for both the research agenda, some of which is going to take 5 to 10 years for that global capacity…and for highlighting the (global health) inequity.

“And so only a global organisation can ask all the countries to do these exercises, asking them to report the data, and then understand, okay, for some of the developing countries, the global capacity will have to help them more.”

Vaccine conundrum

Gates said that valuable lessons had already been learned from the Covid-19 pandemic, including that ensuring Africa has independent vaccine manufacturing capacity is less vital than ensuring effective distribution systems.

In 2021, the Gates Foundation, which is one of the largest donors to Gavi, the Vaccine Alliance, called for high-income countries to share at least 1 billion excess Covid-19 doses with lower-income countries to accelerate global vaccine access. 

Gates said that most vaccinations which might have been expected to fail ended up being “very good vaccines” for preventing severe disease and death, meaning that there was no shortage of available vaccines.

“Because building up regulatory capacity in vaccine factories is like a decade-long thing, it was never very likely that, starting from scratch during the pandemic, that a new site would make any contribution to the global vaccine availability…The limit to vaccination is not supply. It’s demand and the logistics of getting these huge number of vaccines, which at least in some respects are very, very good. I’m not sure every country should make everything itself. I think there will still be intercontinental trade for some things, but the path forward is better regulatory science, better understanding of where the new market opportunities are.”

Gates also said a focus on vaccines should play second fiddle to diagnostics in future pandemic prevention. 

“I wouldn’t overfocus on vaccines, though. I mean, if you want to stop pandemics, diagnostics are way more important. It’s only once the pandemic gets out of control that then you go to vaccines.”