Bill Gates believes that the Ebola outbreak is only the beginning:
Of all the things that could kill more than 10 million people around the world in the coming years, by far the most likely is an epidemic. But it almost certainly won’t be Ebola. As awful as it is, Ebola spreads only through physical contact, and by the time patients can infect other people, they are already showing symptoms of the disease, which makes them relatively easy to identify.
Other diseases — flu, for example — spread through the air, and people can be infectious before they feel sick, which means that one person can infect many strangers just by going to a public place. We’ve seen it happen before, with horrific results: In 1918, the Spanish flu killed more than 30 million people. Imagine what it could do in today’s highly mobile world.
I worked on epidemics for a short time in college. My job was to “red team”: play out possible scenarios, often worst case, and imagine feasible responses to mass outbreak.
At the time, swine flu was the threat. It was heavy work — the red team scenarios, with mass casualties and mass chaos, were dire.
What happens when 10,000 people in NYC are infected with swine flu? What happens when waves of infected people try to leave NYC? At what point do we divide the city between sick and healthy? At what point does the health of the many outweigh the need of the sick?
Red teaming is necessary and eye-opening. As it turns out, there’s no functional response system and certainly no response force. In the best case scenario, handling the logistics — local, state, national, international — would be borderline impossible. Imagine the added layers of logistical difficulty with limited movement, mass casualties, and unprecedented social media saturation.
At this point, the only force that could possibly contain a global epidemic is the US military. Because of its reach, training, and logistical capability, the US military serves as the globe’s first responder. Like the 2004 Indonesian tsunami, the US military would be tasked with stabilizing the unstable. Disaster — natural or public health — and chaos are two sides of one coin.
But the US military should not be solely responsible for wide-scale disaster response.
To get in front of the Next Big One, I wonder what lessons we can learn from relatively successful public health campaigns, especially the AIDS epidemic. AIDS is of course heavily stigmatized, so the comparisons may be difficult, but the health-led progress is undeniable. If the AIDS campaign has been successful by combining public policy, healthcare innovation, and a public awareness campaign, how can we do the same thing for a looming epidemic? To start, by acknowledging its possibility.
Originally published at brendanhartdotcom.wordpress.com on March 18, 2015.
