The WHO estimates that the Covid-19 pandemic has killed nearly 15 million people worldwide – not just from the virus, but also as an indirect result of the crisis, such as not being able to get other types of medical care because hospital systems were overloaded. But it didn’t have to be so disastrous. Experts say its impact was compounded by a number of factors: the world was ill-prepared for a pandemic, many countries were slow to develop access to Covid-19 testing, and economic inequality made things worse.
Low- and middle-income countries still struggle to access life-saving vaccines, putting these populations at risk of contracting the virus. In the US, a preprinted paper found that working-class Americans were five times more likely to die from Covid-19 than college-educated Americans. In general, the pandemic has also greater global income inequalitypartly because rich countries have been able to provide more economic aid to their residents, while poorer countries have had far fewer resources to recover.
Two years after Covid-19 was declared a pandemic, Bill Gates wrote: How to avoid the next pandemic?, a book that outlines how the co-founder and global health expert of the Bill and Melinda Gates Foundation believes the world should prepare for future health crises — including how to tackle the enduring problem of economic inequality, which puts already vulnerable people at even greater risk. walk . In the US, poverty rates fell in 2021 due to spending on pandemic relief, such as stimulus measures and the expanded child tax credit. But since then, poverty has risen againof child poverty rates are rising sharply after the expiry of the extended child discount, which gave many parents a monthly benefit from July to December 2021.
Here are five ideas Gates explored with Recode via email on how to account for economic inequality in preparing for the next pandemic. The interview has been slightly edited for clarity.
In your book, you mention how wary people are of the great influence wealthy philanthropists have today — while also acknowledging that many governments failed to act sufficiently when the pandemic hit.
How do we ensure that the government can resign next time? Do you see it mainly as a matter of funding the right agencies (and would that require higher taxes)? Is it a matter of political will? Is it something else?
I am hopeful that after the past two years – with millions of lives lost and trillions of dollars in economic impact – every country now understands that they need to be better prepared at the government level. Philanthropy can help test new ideas and mobilize resources faster than government, but pandemic prevention must be funded and supported for the long term, and it requires global collaboration. The world cannot and should not rely on philanthropy to guide it.
In my book, I write that governments should prepare for outbreaks and prevent pandemics just as they fund fire and earthquake prevention measures and practices. To end preventable diseases and prevent emerging diseases from becoming pandemics, governments will need to invest more in R&D for vaccines and therapies, integrated disease monitoring and well-funded multilateral organizations, such as the World Health Organization (WHO). They will also need to make greater investments to improve primary health care in all countries.
The natural place for government funding is the WHO, as it was created to coordinate the global response to health problems. Philanthropy cannot be a voting member of WHO. It is up to each member state to decide that WHO should focus on pandemic prevention. But right now, the WHO is not funded to do much work on pandemics. It has no significant full-time staff. It does not require countries to go through exercises. That has to change if the world is to get serious about making Covid the last pandemic.
Do you think there will always be a need and space for private philanthropy to coexist with governments? What needs to change in the relationship between the private and public sectors? How do we get there? Who should change it?
Governments play the most critical role in protecting people from infectious diseases and other serious health risks. But I do believe that philanthropy can play a role – for example, we can fund initiatives that governments or the private sector can’t or won’t. Most global health problems, such as malaria, must be solved outside of traditional market-based systems because they will never be profitable for the private sector. During the Covid pandemic, global collaboration between scientists, philanthropists and global health institutions (such as the ACT accelerator) have developed, tested and deployed safe and effective vaccines faster than ever before. That is a great example of how the three sectors can work together to solve these major problems.
How should government policy change to be better prepared for the next pandemic, and what role do you see billionaires/other wealthy philanthropists playing in that?
One of the greatest tragedies the world has learned from Covid is that governments have not invested enough in the tools they need to effectively prepare for a pandemic. Countries need to step up and develop their policies and invest more in improving disease monitoring, funding R&D and strengthening health systems. What I’m trying to do, and the foundation is doing, is help catalyze new ideas, especially ideas that will give fair access to life-saving resources for people in low-income countries, who often lag behind as new health innovations come to market. We also play a role in attracting private sector companies by helping companies secure funding to manufacture tests, therapies and vaccines for low- and middle-income countries.
Public discourse surrounding Covid-19 is extremely polarized and politicized. What is your conclusion on the role misinformation versus good, reliable information plays in public health outcomes?
I’m concerned about the spread of misinformation and public health conspiracy theories because it makes people question their own doctors and question science. It is understandable that people are looking for easy answers as it has been two very scary years. And I think most people are concerned about their own health and the health of their families and loved ones. They come from the right place, but they are brought in by false information.
What role do you think economic inequality plays in disease outcome? It has hampered access to vaccines and medicines in low- to middle-income countries, but we’ve seen even within the US that black and brown communities have been hardest hit by Covid-19.
How do we ensure that economic inequality is not such a big factor in surviving the next pandemic?
Melinda and I founded the Gates Foundation over two decades ago because we were shocked by the inequalities in health around the world. Phenomenal progress has been made since then, but even today a child born in Nigeria is about 28 times more likely to die before her 5th birthday than a child born in the United States.
When Covid emerged, these existing health inequalities helped turn it into a global catastrophe. In my book, I propose a plan that includes three key measures. First, we need to improve disease monitoring by developing early warning systems that coordinate new viruses and outbreaks across borders, and the world needs to stand up the GERM teama paid, full-time group dedicated to pandemic prevention. [Editor’s note: The Global Epidemic Response and Mobilization team is a permanent disease outbreak watchdog group that Gates’s book proposes we create.]
Second, we need to invest more in R&D for next-generation vaccines and effective treatments, and ensure production capacity in every region of the world. And we need to strengthen global health systems by investing in primary health care, especially in low- and middle-income countries, but also in low-income communities in rich countries.
There are programs that focus on equitable health outcomes, such as the Global Fund and the Global Polio Eradication Initiative, Gavi, the Global Financing Facility, and CEPI. Fully funding these organizations would have a major impact on health equity around the world. [Editor’s note: These are all global health programs that the Gates Foundation has funded. The Global Fund is a public-private partnership that finances the fight against AIDS, tuberculosis, and malaria. The Global Polio Eradication Initiative is a WHO-led public-private partnership that seeks to immunize all children at risk for polio. Gavi is a public-private partnership that strives to improve vaccine access in low-income countries. The Global Financing Facility is a World Bank-led public-private partnership that focuses on promoting the health and nutrition of women and children. And CEPI, the Coalition for Epidemic Preparedness Innovations, is a public-private partnership that invests in vaccine research.]