New England Journal of Medicine
April 9, 2015 Vol. 372 No. 15
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
The Next Epidemic — Lessons from Ebola
Bill Gates
N Engl J Med 2015; 372:1381-1384 April 9, 2015 DOI: 10.1056/NEJMp1502918
Extract
Perhaps the only good news from the tragic Ebola epidemic in Guinea, Sierra Leone, and Liberia is that it may serve as a wake-up call: we must prepare for future epidemics of diseases that may spread more effectively than Ebola. There is a significant chance that an epidemic of a substantially more infectious disease will occur sometime in the next 20 years; after all, we saw major epidemics during the 20th century, including the Spanish influenza epidemic of 1918–1919 and the ongoing pandemic of human immunodeficiency virus. In fact, of all the things that could kill more than 10 million people around the world, the most likely is an epidemic stemming from either natural causes or bioterrorism…

…A Global Call to Action
Despite efforts by the United States and a few other countries, there are still big holes in the world’s ability to respond to an epidemic. Other countries may be more likely to step up if they see an overall plan and understand their role in it. We need a rigorous study of the cost of building a global warning and response system and a plan for contributions from various countries.
Through the United Nations, some global institution could be empowered and funded to coordinate the system. The United Nations and the WHO are studying the lessons from the Ebola epidemic and ways to improve international crisis management; these evaluations can provide a starting point for discussions of ways to strengthen the WHO’s capacity and about which parts of the process it should lead and which ones others (including the World Bank and the G7 countries) should lead in close coordination. The conversation should include military alliances such as NATO, which should make epidemic response a priority. The final arrangement should include a reserve corps of experts with the broad range of skills needed in an epidemic.
An epidemic is one of the few catastrophes that could set the world back drastically in the next few decades. By building a global warning and response system, we can prepare for it and prevent millions of deaths.

Recommendations for Preparing for Future Epidemics
The world needs to build a warning and response system for outbreaks. This system should
– be coordinated by a global institution that is given enough authority and funding to be effective,
– enable fast decision making at a global level,
– expand investment in research and development and clarify regulatory pathways for developing new tools and approaches,
– improve early warning and detection systems, including scalable everyday systems that can be expanded during an epidemic,
– involve a reserve corps of trained personnel and volunteers,
– strengthen health systems in low- and middle-income countries, and
– incorporate preparedness exercises to identify the ways in which the response system needs to improve.