The next outbreak? We’re not ready | Bill Gates | TED

Translator: Cristiano Eriksen Reviewer: Aviaja Josenius

When I was a kid,

Da jeg var barn,

the disaster we worried about most was a nuclear war.

var katastrofen, som vi var mest bekymrede over en atomkrig.

That's why we had a barrel like this down in our basement,

Det var grunden til, at vi havde en tønde som denne nede i vores kælder

filled with cans of food and water.

fyldt med dåser med mad og vand.

When the nuclear attack came,

Når atomangrebet kom,

we were supposed to go downstairs, hunker down, and eat out of that barrel.

skulle vi gå nedenunder, gå på hug og spise ud af den tønde.

Today the greatest risk of global catastrophe

I dag ser den største risko for en global katastrofe

doesn't look like this.

ikke sådan ud.

Instead, it looks like this.

Den ser i stedet således ud.

If anything kills over 10 million people in the next few decades,

Hvis noget slår over 10 millioner mennesker ihjel over de næste par årtier,

it's most likely to be a highly infectious virus

så er det højst sandsynligt en meget smitsom virus

rather than a war.

snarere end en krig.

Not missiles, but microbes.

Ikke missiler men mikrober.

Now, part of the reason for this is that

En del af grunden til dette er,

we've invested a huge amount in nuclear deterrents.

at vi har investeret massivt i atomar afskrækning.

But we've actually invested very little in a system to stop an epidemic.

Men vi har faktisk investeret meget lidt i et system til at stoppe en epidemi.

We're not ready for the next epidemic.

Vi er ikke klar til den næste epidemi.

Let's look at Ebola.

Lad os se på Ebola.

I'm sure all of you read about it in the newspaper,

Jeg er sikker på, at I alle har læst om det i avisen,

lots of tough challenges.

mange svære udfordringer.

I followed it carefully through the case analysis tools

Jeg fulgte det omhyggeligt via de analyseværktøjer,

we use to track polio eradication.

som vi bruger til at holde styr på polioudryddelse.

And as you look at what went on,

Og når man ser på, hvad der fandt sted,

the problem wasn't that there was a system that didn't work well enough,

var problemet ikke, at der ikke var et system, som ikke virkede godt nok,

the problem was that we didn't have a system at all.

problemet var, at vi ikke havde noget system overhovedet.

In fact, there's some pretty obvious key missing pieces.

Faktisk mangler der nogle ret vigtige brikker.

We didn't have a group of epidemiologists ready to go, who would have gone,

Vi havde ikke en gruppe af epidemiologer klar, som ville være taget afsted,

seen what the disease was, seen how far it had spread.

set hvilken sygdom det var, set hvor vidt den havde spredt sig.

The case reports came in on paper.

Caserapporterne ankom i papirformat.

It was very delayed before they were put online

De var meget forsinkede før de kom online,

and they were extremely inaccurate.

og de var meget unøjagtige.

We didn't have a medical team ready to go.

Vi havde ikke et lægehold klar.

We didn't have a way of preparing people.

Vi havde ikke en måde at forberede folk.

Now, Médecins Sans Frontières did a great job orchestrating volunteers.

Læger uden Grænser gjorde et godt stykke arbejde med at orkestrere frivillige.

But even so, we were far slower than we should have been

Men selv da, var vi langt langsommere end vi burde have været

getting the thousands of workers into these countries.

i at få de tusindvis af arbejdere ind i disse lande.

And a large epidemic would require us to have hundreds of thousands of workers.

Og en stor epidemi ville kræve, at vi har hundredetusinde af arbejdere.

There was no one there to look at treatment approaches.

Der var ingen der til at se på behandlingsmetoder.

No one to look at the diagnostics.

Ingen til at se på diagnoserne.

No one to figure out what tools should be used.

Ingen til at finde ud af hvilke værktøjer skulle benyttes.

As an example, we could have taken the blood of survivors,

For eksempel kunne vi have taget blod fra de overlevende,

processed it, and put that plasma back in people to protect them.

forarbejdet det, og puttet det plasma tilbage i folk for at beskytte dem.

But that was never tried.

Men det var aldrig forsøgt.

So there was a lot that was missing.

Så der var meget, som manglede.

And these things are really a global failure.

Og disse ting er virkelig en global fiasko.

The WHO is funded to monitor epidemics, but not to do these things I talked about.

WHO er finansieret for at overvåge epidemier, men ikke for at gøre hvad jeg snakkede om.

Now, in the movies it's quite different.

I filmene er det ganske anderledes.

There's a group of handsome epidemiologists ready to go,

Der er gruppe smukke epidemiologer klar til at tage afsted,

they move in, they save the day, but that's just pure Hollywood.

de ankommer, de redder dagen, men det er bare Hollywood.

The failure to prepare could allow the next epidemic

Undladelsen i at forberede os kunne tillade den næste epidemi

to be dramatically more devastating than Ebola

at være drastisk mere ødelæggende end Ebola.

Let's look at the progression of Ebola over this year.

Lad os se på udviklingen af Ebola over dette år.

About 10,000 people died,

Omkring 10.000 er døde,

and nearly all were in the three West African countries.

og næsten alle var i de tre vest-afrikanske lande.

There's three reasons why it didn't spread more.

Der er tre grunde til, at det ikke spredte sig mere.

The first is that there was a lot of heroic work by the health workers.

Den første er, at der blev udført meget heroisk arbejde af sundhedsarbejdere.

They found the people and they prevented more infections.

De fandt folkene, og de forhindrede flere infektioner.

The second is the nature of the virus.

Den anden er virussens natur.

Ebola does not spread through the air.

Ebola er ikke luftbåren.

And by the time you're contagious,

Og når du er smitsom,

most people are so sick that they're bedridden.

er de fleste så syge, at de er sengeliggende.

Third, it didn't get into many urban areas.

Tredje grunden er, det spredte sig ikke i mange by-områder.

And that was just luck.

Og det var udelukkende held.

If it had gotten into a lot more urban areas,

Hvis det havde spredt sig i flere by-områder,

the case numbers would have been much larger.

ville antallet af tilfælde være blevet langt større.

So next time, we might not be so lucky.

Så næste gang er vi måske ikke så heldige.

You can have a virus where people feel well enough while they're infectious

Du kan have en virus, hvor folk føler sig så veltilpas, mens de er smitsomme,

that they get on a plane or they go to a market.

at de stiger på et fly, eller de tager til et marked.

The source of the virus could be a natural epidemic like Ebola,

Kilden til virussen kunne være en naturlig epidemi som Ebola,

or it could be bioterrorism.

eller det kunne være bioterrorisme.

So there are things that would literally make things a thousand times worse.

Så der er ting som bogstaveligt talt ville gøre det tusind gange værre.

In fact, let's look at a model of a virus spread through the air,

Lad os se på en model af en virus, som spredes igennem luften,

like the Spanish Flu back in 1918.

ligesom Den Spanske Syge i 1918.

So here's what would happen:

Her er hvad der kunne ske:

It would spread throughout the world very, very quickly.

Det kunne sprede sig over verden meget, meget hurtigt.

And you can see over 30 million people died from that epidemic.

Og du kan se over 30 millioner mennesker dø af den epidemi.

So this is a serious problem.

Så det er et seriøst problem.

We should be concerned.

Vi burde være bekymrede.

But in fact, we can build a really good response system.

Men vi kan faktisk bygge et rigtigt godt respons system.

We have the benefits of all the science and technology that we talk about here.

Vi har fordelen af al den videnskab og teknologi, som vi snakker om her.

We've got cell phones

Vi har mobiltelefoner

to get information from the public and get information out to them.

til at modtage og give information til og fra offentligheden.

We have satellite maps where we can see where people are and where they're moving.

Vi har satellitkort, hvor vi kan se hvor folk er, og hvor de bevæger sig hen.

We have advances in biology

Vi har fremskridt i biologi,

that should dramatically change the turnaround time to look at a pathogen

som drastisk burde ændre vendingstiden til at se på et patogen,

and be able to make drugs and vaccines that fit for that pathogen.

og være i stand til at lave medicin og vacciner passende til det patogen.

So we can have tools,

Så vi kan have værktøjer,

but those tools need to be put into an overall global health system.

men de værktøjer er nødt til at blive implementeret i et globalt sundhedssystem.

And we need preparedness.

Og vi har brug for beredskab.

The best lessons, I think, on how to get prepared

De bedste lektioner, tror jeg, i at forberede sig

are again, what we do for war.

er igen, hvad vi gør for krig.

For soldiers, we have full-time, waiting to go.

For soldater, har vi fuldtid, ventende til at tage afsted.

We have reserves that can scale us up to large numbers.

Vi har reserver, som kan skalere os op til store numre.

NATO has a mobile unit that can deploy very rapidly.

NATO har en mobil enhed, som kan indsættes meget hurtigt.

NATO does a lot of war games to check, are people well trained?

NATO har en masse krigslege for at undersøge om folk er veltrænet.

Do they understand about fuel and logistics

Forstår de brændstof og logistik

and the same radio frequencies?

og de samme radiofrekvenser?

So they are absolutely ready to go.

Så de er absolut klar.

So those are the kinds of things we need to deal with an epidemic.

Så de er den slags ting, som vi skal håndtere med en epidemi.

What are the key pieces?

Hvad er de vigtigste brikker?

First, we need strong health systems in poor countries.

For det første har vi brug for stærke sundhedssystemer i de fattige lande.

That's where mothers can give birth safely,

Det er hvor mødre sikkert kan føde,

kids can get all their vaccines.

børn kan få alle deres vacciner.

But, also where we'll see the outbreak very early on.

Men også hvor vi vil se udbruddet meget tidligt.

We need a medical reserve corps:

Vi har brug for en medicinsk reserve:

lots of people who've got the training and background

mange mennesker, som har fået træningen og baggrunden,

who are ready to go, with the expertise.

som er klar til at tage afsted med ekspertise.

And then we need to pair those medical people with the military.

Og derefter er vi nød til at parre de medicinske folk med militæret,

taking advantage of the military's ability to move fast, do logistics

drage fordel af militærets evne til at bevæge sig hurtigt, til logistik

and secure areas.

og sikre områder.

We need to do simulations,

Vi er nød til at foretage simulationer,

germ games, not war games, so that we see where the holes are.

bakteriologiske lege, ikke krigs lege, så vi kan se, hvor hullerne er.

The last time a germ game was done in the United States

Den sidste gang bakteriologiske lege fandt sted i USA

was back in 2001, and it didn't go so well.

var tilbage i 2001, og det gik ikke særlig godt.

So far the score is germs: 1, people: 0.

Indtil videre er stillingen bakterier: 1, mennesker: 0.

Finally, we need lots of advanced R&D in areas of vaccines and diagnostics.

Til slut har vi brug for meget avanceret R&D i vacciner og diagnostik.

There are some big breakthroughs, like the Adeno-associated virus,

Der er nogle store gennembrud, som "Adeno-associated" virusset,

that could work very, very quickly.

som kunne arbejde meget, meget hurtigt.

Now I don't have an exact budget for what this would cost,

Jeg har ikke et eksakt budget på hvor meget dette ville koste,

but I'm quite sure it's very modest compared to the potential harm.

men jeg er ganske sikker på, at det er beskedent ift. den potentielle skade.

The World Bank estimates that if we have a worldwide flu epidemic,

Verdensbanken estimerer at, hvis vi har en verdensomspændende influenza epidemi,

global wealth will go down by over three trillion dollars

vil global velstand falde med over tre billioner dollars,

and we'd have millions and millions of deaths.

og vi ville have millioner og million af dødsfald.

These investments offer significant benefits

Disse investeringer tilbyder markante fordele

beyond just being ready for the epidemic.

udover bare at være klar til en epidemi.

The primary healthcare, the R&D,

Det primære sundhedsvæsen, forskningen,

those things would reduce global health equity

disse ting ville reducere global sundheds ulighed

and make the world more just as well as more safe.

og ville gøre verden mere retfærdig og mere sikker.

So I think this should absolutely be a priority.

Så jeg mener at dette absolut burde være en prioritet.

There's no need to panic.

Der er ingen grund til panik.

We don't have to hoard cans of spaghetti or go down into the basement.

Vi har ikke brug for at hamstre spaghetti dåser eller gå ned i kælderen.

But we need to get going, because time is not on our side.

Men vi er nød til at komme igang, fordi tiden er ikke på vores side.

In fact, if there's one positive thing that can come out of the Ebola epidemic,

Der er faktisk kun en positiv ting, som kan komme fra en Ebola epidemi,

it's that it can serve as an early warning, a wake-up call, to get ready.

og det er, at det kan tjene som en tidlig advarsel, et varsel til at blive klar.

If we start now, we can be ready for the next epidemic.

Hvis vi starter nu, kan vi være klar til den næste epidemi.

Thank you.

Tak.

(Applause)

(Bifald)