In fact, I want to do something more extraordinary than just stop bad things from happening.
In other words, we are trying to find an opportunity to eradicate the entire respiratory virus family.
This means the end of coronaviruses like this pandemic, and even the end of influenza.
Every year, influenza alone affects up to 1 billion people, of which 3 to 5 million develop severe illness requiring hospitalization, and more than 300,000 people die.
The benefits of fighting respiratory viruses would be enormous if we added the impact of coronaviruses, which cause common cold symptoms.
---From "Entering"

Most of the countries with the lowest excess mortality rates (close to zero or negative)—Australia, Vietnam, New Zealand, and South Korea—did three things well early in the pandemic.
We conducted rapid testing on a large number of people, and isolated those who tested positive and those who were exposed to the virus.
And we implemented a plan to identify, track, and manage cases that may have crossed the border.
(Omitted) But the most serious failure of all is that Americans were not properly tested.
There wasn't enough testing done and it took too long for the results to come back.
What if someone carrying the virus doesn't know it for seven days? That gives them a full week to infect others.
(Omitted) Chapter 1 can be summarized as follows.
The world is not investing in the tools needed to respond to a pandemic or in adequate pandemic preparedness.
The time has come to begin preparing for such a situation.
---From Chapter 1, What We Learned from Corona

What we need is a well-funded, global organization with a sufficient number of full-time experts in all the necessary fields, the credibility and authority of a public institution, and a clearly defined mandate for pandemic prevention.
I call it the GERM (Global Epidemic Response and Mobilization) Team (hereafter GERM).
(Omitted) They should be well-paid, receive regular training, and be prepared to organize a response to the next pandemic threat. GERM should have the authority to declare pandemics and, in collaboration with national governments and the World Bank, should be able to rapidly mobilize funding for the response.
According to my rough calculations, GERM needs 3,000 full-time employees.
We need talent across a wide range of fields, including epidemiology, genetics, drug and vaccine development, data systems, diplomacy, rapid response, logistics, computer modeling, and communications.
---From Chapter 2: How to Prepare for the Next Pandemic

The first step is to invest heavily in all elements of a robust health system that enables disease detection, reporting, and even treatment.
Greater investment is especially needed in low- and middle-income countries, where health systems often suffer from underfunding.
If doctors and epidemiologists don't have the tools they need, if they don't have the training they need, and if national health institutions are weak or nonexistent, disease outbreaks will continue to occur.
Every society in every country must detect and report an outbreak within seven days, initiate an investigation within a day, and implement effective control measures within a week (this is the goal for everyone in the health system and a benchmark for measuring progress).
---From Chapter 3, "How to Detect and Suppress Early Signs of a Pandemic"

The benefits of masks have now been proven worldwide.
Early in the pandemic, Japan took the issue of mask-wearing seriously and combined it with contact tracing.
As a result, the excess mortality rate remained extremely low at 70 per million people at the end of 2021.
In Bangladesh, researchers studied nearly 350,000 adults across 600 villages to determine the impact of public messaging about masks.
One group, about half of the study subjects, received free masks (some cloth, some medical), face-to-face information about the importance of mask use, and encouragement from religious and political leaders.
The second group was not given any of these prompts.
After two months, the first group's appropriate mask use rate was 42 percent, while the second group's was only 13 percent.
The first group also had lower rates of COVID-19 infection and were still more likely to use masks five months later.
---From Chapter 4, Basic Pandemic Measures: Wearing Masks and Social Distancing

Fortunately, the coronavirus was relatively easy to target with a vaccine.
This was partly because the surface spike protein's camouflage was not as severe as that of proteins from other viruses.
That's why the success rate of the coronavirus vaccine was unusually high.
But what's often underestimated about the miracle of the COVID-19 vaccine is not the fact that it was created and approved, but that it was created and approved "faster" than any other vaccine.
(Omitted) Unfortunately, as we saw with COVID, creating and getting a vaccine approved is one thing, but creating a system that doesn't divide the haves from the have-nots—making and distributing enough doses to quickly reach everyone who needs it, including people in low-income countries who are at high risk of developing severe disease—is a completely different matter.
---From Chapter 6, "Make a Vaccine in 6 Months"

So far, we have only discussed naturally occurring pathogens.
But there is a more disturbing scenario that must be kept in mind when conducting disease simulation training.
Biological terrorism is the intentional spread of a pathogen with the intent to kill or maim many people.
The use of viruses and bacteria as weapons has been around for centuries.
(Omitted) The natural pathogen that could become the most terrifying weapon today is smallpox.
Smallpox is particularly frightening because it spreads rapidly through the air and has an extremely high mortality rate, killing one in three people who are infected.
Moreover, since most vaccination programs were discontinued after smallpox was eradicated in 1980, no one is immune to smallpox anymore.
The United States has enough smallpox vaccine stockpiled to protect the entire population, but distributing the vaccine is no simple matter.
Not to mention in situations where people are in a state of panic in the face of an attack.
It is unclear whether it will be able to protect countries other than the United States.
---From Chapter 7, “The Whole World Must Prepare Together”

As of the end of March 2021, 18 percent of Americans had been fully vaccinated, compared with 0.67 percent in India and 0.44 percent in South Africa.
By late July, the U.S. had reached 50 percent fully vaccinated, while India had just 7 percent and South Africa 6 percent.
People in wealthier countries, who are less likely to develop severe illness, were being vaccinated before those in poorer countries, who are at much higher risk.
(Omitted) In other words, it means that health inequality is a common problem.
The reason so many people in wealthy countries are shocked by the inequalities in the response to the coronavirus isn't because it's out of the ordinary.
Because health inequalities were otherwise unnoticed.
The coronavirus pandemic (a disease the world is experiencing) has brought to everyone's attention the unequal distribution of resources.
I'm not trying to depress you or point a finger at people who don't dedicate their lives to global health.
The important thing is that all of this deserves more attention.

---From Chapter 8, Health Disparities: The Gap Between Rich and Poor Countries

Governments must continue to lead the way in securing new funding for the systems, tools, and teams the world needs to prevent pandemics.
As I discussed in Chapter 2, I believe GERM will require an annual budget of about $1 billion.
And I believe that the funds should be raised by governments of wealthy countries and some middle-income countries.
I estimate that over the next decade, every government will need to spend $15 to $20 billion to develop the necessary vaccines, anti-infectives, therapeutics, and diagnostics.
This is what could be achieved if the United States increased its health care spending by 25 percent (about $10 billion) and the rest of the world increased its spending by similar proportions.
Of course, in absolute terms, $10 billion is a huge amount of money.
But that's just over 1 percent of the U.S. defense budget, a drop in the bucket compared to the trillions of dollars lost during the coronavirus pandemic.

---From Chapter 9, “Action Plan to Make COVID-19 the Last Pandemic”