In 2015 Bill Gates advised on the need to prepare for a global pandemic

In 2015 Bill Gates gave a TED Talk on the importance of preparedness for a global pandemic caused by “a highly infectious virus”.

An Ebola epidemic that began in December 2013, and continued until 2016, had by that time killed around 10,000 people in West Africa. Gates cites three reasons as to why there weren’t more deaths. 1.) The selfless work by front line health workers including locating infected persons and preventing further spread (see Contact Tracing below). 2.) Ebola is not an airborne virus and by the time those who are infected become contagious, most are so ill as to be bedridden. 3.) The virus did not reach many urban areas and this directly kept the number of cases lower than had Ebola spread throughout urban communities.

Yet he also refers to what he calls “a global failure”. Noting the slowness of response. The failure to study treatment approaches, diagnostics and the application of epidemiological and medical tools.

In what has been shown to be an uncomfortably prescient statement Gates notes;

So next time, we might not be so lucky. You can have a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market.

Gates uses the Spanish Flu of 1918 to demonstrate how quickly an airborne virus can spread. He observes that the World Bank have estimated that a global flu epidemic will cause a drop in global wealth of “over three trillion dollars” and there would be “millions and millions of deaths”.

It’s important to note that the present reality with COVID-19 is not absolutely reflected in Gates’ TED Talk. Trends of global financial impact have not yet played out. Total fatalities will be disturbing and many may lose friends and loved ones, yet the prediction of “millions and millions” of deaths is not a current reality.

Nonetheless the reason that the capacity to reduce morbidity and mortality – to flatten the curve – is in our hands is indeed touched on by Gates. Just after the five minute mark he speaks of our ability to use certain tools to create an effective response system. Science and technology. The use of cell phones to inform the public. Satellite maps to inform on the movement of people. Advances in biology and research that will support rapid turnaround of drugs and vaccines to fit the pathogen responsible for the pandemic.

As I touched on above another factor discussed but not labelled as such by Gates, that is presently more robustly employed to reduce the spread of COVID-19 is Contact Tracing. Gates talks about locating infected persons and preventing further spread. In May 2017 African Health Sciences published a review of contact tracing in containing the 2014 Ebola outbreak. However with an airborne coronavirus this has proven, as expected, to be enormously more complicated.

At the time of writing there exists a spectrum of tactics in various countries, with some considered invasive to privacy. Israel has passed emergency laws to allow its security agency, Shin Bet to tap peoples phones without a warrant.

According to the Computational Privacy Group in the case of Singapore (using TraceTogether), Taiwan and South Korea this involves using cell phones and dedicated software in the;

…recording [of] close proximity between people using Bluetooth, WiFi, or GPS data, [which] could help efficiently notify people that they have earlier been in contact with someone now diagnosed with coronavirus and should self-isolate

The CPG have published Can we fight COVID-19 without resorting to mass surveillance? which looks at both location data and contact tracing in different regions, and the technology used.

Reports in Australia have suggested that tracking the public through their phones has been considered and that the federal government is “looking to Singapore” and the TraceTogether app. Victoria’s Department of Health and Human Services has expanded contact tracing to include use of the messaging platform Whispir.

IT News reports;

The department will begin using the cloud-based platform from Thursday to regularly interact with those that have come into close contact with someone who has contracted COVID-19.

The platform, which will automate interactions between the department and select individuals, will also be used to enforce self-isolation for Victorians who have confirmed cases of the virus.

Gates was more than reasonably accurate in predicting our response. Presented without exact figures from the epidemiology and pathology of the infectious agent Gates’ description of how we could and would respond deserves high marks.

Presently we are witnessing the application of the tools at our disposal to flatten the curve of morbidity and mortality. We know that only an effective vaccine can break the back of the pandemic as it now exists. Drugs that target specific symptoms and slow or prevent the impact on COVID-19 comorbidity are greatly needed. The use of cell phone apps to both inform and trace the public is well underway.

Most importantly we have accepted that staying at home, social distancing and increasingly reducing the number of people together in public, together with effective hand washing and smothering of coughs or sneezes are vitally effective measures. Some of these measures should be employed every flu season and it’s hoped we will continue to do just that.

One imagines we will be better prepared in future for the emergence of another pandemic. Gates was right in that we needed to prepare. We see that clearly now in the need for hospital beds, ventilators and other medical equipment. He also noted the necessity of strong health systems in poor countries and presently the need for increased funding in developing nations is a reality. [AlJazeera news video]

To finish off perhaps we should focus on what Gates observed at the end of his talk;

So I think this should absolutely be a priority. There’s no need to panic. We don’t have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side.

In fact, if there’s one positive thing that can come out of the Ebola epidemic, it’s that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.

Of course we were not utterly unprepared for a pandemic. Far from it. There are global and national agencies throughout the world that focus on both the risk of a viral pandemic and how we can best prepare. Developing nations are closely monitored by organisations such as the WHO and the UN. Still the lack of any treatment or vaccine to prevent COVID-19 has proven to be an enormous hurdle.

Developed nations are in a better position to fund and respond to recommendations. Australia has a Health Management Plan for Pandemic Influenza, last updated in August 2019. The UK has its Pandemic Contingency/Major Infectious Diseases Outbreak Plan. Similar plans exist around the world.

An interesting dynamic in the USA at present is whilst President Trump has criticised the CDC for its response to coronavirus, he had from 2018 cut their budget for global disease management and closed government units dedicated to preventing pandemics.

Trump’s administration has also cut similar funding for the National Security Council (NSC), Department of Homeland Security (DHS), and Health and Human Services (HHS). Other cuts to CDC funding used to manage chronic disease are scheduled for 2021 and as yet have not been approved by Congress. Perhaps justifiably Trump has come under scorn for his approach to the coronavirus outbreak.

Funding for the prevention of pandemics is an essential part of a solid public health budget. Without a doubt these budgets should be designed with input from scientists. By shirking reason and evidence in their pursuit of “alternative facts” and a post truth world, the Trump administration had maneuvered itself into an increasingly perilous position.

One hopes that as we move toward the future and find ourselves past the COVID-19 pandemic that we aim to listen to the evidence, learn from the past and prepare for pandemics we cannot yet predict.


 

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TRANSCRIPT

00:17
When I was a kid, the disaster we worried about most was a nuclear war. That’s why we had a barrel like this down in our basement, filled with cans of food and water. When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel.

00:37
Today the greatest risk of global catastrophe doesn’t look like this. Instead, it looks like this. If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war. Not missiles, but microbes. Now, part of the reason for this is that we’ve invested a huge amount in nuclear deterrents. But we’ve actually invested very little in a system to stop an epidemic. We’re not ready for the next epidemic.

01:20
Let’s look at Ebola. I’m sure all of you read about it in the newspaper, lots of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication. And as you look at what went on, the problem wasn’t that there was a system that didn’t work well enough, the problem was that we didn’t have a system at all. In fact, there’s some pretty obvious key missing pieces.

01:51
We didn’t have a group of epidemiologists ready to go, who would have gone, seen what the disease was, seen how far it had spread. The case reports came in on paper. It was very delayed before they were put online and they were extremely inaccurate. We didn’t have a medical team ready to go. We didn’t have a way of preparing people. Now, Médecins Sans Frontières did a great job orchestrating volunteers. But even so, we were far slower than we should have been getting the thousands of workers into these countries. And a large epidemic would require us to have hundreds of thousands of workers. There was no one there to look at treatment approaches. No one to look at the diagnostics. No one to figure out what tools should be used. As an example, we could have taken the blood of survivors, processed it, and put that plasma back in people to protect them. But that was never tried.

02:53
So there was a lot that was missing. And these things are really a global failure. The WHO is funded to monitor epidemics, but not to do these things I talked about. Now, in the movies it’s quite different. There’s a group of handsome epidemiologists ready to go, they move in, they save the day, but that’s just pure Hollywood.

03:22
The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola. Let’s look at the progression of Ebola over this year. About 10,000 people died, and nearly all were in the three West African countries. There’s three reasons why it didn’t spread more. The first is that there was a lot of heroic work by the health workers. They found the people and they prevented more infections. The second is the nature of the virus. Ebola does not spread through the air. And by the time you’re contagious, most people are so sick that they’re bedridden. Third, it didn’t get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas, the case numbers would have been much larger.

04:17
So next time, we might not be so lucky. You can have a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So there are things that would literally make things a thousand times worse.

04:39
In fact, let’s look at a model of a virus spread through the air, like the Spanish Flu back in 1918. So here’s what would happen: It would spread throughout the world very, very quickly. And you can see over 30 million people died from that epidemic. So this is a serious problem. We should be concerned.

05:04
But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talk about here. We’ve got cell phones to get information from the public and get information out to them. We have satellite maps where we can see where people are and where they’re moving. We have advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that pathogen. So we can have tools, but those tools need to be put into an overall global health system. And we need preparedness.

05:41

The best lessons, I think, on how to get prepared are again, what we do for war. For soldiers, we have full-time, waiting to go. We have reserves that can scale us up to large numbers. NATO has a mobile unit that can deploy very rapidly. NATO does a lot of war games to check, are people well trained? Do they understand about fuel and logistics and the same radio frequencies? So they are absolutely ready to go. So those are the kinds of things we need to deal with an epidemic.

06:13
What are the key pieces? First, we need strong health systems in poor countries. That’s where mothers can give birth safely, kids can get all their vaccines. But, also where we’ll see the outbreak very early on. We need a medical reserve corps: lots of people who’ve got the training and background who are ready to go, with the expertise. And then we need to pair those medical people with the military. Taking advantage of the military’s ability to move fast, do logistics and secure areas. We need to do simulations, germ games, not war games, so that we see where the holes are. The last time a germ game was done in the United States was back in 2001, and it didn’t go so well. So far the score is germs: 1, people: 0. Finally, we need lots of advanced R&D in areas of vaccines and diagnostics. There are some big breakthroughs, like the Adeno-associated virus, that could work very, very quickly.

07:21
Now I don’t have an exact budget for what this would cost, but I’m quite sure it’s very modest compared to the potential harm. The World Bank estimates that if we have a worldwide flu epidemic, global wealth will go down by over three trillion dollars and we’d have millions and millions of deaths. These investments offer significant benefits beyond just being ready for the epidemic. The primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe.

07:55
So I think this should absolutely be a priority. There’s no need to panic. We don’t have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side.

08:09
In fact, if there’s one positive thing that can come out of the Ebola epidemic, it’s that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.

08:26
Thank you.

No reason to not vaccinate but anti-vaxxers continue to resist sound health policy

On April 17th last year Paul Offit was interviewed by Christiane Amanpour of CNN on the fact that there is “no legitimate reason” for not vaccinating.

This video very recently accompanied a February 21st article by U.S. pediatrician Dr. Edith Brancho-Sanchez, entitled Several vaccines at once might be too much for parents, but kids are just fine. The article reinforced the fact that the misinformation regarding the safety and efficacy of vaccines causes variations of anxiety in parents who take their children to be vaccinated.

It was reported that a 2014 USA National Immunization Surveillance Survey indicated that;

… over a third of parents of children ages 19 to 35 months followed delayed immunization schedules. Of the parents surveyed, 23% followed an alternate schedule that either limited the number of shots per visit or skipped at least one vaccine series altogether. Another 14% followed an unknown or unclassifiable schedule that did not follow a pattern and was not in line with national recommendations. Children who followed an alternate pattern were four times as likely not to be up to date on their vaccines and those who followed an unclassifiable pattern were over twice as likely not to be up to date.

Regrettably pediatricians are in a Catch 22 situation. They need to build parental trust. A 2015 study published in Pediatrics indicated that 93% of 534 pediatricians had been asked by parents of children under 2 to spread out vaccines. 82% believed complying with the parent’s request would build trust, whilst 80% thought if they declined, this may lead to parents leaving their practice.

In Connecticut, USA state lawmakers “narrowly advanced a bill” this week that seeks to ban religious vaccine exemptions for children. Despite reports of a 25% increase in religious exemptions from last year anti-vaccine opposition to the bill was fierce including protests in Connecticut’s Legislative Office Building. One Democrat representative, who seemed to have abandoned any pretense of basing his decision on evidence, referred to vaccination as “injecting a witches brew of chemicals”.

Here in Australia the leading anti-vaccine disinformation group The Australian Vaccination-risks Network has called on members and fellow anti-vaxxers to heed another infamous Action Alert. They are targetting Victoria and South Australia. In Victoria the Health Services Amendment Bill 2020 seeks to provide for mandatory vaccination of healthcare and ambulance workers with specific immunisations. Ten days ago the Victorian Minister for Health published this media release outlining the logic behind the decision.

The vaccines included are the flu vaccine, whooping cough, measles, chicken pox and hepatitis B. It is astonishing, as we witness the evolving impact of COVID-19 in the absence of a vaccine, that groups such as the AVN seek to multiply these negative effects. They have teamed up with the anti-science, anti-medicine group, Health Freedom Victoria helping to disseminate their “generic letter” for anti-vaxxers to mail to “all Victorian politicians including your local member”. Of course one may pen ones own. Be sure to stress you “vehemently oppose this draconian overreach of the Andrews’ government”.

They also advise to follow up with phone calls. Following that, they basically suggest harassing Martin Foley who is Minister for Mental Health, Minister for Equality and Minister for Creative Industries. Martin Foley’s mental health portfolio sees him quite active in reducing discrimination for Victorians living with mental health challenges. Health Freedom Victoria want anti-vaxxers working in the health sector to email and call Mr. Foley to;

Tell him you are appalled that he would change the Discrimination Act to get away with forcing you to take an untested and unwanted medical procedure in order to keep your job

In the material they have disseminated to encourage targetting Martin Foley, Health Freedom Victoria refer to him as, “the Minister for amongst other things, Mental Health and Discrimination”.

South Australia introduced No Jab No Play legislation on September 30th 2019. Again there is a “generic letter” ready to go. In both cases the AVN seek to motivate loyal anti-vaccine followers to engage in pestering letter and/or email writing campaigns, asking those involved to follow up with a phone call, in this case “within half an hour but at least by the end of the day”. This is to confirm they have received your email and will be sending a Decision Regulatory Impact Statement (RIS). Of course one should inform the person you’ll call back in two weeks to chase up that RIS. And why?

In the words of the AVN themselves;

Phone calls increase their workload, so they’re more likely to do their job to avoid getting repeat calls.

Yep, you read that right. Wasting the time of your local members already busy and hard working staff is ensuring they “do their job”.

Now, it’s over to Paul Offit…

 

Immunisation: Why we do it and how ‘herd immunity’ works

Denial of community immunity or herd immunity is a common feature of antivaccinationists.

In fact groups that spread harmful disinformation, such as the Australian based Australian Vaccination-risks Network (AVN), have for years been refining the denial of this evidence based fact. Notably they misrepresent what herd immunity is, primarily by referencing an aspect of herd immunity or an expected result of herd immunity.

The Australian Government Department of Health offer this definition;

If enough people in a community are immunised against an infectious disease, there is less of the disease in the community, which makes it harder for the disease to spread.

Immunisation protects both people who are vaccinated and also helps the entire community. It helps protect those who are too young to be vaccinated and those who can’t be vaccinated for medical reasons. This is known as community (herd) immunity.

Claiming that the “laws” of No Jab No Pay and No Jab No Play “are based on herd immunity”, Meryl Dorey of the AVN contends;

The theory claims that the unvaccinated are more likely to contract and transmit diseases than their vaccinated peers.

Travel to a largely unvaccinated country, get shots and you’re apparently in a protected bubble. Back home and they’d have us believe we need a 95 per cent plus vaccination rate to be protected and that a lone unvaccinated individual can be responsible for an epidemic.

Indeed rather than “claim” that unvaccinated community members will contract and transmit disease, herd immunity provides greater protection for the unvaccinated. Nonetheless herd immunity cannot protect any particular unvaccinated individual and is very important with respect to protection from measles infection.

This is why individuals who cannot be vaccinated for specific reasons or those with weakened immune systems will be better protected in a community that has a vaccination level of 95% or above. In certain communities where vaccination levels are low, herd immunity and the cluster of immune individuals doesn’t exist. In this instance measles can easily spread from an infected individual to unvaccinated individuals.

If not for herd immunity providing protection to those who refuse vaccination and deny their children the protection of vaccine induced immunity, many of the false beliefs held by antivaccinationists could not persist. The success of so-called natural remedies, homeoprophylaxis and so on persist simply due to the protection of herd immunity.

  • The video below was produced by the BBC and provides an accurate summary of vaccination and herd immunity.

Immunisation: Why we do it and how ‘herd immunity’ works – © BBC News

Discredited anti-vaccine conspiracy theorist Judy Wilyman has even used denial of herd immunity in her ongoing attacks on Australia’s successful vaccination policy. Wilyman wrongly contends that only public health reforms such as sanitation led to the control of vaccine preventable diseases.

Vaccines did not create herd immunity to control infectious diseases, is an open letter on her website. The monumental flaw in her fallacious claim begins with her use of only mortality, and no morbidity data.

Also, Wilyman refers to changes in public health occurring before 1950. This ignores more modern vaccines such as that for Haemophilus influenzae type b (Hib) used in Australia from 1993 and later in Kenya from 1999.

Only vaccination can explain the control of Hib and the emerging success of the HPV vaccine.

Measles outbreaks are due to low vaccination rates and antivaccinationists

The video below is from the USA. The reasons it lists for the increase in measles cases there however, apply directly to Australia.

First however I want to draw attention to the screenshot from the video. Note the high number of fatalities. In the USA measles killed around 500 children per year during the 1950’s. Also pay attention to the drop in measles cases after the 1963 introduction of the measles vaccine.

In Australia a live attenuated measles vaccine was first licenced in 1968. Since then according to the Department of Health, “the burden of measles has substantially fallen in Australia”.

Measles cases USA – Source: CDC

You may be thinking, “But… I’ve seen graphs showing a huge decline in vaccine preventable diseases before vaccines were even introduced”. Yes, yes you have… kind of. What the anti-vaccine lobbyists did to create those misleading graphs is to firstly plot mortality rate (fatalities), and not morbidity (cases). Their argument is that diet, personal and public sanitation alone controlled vaccine-preventable disease and that vaccination had no effect.

Health professionals agree that sanitation and nutrition is vital to health. Cleaner cities, homes, personal hygeine and a varied diet play a large role in keeping us healthy, aiding in recovery and in fighting off the effects of disease. Including mortality caused by disease. But the incidence, or morbidity of disease is not reduced anywhere near as dramatically. So to discredit vaccines antivaccinationists would plot mortality and not morbidity of disease.

More so, they crammed many years horizontally and a comparatively small number of fatalities vertically. This had the effect of squeezing data in so tightly that individual bars vanished and were replaced with a single contoured shape that seemed to hit zero well before vaccines were introduced. With an accompanying narrative or explanatory text the listener or reader was easily fooled into “seeing” diseases dwindle away long before vaccines were introduced.

And the best trick was to emphasize, in the true Viera Scheibner and Judy Wilyman fashion, that it’s all government data to begin with. So it must be true. But it never was. It was and is a lie. A dangerous lie that hides the truth of how dangerous vaccine-preventable diseases are and how permanent are the injuries and disabilities for many of those who contract them.

The rumour that Donald Trump would be supporting the anti-vaccine lobby and financing vaccine conspiracy theorist, Robert F. Kennedy, is all but dust. Just three days ago when asked about the measles outbreak he replied, “They have to get the shot. The vaccinations are so important. This is really going around now, they have to get their shot”.

The Australian Department of Health has a page dedicated to the current measles outbreak, Measles Outbreak 2019. It was updated two weeks ago and includes;

Anyone who is not fully vaccinated against measles is at risk of becoming infected when traveling overseas. You may also risk exposing others to this highly infectious, serious illness either while travelling, or when you return to Australia.

Measles is a very contagious viral illness that causes a skin rash and fever in some cases. Measles can cause serious, sometimes fatal, complications including pneumonia and encephalitis (swelling of the brain). Measles spreads when an infected person coughs or sneezes and another person breathes in the droplets from the air, or touches the droplets and then touches their nose or mouth.

Measles remains a common disease in many parts of the world, including areas of Europe, Asia, the Pacific, and Africa, with outbreaks often occurring.

In Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling to countries in which measles is either common or there are outbreaks occurring. As measles is highly contagious, these people can then spread the disease to others, causing outbreaks, often before they are aware that they have the virus.

Why Measles Is Back In The US

Don’t be fooled by claims that antivaccinationists are not to blame. That we must accept socioeconomic and language hurdles are placing a considerable downward pressure on vaccination numbers. The increased use of social media has been a boon to antivaccinationists. From spreading misinformation, to organising events to raising money and making their entire gig easier we must accept they continue to ruin lives and public health strategy.

No doubt there are socioeconomic problems that play a role. But not the role. That argument is partial evidence denial at best. In fact social media should be used more skillfully to address problems faced by members of our community who are struggling to meet vaccination schedule requirements due to genuine hurdles.

Social scientists interested in vaccination and/or resistance to vaccination may have much to offer in addressing socioeconomic hurdles to vaccination via social media.

Facts about meningococcal disease

The Melbourne Vaccine Education Centre has an excellent page on meningococcal disease and vaccines which includes comprehensive resources and the video below from the Australian Academy of Science.

Meningococcal disease is a bacterial infection which can kill in hours. It is caused by the bacteria Neisseria meningitidis. Risk groups include children under 5, teens and young adults aged between 15 – 24, smokers, those with a suppressed immune system and anyone living in crowded accommodation. Of the 13 known sub-types of meningococcal bacteria, five are vaccine preventable.

These are B and A, C, W, Y.

Over 2018 the main serotypes causing disease in Australia were B, W and Y. Variations in serotype infection were specific to Australian states. On the information page the Melbourne Vaccine Education Centre (MVEC) notes;

People with meningococcal disease can become extremely unwell very quickly. Invasive meningococcal disease (IMD) can cause meningitis (inflammation of the membrane covering the brain and spinal cord), septicaemia (infection in the blood) as well as other infections like pneumonia (lung infection), arthritis (inflammation of the joints) and conjunctivitis (eye infection). Mortality (death) can be as high as 5-10% and permanent lifelong complications can occur in 10-20% of those who survive. Disease is transmitted via respiratory droplets (sneezing and coughing etc).

Prevention is via vaccination. Three quadrivalent vaccines are available for the A, C, W and Y meningococcal serogroups. One, Nimenrix® is freely available from 12 months of age as part of the National Immunisation Program.

In September last year it was announced that the federal government will fund the addition of meningococcal A, C, W and Y vaccine for 14 to 19 year olds. From April 2019 teens aged 14 to 16 years will have free access via school based programs as part of the National Immunisation Program. Teenagers aged 15 to 19 years who do not receive the vaccine at school can be vaccinated for free via “an ongoing GP based catch up program”.

The details of access to the vaccines are clearly explained on the MVEC information page. Private scripts are available and required to purchase the meningococcal A, C, W, Y vaccine for those who don’t meet NIP criteria.

Meningococcal B vaccines are available although not yet part of the National Immunisation Program. Bexsero® is suited for use from 6 weeks of age. Trumenba® is suited for use from 10 years onward.

There is additional information in this post from September last year. Access the Department of Health immunisation information here.

Facts About Meningococcal DiseaseAustralian Academy of Science