TED2015
Bill Gates: The next outbreak? We're not ready
Bill Gates: Det næste udbrud? Vi er ikke klar
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I 2014 undgik verden et forfærdeligt globalt udbrud af Ebola takket være tusinde af uselviske sundhedsarbejdere - plus, for at sige det lige ud, en god portion held.
I bagklogskabens lys ved vi, hvad vi burde have gjort bedre. Så nu er tiden, forslår Bill Gates, til at implementere alle de gode ideer i praksis, fra scenarie planlægning til vaccineforskning til sundhedsarbejder træning. Som han siger, "Der er ingen grund til panik ... men vi er nød til at komme igang."
Bill Gates - Philanthropist
A passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation. Full bio
A passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation. Full bio
Double-click the English transcript below to play the video.
00:17
When I was a kid,
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Da jeg var barn,
00:19
the disaster we worried about most
was a nuclear war.
was a nuclear war.
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var katastrofen, som vi var mest
bekymrede over en atomkrig.
bekymrede over en atomkrig.
00:23
That's why we had a barrel like this
down in our basement,
down in our basement,
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Det var grunden til, at vi havde en tønde
som denne nede i vores kælder
som denne nede i vores kælder
00:27
filled with cans of food and water.
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fyldt med dåser med mad og vand.
00:30
When the nuclear attack came,
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Når atomangrebet kom,
00:31
we were supposed to go downstairs,
hunker down, and eat out of that barrel.
hunker down, and eat out of that barrel.
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skulle vi gå nedenunder,
gå på hug og spise ud af den tønde.
gå på hug og spise ud af den tønde.
00:37
Today the greatest risk
of global catastrophe
of global catastrophe
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I dag ser den største risko
for en global katastrofe
for en global katastrofe
00:41
doesn't look like this.
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ikke sådan ud.
00:44
Instead, it looks like this.
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Den ser i stedet således ud.
00:48
If anything kills over 10 million people
in the next few decades,
in the next few decades,
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Hvis noget slår over 10 millioner
mennesker ihjel over de næste par årtier,
mennesker ihjel over de næste par årtier,
00:53
it's most likely to be
a highly infectious virus
a highly infectious virus
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så er det højst sandsynligt
en meget smitsom virus
en meget smitsom virus
00:57
rather than a war.
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snarere end en krig.
00:59
Not missiles, but microbes.
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Ikke missiler men mikrober.
01:03
Now, part of the reason for this is that
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En del af grunden til dette er,
01:05
we've invested a huge amount
in nuclear deterrents.
in nuclear deterrents.
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at vi har investeret massivt i
atomar afskrækning.
atomar afskrækning.
01:10
But we've actually invested very little
in a system to stop an epidemic.
in a system to stop an epidemic.
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Men vi har faktisk investeret meget lidt
i et system til at stoppe en epidemi.
i et system til at stoppe en epidemi.
01:16
We're not ready for the next epidemic.
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Vi er ikke klar til den næste epidemi.
01:20
Let's look at Ebola.
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Lad os se på Ebola.
01:21
I'm sure all of you read about it
in the newspaper,
in the newspaper,
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Jeg er sikker på, at I alle har læst
om det i avisen,
om det i avisen,
01:25
lots of tough challenges.
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mange svære udfordringer.
01:27
I followed it carefully
through the case analysis tools
through the case analysis tools
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Jeg fulgte det omhyggeligt
via de analyseværktøjer,
via de analyseværktøjer,
01:30
we use to track polio eradication.
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som vi bruger til at holde styr på
polioudryddelse.
polioudryddelse.
01:35
And as you look at what went on,
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Og når man ser på, hvad der fandt sted,
01:37
the problem wasn't that there was a system
that didn't work well enough,
that didn't work well enough,
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var problemet ikke, at der ikke var et
system, som ikke virkede godt nok,
system, som ikke virkede godt nok,
01:42
the problem was that we
didn't have a system at all.
didn't have a system at all.
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problemet var, at vi ikke havde
noget system overhovedet.
noget system overhovedet.
01:46
In fact, there's some pretty obvious
key missing pieces.
key missing pieces.
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Faktisk mangler der nogle ret vigtige brikker.
01:51
We didn't have a group of epidemiologists
ready to go, who would have gone,
ready to go, who would have gone,
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Vi havde ikke en gruppe af epidemiologer
klar, som ville være taget afsted,
klar, som ville være taget afsted,
01:55
seen what the disease was,
seen how far it had spread.
seen how far it had spread.
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set hvilken sygdom det var,
set hvor vidt den havde spredt sig.
set hvor vidt den havde spredt sig.
01:59
The case reports came in on paper.
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Caserapporterne ankom i papirformat.
02:02
It was very delayed
before they were put online
before they were put online
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De var meget forsinkede
før de kom online,
før de kom online,
02:04
and they were extremely inaccurate.
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og de var meget unøjagtige.
02:07
We didn't have a medical team ready to go.
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Vi havde ikke et lægehold klar.
02:09
We didn't have a way of preparing people.
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Vi havde ikke en måde at forberede folk.
02:12
Now, Médecins Sans Frontières
did a great job orchestrating volunteers.
did a great job orchestrating volunteers.
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Læger uden Grænser gjorde et godt stykke
arbejde med at orkestrere frivillige.
arbejde med at orkestrere frivillige.
02:17
But even so, we were far slower
than we should have been
than we should have been
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Men selv da, var vi langt langsommere
end vi burde have været
end vi burde have været
02:20
getting the thousands of workers
into these countries.
into these countries.
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i at få de tusindvis af arbejdere
ind i disse lande.
ind i disse lande.
02:24
And a large epidemic would require us
to have hundreds of thousands of workers.
to have hundreds of thousands of workers.
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Og en stor epidemi ville kræve,
at vi har hundredetusinde af arbejdere.
at vi har hundredetusinde af arbejdere.
02:32
There was no one there
to look at treatment approaches.
to look at treatment approaches.
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Der var ingen der til
at se på behandlingsmetoder.
at se på behandlingsmetoder.
02:37
No one to look at the diagnostics.
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Ingen til at se på diagnoserne.
02:38
No one to figure out
what tools should be used.
what tools should be used.
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Ingen til at finde ud af
hvilke værktøjer skulle benyttes.
hvilke værktøjer skulle benyttes.
02:42
As an example, we could have
taken the blood of survivors,
taken the blood of survivors,
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For eksempel kunne vi have
taget blod fra de overlevende,
taget blod fra de overlevende,
02:45
processed it, and put that plasma
back in people to protect them.
back in people to protect them.
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forarbejdet det, og puttet det plasma
tilbage i folk for at beskytte dem.
tilbage i folk for at beskytte dem.
02:51
But that was never tried.
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Men det var aldrig forsøgt.
02:53
So there was a lot that was missing.
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Så der var meget, som manglede.
02:55
And these things
are really a global failure.
are really a global failure.
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Og disse ting
er virkelig en global fiasko.
er virkelig en global fiasko.
03:00
The WHO is funded to monitor epidemics,
but not to do these things I talked about.
but not to do these things I talked about.
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WHO er finansieret for at overvåge epidemier,
men ikke for at gøre hvad jeg snakkede om.
men ikke for at gøre hvad jeg snakkede om.
03:07
Now, in the movies it's quite different.
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I filmene er det ganske anderledes.
03:09
There's a group of handsome
epidemiologists ready to go,
epidemiologists ready to go,
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Der er gruppe smukke
epidemiologer klar til at tage afsted,
epidemiologer klar til at tage afsted,
03:14
they move in, they save the day,
but that's just pure Hollywood.
but that's just pure Hollywood.
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de ankommer, de redder dagen,
men det er bare Hollywood.
men det er bare Hollywood.
03:22
The failure to prepare
could allow the next epidemic
could allow the next epidemic
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Undladelsen i at forberede os
kunne tillade den næste epidemi
kunne tillade den næste epidemi
03:25
to be dramatically
more devastating than Ebola
more devastating than Ebola
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at være drastisk
mere ødelæggende end Ebola.
mere ødelæggende end Ebola.
03:30
Let's look at the progression
of Ebola over this year.
of Ebola over this year.
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Lad os se på udviklingen
af Ebola over dette år.
af Ebola over dette år.
03:36
About 10,000 people died,
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Omkring 10.000 er døde,
03:39
and nearly all were in the three
West African countries.
West African countries.
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og næsten alle var i de tre
vest-afrikanske lande.
vest-afrikanske lande.
03:43
There's three reasons why
it didn't spread more.
it didn't spread more.
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Der er tre grunde til, at
det ikke spredte sig mere.
det ikke spredte sig mere.
03:46
The first is that there was a lot
of heroic work by the health workers.
of heroic work by the health workers.
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Den første er, at der blev udført meget
heroisk arbejde af sundhedsarbejdere.
heroisk arbejde af sundhedsarbejdere.
03:50
They found the people and they
prevented more infections.
prevented more infections.
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De fandt folkene, og de
forhindrede flere infektioner.
forhindrede flere infektioner.
03:54
The second is the nature of the virus.
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Den anden er virussens natur.
03:56
Ebola does not spread through the air.
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Ebola er ikke luftbåren.
03:59
And by the time you're contagious,
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Og når du er smitsom,
04:01
most people are so sick
that they're bedridden.
that they're bedridden.
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er de fleste så syge,
at de er sengeliggende.
at de er sengeliggende.
04:06
Third, it didn't get
into many urban areas.
into many urban areas.
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Tredje grunden er, det spredte sig ikke i
mange by-områder.
mange by-områder.
04:10
And that was just luck.
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Og det var udelukkende held.
04:12
If it had gotten into a lot
more urban areas,
more urban areas,
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Hvis det havde spredt sig i flere
by-områder,
by-områder,
04:14
the case numbers
would have been much larger.
would have been much larger.
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ville antallet af tilfælde være
blevet langt større.
blevet langt større.
04:17
So next time, we might not be so lucky.
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Så næste gang er vi måske ikke så heldige.
04:21
You can have a virus where people
feel well enough while they're infectious
feel well enough while they're infectious
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Du kan have en virus, hvor folk føler
sig så veltilpas, mens de er smitsomme,
sig så veltilpas, mens de er smitsomme,
04:26
that they get on a plane
or they go to a market.
or they go to a market.
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at de stiger på et fly,
eller de tager til et marked.
eller de tager til et marked.
04:29
The source of the virus could be
a natural epidemic like Ebola,
a natural epidemic like Ebola,
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Kilden til virussen kunne være
en naturlig epidemi som Ebola,
en naturlig epidemi som Ebola,
04:32
or it could be bioterrorism.
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eller det kunne være bioterrorisme.
04:34
So there are things that would literally
make things a thousand times worse.
make things a thousand times worse.
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Så der er ting som bogstaveligt talt
ville gøre det tusind gange værre.
ville gøre det tusind gange værre.
04:39
In fact, let's look at a model
of a virus spread through the air,
of a virus spread through the air,
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Lad os se på en model af en virus,
som spredes igennem luften,
som spredes igennem luften,
04:45
like the Spanish Flu back in 1918.
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ligesom Den Spanske Syge i 1918.
04:49
So here's what would happen:
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Her er hvad der kunne ske:
04:51
It would spread throughout the world
very, very quickly.
very, very quickly.
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Det kunne sprede sig over verden
meget, meget hurtigt.
meget, meget hurtigt.
04:55
And you can see over 30 million people
died from that epidemic.
died from that epidemic.
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Og du kan se over 30 millioner mennesker
dø af den epidemi.
dø af den epidemi.
05:00
So this is a serious problem.
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Så det er et seriøst problem.
05:02
We should be concerned.
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Vi burde være bekymrede.
05:04
But in fact, we can build
a really good response system.
a really good response system.
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Men vi kan faktisk bygge et
rigtigt godt respons system.
rigtigt godt respons system.
05:08
We have the benefits of all the science
and technology that we talk about here.
and technology that we talk about here.
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Vi har fordelen af al den videnskab
og teknologi, som vi snakker om her.
og teknologi, som vi snakker om her.
05:13
We've got cell phones
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Vi har mobiltelefoner
05:14
to get information from the public
and get information out to them.
and get information out to them.
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til at modtage og give information
til og fra offentligheden.
til og fra offentligheden.
05:18
We have satellite maps where we can see
where people are and where they're moving.
where people are and where they're moving.
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Vi har satellitkort, hvor vi kan se
hvor folk er, og hvor de bevæger sig hen.
hvor folk er, og hvor de bevæger sig hen.
05:22
We have advances in biology
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Vi har fremskridt i biologi,
05:24
that should dramatically change
the turnaround time to look at a pathogen
the turnaround time to look at a pathogen
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som drastisk burde ændre
vendingstiden til at se på et patogen,
vendingstiden til at se på et patogen,
05:28
and be able to make drugs and vaccines
that fit for that pathogen.
that fit for that pathogen.
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og være i stand til at lave medicin
og vacciner passende til det patogen.
og vacciner passende til det patogen.
05:33
So we can have tools,
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Så vi kan have værktøjer,
05:34
but those tools need to be put
into an overall global health system.
into an overall global health system.
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men de værktøjer er nødt til at blive
implementeret i et globalt sundhedssystem.
implementeret i et globalt sundhedssystem.
05:39
And we need preparedness.
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Og vi har brug for beredskab.
05:41
The best lessons, I think,
on how to get prepared
on how to get prepared
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De bedste lektioner, tror jeg,
i at forberede sig
i at forberede sig
05:44
are again, what we do for war.
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er igen, hvad vi gør for krig.
05:46
For soldiers, we have full-time,
waiting to go.
waiting to go.
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For soldater, har vi fuldtid,
ventende til at tage afsted.
ventende til at tage afsted.
05:51
We have reserves that can scale
us up to large numbers.
us up to large numbers.
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Vi har reserver, som kan skalere
os op til store numre.
os op til store numre.
05:54
NATO has a mobile unit
that can deploy very rapidly.
that can deploy very rapidly.
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NATO har en mobil enhed,
som kan indsættes meget hurtigt.
som kan indsættes meget hurtigt.
05:58
NATO does a lot of war games
to check, are people well trained?
to check, are people well trained?
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NATO har en masse krigslege
for at undersøge om folk er veltrænet.
for at undersøge om folk er veltrænet.
06:01
Do they understand
about fuel and logistics
about fuel and logistics
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Forstår de
brændstof og logistik
brændstof og logistik
06:03
and the same radio frequencies?
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og de samme radiofrekvenser?
06:06
So they are absolutely ready to go.
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Så de er absolut klar.
06:08
So those are the kinds of things
we need to deal with an epidemic.
we need to deal with an epidemic.
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Så de er den slags ting, som vi
skal håndtere med en epidemi.
skal håndtere med en epidemi.
06:13
What are the key pieces?
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Hvad er de vigtigste brikker?
06:15
First, we need strong health systems
in poor countries.
in poor countries.
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For det første har vi brug for stærke
sundhedssystemer i de fattige lande.
sundhedssystemer i de fattige lande.
06:20
That's where mothers
can give birth safely,
can give birth safely,
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Det er hvor mødre
sikkert kan føde,
sikkert kan føde,
06:23
kids can get all their vaccines.
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børn kan få alle deres vacciner.
06:25
But, also where we'll see
the outbreak very early on.
the outbreak very early on.
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Men også hvor vi vil se
udbruddet meget tidligt.
udbruddet meget tidligt.
06:30
We need a medical reserve corps:
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Vi har brug for en medicinsk reserve:
06:31
lots of people who've got
the training and background
the training and background
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mange mennesker, som har fået
træningen og baggrunden,
træningen og baggrunden,
06:34
who are ready to go, with the expertise.
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som er klar til at tage afsted
med ekspertise.
med ekspertise.
06:37
And then we need to pair those
medical people with the military.
medical people with the military.
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Og derefter er vi nød til at parre de
medicinske folk med militæret,
medicinske folk med militæret,
06:42
taking advantage of the military's ability
to move fast, do logistics
to move fast, do logistics
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drage fordel af militærets evne
til at bevæge sig hurtigt, til logistik
til at bevæge sig hurtigt, til logistik
06:46
and secure areas.
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og sikre områder.
06:48
We need to do simulations,
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Vi er nød til at foretage simulationer,
06:51
germ games, not war games,
so that we see where the holes are.
so that we see where the holes are.
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bakteriologiske lege, ikke krigs lege,
så vi kan se, hvor hullerne er.
så vi kan se, hvor hullerne er.
06:55
The last time a germ game
was done in the United States
was done in the United States
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Den sidste gang bakteriologiske lege
fandt sted i USA
fandt sted i USA
06:58
was back in 2001,
and it didn't go so well.
and it didn't go so well.
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var tilbage i 2001,
og det gik ikke særlig godt.
og det gik ikke særlig godt.
07:02
So far the score is germs: 1, people: 0.
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Indtil videre er stillingen bakterier: 1,
mennesker: 0.
mennesker: 0.
07:07
Finally, we need lots of advanced R&D
in areas of vaccines and diagnostics.
in areas of vaccines and diagnostics.
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Til slut har vi brug for meget avanceret
R&D i vacciner og diagnostik.
R&D i vacciner og diagnostik.
07:13
There are some big breakthroughs,
like the Adeno-associated virus,
like the Adeno-associated virus,
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Der er nogle store gennembrud,
som "Adeno-associated" virusset,
som "Adeno-associated" virusset,
07:17
that could work very, very quickly.
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som kunne arbejde meget, meget hurtigt.
07:21
Now I don't have an exact budget
for what this would cost,
for what this would cost,
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Jeg har ikke et eksakt budget
på hvor meget dette ville koste,
på hvor meget dette ville koste,
07:24
but I'm quite sure it's very modest
compared to the potential harm.
compared to the potential harm.
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men jeg er ganske sikker på, at det er
beskedent ift. den potentielle skade.
beskedent ift. den potentielle skade.
07:29
The World Bank estimates that
if we have a worldwide flu epidemic,
if we have a worldwide flu epidemic,
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Verdensbanken estimerer at, hvis vi har
en verdensomspændende influenza epidemi,
en verdensomspændende influenza epidemi,
07:33
global wealth will go down
by over three trillion dollars
by over three trillion dollars
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vil global velstand falde
med over tre billioner dollars,
med over tre billioner dollars,
07:37
and we'd have millions
and millions of deaths.
and millions of deaths.
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og vi ville have millioner
og million af dødsfald.
og million af dødsfald.
07:41
These investments
offer significant benefits
offer significant benefits
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Disse investeringer
tilbyder markante fordele
tilbyder markante fordele
07:44
beyond just being ready for the epidemic.
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udover bare at være klar til en epidemi.
07:46
The primary healthcare, the R&D,
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Det primære sundhedsvæsen, forskningen,
07:48
those things would reduce
global health equity
global health equity
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disse ting ville reducere
global sundheds ulighed
global sundheds ulighed
07:51
and make the world more just
as well as more safe.
as well as more safe.
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og ville gøre verden mere retfærdig
og mere sikker.
og mere sikker.
07:55
So I think this should absolutely
be a priority.
be a priority.
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Så jeg mener at dette absolut
burde være en prioritet.
burde være en prioritet.
07:59
There's no need to panic.
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Der er ingen grund til panik.
08:00
We don't have to hoard cans of spaghetti
or go down into the basement.
or go down into the basement.
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Vi har ikke brug for at hamstre spaghetti
dåser eller gå ned i kælderen.
dåser eller gå ned i kælderen.
08:05
But we need to get going,
because time is not on our side.
because time is not on our side.
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Men vi er nød til at komme igang,
fordi tiden er ikke på vores side.
fordi tiden er ikke på vores side.
08:09
In fact, if there's one positive thing
that can come out of the Ebola epidemic,
that can come out of the Ebola epidemic,
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Der er faktisk kun en positiv ting,
som kan komme fra en Ebola epidemi,
som kan komme fra en Ebola epidemi,
08:15
it's that it can serve as an early
warning, a wake-up call, to get ready.
warning, a wake-up call, to get ready.
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og det er, at det kan tjene som en tidlig
advarsel, et varsel til at blive klar.
advarsel, et varsel til at blive klar.
08:21
If we start now, we can be ready
for the next epidemic.
for the next epidemic.
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Hvis vi starter nu, kan vi være klar
til den næste epidemi.
til den næste epidemi.
08:26
Thank you.
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Tak.
08:28
(Applause)
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(Bifald)
ABOUT THE SPEAKER
Bill Gates - PhilanthropistA passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation.
Why you should listen
Bill Gates is the founder and former CEO of Microsoft. A geek icon, tech visionary and business trailblazer, Gates' leadership -- fueled by his long-held dream that millions might realize their potential through great software -- made Microsoft a personal computing powerhouse and a trendsetter in the Internet dawn. Whether you're a suit, chef, quant, artist, media maven, nurse or gamer, you've probably used a Microsoft product today.
In summer of 2008, Gates left his day-to-day role with Microsoft to focus on philanthropy. Holding that all lives have equal value (no matter where they're being lived), the Bill and Melinda Gates Foundation has now donated staggering sums to HIV/AIDS programs, libraries, agriculture research and disaster relief -- and offered vital guidance and creative funding to programs in global health and education. Gates believes his tech-centric strategy for giving will prove the killer app of planet Earth's next big upgrade.
Read a collection of Bill and Melinda Gates' annual letters, where they take stock of the Gates Foundation and the world. And follow his ongoing thinking on his personal website, The Gates Notes. His new paper, "The Next Epidemic," is published by the New England Journal of Medicine.
Bill Gates | Speaker | TED.com