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Bill Gates: Time to make a 'war game' for infectious disease

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Imitate war efforts — but with disease as a target

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The Ebola epidemic that ravaged Sierra Leone, Guinea, and Liberia suggests we need a better worldwide warning and response system for infectious disease, says Bill Gates, the richest man in the world. That means borrowing a variety of techniques from the military, including "the idea of a war game."

"It’s useful to compare our preparations for epidemics with our preparations for war," Gates writes in The New England Journal of Medicine. "Defense budgets and investment in new weapons dwarf investments in epidemic preparation. NATO has a mobile unit that is ready to deploy quickly. Although it’s not a perfect system, they do joint exercises where they work out basic logistics like how fuel and food will be provided, what language they will speak, what radio frequencies will be used. When soldiers sign up to serve, they know what the risks are and who will take care of them if they’re injured or killed. Few if any of these things exist for an epidemic response."

"An avoidable crisis"Almost 25,000 people in those three countries have been infected with Ebola as of March 15th, and 10,000 people have died, according to the US Centers for Disease Control and Prevention. The virus is still spreading; 116 new cases were confirmed in the week before March 8th in Sierra Leone and Guinea, according to the World Health Organization. Liberia is faring better — there have been no new reports of confirmed Ebola cases for the last two weeks.

The epidemic has been characterized as "an avoidable crisis" by Jeremy Farrar of the Wellcome Trust and Peter Piot of the London School of Hygiene and Tropical Medicine, in a September editorial in The New England Journal of Medicine. The outbreak began in December 2013 in Guinea, but the WHO wasn't notified until March 23th, 2014. The WHO didn't declare the Ebola crisis a global emergency until August — when more than 1,000 Africans had already died of the disease. The global response was "highly inadequate and late," Farrar and Piot write.

"The world spends a great deal of money getting ready for war."The ideal warning system would be coordinated by a global agency with "enough authority and funding to be effective," according to Gates. That's not the WHO, he says — the organization isn't "clearly chartered or funded to handle most of the things required in an epidemic."

Gates also writes that the global health community should increase its investment in developing new tools for diagnosis and treatment, as well as improving the global health warning system. Also, the global community should establish a NATO-like force of trained people and run preparedness drills to help identify any weak links, he says.

"The world spends a great deal of money — hundreds of billions of dollars a year — getting ready for war," he writes. "I am not saying this is a mistake, but given that an epidemic is more likely to kill millions of people than a future war, I believe we should build on these efforts so we can be more prepared for a severe epidemic."

In the editorial, Gates didn't commit the Gates Foundation, worth $42.3 billion as of February 17th, to funding any of these efforts.