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Bill Gates’s plan to tackle a possible pandemic only works if governments handle health care

The Covid-19 epidemic has yet to go global, yet there are fears among public health professionals it could be our century’s Spanish flu.

The 1918 pandemic circled the world three times over two years, infecting a third of the population and killing at least 50 million —and that was before globalization, and widespread international travel. The fact that it is still being talked about over a century later gives a measure of both the gravity of the outbreak—and the potential threat we are currently facing.

For years the public health community has been saying two important things in this respect: One, that it was only a matter of time before a serious pandemic hit again; and two, that the global health systems were woefully unprepared to tackle the emergency.

Still, there are still steps to be taken that can control the current emergency and prepare for future ones, and lessons to learn. A clear lesson is the risk of having the markets set the price of health care, and individual companies handle the service.

In an article published today in the New England Journal of Medicine , Bill Gates—who has been working on public health for the past two decades through the Bill and Melinda Gates Foundation—broke down what he thinks would be the best way to deal with the epidemic.

Key amongst them are actions only the government can take: Investments to tackle treatment which are too risky for private companies to make; control of the market price of treatments and vaccines, which would otherwise skyrocket were makers allowed to maximize profits from them; and international aid, which would strengthen the health systems of low-income countries and reduce the spread of the virus.

In his letter, Gates lists all of the actions that should be taken at this point to prevent the worst-case scenario. And though he is the head of a private foundation, and a man who built a fortune by embracing free enterprise, there is a clear thread that runs through his whole plan: This is the government’s job—one that only a public health system can do effectively.

Here is what Gates recommends:

  1. Ensure global cooperation: The virus will spread faster in poor countries with ill-equipped health systems, so it’s important that rich countries send support to low- and middle-income countries even before they are hit, specifically to help them prepare for the emergency.
  2. Promote research: There is no vaccine for the Covid-19, but the speed at which research has moved since the virus was discovered has been impressive. An optimistic, yet not utopian, estimate says there may be a vaccine as early as June, and with optimal research setups, a treatment could come relatively quickly, too. Successful vaccine development requires coordination between the public and private sectors.
  3. Build shared databases: Countries need to build capacity for disease surveillance, sharing information on outbreaks, trained personnel, best practices, and experts.
  4. Get diplomacy working: Researchers of different countries have to be able to share findings, resources, and anything that can speed up the search for a vaccine or treatment. Covid-19 is the common enemy that can create coalitions among otherwise antagonistic governments.
  5. Look forward: If there is an opportunity in this, is to take this chance to set up the global health system so it’s less vulnerable to epidemics—even ones that don’t make history. Tackling the emergency is necessary but not sufficient, countries need to make long-term investments, including through aid for poorer countries, so that the world is better prepared next time. These aren’t necessarily financially profitable actions, so private capital is unlikely to be attracted.

One country that may struggle to pursue this course of action is the US, where anything from centralized data to control of market price for drugs is limited in a health system that primarily relies on private providers.

As the nation prepares for the seemingly inevitable American phase of the epidemic, the lack of a strong universal health care system is already showing its limits—for instance, with patients potentially charged thousands of dollars for tests. Democratic candidates such as Elizabeth Warren or Bernie Sanders who are proposing a plan for universal health coverage might find in the Covid-19 epidemic an unfortunately strong case to support their argument

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