Bill Gates warned that a devastating 'quirk of nature' could kill 30 million people in less than a year. Experts say we're still not doing enough to prepare.

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  • In 2017, Bill Gates warned that if a pandemic virus like the Spanish flu of 1918 that killed 50 million people hit the world today, it could still finish off "more than 30 million people in less than a year."

  • Researchers at the World Health Organization's Global Preparedness Monitoring Board say that little progress has been made to prepare for a pandemic and that countries urgently need to step up preparations for a "worst-case scenario" like that flu.

  • If a virus like that one emerged today, it could spread around the world in less than 36 hours.

  • Outbreaks have been on the rise in recent years, driven in part by rising global temperatures and more crowded cities.

  • Visit Insider's homepage for more stories.

Bill Gates fears that the world is not ready for the next big one.

The threat he worries about isn't a nuclear bomb or impending earthquake. What Gates is concerned about is a yet-to-be-unleashed tiny, invisible virus that could wipe out millions of people around the world in just months.

"Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year," Gates told a room full of security experts in Munich, Germany, in 2017. "They say there is a reasonable probability the world will experience such an outbreak in the next 10 to 15 years."

Bird Flu
Bird Flu

Global health experts fear not enough has changed since Gates issued that stark warning.

"It has to be said again," Victor Dzau, the president of the National Academy of Medicine, told Insider. "There's a sense of urgency: The world's at risk."

Dzau is part of an internationally esteemed group of 15 public health experts behind a new, independent report from the World Health Organization's Global Preparedness Monitoring Board suggesting that the world is still unprepared for a pandemic virus and that cramped cities, warmer temperatures, and deforestation are making the world a breeding ground for contagions to thrive.

Bird flu and swine flu can quickly morph into novel strains of people-killing viruses

One of these pandemic viruses could even be hiding out in a bird near you.

"More than 60% of human disease, particularly related to infections, are coming from animals," Dzau said.

Traveling birds are the primordial hosts of influenza viruses in humans — and while researchers scramble to collect their beach poo and discover what kinds of bird flu might be coming our way next, global health leaders say time may be running out. An innocent-looking bird, chicken, or pig could become the origin of a deadly human pandemic.

"The fact that animals are not living in the forest but we are domesticating them ... putting them in crowded conditions close to humans, that's really a very big factor," Dzau added.

Read more: Bill Gates says a devastating 'quirk of nature' could kill 30 million people in a year. Researchers are fighting that threat by studying bird butts.

Earth's population is also now four times what it was in 1918. Air travel makes it possible to visit other people anywhere around the globe in 36 hours or less. And it's not difficult to imagine how a new virus like the Spanish flu could sweep through entire continents before health experts have time to recognize what's happening.

"In addition to tragic levels of mortality, such a pandemic could cause panic, destabilize national security and seriously impact the global economy and trade," the report's authors wrote, warning that if a pandemic like the Spanish flu were unleashed today, it could cost the world $3 trillion, or nearly 5% of global gross domestic product.

Pandemic preparedness is a national security issue

The first step in being prepared for the next pandemic has to come from the top, Dzau said. Heads of state should make pandemic preparedness an integral part of their national security strategies, the report suggested. More money should be spent on simulation exercises, vaccine research, and rapid communication systems.

Even without a vaccine, basic healthcare practices like quarantine measures and good sanitation can stop viruses dead in their tracks.

But in some lower- and middle-income countries, Dzau said, there's still a missing "backbone of public health and health system," which is foundational to containing disease and treating people during an outbreak.

"Even though America does better than others," Dzau said, "don't forget: If we don't help low- and middle-income countries to deal with these things, they'll come to our country."

That happened in 2014, when two nurses who never left the US contracted Ebola, a relatively difficult virus to transmit. Ebola can travel from person to person only through close, direct physical contact with infected bodily fluids like blood, vomit, or feces. A lot of other contagious illnesses need much less than that to thrive and can be caught with just a wayward cough or sneeze.

"There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people," the report's authors cautioned.

Ebola treatment center in DRC
Ebola treatment center in DRC

World Health Organization/J. Kannah

Bioterror is not nearly as threatening as naturally circulating pathogens

According to the report, 56 countries now have some form of a national action plan for health security, but none of those programs has been fully funded.

It's a scary prospect, given that there were 1,483 epidemic events in 172 countries between 2011 and 2018, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), Zika, Ebola, and the plague, the report said.

Dzau's own research has demonstrated how from 2002 to 2015 outbreaks and pandemics of diseases including cholera, chikungunya, and Zika only became more common.

While there's been only one big bioterror scare in the past 50 years — the anthrax outbreak of 2001 — other naturally incubated diseases have been spreading.

emerging and re-emerging diseases in last 50 years
emerging and re-emerging diseases in last 50 years

US National Institutes of Health, National Institute for Allergies and Infectious Diseases

"Warmer climate, more mosquitoes, flying much further," Dzau said of the drivers of such diseases spreading. "It is climate change, deforestation, urbanization, and the closeness of humans and animals that just quickly increases that opportunity to have infections."

He's calling on world leaders to prioritize preparedness for the next great pandemic as they would prepare for war: before it begins.

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