What Bill Gates says matters.  He is deeply influential on public health policy.  His generosity as a philanthropist may also stifle criticism of his positions by experts and practitioners alike who depend on his largesse.  Now, he has a lot to say about how to prevent future pandemics in his new book.  The short version of his upbeat vision is that we can prevent pandemics by getting better at developing vaccines and treatments to quickly respond when new infectious diseases emerge.  He advocates for new funding of a few tens of billions of dollars annually to achieve this laudable goal.

 

Gates is, however, at best, half right.  The mRNA vaccines that now protect many of us from the worst of COVID-19 are little short of a scientific miracle, developed in record time and remarkably effective.  However, vaccine hesitancy and misinformation, evolution of the virus, and weaknesses in national healthcare systems continue to frustrate efforts to get vaccination rates up to the levels needed to stop the spread of the coronavirus behind this pandemic.  This is only partly due to lack of money or technology.  In the United States, with the richest healthcare system in the world, and vaccines freely available, 18 months after vaccines became widely available, around 500 people are still dying each day, and we will soon pass the gruesome milestone of one million deaths due to COVID-19.  Less than half of Americans have availed themselves of the boosters needed to protect against the latest variants.

 

We are not public health experts.  Instead, our backgrounds are as a community leader and activist in the Brazilian Amazon and a tropical forest scientist.  Our journeys intersected at deep and growing frustration with the public health establishment and its inability to recognize that there is another side to pandemic prevention.  We believe that there are deeper and more cost-effective solutions to true pandemic prevention.  These are to be found in the relationships between people and nature, which seem to be studiously ignored by Gates, his big health brethren at the Gates Foundation and other key thought leaders including the Rockefeller Foundation, Wellcome Trust, and World Health Organization.

 

All seven of the major pandemics, back to the Spanish Flu of 1918, were caused by viruses that spread quietly and unnoticed in wildlife until they spilled over into humans.  Some, like HIV/AIDS, SARS and probably COVID-19, likely moved directly from wildlife to humans because of human consumption of animals like bats, pangolins, raccoon dogs, or primates.  Others, especially the influenzas, first infected our livestock, such as chicken or pigs, where they multiplied, evolved, and from there made their way to us.

 

True pandemic prevention comes down to reducing the opportunities for novel viruses that cause deadly new diseases to spread from wildlife into humans.  The good news is that scientists know what we need to do to reduce the risk of spillover, and it’s been costed out with help from economists.  Vitally important, the leaders of indigenous communities across the Amazon and other tropical regions that are home to most of the viruses, have also proven they can protect tropical forests and wildlife – also reducing spillover risk – when given the chance to do so.

 

Reducing risky human-wildlife contact comes down to stopping clearing of tropical forests, curbing commercial hunting, trade, and consumption of wildlife, and improving the healthcare provided to people and domesticated animals, especially in rural communities.  Other priorities are better surveillance to detect spillover events and making animal agriculture safer from wildlife contact and rapid spread of viruses when infections occur.  The global annual cost of properly implementing these measures is only about $20 billion, or less than one percent of spending to date by the United States alone to respond to COVID-19.

 

The bad news is that governments are balking at this cost even though risk reduction of just a few percentage points would more than justify the investment needed.  Worse, influential voices like Bill Gates and his foundation, the Rockefeller Foundation, Wellcome Trust, and other top global funders and influencers in public health refuse to support a more holistic approach, and even disparage it, questioning the science and practicality of the true upstream prevention.  Or they simply suggest that spillover prevention should be left to environmental funders and agencies.

 

We understand that governments are preoccupied with dealing with the current pandemic and have little bandwidth to consider new approaches.  Clearly, public health agencies traditionally have little knowledge or understanding of deeper preventative measures involving wildlife and animal husbandry – expertise well beyond what is taught in medical schools.  Budgets are also severely strained after carrying the costs of COVID-19 (and now the Ukraine crisis).  More insidiously, upstream prevention does not get industry and supply chains energized and engaged.  Vaccines, personal protective equipment, testing, tracing, quarantine facilities, and anti-viral treatments, are all highly profitable.  Politicians and foundation leaders love cutting ribbons on new vaccine factories and grabbing selfies with huge planes carrying emergency medical supplies as the backdrop.

 

Despite these challenges, it is imperative that all governments learn about and take action to reduce the risk of spillover of novel viruses.  Rich-country governments need to finance global efforts to protect tropical forests and wildlife, combat the live animal trade, and strictly regulate and surveil trade in exotic animals for pets and consumption.  All governments should strengthen regulations governing animal husbandry and work on improving domesticated animal health and wellbeing, as well as ensure farmers are trained in reducing contact between livestock and wildlife.  Governments and business must also do much more to respect and defend the fundamental rights of indigenous peoples to manage and protect the lands and forests they depend upon and have stewarded for countless generations.

 

These actions come with no regrets.  They are all things that governments would be wise to do even without regard for pandemic risk – better protecting wildlife and tropical forests, improved animal welfare and strengthening health services for people in rural areas, all make good sense, helping to avert other crises in climate change and biodiversity loss.

 

Each national government can take steps to implement these measures, they do not need to wait for others to act internationally.  Rich-country governments can help poorer regions to implement these steps – thereby helping protect everyone from emerging disease risk. And venues like the Group of 20 major economies (G20) have ongoing processes where coordinated funding efforts, reporting and accountability for progress, should also be agreed.

 

If such steps are not taken, then governments will have failed to heed the science and we may well face future pandemics disrupting all our lives again before this decade is over. 

 

We urge Bill Gates, his foundation, and other influential philanthropists and leaders, to see the bigger picture and the need for more comprehensive efforts to reduce the risk of future pandemics.  Yes, we need more and better vaccines and treatments.  And we also urgently need to do a much better job in stewarding nature.  We need to bridge the gulf and escape from the siloed thinking that has kept public health, animal health and ecological integrity apart.