I was recently traveling abroad with family this summer. Two days after arrival, we woke up with sore throat and fever, having contracted COVID-19. I obviously overestimated the immune protection provided by two doses of mRNA vaccine, and previous exposures, and underestimated the infectiousness of this pathogen, and made the mistake of not wearing a mask during our transcontinental trip. Fortunately, none of us ended up in the hospital or worse, but we had to spend a week out of our trip in isolation. Quite ironically, I spent some of this time reading the book I took with me, titled “How to Prevent the Next Pandemic” by Bill Gates.

I found this book成为interesting and useful, and I learned quite a few interesting tidbits. It’s style is easy to understand, andmostly avoids难以理解的行话。有有效的，如果简化的话，可以对获得的免疫力以及疫苗接种和治疗药物的调节过程进行描述。我从来没有想过这两套药物之间的法规差异，但是有道理的是，由于对健康而不是已经病人的人，因此需要更加严格地调节疫苗。这本书忠于比尔·盖茨（Bill Gates）作为技术专家，许多对不同技术的描述，这些技术具有改善大流行预防和反应的巨大潜力，例如这Nexarhigh-throughput PCR machine that can process 150,000 test per day.He does spend a bit too much emphasis on technological solutions for my taste, and not enough on the sociological, cultural, political and philosophical issues that are crucial to understand to see if people would be even comfortable using the technologies, but that’s not surprising coming from him.他表达s对疾病建模作为工具和职业的深厚支持，这是makes sensegiven how theInstitute for Disease Modelingis part of the比尔和梅琳达·盖茨基金会,and funded theInstitute for Health Metrics and Evaluationat the University of Washington. An entire chapter of the book focuses on non-pharmaceutical interventions, such as masks and social distancing, and provides many good ideas, but also talks about the drawbacks of someinterventions, such as边界封闭和影响学校关闭on the socio-psychological development of children. It was interesting to see that, despite his personal role in the development of personal computers, Bill Gates does not advocatefor a广泛转向在线学习，并承认对所有年龄段的学生的面对面教学和互动的重要性。However, in the Afterword, he focuses on how the world of work may change during and after the pandemic, with increased options for remote work across large sectors of industry.

The main idea of the book is presented in Chapter 2, and subsequent chapters provide supporting evidence for this main idea. Bill Gates advocates for the creation of a global pandemic prevention team, which he calls GERM (Global Epidemic Response and Mobilization), whose purpose would be to make sure the world is ready for the next outbreak, and improve pandemic preparedness globally. The idea is loosely based on existing teams organized to coordinate polio surveillance and vaccination in endemic countries, called紧急行动中心（EOC）。尽管这些EOC专注于脊髓灰质炎，但可以重新定位并重新使用，以专注于以前有新兴的大流行病原体，例如SARS-COV-2或埃博拉病毒。细菌将受到的任务WHO, and would only require $1 billion a year to employ a staff of 3,000 to coordinate pandemic surveillance and preparedness at a global level. While we might assume this is already happening at WHO, that is not the case, according to Gates, and WHO does not have the required funding for such a program at sufficient scale. He does mention果阿(the Global Outbreak Alert and Response Network) as the most similar existing system, but it is functioning on a volunteer basis. I was surprised and disappointed that he did not mention or include世界卫生网, where at least I saw the first report on what later turned out to be the COVID-19 pandemic, so then I’m not sure what else is there that he might not be aware of. In general, I found the idea of GERM to be interesting, and would definitely improve our pandemic preparedness, but it makes me wonder why we didn’t have it previously. The WHO is notoriously underfunded, and individual countries are unlikely to take kindly to interference from a WHO team into their own internal surveillance and pandemic preparedness. I even wonder if some countries would be reluctant to share information publicly on their pandemic preparedness (or lack thereof) to shield it from their adversaries. However, if anyone, the Bill and Melinda Gates Foundation does have the deep pockets to get such a team going, even on their own, and once it’s value is demonstrated, perhaps the WHO or other countries would pick up the tab.

这本书中的一个有趣的花絮与周围的道德问题有关西雅图流感研究and their detection of SARS-CoV-2 on tests taken for other purposes in February 2020. Without getting into much detail, the Seattle Flu Study was established (as it’s name suggests) to collect samples for influenza surveillance and genomic sequencing in the Seattle area. When COVID-19 started spreading in the US, some of the scientists made their own in-house PCR tests for SARS-CoV-2, and ran some of the samples collected to test for the flu for this new pathogen instead. The ethical dilemma struck when one of their samples came back positive. Genetic analysis suggested that the virus they sampled and sequenced was related to the virus in the first COVID-19 patient detected in the US in the Seattle area, and that many times more people were actually infected (and potentially infectious) than the known number of cases in the area. The道德困境是收集样品以测试流感，而不是SARS-COV-2，而SARS-COV-2的内部PCR测试仅被批准用于研究，而不是用于医学诊断目的。但是，研究人员继续宣布他们的发现，使我们所有人（包括我本人）突然意识到，这种大流行已经在2月失控了。这导致了一系列决定，例如在冬季末期结束之前关闭校园，保护无数人免受感染。这做出了Trevor Bedford我的一个个人英雄之一，阅读我在这本书中不知道的背景故事非常有趣。

比尔·盖茨（Bill Gates）在本书中认为的其他有趣的想法之一是，为下一个大流行和处理当前问题做准备并不是矛盾的，而是互补的。有很多覆盖范围（包括在Bugbitten) on how shifting focus and resources to COVID-19 took away those same resources from endemic chronic conditions such as HIV, malaria, TB and many others. Gates argues that should not necessarily be the case, and that pandemic preparedness (as opposed to response) can also benefit local health systems, such as increasing routine surveillance and monitoring. Gates also decries the lack of good preparation for pandemics, in contrast to e.g. armed conflict, and that very few countries (e.g. Vietnam) choose to spend time and money on conducting full-fledged pandemic simulations that would reveal flaws and lead to improvements. Most countries (including the United States) stop at conductingtable-top exercises不要有显著疗效,甚至tough they already reveal dysfunction on delegating roles and responsibilities (e.g. between the states and the federal government). He also focuses on closing the gap between rich and poor countries in health outcomes and vaccine coverage, and provides good evidence of the enormous progress that has been achieved (with partly his help) in the last 50 years.

他为预防大流行的计划做出了很好的论据，专注于四个步骤，这些步骤（1）制造和提供更好的工具；（2）建立细菌团队；（3）改善疾病监测；（4）加强卫生系统。他是非常自我意识的，他谈到了自己似乎总是写关于当前的大问题的文章，为他可能不是专家的问题提供了建议。他说，目前，他只看到气候变化大流行风险是我们这个时代最重要的两个问题。但是，不幸的是他没有连接两者，因为气候变化可以并且确实会导致大流行的风险增加。最后，他认为我们不应该让社会和政策制定者忘记1918年西班牙流感之后所做的那样，而是从我们犯下的错误中学习，并为下一个造成的错误做好准备。作为准备工作的一部分，我可以全心全意地推荐他关于“如何防止下一个大流行”的书。