Gates Package — page 1063

The second thing these exercises have in common is that virtually nothing was done as a result to make America more ready to handle an outbreak. Although some adjustments were made at the federal and state levels, we only need to look at what's happened since December 2019 to see that whatever changed was not enough. The third is that, with the exception of Crimson Contagion, each of the U.S. simulations took place exclusively in conference rooms, and none of them involved moving real people or equipment from one place to another. Full-scale exercises aren't run as often as tabletop and functional ones for the obvious reason that they're expensive, time-consuming, and intrusive. In addition, some public health leaders have argued that the best way to prepare for a pandemic is to simulate smaller outbreaks, which means not preparing for things that happen only in an epidemic or pandemic--problems like supply chains being disrupted, economies shutting down, and heads of state interfering for political reasons. It's also likely that, until 2020, the threat of a worldwide contagion seemed remote to most people, and therefore not worth the trouble and cost of a full-scale, real-life exercise. Two years into COVID, the argument is much easier to make. The world needs to be running far more full-scale exercises that test its readiness for the next major outbreak. In most countries, these exercises can be run by national public health institutions, emergency operations centers, and military leaders, with the GERM team that I described in Chapter 2 acting as an advisor and reviewer. For low-income countries, the world will have to bring in resources to help out. Here's how a full-scale outbreak exercise might work. The organizers would pick a city and act as if it's experiencing a bad outbreak that could spread nationally or globally. How