Gates Package — page 1147

is addressed somewhat later in the book by discussing universal vaccines: the mRNA vaccines are the opposite in being non-universal but very strain specific, highly problematic for a virus that easily mutates into new strains the vaccine can't cover. Chapter 1 Page 26, the whole page, brings up some very important issues. The 2020 US federal COVID response is rightly criticized, BUT..... A larger problem not directly addressed here is the relationship between the political and public health/scientific spheres. For example, in criticizing CDC it is worth remembering that unlike every single developed nation in the world, the US has no national health department or health ministry. Way back in 1783 our founding fathers set up a system in which public health sovereignty resided entirely at the State and local level. With the limited exception of a 1798 act establishing several quarantine stations at east coast ports, PH sovereignty today remains at the State and local level. CDC has to GET PERMISSION to go to a State, look at their data, etc., and basically what CDC gets is only what 50 States and numerous cities and counties agrees to give them, in a variety of formats and degrees of detail. Attempts to fix this situation stretch back to 1870, but all have failed. So, the failed system we have with respect to pandemic response is the one we set up more than 235 years ago. Blaming the agencies does not fix the problem. A second point touched on here, that is mentioned tangentially later, is the control over national PH by politicians. Until 1977 CDC had always had expert scientific leaders. When David Sencer was fired over the "swine flu affair" there was an international outcry attacking then-HEW Secretary Califano, who retreated by replacing Sencer with his young protégé Bill Foege. But in subsequent years CDC directors have more often been political appointees, often with little PH expertise. (There are exceptions: you mention Bill Foege and Tom Frieden, but you could also add Jeff Koplan). You could make a stronger point here that CDC directors and other health agency directors should be top scientists widely respected as such by experts, and they should be allowed to function independently, without political interference. This is a pull-no-punches book, and it might be worth going out on a limb to say that over the past century, around the world, political coopting of national health and science leaders has too often led to disasters. Page 30, para 1, line 4: the flu vaccine DOESN'T always need not be update annually, although even when it doesn't, we still need to get vaccinated a year later because protection is transient. These are 2 different issues. Page 30, para 2, line 6: Delta's arrival was a surprise only in its specifics. Most experts believed that problematic variants were likely to arise in one form or another. Some predicted a delta-like virus, and others predicted a different phenotype. Page 32, bottom, and top of page 33: it might be worth noting that the value of masks was not only well appreciated in 1918 but that residents of many big Asian cities have been wearing them in public ever since. Here too, it might be worth saying more about the superiority of N95 asks, which offer an order of magnitude greater protection than paper masks. Why do we not highly recommend or even mandate