Gates Package — page 1148

them? Cost? They are more expensive than paper masks, but at scale could be made for a very low price, and some could be used multiple times. Page 34, line 6: CDC whiplash. Again, I think this may be more a function of political interference than CDC incompetence. Page 34, bottom two paras: I completely agree that David Sencer was a great leader, and I have always admired him. HOWEVER, it is worth being aware that, however unfairly, Sencer was during his lifetime severely criticized as one of those leaders who did not end the old Tuskegee syphilis studies (which you mention later on) when he could have. This is a complicated story, usually portrayed unfairly, but lauding Sencer might provoke some push back. If it were me, I would certainly sing his praise, but there could be a downside. Page 35, para 3. This was not purely Sencer's decision but a consensus decision of all but one of the top US flu and PH experts Sencer convened, made in conjunction with Califano and the Ford White House. The one dissenter was Russ Alexander, but as I recall Russ later said he thought it was the call Sencer had to make. Regarding the firing of Sencer, and the statement that he did know exactly why he was fired. He knew, as did everyone else. It's worth noting that many years later it came out that the damning 1977 book "The Swine Flu Affair", authored by Neustadt and Fineberg, was actually an HEWinstigated hatchet job designed as a pretext to fire Sencer, another reason to hope for a return to independence of HHS agency directors. Page 37, para 4, line 3, the profit motive isn't always determinative. The original polio vaccine, the Salk vaccine, was funded by the private NFIP (National Foundation for Infantile Paralysis) at a time when NIH had limited funds. Page 38, line 1. Many would say the response to SARS in 2003 was faster and more effective: it actually PREVENTED a pandemic-in process. Chapter 2 Page 40, para 2. The fire brigade analogy is instructive. It might also be said that in the US and elsewhere we had city boards of health, sometimes set up and dismantled as circumstances dictated, throughout the 1880s, with occasional examples going back centuries. Thus, the concept is old. Page 45, para 2. The GERM idea is fantastic and should be fleshed out in greater detail. Many similar ideas arose spontaneously during and after the 2015 Ebola epidemics. I argued at the time, and some others agreed, that such a force needed a "strike force" with a "military-like" component. NOT a military, but a force that could quickly deploy to remote areas and bring in teams, water purification, electrical generators, set up temporary buildings and compounds, etc. The Ebola epidemic began in a remote Guinea border area where access is limited, roads are washed out in the rainy season, no electricity (to run PCR machines, for example) or safe water, and no safe facilities to treat infected patients. Page 46: there may be a disproportionate emphasis on the supposed magic of computer modeling for predictions, as opposed to biostatistical study. The 4-decade history of predicting various diseases with computer modeling is actually not very good, e.g., for early HIV and for BSE. Modeling used to be called