Gates Package — page 952

The problem that the Seattle scientists and their colleagues kept running up against was that in the United States key parts of the infrastructure needed for this kind of analysis were missing. Think about the way we handle influenza here. Most people who think they have the flu don't bother going to the doctor--they just stock up on over-the-counter drugs and sweat it out. If they do end up at a clinic, the doctor might make a diagnosis based on the symptoms alone, without running a test. The only cases that get reported to public health officials are the ones in which a test is ordered by a doctor who works at a clinic that is participating in a voluntary influenza-reporting program. The fact that so few tests are run has a ripple effect: Too few samples of the influenza virus are sequenced. Plus, many of the ones that do get sequenced are not accompanied by information about the people they came from--where they live, how old they are, and so on. You could have a million sequences of a virus, but if you don't know anything about who they came from, you won't be able to figure out where the disease started or how it spread from one place to another. The Seattle Flu Study was designed to tackle this problem head-on. Not only would it create a system for testing lots of volunteers and sequencing lots of viral genomes, but--subject to privacy safeguards--the sequencing data would be linked to information about the volunteers it came from. And the near-real-time, citywide flu map that the project was going to create would be a game changer for detecting and stopping outbreaks. I thought the Seattle Flu Study was an ambitious and unique idea, and it had a chance to make progress on some of the problems I had called out in my TED talk years before. I agreed to