Gates Package — page 997

molecule of aspirin is just 180 times more massive than a single atom of hydrogen--they belong to a class of drugs known as small molecules. Small-molecule drugs have several advantages that make them especially appealing in an outbreak. Because their chemical structure is so easy to describe, they're easier to manufacture, and thanks to their minuscule size, they don't get broken down by your digestive system, so you can take them as a pill. (This is why you've never had an injection of aspirin.) And most of them can be kept at room temperature and have a long shelf life. Larger molecules are more complicated in just about every respect. Monoclonal antibodies, for example, are 100,000 times larger than aspirin. Because large molecules are broken down by your digestive system if you swallow them, they need to be injected or given by an IV drip. This means you'll need medical personnel and equipment to make sure it is done properly, and you'll need to isolate infected patients when they come in for treatment so they don't pass the virus to other people at the facility. Large molecules also require far more complex manufacturing--they're produced using live cells--which means they're more expensive, and it takes more time to scale them up. In short, during an outbreak, you'd rather have small-molecule treatments than large ones, all other things being equal. But we may not be able to find a small-molecule drug that works well against a particular pathogen (or works without causing bad side effects), so our pandemic plan should have us ready to do both and pursue them in parallel. We can do research and development over the next decade to shorten the steps required when a potential pandemic is detected..