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In which John, months before the pandemic began, says, "We all must prepare ourselves for the global disease pandemic we all know is coming." Read Melinda and Bill Gates' annual letter about Covid-19, health equity, and the future of global health,.

We are in this mess because we did not prioritize as a species strong and equitable healthcare systems for all humans. We have a choice.

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Good morning, Hank, it's Tuesday.  In mid-2019, on our podcast Dear Hank & John, I said, and I'm quoting myself directly here, "We all must prepare ourselves for the global disease pandemic we all know is coming."  The year before on the podcast 10 Things that Scare Me, I listed as one of my chief fears "a global disease pandemic".  In fact, I predicted the pandemic so many times from podcasts to essays to Crash Course, that if I were more famous, conspiracy theorists would probably conclude I had some kind of inside knowledge, which I suppose I did in the sense that I read a lot of history.

From the great dying in the Americas to the black death in Eurasia, infectious diseases has long been a central force in human history and not just ancient history.  I was four years old when the United States recorded its first AIDS related death.  Since then, tens of millions of people have died of AIDS related illnesses, mostly in impoverished communities where people were denied access to anti-retroviral therapy for decades.

We shouldn't be surprised by something as historically routine as pandemics.  What we should be is prepared.  I'm thinking about this because I just read Melinda and Bill Gates' annual letter.  I recommend reading it, link in the doobly-doo, because it articulates some stuff about COVID that I hadn't seen written so clearly before.

Like, one of the points it makes is that, for too long, we've used the phrase "global health" to refer mostly to impoverished countries, the kind of places we associate with vulnerability to infectious disease, but as we have lately learned, 1) infectious disease is a threat to everyone and 2), the fact that infectious disease is a greater threat to the most vulnerable and marginalized among us does not mean that we should spend less time and money fighting those diseases.  It means we should spend more time and money fighting those diseases.

We need to think of global health differently now, as a shared worldwide effort to improve the health of all humans through openly exchanging resources and expertise, and this will require truly global cooperation, because as the Gates letter says, in a global crisis like this one, you don't want companies making decisions driven by a profit motive or governments making decisions with the narrow goal of protecting only their citizens.  

So what does a post-pandemic model of global health look like?  Well, we need a global alert system so that we can identify new pathogens quickly, but for that to work well, people need to be able to access healthcare so that their illnesses can be diagnosed and treated in a safe, sanitary, and adequately staffed facility.  We also need to invest in vaccine development, as the Gates letter points out, if this pandemic had occurred in 2010, it would have been much, much worse because we've made so much progress with vaccines in the last decade, but we need to accelerate that progress, and we need to address the underlying inequities that have long driven the spread of infectious disease.  I mean, almost 700 years ago, a chronicler of the black death in England wrote, "Virtualy none of the lords and great men died in this pestilence."  

Disease does not treat people equally because our social orders do not treat people equally and if we don't address unequal access to healthcare, pandemics will continue to be routine and they will continue to disproportionately harm the most vulnerable among us.  

The Gates letter argues that pandemic preparedness needs to be taken as seriously as we take the threat of war, and that made me think of how we're long placed war at the center of our historical narratives.  You know, we learn about this empire taking on that one and the causes of this war and how that war was won.  We learn much less about disease, even when it's deeply connected to war, as in the Spanish flu of 1918 or more recent cholera outbreaks in Yemen.

I think this sidelining of illness used to make a kind of sense, because history was seen as the story of human choices, and disease did not feel like a choice, but now, while we certainly don't control infectious disease, we do have quite a lot of choice around it.  I mean, we chose to eliminate smallpox.  We also choose to accept a world where, on average, the poorest people die 30 years before the richest people.  We won't choose whether the next novel disease pandemic emerges, but we will choose how ready we are and how quickly and equitably we respond, which is why stronger and more equitable healthcare systems is on my 2021 vision board, Hank, I will see you on Friday.