Good introduction. Not much that’s new if you’ve read Zeynep Tufekci, David Wallace-Wells or Alex Tabarrok. Interesting paragraphs on COVAX, mRNA history, and simulations. Insufficient attention to OWS, dose-stretching, or bureaucratic failures.

If you in Public Health domain or you want to know about prevention of diseases and its idea on how to prevent, this book will give insights.

I picked up this book to understand Gates’ perspective on the pandemic. True to form, he talks up his ideas and investments almost exclusively. He doubles down on vertical interventions (ie initiatives that target one thing like polio eradication) and argues they prepared countries for the pandemic - I’d counter, if we had comprehensive primary healthcare, emergency healthcare in rural areas, widespread disease surveillance, well funded public health infrastructure, and logistics networks, we would have been prepared. Vertical interventions I’ve seen in the field no question save lives, like PEPFAR, but also create parallel systems and minimize the very challenging work of healthcare financing and health systems strengthening. I appreciate at least that he acknowledges strong health systems and especially primary care will help prevent pandemics. Biggest takeaway is the quote from Larry Brilliant that “Outbreaks are inevitable, but pandemics are optional.” There is a lot we need to do - and of course, he was writing in 2022 and didn’t see that we’ve already moved on and seemingly applied none of the learnings. “Elect leaders who will take pandemics serious and make good, science- based decisions when the time comes.” Welp. Nice that Fred Hutch gets several shout outs from the Seattle Flu Study story and Trevor Bedford to HVTN and Stephaun Wallace (RIP). The audience for this book seems like it is more the lay public than public health professionals. I liked the drawings/graphics (some humorous) and his clear-eyed focus on equity. The ending was underwhelming and the reflections on digitization and technology during the pandemic felt a bit like an afterthought. Glad I read it, but overall didn’t seem to contribute many new ideas to the dialogue.