Less than two years before the coronavirus pandemic claimed thousands of lives globally, sent markets plummeting, and upended day-to-day life for virtually everyone on the planet, Microsoft founder Bill Gates warned the world was ill-prepared to handle a health crisis of this magnitude.

Gates made the comments during a speech to the Massachusetts Medical Society in Boston in April 2018. The text of the speech is posted to his personal blog, “Gates Notes.”

While noting the many strides researchers have made in terms of treating diseases such as HIV, malaria, and polio, the multi-billionaire and philanthropist also pointed to a trouble spot.

“There is one area, though, where the world isn’t making much progress, and that’s pandemic preparedness,” Gates said. “This should concern us all, because if history has taught us anything, it’s that there will be another deadly global pandemic.”

He suggested areas for improvement.

“What the world needs – and what our safety, if not survival, demands – is a coordinated global approach. Specifically, we need better tools, an early detection system, and a global response system,” Gates said.

The Institute for Disease Modeling, he said, has projected that if a contagious, lethal and airborne pathogen on the order of the 1918 flu pandemic were to emerge today, nearly 33 million people worldwide would die in six months.

“That’s the sobering news,” Gates said. “The good news is that scientific advances and growing interest on the federal level, in the private sector, and among philanthropic funders makes development of a universal flu vaccine more feasible now than 10 or 20 years ago.”

His foundation, he said, is supporting efforts to develop a universal flu vaccine.

“However, the next threat may not be a flu at all,” Gates said.

“More than likely, it will be an unknown pathogen that we see for the first time during an outbreak, as was the case with SARS, MERS, and other recently-discovered infectious diseases.”

He said a public-private partnership dubbed the Coalition for Epidemic Preparedness Innovations is working on vaccines for infectious diseases, but vaccines aren’t the only tool.

“I’m a big fan of vaccines, but they may not be the answer when we have to respond immediately to rapidly spreading infectious disease pandemics,” Gates said.

“Not only do vaccines take time to develop and deploy; they also take at least a couple of weeks after the vaccination to generate protective immunity. So, we need to invest in other approaches like antiviral drugs and antibody therapies that can be stockpiled or rapidly manufactured to stop the spread of pandemic diseases or treat people who have been exposed.”