The alarm bells are ringing again. A new infectious disease is spreading internationally, and the world is working to prevent another potential pandemic. Memories of earlier global health threats – from SARS to H1N1 to Ebola to Zika – come to the fore as we deal with the novel coronavirus (now known as COVID-19) emanating from Wuhan, China.
While much progress has been made in improving global health security since SARS in 2003, everyone recognizes that much more needs to be done.
Certainly, improvements in global health security are bearing fruit in the current response. The WHO Health Emergencies Program – established in the wake of its slow response to the 2014 Ebola outbreak in West Africa – has been quick to act, sending masks, respirators, and other supplies to dozens of countries that need support, in addition to sending diagnostic test kits to more than 70 laboratories. WHO is also working with dozens of partners to rapidly accelerate the critical research and development agenda for new vaccines, diagnostics and therapeutics, as well as with social media companies to help combat the spread of misinformation and stigma. Additionally, WHO Director-General Dr. Tedros Adhanom Ghebreyesus has briefed the UN Secretary-General and the UN senior management team to help ensure coordination across the entire UN system in responding to the outbreak.
A critical improvement in global health security – the International Health Regulations (IHR, adopted in 2005) – provide a public health response to the international spread of disease while avoiding unnecessary interference with international traffic and trade. The regulations, which are legally binding but lack an enforcement mechanism, obligate governments to notify WHO of events that may constitute a public health emergency of international concern (PHEIC), which China did on December 31, 2019. Many have criticized the Chinese government for a slow response when COVID-19 first appeared and for censoring information, but I shudder to think what could have transpired if the IHR global standards for reporting and responding did not exist.
We still are in the midst of the “fog of war,” the uncertain situation where we don’t know many key facts about spread of the virus. The IHR Emergency Committee was divided when it met on January 22-23 to consider whether to recommend a PHEIC, in part because data on severity of the disease were unclear. A week later, with a clearer picture of the potential toll on countries ill-equipped to prepare for and respond to COVID-19, the Emergency Committee recommended, and Dr. Tedros agreed, to declare this an international health emergency.
Tedros has praised the Chinese response, for which he has been criticized but which has served to encourage the Chinese government to be cooperative and forthcoming. The Director-General has a delicate role to play. While WHO is considered to be the global guardian of public health and has a global diplomacy role, it is clear to anyone who has attended the World Health Assembly that the political interests of 194 member countries often come into play.
On January 30, many observers paid scant attention to the Director-General’s call to action to help countries with weaker health systems. Data show that all countries, including the United States, are not fully prepared to handle health threats. Recent reports from the Global Health Security Index and the Global Preparedness Monitoring Board demonstrate that every country has important gaps to address to be prepared for the very real threat of a fast-moving, lethal global pandemic which could kill an estimated 50-80 million people and wipe out 5% of the world’s economy. Low-resource communities and countries, in particular, will be hit much harder because of their lack of access to basic health services, clean water, and sanitation.
The Global Health Security Agenda, a partnership that began in 2014, has had great success in spurring the use of what’s known as Joint External Evaluations to assess countries’ capacities to prevent, detect, and rapidly respond to public health risks, which are central to IHR implementation. But follow-up implementation plans desperately need funding to build capacity.
Since working on pandemic influenza preparedness during the H5N1 “bird flu” scare, I have witnessed a constant theme in global health security discussions: Preparedness efforts are grossly underfunded.
The resources needed for this novel coronavirus outbreak are no exception. WHO has released a $675 million Strategic Preparedness and Response Plan to support countries in limiting human-to-human transmission, caring for patients and minimizing social and economic impact. The Bill & Melinda Gates Foundation has been quick to act, announcing that it will provide up to $100 million to improve detection and treatment, protect at-risk populations and accelerate vaccine development. A few governments have also pledged funds.
However, many more governments and others need to respond. This includes providing funding for WHO’s Contingency Fund for Emergencies (CFE), which allows WHO to respond in as little as 24 hours to disease outbreaks and humanitarian crises with health consequences, but which has been chronically underfunded.
So here we are again, scrambling to respond without sufficient capabilities in place and with insufficient resources. Although no one can predict the exact nature or origin of future global health emergencies, it is certain that there will be future infectious disease outbreaks that threaten the health and well-being of the world.
It is time for presidents, prime ministers, members of congress and parliamentarians to recognize that every nation’s security depends in part on global health security. And that requires serious, consistent, long-term planning and investment to make the world much better equipped to respond to global health threats. The proposed Global Health Security Challenge Fund to incentivize countries to make capital investments to close their preparedness gaps should be seriously considered.
As Dr. Tedros told the WHO Executive Board on February 3, “For too long, the world has operated on a cycle of panic and neglect. We throw money at an outbreak, and when it’s over, we forget about it and do nothing to prevent the next one…. This is dangerously short-sighted, and frankly difficult to understand. If we fail to prepare, we are preparing to fail.”
Ambassador John E. Lange (Ret.), Senior Fellow for Global Health Diplomacy at the United Nations Foundation, was a foreign service officer and served as the State Department’s Special Representative on Avian and Pandemic Influenza, 2006-2009.