In early December 2019, a cluster of cases of novel pneumonia began circulating in Wuhan, China, which we now know as COVID-19. Within months, this microscopic novel coronavirus would travel globally, infecting many millions of people, devastating human health and the economy. And so began the Great Coronavirus Pandemic of 2020.
In my book, Global Health Security: A Blueprint for the Future (Harvard, 2021), I offer a comprehensive plan for a more secure world, including four action agendas outlined below.
National Health Systems at the Foundation
Robust national health systems are the foundation for a safer world. The International Health Regulations (IHR) — a binding World Health Organization (WHO) treaty — requires all 196 states parties to develop “core” health system capacities to rapidly detect, report, and respond to novel outbreaks. Key capacities include surveillance, laboratories, health workforce, and medical countermeasures. Yet, most countries have not fulfilled their legal obligations, and cannot be relied upon to quickly detect and report a novel infectious disease. As the COVID-19 pandemic has demonstrated, delays in detection and notification can prove deadly. With each passing day, a novel pathogen will spread — possibly beyond national borders — and will be harder to contain. At a certain point, keeping an outbreak under control becomes nearly impossible. The international community is only as secure as its weakest link, so strong and resilient health systems are required everywhere.
What’s also required is an independent global monitoring mechanism of outbreaks and strong system-wide tracking and assessment of outbreak management capacities. The Global Health Security Index assesses every country’s technical, financial, socioeconomic, and political capabilities to prevent, detect, and rapidly respond to epidemic threats. Before the pandemic, countries like the U.S., U.K., and European nations scored highest. Then why did they perform so badly? It turned out that political leadership, and trust in science and public health, were crucially absent.
The World Health Organization at the Apex
If national health systems are the foundation for global health security, an empowered WHO is at the apex. Its constitution designates WHO as the lead agency for global health, charged with directing and coordinating the international response. Yet, the COVID-19 pandemic revealed deep structural problems that constrain WHO from putting health and science ahead of politics, including its reliance on states’ largely voluntary funding and cooperation. Perhaps WHO’s most visible flaw was its lack of power to independently verify China’s reporting. China blocked WHO from entering all parts of the country and objectively investigating the pandemic’s origins and likely trajectory. WHO’s investigation of the virus’ origins did not even begin until a full year after the first report of the novel coronavirus.
Even before COVID-19, the West African Ebola epidemic (2013 to 2016) revealed deep flaws in WHO’s ability to lead and coordinate a coherent international response, with delays, dysfunctional emergency response, and poor communication and coordination. By the time another Ebola outbreak emerged in the Democratic Republic of the Congo (2018 to 2020), the agency performed far better. Despite major post-Ebola reforms, the Organization’s budget is still wholly incommensurate with its global mandate, while its governance remains antiquated. A clear governing framework and leadership are needed to ensure coherent efforts and a functional global system.
Research and Development for Top-Priority Medical Countermeasures
Modern medical tools are critical for fighting epidemics. Developing an armory of diagnostics, vaccines, and medicines to prevent, identify, and treat novel infections requires a new strategy for research and development (R&D). R&D needs to start long before an epidemic so that clinical trials or emergency deployment can begin swiftly. Pharmaceutical companies rarely invest in technologies against novel pathogens with sudden outbreaks. Safe and effective vaccines usually take ten years to develop.
WHO is working on “platform” technologies against top-priority pathogens, so that clinical trials can be launched at the first signs of an outbreak. CEPI — the Coalition for Epidemic Preparedness Innovations — is using an innovative funding model to fund early vaccine R&D. Yet, sustainable funding and incentives for high-priority research are well below the level needed to stay a step ahead of fast-moving epidemics.
SARS-CoV-2 is a wily virus. But human ingenuity was equal to the task. COVID-19 has taught us that the world can create the most remarkable vaccines and treatments when there is the political will. Investing in R&D for novel pathogens in advance can literally save millions of lives.
A “Peace” Dividend
Investments in national health systems, WHO capacities, and R&D not only prevent widescale illness and death, but also promise economic benefits. Prevention is far more efficient than stemming out-of-control epidemics.
What level of economic investment in preparedness is required? In 2012, the World Bank estimated that $1.9 to $3.4 billion was required to upgrade zoonotic disease prevention and control systems in developing countries to meet World Organisation for Animal Health (OIE) and WHO standards. In 2016, the Commission on a Global Health Risk Framework proposed what I call a “peace” or “security” dividend — an incremental additional investment of $4.5 billion per year, just 60 cents per person per annum. The enormous economic toll of COVID-19 may have been largely avoided through far smaller investments in preparedness.
Making progress in these four global health security action areas will require action from all sectors. The blueprint and ideas presented in my book are based on 30 years of experience in global health, including directing the WHO Collaborating Center on National and Global Health Law and serving on two global commissions evaluating the Ebola response in West Africa. I’ve been privileged to serve on key WHO expert committees over the years, including on smallpox, pandemic influenza, viral genomic sequencing, and universal health coverage. The blueprint I offer also follows a strong consensus in the global health community on the importance of preparedness, with robust national health systems, innovative R&D, and sound global health leadership and governance.
The world’s future depends on an ongoing evaluation of what works and what doesn’t, which values are crucial (equity and justice) and which are harmful (stigma and blame). It depends on well-informed leaders and policymakers, and an empowered civil society that will insist on the truth and hold them to account. My book aims to inform and empower policymakers, as well as scholars, advocates, and students, and I hope to arm all these key actors with the knowledge and ideas they need to advocate for change.
We have the tools to rapidly detect and respond to novel outbreaks. What we need is the political will. Next time a novel pathogen emerges, let’s hope we have learned the lessons of the Great Coronavirus Pandemic of 2020.
This excerpt was adapted from Global Health Security: A Blueprint for the Future by Lawrence O. Gostin, published by Harvard University Press. Copyright 2021 by the President and Fellows of Harvard College. Used by permission. All rights reserved.
Lawrence O. Gostin, JD, is university professor, Georgetown University’s highest academic rank, where he directs the O’Neill Institute for National & Global Health Law. He is also director of the World Health Organization Collaborating Center on National & Global Health Law.
Source: MedicalNewsToday.com
