The Covid-19 pandemic has shown that a danger in one part of the planet poses a global threat. The disease has caused enormous damage in terms of lives lost, economic impact and human development; it has also revealed countries’ inadequate response strategies, identified key weaknesses in global health security systems and shown examples of poor leadership.
When faced with such a threat to our collective health security, the priority is to set up early detection systems to track the spread of virus and identify new strains early enough in order to mount an effective response. We had close calls with the SARS virus in 2003 and MERS in 2012, yet we find ourselves ill-prepared for Covid-19.
SARS did lead to the establishment of several global measures that included European Union funding to establish labs to sequence mystery respiratory viruses, and it prompted the Chinese to set up similar labs — which later identified Covid-19 in Wuhan.
The Ebola crisis also taught us some painful lessons about lapses in surveillance systems. It did, however, prompt important initiatives in resource-strained countries in West Africa, with the rapid setting up of active surveillance systems, strong community mobilisation and laboratory systems with capacity to provide timely results.
Notwithstanding such gains, based on disease outbreaks, the Covid-19 pandemic has shown that current measures for dealing with pandemics are insufficient. This is aptly illustrated in the recent Global Health Security Index report (2019) that reviewed existing health system capacities in countries to respond to public health emergencies in line with the International Health Regulations (IHR) (2005) norms.
The report showed countries varied widely in terms of their capacity to prevent, detect and control outbreaks of infectious diseases, with only half of them reporting operational readiness capacities to respond to public health emergencies. Of concern, Africa scored in the mid-30s (maximum score 100) and below, with the US, UK, the Netherlands, Australia and Canada topping the ranks (scores ranging from 84 to 75).
Covid-19 has, however, shown that sustained health threats will even strain well-resourced countries.
Disquiet among public health advocates about a lack of global preparedness can be traced back to well before the Ebola crisis, with the call for global health security suffering a series of setbacks that included political neglect by governments, lack of confidence in the World Health Organisation’s ability to operationalise a global health governance model and the downgrading within WHO and in richer nations of emerging and infectious diseases (other than HIV, TB or malaria) as a priority. Non-compliance by countries to IHR, without consequence, did not help the cause.
With the Ebola outbreak in 2014, West African countries were compelled to scramble together responses. The crisis teetered on catastrophe, yet the scale of the tragedy and the much-needed global response highlighted the lack of political commitment seen way before this outbreak.
The lack of a sustained focus for tackling emerging infectious diseases was also seen in the limited availability of health tools for Ebola and other infectious diseases such as SARS and MERS.
The complacency in judgment was induced by thinking that these viruses were one-time, rare phenomena and major drug companies were not keen to invest in developing vaccines and treatments when there was no obvious market.
The slow momentum in vaccine research for coronaviruses and, more generally, the lack of investment in research on infectious and emerging diseases does raise some tough questions about the relationship between science, the “need-for-profit industry” and the suitability of the current medical research and development model in addressing the world’s health priorities.
Questions have been raised about the global pharmaceutical sector being largely geared towards developing products to maximise profits and with little therapeutic value; and when innovative treatments are produced they are unaffordable (for example, the hepatitis-C drug was first introduced at a price of $84,000 in the US, which was totally out of reach for millions of people living with this disease worldwide).
Covid-19 has already begun to affect the global pharmaceutical sector, with the prices of pharmaceutical ingredients manufactured in China rising or being unavailable after extended factory closures and supply chain disruptions. India, the world’s largest producer of generic medicines, is also expected to restrict exports of medical products (including paracetamol and some antibiotics), which could lead to a shortage in other countries.
While the pandemic is being fought on many fronts, a key priority is to resuscitate commitments to the global health security agenda.
First, we need to urgently capacitate defaulting countries with technical and financial resources to implement core health systems infrastructure to comply with the IHR norms. We can leverage existing international commitments to global health security through mobilising resources and securing wider collaboration to accelerate this development. Like the Ebola epidemic, Covid-19 has shown how connected we are as a global community; we are only as safe as the most fragile states.
Second, we need to consider alternative ways to conduct and finance research and development. A revised model has to prioritise public health needs, where the primary payback is improved global health security and the fulfilment of the individual right to health. Research and development cannot be left purely to market-driven models. Innovative technology needs to drive rapid and affordable tests and viable vaccines.
Third, and equally important, plans for preventing, detecting and controlling outbreaks of emerging infectious diseases ought to be built on a One Health foundation that emphasises the interconnectedness of humans, animals and ecosystems. Here we must prioritise the human-wildlife interface and have the ability to detect viruses in livestock and wildlife as a crucial component of early warning systems for human pandemics.
Covid-19 has shown that the world is ill-prepared to handle a sustained and threatening public health emergency. Unfortunately, there remain far too many blind spots around the globe where public health systems lack trained staff, functional laboratories and quality surveillance data to make timely decisions to respond to infectious diseases.
To ensure our collective health security, there has to be a capable governance framework which can work to repair the political, institutional and legal pillars of the global health security strategy. This has to entail institutional, financial and legal actions that countries have been unwilling to take in the past.
Such a transformation is a tall order – but the future of the planet’s health is dependent on it. DM