In early December 2019, a cluster of cases of new pneumonia began circulating in Wuhan, China, which we now know as COVID-19. In a matter of months, this microscopic new coronavirus would travel around the world, infecting 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 plan for the future (Harvard, 2021), I propose a comprehensive plan for a safer world, comprising four action programs described below.
National health systems at the Foundation
Strong national health systems are the foundation for a more secure world. The International Health Regulations (IHR) – a binding treaty of the World Health Organization (WHO) – require all 196 states parties to develop âcoreâ health system capacities to detect, report and respond quickly to new epidemics . Key capacities include surveillance, laboratories, health personnel and medical countermeasures. Yet most countries have not fulfilled their legal obligations and cannot be relied on to detect and report a new infectious disease early. As the COVID-19 pandemic demonstrated, delays in detection and notification can prove fatal. With each passing day, a new pathogen will spread – perhaps beyond national borders – and be harder to contain. At some point, keeping an epidemic under control becomes almost impossible. The international community is only secure at its weakest link, so strong and resilient health systems are needed everywhere.
What is also needed is an independent global epidemic surveillance mechanism and strong system-wide monitoring and evaluation of epidemic management capacities. The Global Health Security Index assesses the technical, financial, socio-economic and political capacities of each country to prevent, detect and respond rapidly to epidemic threats. Before the pandemic, countries like the United States, the United Kingdom and European countries had the highest scores. So why did they perform so poorly? As it turned out, political leadership and confidence in science and public health were absolutely lacking.
World Health Organization at the top
If national health systems are the foundation of global health security, an empowered WHO is at the top. Its constitution designates WHO as the lead agency for global health, responsible for leading and coordinating the international response. Yet the COVID-19 pandemic has exposed deep structural issues that prevent the WHO from putting health and science ahead of politics, including its reliance on largely voluntary funding and cooperation from states. Perhaps the WHO’s most visible flaw was its lack of power to independently verify China’s reports. China has blocked the WHO from entering all parts of the country and objectively investigating the origins and likely trajectory of the pandemic. The WHO investigation into the origins of the virus didn’t even begin until a year after the novel coronavirus was first reported.
Even before COVID-19, the Ebola outbreak in West Africa (2013 to 2016) revealed deep gaps 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 much better. Despite significant post-Ebola reforms, the Organization’s budget remains totally out of step with its overall mandate, while its governance remains archaic. A clear governance framework and leadership are needed to ensure coherent efforts and a functioning global system.
Research and development for priority medical countermeasures
Modern medical tools are essential in the fight against epidemics. Developing an arsenal of diagnostics, vaccines and drugs to prevent, identify and treat new infections requires a new research and development (R&D) strategy. R&D must start well in advance of an outbreak so that clinical trials or emergency deployment can begin quickly. Pharmaceutical companies rarely invest in technologies against new pathogens with sudden outbreaks. Safe and effective vaccines generally take ten years to develop.
WHO is working on âplatformâ technologies against priority pathogens, so that clinical trials can be launched at the first sign of an epidemic. CEPI – the Coalition for Epidemic Preparedness Innovations – uses 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 ahead of rapidly evolving epidemics.
SARS-CoV-2 is a tricky virus. But human ingenuity was up to the task. COVID-19 has taught us that the world can create the most remarkable vaccines and treatments when there is political will. Investing in R&D for new pathogens up front can literally save millions of lives.
A “Peace” dividend
Investments in national health systems, WHO capacity and R&D not only prevent large-scale disease and death, but also promise economic benefits. Prevention is much more effective than containing epidemics that cannot be controlled.
What level of economic investment in preparedness is needed? In 2012, the World Bank estimated that $ 1.9 billion to $ 3.4 billion was needed to improve zoonotic prevention and control systems in developing countries to meet World Health Organization standards. (OIE) and WHO. In 2016, the Commission on a Global Health Risks Framework proposed what I call a ‘peace’ or ‘security’ dividend: an additional investment of $ 4.5 billion per year, or just 60 cents per person per year. The huge economic toll from COVID-19 may have been largely avoided thanks to much smaller investments in preparedness.
Making progress in these four policy areas for global health security will require action from all sectors. The plan and ideas presented in my book are based on 30 years of experience in global health, including leading the WHO Collaborating Center on National and Global Health Law and two global commissions evaluating the Ebola response in West Africa. I have had the privilege of serving on key WHO expert committees over the years, including on smallpox, pandemic influenza, viral genomic sequencing and universal health coverage. The plan I am proposing also follows a strong consensus within the global health community on the importance of preparedness, with strong national health systems, innovative R&D, and strong leadership and governance in health care. global health.
The future of the world depends on a continuous assessment of what works and what does not, which values ââare crucial (fairness and justice) and which are harmful (stigma and blame). It depends on well-informed leaders and decision-makers, 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 academics, advocates and students, and I hope to give all of these key players the knowledge and insights they need to advocate for change.
We have the tools to quickly detect and respond to new epidemics. What we need is political will. The next time a new pathogen emerges, let’s hope we’ve learned the lessons from 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 with permission. All rights reserved.
Lawrence O. Gostin, JD, is a University Professor, the highest rank at Georgetown University, where he heads the O’Neill Institute for National and Global Health Law. He is also director of the World Health Organization’s Collaborating Center on National and Global Health Law.