Preempt­ing the next pan­demic

Financial Mirror (Cyprus) - - FRONT PAGE -

Re­cent dis­ease out­breaks, like Ebola and Zika, have demon­strated the need to an­tic­i­pate pan­demics and con­tain them be­fore they emerge. But the sheer di­ver­sity, re­silience, and trans­mis­si­bil­ity of deadly dis­eases have also high­lighted, in the stark­est of terms, just how dif­fi­cult con­tain­ment and pre­ven­tion can be.

One threat to our pre­pared­ness is our con­nect­ed­ness. It was thanks to easy in­ter­na­tional travel that in re­cent years the dengue, chikun­gunya, and Zika viruses were all able to hitch a ride from east to west, caus­ing mas­sive out­breaks in the Amer­i­cas and Caribbean. An­other threat is more mun­dane: fail­ing to agree about money. What­ever the rea­son, the fact is that as long as hu­mans fail to or­gan­ise a col­lec­tive and com­pre­hen­sive de­fense, in­fec­tious dis­eases will con­tinue to wreak havoc – with dis­as­trous con­se­quences.

Build­ing an ef­fec­tive pre­ven­tion and con­tain­ment strat­egy – be­ing bio-pre­pared – is the best way to re­duce the threat of a global con­ta­gion. Pre­pared­ness re­quires co­or­di­na­tion among agen­cies and fun­ders to build net­works that en­able quick de­ploy­ment of and ac­cess to vac­cines, drugs, and pro­to­cols that limit a dis­ease’s trans­mis­sion. Sim­ply stated, pre­par­ing for the next pan­demic means not only build­ing global ca­pac­ity, but also pay­ing for it.

That’s the idea, at least. The re­al­ity of bio­pre­pared­ness is far more com­pli­cated. For starters, the ab­sence of ded­i­cated fund­ing is im­ped­ing im­ple­men­ta­tion of long-term pre­ven­tion strate­gies in many coun­tries; a new World Bank re­port finds that only six coun­tries, in­clud­ing the United States, have taken the threat se­ri­ously. Mean­while, pub­lic health of­fi­cials in many parts of the world strug­gle to re­spond to dis­ease out­breaks, ow­ing to a dearth of labs and clin­ics. And many fund­ing agen­cies, in­clud­ing gov­ern­ments and NGOs, typ­i­cally of­fer only one-year com­mit­ments, which rules out long-term plan­ning.

For years, sci­en­tists, physi­cians, and civil­so­ci­ety ac­tors have voiced con­cern over the lack of re­li­able, mean­ing­ful, and in­sti­tu­tion­alised in­vest­ment in pan­demic pre­pared­ness. These pleas have come, frus­trat­ingly, as mil­i­tary fund­ing to thwart bio-at­tacks, con­sciously mounted by hu­man ac­tors, has re­mained ro­bust. But while pur­pose­ful and ne­far­i­ous in­fec­tious-dis­ease out­breaks could do mas­sive dam­age, they re­main rel­a­tively un­likely. Nat­u­rally oc­cur­ring out­breaks, by con­trast, oc­cur reg­u­larly and are far more costly, even if they lack the sen­sa­tional “fear fac­tor” of bioter­ror­ism.

Not that long ago, those of us en­gaged in the pre­ven­tion of in­fec­tious-dis­ease out­breaks felt more se­cure about the avail­abil­ity of the re­sources re­quired to pre­pare. But in many places, bud­gets are stag­nat­ing or even de­clin­ing. This is as­ton­ish­ingly short­sighted, given the rel­a­tive costs of pre­ven­tion ver­sus re­sponse. For ex­am­ple, what would it have cost to build the clin­i­cal and lab­o­ra­tory in­fra­struc­ture and pro­vide the train­ing needed to iden­tify and pre­vent the re­cent Ebola out­break in West Africa? Pre­cise fig­ures are elu­sive, but I have no doubt it would have been less than the bil­lions of dol­lars Pre­pared­ness pays.

It is not only the lack of fund­ing that is rais­ing alarms; so are re­stric­tions on how avail­able funds can be used. It is not un­com­mon for a grant to be re­stricted to spe­cific ac­tiv­i­ties, leav­ing ma­jor gaps in a pro­gramme’s ca­pac­ity to meet its ob­jec­tives. A fun­der may, for ex­am­ple, al­low the ren­o­va­tion of an ex­ist­ing lab but not the con­struc­tion of a new one; or funds may sup­port the pur­chase of a di­ag­nos­tic ma­chine but not the train­ing of those re­quired to op­er­ate it. In many de­vel­op­ing coun­tries, com­mu­ni­ties do not even have the phys­i­cal build­ings in which to test, mon­i­tor, or store dan­ger­ous pathogens. My­opic fund­ing that over­looks key el­e­ments of the big pic­ture is money poorly spent.

Add to these chal­lenges the dif­fi­culty of pay­ing staff or en­sur­ing re­li­able elec­tric­ity and other es­sen­tial ser­vices, and it be­comes clear that pre­par­ing for dis­ease out­breaks re­quires broad en­gage­ment with the in­ter­na­tional aid com­mu­nity. But at the mo­ment, oner­ous spend­ing rules and weak fi­nan­cial com­mit­ments are ty­ing the hands of those work­ing to pre­vent the next se­ri­ous dis­ease out­break.

The num­ber of ob­sta­cles faced by sci­en­tists and pub­lic health ex­perts in the race to con­tain deadly in­fec­tious dis­eases is stag­ger­ing. To over­come them, we need to re­de­fine how we think about pre­pared­ness, mov­ing from a re­ac­tive po­si­tion to a more proac­tive ap­proach. Money ear­marked for pre­pared­ness must be al­lo­cated at lev­els suf­fi­cient to have the re­quired i mpact. Lim­i­ta­tions on how it can be spent should be loos­ened. Fund­ing sources must be opened to al­low for multi-year com­mit­ments. Health-care providers and first re­spon­ders

spent on

con­tain­ment.

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