Pre­vent­ing the next pan­demic

The Washington Post Sunday - - SUNDAY OPINION - BY RON KLAIN The writer was White House Ebola re­sponse co­or­di­na­tor from Oc­to­ber to Fe­bru­ary.

When Pres­i­dent Obama and his fel­low Group of Seven lead­ers meet in Ger­many be­gin­ning to­day, Ebola will be on the agenda. The lead­ers will talk about the need to wipe out the rel­a­tively small num­ber of re­main­ing cases in West Africa, as well as the need for aid to rebuild the rav­aged na­tions of the re­gion. Both steps are crit­i­cal.

But nei­ther will ad­dress what should be our No. 1 les­son from the Ebola cri­sis: the need for sub­stan­tial mea­sures to keep us safe from the pan­demic on the hori­zon, a cat­a­strophic event that is in­evitable if we don’t move quickly to pre­vent it. As Bill Gates re­cently said, “If any­thing kills over 10 mil­lion peo­ple in the next few decades, it’s most likely to be a highly in­fec­tious virus, rather than a war.” So why, with the Ebola epi­demic serv­ing as a fresh warn­ing, aren’t the G-7 lead­ers do­ing more to tackle this crit­i­cal health and se­cu­rity is­sue?

As scary as Ebola was, the world’s suc­cess in tam­ing it may have given us a false sense of se­cu­rity. Ebola was, in many ways, a de­cep­tively sim­ple test of the world’s epi­demic re­sponse sys­tem. Ebola is hard to trans­mit and easy to de­tect. The epi­demic broke out in three rel­a­tively small coun­tries that con­tained no mega-city and sent only a limited num­ber of trav­el­ers out of the re­gion.

The next time, the world might face a far more danger­ous threat. A pan­demic flu could be spread eas­ily and quickly, car­ried by in­di­vid­u­als with no ob­vi­ous symptoms. It could ex­plode like a wild­fire in a mas­sive city and be car­ried overnight by thou­sands of trav­el­ers to the world’s ma­jor com­merce cen­ters.

To the ex­tent there is dis­cus­sion of im­prov­ing the in­ter­na­tional re­sponse to epi­demics, the fo­cus has been on the need to re­form the World Health Or­ga­ni­za­tion. Such re­forms are badly needed, but even a fully ef­fec­tive WHO will not close the most gap­ing holes in the world’s epi­demic re­sponse sys­tem. Even if the WHO did a bet­ter job of rec­og­niz­ing out­breaks that pose a risk of epi­demic and alert­ing the world that ac­tion is needed, it does not have the sub­stan­tial re­sponse func­tion needed to com­bat such an epi­demic. Re­cent dis­cus­sions about cre­at­ing a WHO re­sponse func­tion — as­sum­ing that the agency could be trusted to man­age it— rely largely on over­bur­dened and un­der­funded non­govern­men­tal or­ga­ni­za­tions to staff a re­sponse. Thus, any new WHO re­sponse ca­pac­ity will lack mil­i­tary-style mo­bile hos­pi­tals ready to be de­ployed; bat­tal­ions of med­i­cal per­son­nel with ac­com­pa­ny­ing se­cu­rity sup­port to iso­late and treat the in­fec­tious and the ill; or a med­i­cal air­lift ca­pac­ity to move pa­tients to places where they can get help. Here is what should be on the G-7 agenda: First, the G-7 na­tions — es­pe­cially the United States, Bri­tain, Ger­many and France— should agree to re­tain the ca­pac­i­ties their mil­i­taries de­vel­oped dur­ing the Ebola epi­demic for in­fec­tious dis­ease re­sponse and pa­tient air­lift. Th­ese ca­pac­i­ties could eas­ily dis­si­pate now that the most acute phase of epi­demic is over. In a fu­ture pan­demic, the world may not have the four to six months it took to as­sem­ble th­ese spe­cial­ized units and ca­pa­bil­i­ties, such as the tools to air­lift in­fec­tious pa­tients to treat­ment.

Sec­ond, the G-7 should com­bine th­ese na­tional mil­i­tary re­sources into a sin­gle in­ter­na­tional en­tity — what Ger­man For­eign Min­is­ter Frank-Wal­ter Stein­meier has called a “white hel­met bat­tal­ion”— that could re­spond to an out­break be­fore it be­comes a full-scale epi­demic. This body should have the ca­pac­ity to deploy rapidly any­where in the world with med­i­cal field fa­cil­i­ties, lab equip­ment, se­cu­rity and med­i­cal teams. The Euro­pean Union has pledged to take up the ques­tion of cre­at­ing an E.U. -flagged unit; what is re­ally needed, how­ever, is a broader ef­fort that in­cludes the United States (and per­haps other non -E.U. coun­tries).

Third, the G-7 na­tions need to con­vene the rel­e­vant ex­perts and au­thor­i­ties to de­velop a co­her­ent ap­proach to the fast ap­proval and de­ploy­ment of new vac­cines and treat­ments that might be re­quired to re­spond to a pan­demic. In West Africa we saw a plethora of clin­i­cal tests separately led by the United States, Bri­tain, France and China with no co­or­di­na­tion. More­over, fights about who would be li­able if any­one was in­jured by th­ese un­proven vac­cines and treat­ments went un­re­solved. GAVI, the global vac­cine al­liance, runs hugely suc­cess­ful im­mu­niza­tion pro­grams for proven vac­cines, but it lacks a mech­a­nism for han­dling un­proven vac­cines (or ther­a­peu­tics), or for deal­ing with the in­tel­lec­tual prop­erty and li­a­bil­ity is­sues in­volved when new medicines are in­tro­duced with­out a track record. The time to re­solve such is­sues is be­fore an epi­demic is rag­ing.

Fi­nally, the G-7 na­tions need to step up their com­mit­ment to global health se­cu­rity, be­cause in the long run, the only way to keep all of us safe from out­breaks is to have ev­ery na­tion’s health-care sys­tem suf­fi­ciently re­sourced to pro­vide at least a pre­lim­i­nary re­sponse to an out­break. Pres­i­dent Obama’s lead­er­ship in this area has been ex­cep­tional, and — in a rare act of bi­par­ti­san­ship — Congress ap­pro­pri­ated more than $800 mil­lion to sup­port this ef­fort dur­ing the Ebola cri­sis. But all of the G-7 na­tions need to dig deep to ad­vance this pro­gram.

The last time the G-7 met, the Ebola epi­demic had not yet cap­tured global at­ten­tion; now, a year later, it has faded from public con­scious­ness. But un­less the world wants to con­sign it­self to an end­less cy­cle of re­peat­ing what tran­spired in the year be­tween th­ese two meet­ings, it needs to take steps to com­bat the next pan­demic be­fore it is upon us.


A health worker takes the tem­per­a­ture of U.S. Marines ar­riv­ing in Liberia last fall to help con­tain the Ebola out­break.

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