Preventing the next pandemic
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.