How we can all prepare for next deadly epidemic
Hours after the World Health Organization declared the end of the Ebola epidemic earlier this month, another case was reported in Sierra Leone. The twoyear-long outbreak that has already taken 11,000 lives not only continues, but the circumstances that enabled it to spiral out of control in the first place persist.
Most reporting on Ebola has focused narrowly on the WHO’s failings. But WHO reforms alone will not create an effective system for infectious disease control. Far-reaching changes are needed across domestic governments to build robust national public health systems and to invest in a strong WHO.
Currently, infectious disease control efforts focus on emergency response rather than prevention. And our emergency response system is vastly underfunded. For the two-year period when most of the Ebola outbreak took place, the WHO’s budget plan set aside for global outbreak response less than 10 per cent of the cost of addressing Ebola alone over a ninemonth period, according to United Nations figures.
As the Ebola outbreak worsened, the WHO and the UN appealed to governments and private actors for donations. But donations made in the moment of a crisis are unreliable and take too long to materialize. In November 2014, nearly a year into the Ebola outbreak, the UN was still seeking resources to meet immediate needs on the ground. Two months later, after the peak of the crisis had passed, more than half of the pledged monies had not yet appeared.
More critically, governments have not adequately funded outbreak prevention. Strong domestic public health systems are the only way to prevent outbreaks before they occur, and the best means to swift control before outbreaks spread internationally. Such systems can only be built globally if wealthy countries transfer resources to developing countries.
Ebola is an urgent reminder that weak public health capacities in any country endanger the whole world. Few healthcare workers, insufficient supplies and rundown medical facilities in West Africa created ideal conditions for disease spread. The most recent case in Sierra Leone highlights gaps in the system that continue to jeopardize global safety: the patient travelled extensively while ill, was treated by health-care workers who did not use protective equipment and died before she was diagnosed.
Weak public health capacities also raised the subsequent cost of mounting an international response. To control Ebola, Doctors Without Borders had to build makeshift hospitals in Guinea, Sierra Leone, and Liberia. Basic equipment such as incinerators had to be shipped in to cremate bodies. This money would have been better spent building longterm facilities before the outbreak began. Donations made for responding to Ebola add up to more than four times the external funding needed annually to provide essential health services for the entire populations of Guinea, Sierra Leone, and Liberia, based on Save the Children estimates.
These crippling deficiencies in our international system for infectious disease control have been known for years. A WHO report on the 2009 swine flu pandemic concluded that the world was not prepared to respond to any sustained, severe global outbreak. But, due to the reluctance of wealthy countries — includ- ing Canada — to fund the report’s proposals, no meaningful change followed.
It is long past time to move beyond a system of infectious disease control that relies on ad hoc donations and shortterm self-interest.
The WHO needs a standing fund sufficient to support large-scale emergency responses. The international community needs a co-ordinated long-term plan to finance public health capacity building around the world, particularly in developing countries. Over time, we must shift our strategy from reaction to prevention.
These changes carry a hefty price tag. But the cost of not building an effective global system for outbreak control is too high — in terms of human suffering, risk exposure, and money. A recent U.S. National Academy of Medicine report calculated the annual expected loss from pandemics to be more than $60 billion (U.S.). By comparison, the report’s suggested annual global investment of $4.5 billion to protect the world from outbreaks is modest.
Ebola’s toll over the last few years has been devastating, but it is nowhere near the destruction that could result from a more transmissible disease, such as influenza.
The 1918 flu pandemic killed more people than the First World War, and a Harvard study estimated that a similar pandemic in current times would lead to over 60 million deaths — almost twice the population of Canada.
Epidemics are predictable problems that need predictable long-term solutions and financing.
We must invest in infectious disease control now — before the next deadly epidemic hits.
The recent Ebola crisis is an urgent reminder that weak public-health capacities in any country can endanger the whole world
Yanbai Andrea Wang is a fellow at the Center for Law and the Biosciences at Stanford Law School.