Expert: Methods for spotting future pandemics exist
Could the world have seen the coronavirus pandemic coming sooner? And how, in a high-tech world, should we keep watch for the next dangerous outbreak of disease?
Last week Andrew Natsios, director of Texas A&M’s Scowcroft Institute of International Affairs, called to create a new global early-warning system. Natsios has deep expertise in addressing global disasters, including pandemics. Under President George W. Bush, he ran the U.S. Agency for International Development; and before that, during the presidency of George H.W. Bush, he led USAID’s emergency disaster management. Were he in that job now, he’d be in charge of American pandemic response throughout the world.
He spoke with us from his home office.
Last week, in the journal Foreign Affairs, you called for an early-warning system able to spot pandemics-in-the-making. What makes you believe that’s possible?
After the Ethiopian famine killed almost a million people, in AID we set up the Famine Early Warning System, called FEWS. In the humanitarian world, it’s very well-known and well-respected.
What it does is take aerial photos of ground cover in famine-prone areas of the world, then compares one year to the next. So they’ll look at June 1 in, let’s say, South Sudan in 2018 and in 2019. If it’s green one year and brown the next, they can assume that the crop may have failed. Then they send teams in on the ground to check out what’s going on.
That system has succeed
ed, along with the rest of the humanitarian response system, in substantially reducing the number of famine deaths. Alex de Waal, a scholar at Tufts, is one of the leading experts in the world on famine. Two years ago, in his book “Mass Starvation,” he looked at famine deaths over the last 150 years. He said it’s very clear there’s been a substantial reduction in starvation deaths. Famines’ death toll is dramatically lower than in the past. One reason is that we have an early warning system, FEWS.
FEWS doesn’t just tell people in USAID the famine is coming. We tell the whole world. It’s opensource information. Tens of thousands of humanitarian-aid workers, governments, churches, religious institutions, NGOs and UN agencies get these reports every couple of weeks and can see where the hot spots are.
I’m proposing that we use the same methodology for a disease early-warning system.
How would that work? Can you see a disease outbreak from a satellite?
Yes. I wrote the article proposing the system and sent it in to “Foreign Affairs,” and then an article appeared from Harvard with very interesting research. They looked in China at hospital parking lots and health clinic parking lots to see how many people were going into the clinic. You can do that from satellite photographs, which the Chinese government has no control over. If a parking lot has got two cars in it for the preceding two months, but all of a sudden it has 100 cars, you can assume something’s going on. And if that’s not just in one clinic, or one hospital, but all the hospitals in the area, something’s wrong.
Now, it doesn't mean you can identify the disease. But the Harvard scientists who did this also looked at the internet. You can buy commercially aggregated anonymized data that show search terms, people asking questions about particular symptoms of disease that they're experiencing. Beginning in August of last year, they were querying exactly the same symptoms of COVID-19.
Now, they also found that the number of people at the parking lots in these clinics in the greater Washington area started increasing last August, along with all of this traffic on the internet about symptoms.
So if you marry those two pieces of information from electronic media and satellite photographs, you can assume something bad is going on.
So assuming that we can get an early warning, what then? How would that warning help?
We don't want these zoonotic diseases to make the jump to people, but there's not a lot we can do to stop that. What we can do is discover the outbreak early enough to send teams in to stop the outbreak from spreading.
That’s what happened in West Africa when an Ebola outbreak started in 2014. Medecins Sans Frontieres — Doctors Without Borders, a French nongovernmental organization — said publicly, “We cannot contain this.”
I couldn’t believe it when they said it. They said that the only thing that could be done was for the U.S. government to intervene with the U.S. military and USAID, and that's what President Obama eventually decided to do. I think he waited too long to do it, but he did do it.
They sent Disaster Assistance Response Teams — DART teams — from
USAID. DART teams, by the way, were invented under Bush 41, when I was running the emergency functions at AID. We first deployed them in the summer of 1989. Now they’ve been sent around the world to contain disasters before they get out of control.
They’re usually successful. Our biggest problem is when there's a civil war going on. An outbreak is hard to contain then, because of the violence. But for Ebola we did go in, and we eventually contained the outbreak in those three countries, Liberia, Sierra Leone and Guinea.
Who would run an early warning system?
Now some people will say, we should vest this in an international organization. There are advocates who say it should be in the World Health Organization.
The World Health Organization already has an early warning system. It's not based on satellite photographs and electronic media. It's basically people on the ground saying, “Something bad is happening, and now you need to intervene.”
The problem is, it doesn't work. It does report that something's wrong, but no action is taken.
When the Ebola outbreak took place in West Africa six years ago, the World Health Organization’s headquarters wanted to send teams in to stop it, but the regional office said, “No, that will damage the economy — there might be shutdowns — so we're not going to let the teams come in here. We're not even going to announce that it’s a disaster.” And they prevented a response.
With respect to COVID-19, China does not want the teams in. The existing early warning systems don’t work in a dictatorship, which China is. They suppress information. In a democracy, there are so many different ways of getting information that it's almost impossible, when you have an outbreak like this, to suppress it. In a dictatorship, you can.
Amartya Sen, at Harvard, is one of the greatest economists of famine in the world. He once said that there's never been a famine in a democracy. A lot of people attack that idea, but I believe that basically he’s right.
Why? Because you can tell a famine is starting six months before it actually starts killing people. In a democracy when people start panicking about the food supply, someone sounds the alarm: the members of parliament or the Congress or the news media or the religious institutions or the nongovernmental organizations. Civil society began sounding the alarm.
Well, in a dictatorship you don't have a free media. You don't have religious institutions to say that. You don't have NGOs that are independent. The biggest risk, it seems to me, is in dictatorships that suppress information.
Is there anything else that you want Houston or Texas to be thinking about right now?
Friends of mine have said, “I don't need the government telling me to wear a face mask. I resent it. It's an intrusion on my liberty.”
Well, actually, during a public health emergency, the government has the right to do that. The Supreme Court decided that 200 years ago. It's not new. Gov. Abbott has the authority to intervene on face masks, and in my view, he made the right decisions, even though they’re very controversial.
In terms of liberty, you do not have the right to infect me and potentially kill me and my family and your own family. Thirty percent of the people who get COVID-19 have no symptoms but can infect other people. If you don't know you're sick, you don't stay at home and selfquarantine. You walk around the streets, you go to the store, you talk to your friends. So people who don't know they're sick are affecting the rights of other people.
No one would say that someone has the right to drink and drive, because when you’re drunk at the wheel of a car, you can kill people. That's why every state prohibits drinking and driving, and they should.
The same argument goes for face masks. We know face masks work. A whole bunch of studies show it. And it's not a matter of you protecting yourself; it's a matter of you infecting other people.