While it might be hasty to suggest we have collectively moved beyond the legacy of panic and neglect behavior, I am hopeful that the multiple global and country level efforts to strengthen pandemic readiness emerging since the deadly West Africa Ebola outbreak of 2014 might be starting to bear fruit.
Clinical research can save lives. In a world where outbreaks of novel infectious diseases are increasing, we urgently need to speed up the development of effective vaccines, therapies, diagnostics and treatment protocols. The horrific loss of life from the 2014-2015 Ebola outbreak in West Africa is a haunting reminder of what is at stake if we do not move fast enough.
The East Asia and Pacific region is vital to global pandemic preparedness. The region has been the epicenter of emerging and re-emerging infectious diseases. China and Southeast Asia alone accounted for approximately 90 percent of SARS cases and two-thirds of the human cases of avian influenza in the world. These outbreaks are driven by several socio-economic, demographic, environmental, and ecological factors, including close contact between humans and animals, encroachment with wildlife, high population density, rapid urbanization, high growth rates, and climate change.
Like many, we were relieved to hear from the Government of Madagascar and WHO in November last year that the pulmonary plague outbreak in Madagascar had been contained. Plague is a disease caused by bacteria called Yersinia pestis that are typically transmitted by rodents through their fleas but can also be transmitted from human to human. Since the onset of the outbreak in early August 2017, there had been 2,300 human cases of plague reported, leading to 207 deaths (WHO update). WHO called for continued vigilance until the end of the plague season at the end of April, as more cases of bubonic plague should be expected and could lead to a resurgence of pulmonary plague. The President of Madagascar also committed to establishing a permanent “plague unit” at the level of the Prime Minister’s office to work on the eradication of plague―rightly so, as experience tells us that addressing risks at the interface of human, animal and environmental health is challenging.
The 2014–2015 Ebola epidemic was the longest and deadliest Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths and reversing a decade of mortality and economic gains in Guinea, Liberia, and Sierra Leone. The statistics would probably have been very different, however, had an Ebola vaccine been available or even further along on the clinical development path.
Turkey is a transcontinental country, with territory contiguously spanning two continents. It is bordered by eight countries and is circled by sea on three sides. The international airport in Istanbul is the 10th busiest airport in the world, and last year, in 2016, more than 60 million passengers went through it. Of these, two-thirds were international passengers. Yes, Turkey is very vulnerable to disease outbreaks. Indeed, all countries are.
In my blog in February I described the rationale behind the creation of the International Working Group on Financing Preparedness (“IWG”), which is focused on how to ensure sustainable funding for the first line of defence against pandemics – prevention, identification and containment of infectious disease outbreaks at a national level. The IWG had its second face-to –face meeting earlier this month in London at Wellcome Trust. The goal of this meeting was to review the analytical work that had taken place over the last couple of months and debate a draft set of recommendations. Since that meeting we have been refining these recommendations with a view to presenting them in draft form to the UN Secretary General’s Global Health Crisis taskforce on May 1 and launching the full report at the World Health Assembly on May 25.
The case for investing in pandemic preparedness is –or at least, should be - completely compelling. Few things could kill as many people as an influenza pandemic. Few threats can cause as much economic disruption as the contagion of fear triggered by a rapidly escalating epidemic. Reinforcing capabilities such as disease surveillance, diagnostic laboratories and infection control would be more effective and cost far less than spending money to contain outbreaks when they occur. Yet, so far, the global community has demonstrably not invested enough in preparedness. As a result, too many lives have been lost and too many livelihoods damaged, and the world remains scarily vulnerable.
Disease Outbreaks: A Constant Threat
The World Health Organization called for “heightened vigilance and strengthened surveillance efforts” last week to prevent and detect human transmission of a highly pathogenic strain of avian influenza or ‘bird flu’. And while no human cases have been reported and WHO itself called the risk “relatively low,” we know the potential devastating impacts of diseases spread from animals to humans.
Today the world is celebrating “One Health Day.” Sometimes great ideas appear simple, even intuitive: the One Health concept was created to demonstrate that the health of people and animals are interconnected, and that these are in turn, inextricably bound to the health of the environment on which all life depends.