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Pandemics will strike but countries' preparedness is less certain

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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.

The memory of the 2009 flu pandemic is still very vivid in our minds. The influenza A virus was first identified in April 2009, termed Pandemic H1N1 virus by the World Health Organization, and colloquially known as swine flu. It was first observed in Mexico. By May 2009, it had reached Turkey. How did it get there? By a tourist flying in to Istanbul, of course.

Turkey was the 17th country in Europe and the 36th country in the world to report an incident of swine flu. All in less than a month after it was noticed in Mexico.

The first case of person-to-person transmission within Turkey was announced on July 26, 2009. After a slow start, the virus spread rapidly in Turkey and the number of cases reached 12,316. The first death in Turkey from swine flu was confirmed on October 24 – and the death toll rapidly reached 627.

Loss of a life is always tragic. The tragedy is further amplified if the death was preventable.

Why am I talking about this? Well, only to emphasize how important it is that we strengthen our systems and keep them strong. Not only health, but also agriculture, veterinary, tourism, administration, and finance. Indeed, all of government, all of private sector, all of society in the interrelated and connected world of today, disease outbreaks get rapidly amplified and become pandemics.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. High rates of worker absenteeism can also interrupt other essential services, such as law enforcement, transportation, and communications.

Preparedness requires coordination, communication, technology, science, and financing. Especially during times when there is a lull in outbreaks. And above all, financing has to be sustained.

Universal health security is key, and I congratulate the International Working Group (IWG) for highlighting that in their new report, From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level . I believe that in order to achieve universal health security, every country needs to do its part. Having some countries investing in preparedness and strengthening their health systems while others do not will not work. In the connected world in which we live, we are only as strong as our weakest link. Therefore, investing in health security is our collective responsibility.

Preparedness starts at the country level and needs to be owned by each country both through prioritization and financial allocations. Pandemics don’t care about political boundaries. Viruses do not need a visa to enter any country, nor do they wait for permission to enter someone’s home.

I urge upon all countries, all international organizations, all national initiatives, all private sector companies, all non-government organizations to take this message forward. Our security depends upon it. Outbreaks occur every day. We must use the shield of universal security to protect us.

I fully agree that domestic resource mobilization is key. It is very important that countries find the necessary fiscal space within their own systems to finance preparedness. The tax to GDP ratio in Turkey is around 30%. This helps us to strengthen our health system, to provide quality health care to everybody, to protect everybody from the onslaught of pandemics.

Countries need to treat pandemic risks at the same level as they treat other risks – especially risks to the economy, financial risks, terrorism risks, and so on. Unlike other risks, which vary from very low to low probability, pandemic risks are certain. Experts believe that it is not a question of if a pandemic will occur in our lifetimes, but when will it occur. Given this 100% certainty, I wonder why countries do not safeguard against this risk.

We have no substitute for preparedness, and the time to act is now. The IWG report provides us a pathway. It makes 12 very compelling recommendations.  Let’s act on these recommendations, break the cycle of panic and neglect, and collectively move toward a system of sustained and well-funded universal health security.

Prof. Dr. Recep Akdag, Turkey’s Minister of Health, recently gave the keynote at a World Health Assembly side event for the launch of the IWG report.


Recep Akdağ

Minister of Health, Turkey

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