Food for Thought: "New partnerships for global health security"
"Lack of preparedness for an epidemic in one country directly increases the risk for people everywhere," writes Caroline Schmutte of the Bill and Melinda Gates Foundation about the link between health and global security.
Health and global security are linked in many ways. Epidemics can threaten stability and security. In turn, war and instability can lead to disease outbreaks that have the potential to spread to other parts of the world, threatening public health and security elsewhere. To address these risks, we need to form new partnerships between the security, foreign policy, health, and research communities around the world.
Whether an epidemic occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say that a fast-moving airborne pathogen could kill more than 30 million people in less than a year. There is a reasonable probability that such an outbreak will occur in the next 10 to 15 years. What we don’t know is precisely where it will come from, or which pathogen it will be.
Protecting ourselves from unknown threats of this nature is both a technical and a political challenge. In an interconnected world, policy solutions for global health issues need to be more holistic than ever. Even small-scale outbreaks can cause instability, conflict, and forced migration; imagine the impact of a full-blown pandemic.
War zones and fragile states with weak or damaged health systems are the most likely places for epidemics to begin, as we have seen with Ebola in Sierra Leone, Liberia, and Guinea. In Syria, there is grave cause for concern. The World Health Organization reports that, as of last June, over half the country’s hospitals and half of its public health centres were "closed or only partially functioning." The targeted destruction of such facilities, denials of access to medical personnel and convoys, and the confiscation of medical supplies severely impede the ability of the country’s remaining doctors and nurses to care for casualties of war. They also make it extremely difficult to provide basics such as routine immunization or treatment for normally manageable conditions like diabetes or hypertension.
Yemen is another case in point. The country’s health, water supply, and sanitation systems have been destroyed in conflict. This has led to a deadly outbreak of cholera, with over 780,000 suspected cases since last spring.
Because we live in an interconnected world, epidemics are likely to travel and reach other regions quickly. Most healthcare systems, including those of wealthy countries, are quite unprepared to take on the challenge of an aggressive outbreak.
And then there is the economic cost of epidemics. Estimates say that the 2003 SARS outbreak caused a projected loss in global GDP of US $33 billion. Different scenarios project annual losses from an epidemic ranging between US $60 billion and US $570 billion.
To mitigate these risks, we need to form new partnerships that include diplomats and civil society as well as military researchers, and the security, medical and development communities. To be better prepared for the next pandemic, we need to invest in (1) health surveillance systems, especially in unstable regions; (2) better access to health infrastructure and innovation; and (3) intensified global cooperation and information-sharing.
Health surveillance is crucial to detect emergencies, such as potential epidemics or emergent anti-microbial resistances, at an early stage. Surveillance means gathering and analyzing health data on a regular basis – key for building early warning systems. The military can fulfill a very important role; particularly in disaster response or conflict situations, armed forces are often the first to witness an outbreak. In these circumstances, they can collect and evaluate data in a way that is unavailable to civilians. Over the longer term, a sustainable surveillance system requires health workers trained on reporting as well as laboratories capable of analyzing the data they submit.
We also need a range of new technology, drugs, and diagnostics to address the threats presented by known and unknown pathogens as well as anti-microbial resistance. And we must ensure that this technology can be accessed where and when it is needed, including in developing countries.
The Gates Foundation, together with the governments of Germany, Norway, and India, as well as the Wellcome Trust and the World Economic Forum, is one of the founders of the Coalition for Epidemic Preparedness Innovation (CEPI). Launched in early 2017 as a new public-private sector partnership, the coalition takes promising vaccine candidates for epidemic diseases from early stages of development through to be ready for distribution. This ensures a faster response capacity when an epidemic is detected.
The threats to our health security cannot be tackled by one institution or by one country alone. Diseases know no borders. The challenges they bring can only be effectively addressed by having the right resources in place and through strong international cooperation. The World Health Organization (WHO) plays a vital role to oversee such global cooperation in health, and has significantly improved its emergency response capacity after the Ebola crisis. However, the WHO must be adequately funded to be able to support local health systems and surveillance capacities – and thus to be able to fund preparedness before the next epidemic or another emergency hits.
To be prepared for a major global epidemic, countries and non-state actors need to cooperate; lack of preparedness in one country directly increases the risk for people everywhere. Countries can pool funding and expertise in epidemic preparedness into R&D partnerships. The commitments made by Norway, Germany and India to CEPI are great examples of this. Governments must also invest in the ability of their health system to identify and respond to a pandemic threat effectively, including sharing of information and samples. And they need to be protected from the economic effects of temporary travel restrictions and security measures that can result from an outbreak.
The Gates Foundation has been discussing these issues with a range of partners, including policymakers, scientists, and experts from civil society. We need to find ways to leverage our respective strengths and complement each other’s work. And we must secure funding commensurate with the seriousness of the risk we face. I firmly believe that this effort is a worthwhile investment, and that we can succeed in building new partnerships that do make a difference to global health security.
Caroline Schmutte is Head of Germany relations at the Bill and Melinda Gates Foundation.