Global health security threats — despite worldwide responses, there’s much more to do

It’s been 100 years since the catastrophic “Spanish” influenza pandemic killed an estimated 20 million to 50 million people worldwide. The good news is that the world will be much better prepared when (not if) another infectious disease outbreak of similar severity takes place. The bad news is that much, much more needs to be done to fund and build global capacity to prevent, detect and respond to such threats.

There are regular reminders that certain infectious disease threats can easily spread with potential to affect the entire globe. The Sept. 5 arrival in New York of an Emirates flight carrying dozens of ill passengers increased concerns for “viruses on a plane.”

{mosads}The World Health Organization (WHO), in partnership with the government of the Democratic Republic of the Congo (DRC) and many others, is currently working in North Kivu and Ituri provinces to battle that country’s tenth Ebola outbreak — one that began days after they had succeeded in ending the ninth outbreak, in Equateur Province. In addition to such naturally occurring biological threats, accidental or deliberate threats (such as the 2001 anthrax attacks that killed five and infected 17 others in the United States) are an ongoing concern.

The United States, under both Republican and Democratic administrations, has been a global leader in efforts to strengthen global and national capacities to prevent, detect, and respond to infectious diseases threats — whether naturally occurring, deliberate, or accidental.

With U.S. support, the International Health Regulations (2005) were successfully negotiated and accepted by 196 nations. While “regulations” may sound bureaucratic, the IHR requires transparency in reporting certain disease outbreaks to WHO and obligates countries to build up their national health surveillance and response capacities.

President George W. Bush initiated a major U.S. Government interagency and international effort to prepare for a potentially severe pandemic influenza when it was feared that the H5N1 “bird flu” virus could mutate to form sustained and efficient human-to-human transmission. Building on those efforts, President Barack Obama developed the broader Global Health Security Agenda, a multilateral and multi-sectoral approach that now involves over 60 countries as well as WHO, the UN Food and Agriculture Organization, the World Organization for Animal Health, and other institutions.

GHSA’s goal is to establish capacity to mitigate the devastating effects of Ebola, other highly pathogenic infectious diseases, and bioterrorism events. The September draft of the new “GHSA 2024” framework has an ambitious target: By 2024, more than 100 countries will have assessed their needs, will have funding available, and will be implementing activities to address health security gaps.

Also in September, the White House announced a new National Biodefense Strategy in recognition of the need to more effectively prepare for and combat biological threats. The Secretary of Health and Human Services is the federal lead for biodefense and a Cabinet-level Biodefense Steering Committee will coordinate within the government.

Globally, WHO has made huge strides in building up its emergencies program since the West Africa Ebola outbreak killed over 11,000 people in 2014. That program now wins praise for its quick responses even as it is being put to the test in a very difficult environment in DRC, where armed opposition groups have attacked civilians and disrupted operations.

On Oct. 3, the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, briefed the UN Security Council on the situation. WHO has more than 200 staff on the ground and so far more than 13,700 people have been vaccinated using a ring vaccination strategy. Because of the security situation in the area and community mistrust, the spread of Ebola is moving into areas bordering Uganda and could become a public health emergency of international concern.

The many international and national efforts to prevent, detect and respond to global health security threats deserve commendation and support for trying to protect all of us. And yet, funding to build required capacity to face these threats is woefully inadequate. A series of “Joint External Evaluations” to assess countries’ capacities under the IHR have identified the most urgent needs within health security systems, but many countries now lack the resources to implement plans that will address those needs.

Meanwhile, WHO’s Contingency Fund for Emergencies (which provides the resources to respond in as little as 24 hours to disease outbreaks and humanitarian crises with health consequences) has received less than $75 million in contributions (short of its $100 million goal) for the period 2015-2018, and WHO already has had to spend over $21 million of those funds to respond to emergencies in 19 countries.

An ounce of prevention is worth a pound of cure. Donors spent over $3.6 billion to fight the West Africa Ebola outbreak.

You are more likely to be killed by a pandemic than by a terrorist. Problems without borders require cooperation across borders. In recent decades, nations around the world have come to realize how they need to build capacity to prevent and prepare for global health security threats, and under the International Health Regulations they took on the obligation to do so. But resources are not available to build capacity commensurate with the threat.

The U.S. commitment to WHO, as both a partner and a contributor, needs to remain robust. Let’s mark the 100th anniversary of the Spanish flu with a story of success, by better protecting Americans and all citizens of the world from the next pandemic.

Ambassador John E. Lange (Ret.) is a senior fellow for Global Health Diplomacy at the United Nations Foundation. He was a foreign service officer and served as the State Department’s special representative on Avian and Pandemic Influenza from 2006-2009.