Last week, the Center for Strategic and International Studies (CSIS) hosted an advance screening of the PBS Great Decisions episode, “Global Health: Preventing Pandemic.” After the screening, a panel of American global health experts took to the stage to discuss US leadership in global health and health security. On the panel were Ambassador Debbie Birx, U.S. global AIDS coordinator and special representative for global health diplomacy; Dr. Helene Gayle, president and CEO of the Chicago Community Trust; Chris Collins, president of the Global Fight Against AIDS, Tuberculosis and Malaria; Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center; and Amanda Glassman, chief operating officer and senior fellow here at CGD. While the group highlighted the scary realities that pandemics present, they also expressed optimism and explored ideas for how we can improve on pandemic preparedness—some of their ideas are in the box below. The bottom-line? The next pandemic is just a matter of when. It’s (past) time that we prepare.
How can we do better on global health security?
1) Direct funds towards hoped-for results 2) Less focus on inputs and more on progress towards outcomes, or system functionality 3) Collaboration and coordination across global health funding mechanisms 4) Develop a storyline and action plan on how these mechanisms fit together with a joint accountability framework to keep everyone aligned 5) Support and nurture youth and country leadership 6) Double-down on performance and use data to focus interventions 7) Form public-private partnerships to enhance technical support and financing for global health security
Calls for a greater focus on global health security aren’t new. Back in 2015, a Blue Ribbon Study Panel on Biodefense released short-term and long-term recommendations for how the United States could prepare for biological threats. Short-term recommendations included institutionalizing biodefense in the Office of the Vice President, establishing a biodefense coordination council at the White House, determining and establishing a clear congressional agenda to ensure national biodefense, implementing an integrated national biosurveillance capability, and empowering nonfederal entities to be equal biosurveillance partners, among many others. But three years later, most of these recommendations have yet to come to fruition. The Blue Ribbon Panel’s warning from three years ago remains true today: “the United States is [still] underprepared for biological threats. Nation states and unaffiliated terrorists (via biological terrorism) and nature itself (via emerging and reemerging infectious diseases) threaten us.”
Changes in the US have been slow, even in the face of new threats. We’ve recently seen the creation of horsepox—a cousin of the virus that causes smallpox in people. While creating viruses using synthetic biology can advance research and help scientists come up with cures, these viruses can be a major threat to the US and the world in the wrong hands. Throw in increased antimicrobial resistance (read about CGD’s work on this here) and, as New York State health commissioner Howard Zucker said at a recent Hudson Institute event on transnational biological threats and global security, “oy.” The threat of drug-resistant strains of diseases (manmade or natural) that will continue to spread without an arsenal of antibiotics to combat them makes this picture even starker.
This could be devastating not only in terms of lives lost but also in terms of economic and political instability. Experts estimate that the 2003 SARS epidemic cost the global economy between $30–40 billion in just six months. As Dr. Rebecca Martin explained at a CGD event on Preventing the Next Pandemic in May last year, “it costs a lot less to prevent now versus being able to respond later.” According to Dr. Martin, by some estimates we’ve spent $6 trillion on epidemic response so far in the twenty-first century. That’s about $60 billion a year. If we put that money towards prevention, experts say that number could be reduced to about $4.5 billion a year, or 65 cents per citizen of the world.
If we aren’t paying attention and reacting to biosecurity threats here in the US, how can we expect low- and middle-income countries to have biosecurity at the top of their agenda? When the Spanish flu hit in 1918, an estimated 500 million people died worldwide, with more American deaths than US casualties in World War I and World War II combined. Today, more than half the world lives in densely populated urban settings, and with air travel, a disease could spread around the global in under 48 hours. Urbanization and globalization, combined with the fact that most infectious diseases are zoonotic (caused by infections that are shared between animals and people), are setting us up for a huge spillover event. As CGD COO and senior fellow Amanda Glassman states in the PBS Great Decisions episode, this “could be catastrophic if we had a disease spread more quickly and widely than what we’ve seen so far.” Thus, even if an outbreak occurs on the other side of the world, we could see effects here in the US within days.
Officials know a major disease outbreak—intentional or not—is bound to occur (we just don’t know what, where, or when yet). But still, the US is not prepared: in most US cities there are only one or two hospital beds equipped to treat a person in quarantine, stockpiles of medicines and devices have proven low or full of expired treatments time and time again, and there is a major lack of control systems. As former Secretary of Homeland Security Tom Ridge and former Senator Joe Lieberman wrote in their preface to the Blue Ribbon Study Panel’s 2015 report, “We have no choice—the Nation must take action to defend against the biological threat. We have done much already, but we need the leadership only a top-level official can bring to bear to optimize the biodefense enterprise.” It’s time to prepare for the inevitable and put the systems in place to protect Americans’ health both at home and abroad against global infectious disease outbreaks.