Health and Healthcare Systems

The world is too complacent about epidemics. Here's how to change

A Congolese health worker administers Ebola vaccine to a boy who had contact with an Ebola sufferer in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland      TPX IMAGES OF THE DAY - RC1A52EFD130

An investigational vaccine is being administered to help contain the current Ebola outbreak. Image: REUTERS/Olivia Acland

Julie Louise Gerberding
Executive Vice President & Chief Patient Officer, MSD
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Nipah virus, Lassa virus, Chikungunya virus, and MERS-CoV – these viruses are unfamiliar to most, yet they cause some of the most serious global infectious disease threats we face.

New viruses like Bourbon virus and Heartland virus are just emerging in humans, and some, like Mengla virus patiently wait for an opportunity to move from their animal hosts to infect people.

No one can predict exactly when or where the next threat will occur, but as we learned from the 2014 West Africa Ebola virus outbreak, and the ongoing Ebola crisis in the Democratic Republic of the Congo (DRC), we live in a world where infectious disease outbreaks with the potential for tragic consequences are a certainty.

Despite ample evidence of this ongoing threat and amidst some progress in outbreak response, we remain vulnerable and are challenged to detect, manage, and prepare for emerging epidemics.

The global community responds to new outbreaks with a now familiar cycle of engagement: urgent containment action (and even panic) supported by emergency funds and other resources (usually accompanied by convincing rhetoric that more will finally be done to avoid such calamities); and then, as the threat subsides, declining interest that culminates in a return to complacent neglect.

Take any recent outbreak – West Nile, SARS, 2009 H1N1 and H5N1 influenza, MERS, Zika, the West Africa Ebola outbreak – and you will recognize this pattern.

The alarm bells ring and the global community jumps, responding as best it can to protect as many people as possible and contain the situation. Human and financial resources are mobilized from multiple sectors and some detection and response capabilities are improved. When the headlines disappear, so do the resources that could strengthen and sustain these improvements. As a result, our collective vulnerability persists.

In fact, our vulnerability is increasing. Our hyper-connected small world of travellers and global commerce quickly transports pathogens from one corner of the world to another. Urbanization creates crowding that promotes person-to-person spread.

Urban sprawl and rural incursion increase the potential for human-to-animal transmission. Political and social conflicts disrupt public health systems and forcibly displace people into environments where infectious diseases thrive.

We are only beginning to understand the impact that climate change will have on the emergence of infectious disease. All of this means that the probability of outbreaks with pandemic potential is increasing and the global risks are higher than ever before.

Our persistent cycles of global unpreparedness and uncoordinated reactive responses not only put people at ongoing risk, they also threaten our global economy. For example, a recent report in the Journal of Infectious Disease estimates the 2014 Ebola outbreak in West Africa cost the world more than $50 billion dollars.

Health security and economic security go hand in hand. Governments and multilateral global health organizations strive to provide the leadership necessary to improve both, but their collective efforts pale in comparison to the trends that are increasing the pandemic threat.

Clearly, business as usual is not enough to assure global health security and economic stability. It is time for the private sector to deploy its leadership, advocacy, innovation, and substantial resources in public-private partnerships that power up the efforts of our governments and civil society. Working together, we can and must strengthen our ability to detect, respond, mitigate, recover, and ultimately prevent infectious disease threats.

As noted in the 2015 World Economic Forum report, Managing the Risk and Impact of Future Epidemics: Options for Public-Private Cooperation, previous outbreak responses have shown that “the private sector can be more than just a chequebook. They can provide capabilities and expertise in partnership with the public sector that can be truly beneficial to a public health emergency.” Furthermore, the private sector can take calculated risks in ways that are not always available to the public sector, such as pursuing a novel concept or intervention.

And we already have proof of concept. Today, for the first time ever, an investigational Ebola vaccine is being administered as part of the global response in the DRC and bordering countries to help contain the current Ebola outbreak.

This investigational Ebola vaccine was developed as the result of a series of international public-private partnerships, between the governments of Canada, the US, and several European and West African countries, the World Health Organization, NewLink Genetics, and MSD. Similar partnerships fuelled the development of two other candidate vaccines against Ebola virus, and others are accelerating the development of potential treatments.

The Coalition for Epidemic Preparedness Innovation (CEPI) is an exemplar of the power of partnerships. CEPI was launched at the 2017 World Economic Forum Meeting in Davos. CEPI is an innovative alliance between governments and private, philanthropic and civil organizations to finance and coordinate the development of new vaccines to prevent and contain infectious disease epidemics. CEPI is already funding academic and biopharmaceutical work on novel vaccines that target some of the most serious known pathogens of global health importance.

The power of public-private partnerships to enhance health security is certainly not limited to the biopharmaceutical industry and there are numerous examples in the technology, communications, energy, and other sectors where private sector contributions are ongoing.

Perhaps our biggest opportunity is this: end the futile cycle of outbreak urgency, emergency investment, and then distraction, resource diversion, and finally a return to complacent neglect.

Private sector leaders engaging in strong and collective advocacy can motivate policy makers to mandate sustained health security investments – and have ample reason to do so. Not only is the health of our families and employees at stake, but also the financial health of our businesses.

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