This guest post was originally published by Management Sciences for Health. The post is written by Ashley Arabasadi and is an overview of “Getting Local with Global Health Security,” a World Health Assembly side-event co-sponsored by partners under the Global Health Security Agenda Consortium including MSH, the Global Health Council, Resolve to Save Lives at Vital Strategies, Nuclear Threat Initiative, PATH, the Global Health Technologies Coalition, the Global Health Security Agenda Next Generation Network, and US Pharmacopeia.
Is the world safer today from the threat of infectious diseases than it was a generation ago?
It is true that we have more tools at our disposal: better surveillance and diagnostic systems, stronger frameworks and regulations, such as the Global Health Security Agenda and Joint External Evaluations (JEE), and a deeper understanding of how diseases spread and what is needed to stop them. It is also true that climate change, deforestation, population growth, and our proximity to farm and wild animals are making the threat of epidemics greater than ever before. Although the challenge is great, we have the knowledge to solve it. So what do we need to do?
This is the question we set out to answer during a discussion on the sidelines of the 71st World Health Assembly in Geneva last week. Industry experts, including Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies; Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr. Diane Gashumba, Rwanda’s Minister of Health; Rüdiger Krech, Director of Health Systems and Innovation at the World Health Organization; and Catharina Boehme, CEO of the Foundation for Innovative New Diagnostics, engaged a room of more than 200 people on what they see are critical gaps—and how to fill them—in global health security.
Knowledge is King
“Three years ago, we were flying blind,” said Dr. Frieden, reflecting on the progress the world has made in strengthening our capacity to prevent, detect, and respond to infectious disease threats. “There was no information about which countries were ready, what they were ready for, or what needed to be done.” While we’ve made important progress in understanding where the gaps are and how to address them, says Frieden, we’re far from filling those gaps.
To date, more than 76 countries have completed the JEE process, and a few dozen of them are developing national action plans for health security. However, virtually none have costed these plans, identified necessary resources to implement programs, or established sustainable systems to close gaps and stop outbreaks at the source.
Frieden signaled where the gap is greatest: “Countries in Africa have the furthest to go and require the greatest partnership, following the leadership of countries like Rwanda, which are in front of implementing effective programs.”
The better we understand the gaps in a country’s capacity to prevent, identify, and fight infectious disease outbreaks, the better positioned we are to implement the right interventions to strengthen health systems in support of health security. But we need to move from awareness into action.
“The number of infectious disease outbreaks is going up,” Peter Sands said. “This is not a problem that is going away as mankind gets bigger and richer. This is a problem that seems to be increasing in magnitude.”
“Although we appear to be getting better in controlling the mortality impact of such outbreaks because of the advances in medical science, we actually appear to be getting more vulnerable to the economic impact,” Sands continued. Fear of an outbreak travels fast, and the behavioral consequences of that fear are extremely powerful and can disrupt economies, even in countries where the disease never appeared.
The challenge is to recognize the cost of epidemics and prepare locally in advance. We must invest now in prevention and preparedness or pay later in lost lives, closed businesses, and disrupted economies.
Poor planning and preparation leaves populations vulnerable to illness and undercuts efforts to treat patients and curb new infections. Each country needs to understand its weaknesses so they can start addressing them right away.
Rwanda, for example, recently finished its JEE. “Each country has to adapt global health security work to its own specific situation,” said Dr. Gashumba, reflecting on the process. “Sometimes it is very difficult to make priorities, especially when you have lot of health and social issues . . . the strategy we adopted is to focus everything on the ground because the issues are on the ground, but also the solutions are on the ground.”
If we are to get local with global health security, we must get local in context and recognize that the threats facing communities today may be endemic diseases, like malaria, tuberculosis, and HIV. Active prevention and constant readiness must break down silos and follow an integrated and holistic approach to health.
The ability to quickly and accurately diagnose an infectious disease where it starts, at the community level, can make or break an epidemic. According to Catharina Boehme, diagnostics is a “blindspot” in global health security. “Effective, affordable diagnostics is critical to every country’s surveillance and response system . . . and diagnostics is one of the pieces that is absent in many of the countries that would be most in need to have early response and preparedness mechanisms.”
She continued: “For six of the nine blueprint pathogens, we have no diagnostics available at all, and even when diagnostics exist, health systems are rarely equipped to deploy them when needed.”
Early response, aided by efficient diagnostics, could save countless lives and billions of dollars every year. According to Boehme, only one laboratory in all of Africa (Senegal) today can confirm yellow fever. For Ebola, she says, despite progress, it took three months in 2014 to diagnose it. “Now in the current Ebola outbreak in DRC, we’re faced with a situation where there’s again a major access problem to diagnostics.”
This is an area where the world clearly hasn’t made enough progress over the years compared with vaccines, says Boehme. “There’s no manufacturing capacity in place to scale up diagnostic manufacturing when needed.” Local partnerships, sample sharing, clinical trial capacity in countries, and local R&D are also lagging far behind. Speaking about the progress made by global vaccine initiatives, she says, “it wouldn’t take much money to leverage these same mechanisms towards some diagnostics.”
A Political Choice
Epidemic preparedness is within any country’s reach, said Rüdiger Krech. But in the end, it’s a matter of political choice. “By and large we know what to do. It’s not that we can’t afford it. We can afford it. That is why it’s a political choice.”
“There will be outbreaks and epidemics if you have weak health systems,” Krech said. “For quite some time, we’ve tried to address the low-hanging fruit, which is disease-specific programs, and we’ve always thought that this was done on the basis of well-functioning health systems, but as we’ve seen, that is not the case.” To make real progress, he says “ We need to much better align the JEE and the Global Health Security Agenda with what’s actually going on in health systems.”
No matter where you live in the world, the risk is universal. To stop outbreaks at the source and prevent threats from becoming epidemics, local preparedness is key. We know that bridging the gap between awareness and action requires us to engage citizens, communities, frontline health workers, and those working with animal populations in the direct reporting of suspected outbreaks. It also requires having in place the tools and skills needed for an effective and efficient response that ensures essential services remain in place when battling an outbreak. The challenge now is to persuade government leaders that preparedness is worth the price tag.
Read more about this event from Global Health NOW: https://www.globalhealthnow.org/2018-05/local-path-global-health-security