Lesson: “We’re only as safe as the most vulnerable people in the most vulnerable places in the world”
Two years after Médecins Sans Frontières advised the world to pay attention to the unprecedented spread of Ebola across West Africa, and a little more than a month after President Obama asked Congress to provide $1.8 million in emergency funding to respond to the spread of Zika virus in the Americas, a group of global health watchers gathered in Washington, DC last week to talk about progress, stakes, and next steps needed to confront outbreaks of infectious diseases world wide.
They included Dr. Ashish Jha, director of the Harvard Global Health Institute, which with the London School of Hygiene and Tropical Medicine, assembled a panel last year to look at the global response to Ebola. When that panel began work year before last year that led it to recommend “Ten essential reforms before the pandemic,” Jha noted, its members little thought that the next public health threat of global proportions would emerge within the next 14 months.
The spread of Zika in countries lacking in basic and necessary components of public health responses, has, Jha and other panelists noted, caught the world not much better prepared than it was two years ago.
“We are only as safe in America as the weakest country in the world,” Jha said. And as tragic as the fallout from each of the most recent infectious disease outbreaks has been (from 90 to 95 percent of Ebola deaths could have been averted with a prompt international response, Jha said) the spread of both viruses has been relatively slowed by the mechanisms through which they were transmitted, compared, for example, to the speed with which airborne viruses can spread. “We’ve gotten lucky with both of them, Jha said, “and might not get that lucky again.”
While the average Ebola case transmitted the virus to two other people, Jha added, the average measles case spreads to 18 other people.
Also there were Dr. Anand Parekh, a senior advisor of the Bipartisan Policy Center, which produced a report last year examining the President’s Emergency Plan for AIDS Relief, making The Case for Strategic Health Diplomacy, and Karl Hofmann, a former ambassador to the West African nation of Togo and now leader of Population Services International.
Both noted that the successes of the President’s Emergency Plan for AIDS Relief inspire optimism for effective global health interventions, showing as Hofmann put it, “that we can get this right,” but it is optimism with limitations, the panelists agreed.
“For strategic health diplomacy, you have to invest in the long term,” Parekh said.
And while recognizing the gains brought by the President’s Malaria Initiative as well as PEPFAR, and affirming they should continue, Jha added, “We have to make broader investments in health systems. Countries will only be safer if they have a health system that works, not an HIV system that works.”
The need for the broad and bipartisan support that made PEPFAR success possible presents another reality, though, Hofman said.
“If PEPFAR had been the President’s Emergency Plan for Health System Strengthening, it would have failed [for lack of broad and bipartisan support]” he said. “I would rather take that vertical system that works,” he said, alluding to the “silos” through which efforts to address specific diseases channel resources, “than a horizontal system that doesn’t.”
In the meantime, panelists agreed, the World Health Organization responded promptly this year to Zika, convening a panel that recognized the spread of the virus with the accompanying rising incidence of microcephaly and other neurological conditions as a public health threat of international concern. But while the response was an improvement over the agency’s response to Ebola, during which local, regional, international entities as well as WHO itself “all failed miserably at what we said we’d do,” Jha is not reassured. “There’s a spotlight on WHO,” he noted. “When the spotlight is off, will it have changed?”
He referred to the Harvard/LSHTM panel’s recommendations, which included developing international strategies to improve national response capacities, creating an accountable entity within WHO to lead and coordinate emergency preparedness and response, as well as a standing, independent committee to recognize and declare global public health emergencies, and building adequate financing for the agency to lead and coordinate appropriate responses.
Until systemic reforms are in place, he added, “I’m not going to sleep any better at night.”