CUGH 2017: Global Health Security Agenda confronts the inevitable and the unknowns in disease threats, responses

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Consider four disaster scenarios acknowledged to have the potential for catastrophic impacts on humanity — an asteroid hit . . . continued unchecked global warming  . . . a nuclear holocaust . . . a global pandemic.

Until recently, the most immediate of these received the least attention, former head of Management Sciences for Health Dr. Jonathan Quick noted during a discussion at the 2017 Consortium of Universities for Global Health Conference Saturday in Washington DC. In fact, another participant in the same talk noted later, the prospect of a zombie apocalypse still gets more attention than the specter of a large-scale airborne infectious disease outbreak.

If you find that anxiety-provoking, it is par for the course in pandemic preparedness circles, which have been pulling together in recent years to catch up. And, in fact, the bulk of the talk here carried optimism, with a focus on the fast momentum gained by the Global Health Security Agenda in the three years since its launch preceded recognition of the West Africa Ebola crisis by just a month.

Ambassador Bonnie Jenkins

“The timing of this was incredible,” Ambassador Bonnie Jenkins, former State Department leader of threat reduction programs, which coordinated the GHSA, acknowledged.

Back then, following a year of discussions across U.S. agencies, as well as a couple of pilot projects in Uganda and Vietnam, 22 nations had joined the initiative. Today 55 countries have joined. And while impetus for forming the agenda and its “action packages” to prevent, detect and respond to infectious disease threats derived from the abject failure of all but a handful of countries worldwide to meet the requirements of International Health Regulations for epidemic outbreak preparedness, health ministries are lining up now for evaluations of their systems’ capacities, with the goal of upgrading them. The effort, which was intended to be truly global, appears to be succeeding in that aim: G7 leaders have made commitments to help 76 countries build the systems necessary to be aware of, track, and act against outbreaks within their borders. The efforts involved sweep across agencies, encompassing ministries of health, environment, agriculture, and security, and have received private sector support, she said. Jenkins only had 15 minutes to talk, and spoke fast, but also invited audience members to visit “for country success stories.”

Dr. Jonathan Quick

Quick compared that momentum to what he calls the “epidemic inertia” that allowed talk of eradicating smallpox to drag on for 15 years, between the year after the United States proved it could be done, and the initiation of action on a global scale in 1966, which then finally saw results in the declared end to the disease in 1980.

But if the current momentum is impressive, so are the current challenges. Continued engagement of U.S. leadership has become uncertain, Jenkins noted. U.S. funding supporting the agenda’s goals took an unrecovered $1 billion hit when emergency Zika money was needed but not provided by Congress. And the proposed reductions in health and science spending in the Trump “America First” budget outline, that include a suggested $5.8 billion cut to the National Institutes of Health, the elimination of the research- and capacity-building Fogarty International Center, and cuts to USAID, would impact global health generally, and programs that support the goals of the GHSA strongly, Jenkins noted.

At the same time, recent realities remain current threats. The Ebola outbreak in West Africa, which led to cases in insufficiently prepared countries around the world, including the United States, showed its greatest potential threat with the July 2014 arrival of an infected man at the airport in Lagos, Nigeria, the continent’s most populous city.

The crisis, Quick pointed out was “one air flight away from spreading all over Africa.”

That continues to be the case for unknown infectious threats, the most potentially harmful of which, lingering unnoticed in rural wildlife including rodents and primates, can make the jump from animals to local humans, to cities, to international travel.

More than 50 percent of people in rural communities in low-income countries report being bitten by rodents regularly, according to Dr. Jonna Mazet of the University of California Davis One Health Institute. “You may not have rodents in your home,” she added. “But people who can get here in a day do.”

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