Commission considers how to improve global disease outbreak response

March / April 2016 | Volume 15, Issue 2

Female researcher in lab coat and surgical mask looks into microscope, female close at hand also in mask observes
Photo by David Rochkind for Fogarty

An urgent investment is needed to improve the global
response to pandemics, according to the Commission
on a Global Health Risk Framework for the Future.

​Zika, Ebola, HIV and other infectious disease outbreaks threaten more than just the world's health and urgent action is needed to strengthen the global response, according to an international group of experts. They propose $4.5 billion be spent worldwide each year to upgrade national health systems, accelerate research and development, and establish preparedness funds at the WHO and World Bank.

The Commission on a Global Health Risk Framework for the Future - comprised of independent, international authorities on finance, governance, R&D, health systems and social sciences - recently released its study of global security and infectious disease response. The National Academy of Medicine served as the Commission's secretariat.

Pandemics cause an annual loss of $60 billion from the global economy, the report estimates, making a $4.5 billion investment in prevention a good buy that protects both health and global security.

"It is not only the health of our people that's at stake, all indications suggest that we are just one major global pandemic away from significant economic and humanitarian catastrophe," noted Dr. Judith Rodin, Rockefeller Foundation president and vice chair of the Commission's international oversight group.

The Commission recommends a three-pronged framework to counter infectious disease crises. First, national governments should strengthen their health systems as part of their basic duty to protect their citizens. The WHO and member states should set benchmarks for core capabilities of effective national systems and provide technical support so goals could be met by 2020. Second, global and regional coordination and capabilities should be improved by bolstering the WHO so it can effectively lead outbreak response, with oversight from an independent technical advisory board. Third, the WHO should establish an independent committee to galvanize acceleration of relevant research and development, define priorities and mobilize resources to counter the threat of infectious diseases.

"The consequences and risks here are immense. And frankly this has not been on the 'A' list of global problems in the way that nuclear proliferation or terrorism or global climate change has been," said Harvard economist Dr. Larry Summers, during a panel discussion at the report's launch.

Regular and transparent assessment of progress is needed, the commission urged. Governments must be held accountable and all must participate, since the global health protection chain is only as strong as its weakest link.

"One lesson we have repeatedly learned is that delays in raising infectious disease alerts have huge costs in terms of both lives and money, given the exponential nature of the threat," said Dr. Peter Sands, Commission chair, and senior fellow at Harvard. "Yet countries are often reluctant to raise alerts since they fear the consequences."

If the WHO publicly distributed a high-priority "watch list" of potential health emergencies on a weekly basis, it would increase transparency and lessen the stigma, the commissioners suggested.

Research and development are also critical to the response effort. "We need innovation," said Dr. Maria Freire, Commissioner and president of the Foundation for the NIH. "We need to innovate the way we develop medicines, we need to innovate the way we regulate how these medicines can come to the patient, and we need to have new ways of doing clinical trials. This has to be a concerted effort."

To develop and improve diagnostics, drugs and vaccines, Freire called for a $1 billion per year investment to fill the gaps. A committee of the best scientists, regulators and manufacturers should be convened to pinpoint existing capabilities and needs, and determine how to most effectively proceed. Researchers and implementers must also consider the important role local communities play, she continued. "Without the anthropological understanding, and the research that needs to be done by the people in the field, we will have developed the best technology but it may not be adopted and it may not be accepted," Freire said.

The Commission's recommendations were informed by 11 days of public workshops across four continents, as well as input from 250 experts and stakeholders.

The effort was supported by the Paul G. Allen Family Foundation, the Ford Foundation, the Bill & Melinda Gates Foundation, Mr. Ming Wai Lau, the Gordon and Betty Moore Foundation, the Rockefeller Foundation, the USAID and Wellcome Trust.

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