Page 23
brucellosis, and leptospirosis. (adapted from OIE, WHO) Few natural hazards threaten more loss of life, economic disruption, and social disorder than serious infectious disease outbreaks. A pandemic of influenza or similarly transmissible disease could infect billions, kill millions, and knock trillions of dollars off global gross domestic product. Even a more contained epidemic could kill millions and cost tens or hundreds of billions of dollars (Commission on a Global Health Risk Framework for the Future 2016). Yet compared to the resources devoted to mitigating other global risks such as terrorism, climate change, or war, the global community invests relatively little to prevent and prepare for infectious disease outbreaks. The typical pattern of response can be characterized as a cycle of panic and neglect: a rushed deployment of considerable resources when an outbreak occurs, followed by diminishing interest and investment as memories of the outbreak fade. The consequent underinvestment in preparedness, and over reliance on reactive responses is enormously costly in terms of both lives and dollars, and aggravates global risk. In the wake of major outbreaks since the beginning of the 21st century– including those of Ebola, Zika, avian flu (H5N1, H7N9, and other strains), Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) as well as the 2009 H1N1 flu pandemic – national and global health security have received increased attention. Efforts were launched to strengthen national public health systems and to reinforce international mechanisms for coordination and response. Yet there are still glaring gaps. The first line of defense is each country’s veterinary and human public health systems’ capacity to detect and promptly control an infectious disease outbreak. Given competing priorities, however, most countries have not devoted sufficient resources and attention to building such skills and infrastructure. As a result, most countries still do not meet their obligations as defined by the International Health Regulations in 2005. At a global level, steps have been taken to reinforce the ability of the World Health Organization, the World Organization for Animal Health, and other multilateral entities to support countries in preventing, detecting, and responding to outbreaks, but there remain issues of funding, coordination, and balancing preparedness and response appropriately. On the scientific front, initiatives such as the Coalition for Epidemic Preparedness Innovations (CEPI) hold great promise but are still at an early stage. As a result, we currently lack good diagnostic tools, vaccines, and therapeutics for many of the most threatening pathogens. This is not an area in which there is significant debate about what to do; in fact, there is strong consensus on what actions are required. While varying in detail and emphasis, in the last two years, several major reports examined the response to the Ebola epidemic (World Health Organization 2015b; Commission on a Global Health Risk Framework for the Future 2016; Moon et al. 2015) and converged in their policy recommendations — strengthening national human and animal health systems as the first line of defense; reinforcing global coordination and capabilities; accelerating the development of diagnostics and vaccines; and improving information sharing and economic incentives. Moreover, many policymakers at national and international levels have accepted these recommendations and made commitments to implement them. The question is whether these commitments will be fulfilled or whether, given scarce resources, weak accountability for governments’ failures to prevent epidemics, and more immediate priorities, we will once again slip into a cycle of neglect until the next outbreak occurs. To help us escape from the damaging neglect phase between outbreak emergencies, this report provides an objective, evidence-based monitoring framework to track the performance of the international community and its key institutions in reducing a substantial global threat, and to regularly disseminate the results. This will help to clarify and increase accountability. Work is already underway to