Can we ever be ready? A clarion call for a paradigm shift in the way the Global Health Community collaborates in fighting disease or promoting health.
With the Covid-19 pandemic picking up speed in several parts of the world, health care systems crashing in its path, and stock markets crashing even faster, these are my thoughts from my dorm as I observe a stay at home order. The absence of a vaccine or an effective therapeutic agent may be a reality in any subsequent outbreak of a high consequence pathogen. A universal vaccine is a goal that the world may have to go without for the foreseeable future.
An extraterrestrial being may not be attacking us anytime soon, but what is clear is that we do not have to wait another century to see a repeat of a flu-like pandemic of this magnitude. This outbreak being the worst pandemic of the 21st century, it is highly likely that it is just the first of its kind this century if our approach to combating outbreaks remains the same.
A pandemic that has brought out the worst in us demonstrating the prevalent "I" or "Us" mentality that has plagued humanity and thus deprived the race of enjoying the full potential that advances in science and technology can offer. Examples of these come in the form of refusal by countries to allow cruise ships to dock in their territorial waters, or flights being turned away because of the presence of potentially sick patients. Worse still is the ban on exportation of life- saving personal protective equipment (PPE) and other medical devices to where they are needed most, by countries and regional bodies or situations where states within the same country compete for what is already available within their borders leading to the skyrocketing of prices for these goods. The same can be said about panic buying, sadly in many countries, leaving shelves in supermarkets empty.
It sounds like there is nothing we can do to stop the spread of this plague, but that's not true. We may be at a loss now, but all is not lost, because as this pandemic exposes our gaps in preparedness, so do we increasingly recognize how we can prepare better as a Global village, that we are today, for the next pandemic. This piece is my take on how we can make the world a safer place again.
What would have happened had an extraterrestrial being attacked Wuhan in eastern China, and we know it would be attacking other countries? The world would have united its armies under a central command to fight off the assault instead of counteracting the enemy as independent nation-states. Is this virus any different from such, and why is our response competition and not cooperation. Lastly, and most importantly, what does this say about us as a race?
Bill Gates, in a speech in 2015, told us all that the world is not ready for a pandemic like Covid-19. His assessment and conclusion are sadly prophetic of the sorry state the world is in today. He also clearly told us how to be ready and what I am going to suggest is in line with his proposal. The West African Ebola Outbreak that Bill recounted as a wakeup call to the world was unfortunately not tragic enough. The fundamental question is, why are we still not ready in the face of these frequently emerging high consequence pathogens?
The protracted undermining of international institutions such as the World Health Organization (WHO), and their dwindling budget in the face of more potent threats to our health security, has led to a missed opportunity to prevent loss of precious lives and many more livelihoods. China has demonstrated her ability to halt the spread of Covid-19 within her borders, on her own. However, the associated human suffering, as a result of her measures, remains unknown and could have been avoided by a united global front.
It is more timely than ever to turn to the inspirational story of individuals like Jonas Salk, who refused to patent his polio vaccine because he wanted it for the human race, and thanks to that, polio is on the brink of eradication. Stories like Jonas’ remind us of the urgent need to remove the incentive for profit-making or individual/institutional/national glory from work related to all pandemic prone diseases. Competing for national and institutional interests, during the West African Ebola Outbreak, undermined that response, and it is unfortunately not different in the Covid-19 response. Data sharing in the field is limited, and this harms the survival of patients.
The human suffering and disruption to daily life that do not make it to the news can be mitigated or avoided altogether. The human race has what it takes, in terms of technology and technocrats, to accomplish the task. What is lacking is the political will to do away with the zero-sum game and the human-made barriers that promote the "them" versus "us" mentality.
It is time for WHO's mandate and structure to be reviewed to allow it to train and have a standby healthcare army of sorts to respond to outbreaks around the world without any political hindrance. An army of trained responders who can be pulled out of their national health systems and deployed overseas within a very short notice.
WHO or a newly setup structure should have the required funding, capacity, and mandate to respond promptly to outbreaks of high consequence pathogens around the world. The response team, of any such institution or arm of WHO, should be devoid of group-based interests of any kind. The rapid and efficient deployment of a response team requires a centralized coordinating framework that promotes and rewards collaborative work; and that recognizes the universality of skill sets and competencies. A standby health workforce, whose deployment is informed by a robust surveillance infrastructure, equipped with a rich blend of skills and competencies, with a robust financing framework under the right leadership/governance structure, is what this dream framework requires.
Funding could come through a pandemic tax paid by each independent territory of the world. Each required to give a percent of its health budget as a contribution to the pandemic preparedness purse (PPP). The purse utilized to stock, staff, and rapidly scale up the deployment of its systems and structures around the globe. The purse should also provide financial risk protection to offset the losses resulting from the measures in the affected community. Rewarding the affected community's corporation by using the PPP is to avoid amplification of an epidemic to a pandemic.
More critical than generating this fund is the removal of the political barriers that prevent this framework from becoming a reality. The Global Health Community needs to be very audible and visible in getting the attention of governments to buy into this idea. Our next steps should be based on lessons learned in this pandemic. One of such early lessons is the theoretical nature of our countries and borders. It has made it evident that it is too soon to break up our unions and think we are safer and better off as independent enclaves of the human race. Far from banking on altruism as a drive to a global health approach to combating diseases of poverty, a global health approach to combating pandemic prone diseases is a matter of self-preservation for all.
There is an overwhelming outburst of appreciation for health care workers around the world. A case in point is the Clap for Carers initiatives globally or messages of thank you by different celebrities facilitated by businesses. More urgent than this, is the hope that the public can force the politicians, and the business interests they represent, to get out of the way of healthcare workers, who in their calling, only desire to provide care to humanity without regard to race, religion, ethnicity, geography, socioeconomic status, sexual, gender, political or economic orientation. My suggestion may sound utopian, I know, but that is so because I believe in the best of humanity, and extreme threats like the one posed by this pandemic demand extreme measures.
A united front to combat pandemics would be an initiative of all humankind, undertaken by all humankind and for the protection of all humankind from pandemic prone high consequence pathogens. My humble suggestion on this blog may appear intuitive but is undoubtedly a practical approach to overcoming this new threat. There is overwhelming evidence that it is doable, costs far less, and makes our world a safer place. The virus is telling us that if we are not ready to think or act as one, then we do not deserve to be together and interact freely as a human race. The social distancing required today is but a reflection of the state of our mindset. The virus has not succeeded in bringing us all to our knees because it is strong; it has because we are weak as a divided race.
Dr Jalloh has been kindly supported by the Harriette Kelso Scholarship which supports students from Sierra Leone and Tanzania to study the DTM&H at LSTM on a fully-funded scholarship. If you would like to find out about how you can support students to study at LSTM, please click here.