by Stephen Taylor, Biodefense MS student
On Thursday May 17, 2018, the Center for Strategic & International Studies (CSIS) brought together health security experts from around the globe for a symposium on pandemic preparedness in the 21stcentury. The event opened with remarks from J. Stephen Morrison, Senior Vice President and Director of the CSIS Global Health Policy Center and Luciana Borio, Director of Medical & Biodefense Preparedness Policy for the National Security Council. Dr. Morrison and Dr. Borio discussed the importance of lessons learned during the 2014-2016 West African Ebola pandemic to global health security. In Nigeria, for instance, where Ebola containment efforts were successful, investments in detection and response capacities made for the Nigerian polio eradication program were instrumental in stopping Ebola. Surveillance systems and trained health care workers were embedded at the community level and field epidemiologists were ready to be deployed. The Nigerian response was an excellent demonstration of how investments toward vaccination and eradication campaigns for one disease can have crosscutting benefits for pandemic preparedness as a whole. Also important were the efforts that grew out of the bungled responses in Liberia, Guinea, and Sierra Leone. In light of the massive casualties, slow and costly international response, and ruinous economic damage in these countries, the international conversation about pandemic preparedness and response was propelled forward. The Global Health Security Agenda enjoyed an increased profile in the years following the pandemic. National leaders committed to increasing prevention, detection, and response capacities and the international community re-evaluated its approach to emergency response efforts.
Two years later, as a nascent Ebola epidemic spreads in the Democratic Republic of Congo (DRC), response efforts appear to be benefiting from lessons learned in the West African pandemic. As Amadou Sall, CEO of Institut Pastueur – Dakar, observed, during the West African pandemic, it took three months to confirm initial Ebola cases at outside labs. In the current outbreak, the DRC was able to confirm cases internally and rapidly disseminate the information to the international community. The DRC, the World Health Organization, Médecins Sans Frontières, the U.S. Centers for Disease Control, and USAID were able to swiftly coordinate a response. Within two days of initial case confirmation, response officials were rushing to deploy the 7,500 doses of the promising rVSV-ZEBOV vaccine and cold chain equipment to DRC. Within ten days, an international coalition of response workers was on the ground implementing a response effort. Dr. Borio also noted the important role played by 150 strategically placed Congolese field epidemiologists. These epidemiologists were trained as part of a GHSA-backed capacity-building initiative in the wake of the West African pandemic. Having them at the ready when the current outbreak started was essential in enabling the rapid identification, treatment, and contact tracing of infected individuals.
The most heavily emphasized theme of the event was that countries must become capable of leading their own pandemic preparedness and response efforts. David Heymann, Head and Senior Fellow of the Centre on Global Health Security at Chatham House, stated that it was important not to build global mechanisms, but rather country capacity. “[The international community] must stop saying ‘we will stop your outbreak’ and start saying ‘we will facilitate your country’s response,” advised Dr. Heymann. The current Ebola epidemic, for instance, is the eighth one on record in DRC. The Congolese have proven their capacity to stop Ebola on their own, so the international response on the ground should be in an advisory and research capacity. Dr. Borio stressed the importance of reliable access to healthcare in reducing pandemic risk. Most infectious diseases should be dealt with on a day-by-day basis, so that they never become pandemics. For the exceptional outbreaks that disseminate beyond control by normal efforts, supportive medical care is still foundational in controlling spread and reducing casualties. These scenarios, such as the current DRC Ebola epidemic, require additional efforts like infection control measures in care giving settings, increased disease surveillance, public education, and deployment of drugs and/or vaccines. The more that countries are able to implement such measures independent of outside assistance, the more quickly they will be able to get epidemics under control.
Finally, all of the speakers highlighted the importance of international financial support. Even as middle and low-income countries become more effective at “in-house” infectious disease prevention, detection, and response, their pandemic preparedness budgets are not sustainable. Dr. Morrison highlighted a trend of decreasing international contributions to capacity-building efforts in the years following the West African Ebola outbreak, as the perceived pandemic threat waned. While Ebola in DRC injects renewed urgency into the pandemic preparedness discussion, the development and implementation of robust prevention, detection, and response capacities will take sustained financial commitments from high-income countries and the private sector. As seen in Nigeria in 2014 and the DRC today, these investments, when properly made, have a massive payoff in the form of increased global security against the pandemic spread of diseases like Ebola. It is essential, therefore, that wealthy world leaders like the United States continue to support prevention, detection, and response capacities in middle and low-income countries.