Deadly global pathogen could kill 80 million due to countries' unpreparedness: WHO report
A highly lethal epidemic of a flu virus killing 50 to 80 million people and wiping out nearly 5% of the world’s economy might sound like science fiction. But global leaders have issued a stark warning that such a deadly disease outbreak is highly possible, and nations are grossly unprepared for it.
The first report of the Global Preparedness Monitoring Board (GPMB) - which focuses on epidemics and pandemics - paints a grim picture. The 1918 global influenza pandemic sickened one-third of the world population and killed as many as 50 million people or 2.8% of the total population.
The 15-member team, which prepared the report, says if a similar contagion happened today, with a population four times larger and travel times anywhere in the world less than 36 hours, 50-80 million people could die. Besides, such a pandemic could cause panic, destabilize national security and severely impact the global economy and trade, they caution.
“There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people. A global pandemic on that scale would be catastrophic, creating widespread havoc, instability, and insecurity. The world is not prepared,” said the report.
The Board - comprising heads of agencies, political leaders and experts - was convened May 2018 in the wake of the 2014-2016 Ebola epidemic by the World Bank Group and the World Health Organization (WHO). The experts reviewed recommendations from previous high-level panels and commissions following the 2009 H1N1 influenza pandemic and the 2014-2016 Ebola outbreak, along with its own commissioned reports and other data.
The researchers found that many of the recommendations reviewed were poorly implemented, or not implemented at all and that serious gaps persist. For too long, world leaders have allowed a cycle of panic and neglect when it comes to pandemics: nations ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides, say experts, adding that it is well past time to act.
The report identifies the most urgent actions required to accelerate preparedness for health emergencies. The central finding is that the world needs to proactively establish the systems needed to detect and control potential disease outbreaks.
“It is high time for urgent and sustained action. This must include increased funding at the community, national and international levels to prevent the spread of outbreaks. It also requires leaders to take proactive steps to strengthen preparedness coordination mechanisms across governments and society to respond quickly to an emergency,” said Dr. Gro Harlem Brundtland, co-chair of the GPMB.
The world is confronted by increasing infectious disease outbreaks
Between 2011 and 2018, WHO tracked 1,483 epidemic events in 172 countries. According to the researchers, epidemic-prone diseases such as influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), Ebola, Zika, plague, yellow fever and others, are “harbingers of a new era” of high-impact, potentially fast-spreading outbreaks that are more frequently detected and increasingly difficult to manage.
The poor suffer the most, it says. Any country without basic primary health care, public health services, health infrastructure and effective infection control mechanisms faces the most significant losses, including death, displacement and economic devastation.
Disease outbreaks disrupt the entire health system reducing access to health services for all diseases and conditions, which leads to more deaths. These negative impacts are particularly profound in fragile and vulnerable settings, said the experts.
“Ebola, cholera, measles - the most severe disease outbreaks usually occur in the places with the weakest health systems. As leaders of nations, communities and international agencies, we must take responsibility for emergency preparedness, and heed the lessons these outbreaks are teaching us. We have to ‘fix the roof before the rain comes,’” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
Besides the loss of life, epidemics and pandemics devastate all economies. According to estimates, there was a loss of over $40 billion in productivity from the 2003 SARS epidemic; $53 billion damage from the economic and social impact of the 2014-2016 West Africa Ebola outbreak, and the cost of the 2009 H1N1 influenza pandemic was $45 to 55 billion.
The findings indicate that despite the “high cost-benefit ratio of emergency preparedness,” governments continue to neglect it. The World Bank and WHO analyses suggest most countries would need to spend on average between $1-$2 per person per year to reach an “acceptable level” of pandemic preparedness.
“The World Bank estimates that a global influenza pandemic akin to the scale and virulence of the one in 1918 would cost the modern economy $3 trillion, or up to 4.8% of gross domestic product (GDP). The cost would be 2.2% of GDP for even a moderately virulent influenza pandemic,” say the experts.
Chances of a global pandemic are growing
While scientific developments provide new tools that advance public health, they also allow for disease-causing microorganisms to be engineered or recreated in laboratories, warn the researchers. The consequences could be as severe, or even greater, than those of a natural epidemic, as could an accidental release of epidemic-prone microorganisms, say the researchers.
High-impact respiratory pathogens, such as an especially deadly strain of influenza, pose particular global risks in the modern age, say experts. The pathogens are spread via respiratory droplets; they can infect a large number of people very quickly and, with today’s transportation infrastructure, move rapidly across multiple geographies.
According to them, a deliberate release would complicate outbreak response. “Taken together, naturally occurring, accidental, or deliberate events caused by high-impact respiratory pathogens pose global catastrophic biological risks,” they say.
In addition to the fact that the world is not prepared for a “fast-moving, virulent respiratory pathogen pandemic,” the researchers say that governments, scientists, the media, public health, health systems, and health workers in many countries are facing a breakdown in public trust. This, in turn, is threatening their ability to function effectively. “The situation is exacerbated by misinformation that can hinder disease control communicated quickly and widely via social media,” they add.
Leadership must drive progress
According to the research team, leaders at all levels hold the key as they are responsible for ensuring preparedness from the country to the community level. The report emphasizes that although governments and international institutions have taken steps to increase preparedness for outbreaks since the deadly Ebola crisis in West Africa five years ago, current preparedness efforts are grossly insufficient.
“The trust between communities and the institutions that serve them is at the core of an emergency response, but it is almost impossible to build trust in the middle of a crisis. Community engagement and trust cannot be an afterthought, it has to be earned. Leaders and public health authorities must work as partners with communities to build that trust," says GPMB co-chair Elhadj As Sy, the Secretary General of the International Federation of Red Cross and Red Crescent Societies.
Action and investment prior to an emergency are essential to provide the best possible protection, they add. “Ensuring recurrent spending for preparedness is a key articulation of political will and leadership. Long-term, sustained community engagement is crucial for detecting outbreaks early, controlling amplification and spread, ensuring trust and social cohesion, and fostering effective responses,” his findings stated.
Besides their domestic responsibilities, say experts, national leaders have “preparedness obligations” to the world at large. The team elaborates that all countries have adopted the binding International Health Regulations (IHR (2005)), which is an agreement requiring governments to develop national core capacities to detect, assess, report and respond to health threats, as well as to report any “public health emergency of international concern” to the World Health Organization (WHO) and to take corresponding action.
However, warn the researchers, preparedness is hampered by the lack of continued political will across levels. While national leaders respond to health crises when fear and panic grow strong enough, most countries do not devote the “consistent energy and resources” needed to keep outbreaks from escalating into disasters, say the researchers.
According to the study, too many places lack even the most rudimentary healthcare infrastructure. “Communities that cannot care for a pregnant woman and her newborn child cannot protect against a disease outbreak,” it said.
Citing examples, the researchers state that in the ongoing Ebola response, and for Zika, influenza and other outbreaks in many countries, the national and international leads have been identified after the fact, or changed in mid-course, causing delays in decision-making. They suggest that leadership should be clearly identified in advance, authorized, and held accountable for preparedness.
The team recommends more and better-targeted funding at all levels, starting with national governments. “Too many national leaders have not prioritized spending on health systems overall and on preparedness in particular. Preparedness investments are also poorly differentiated from other aspects of health system strengthening,” they add.
Stating that countries, donors, and multilateral institutions must be prepared for the worst, the experts recommend adequate investment in the development of innovative vaccine and therapeutics for dealing with a rapidly-spreading pandemic.
“All countries must develop a system for immediately sharing sequences of any new pathogen for public health purposes, along with the means to share limited medical countermeasures across countries,” said the report.