What do Ebola in West Africa, cholera in South Sudan, MERS coronavirus in the Middle East and polio in Syria and Central Africa have in common? These are all current infectious disease outbreaks that the WHO is tracking throughout the world. With globalization, an outbreak that occurs in one corner of the globe can easily spread and impact the entire world. UN Dispatch talked with Keiji Fukuda, Assistant Director-General of Health Security with the WHO, and Scott F. Dowell of the US Centers for Disease Control about the challenges infectious diseases present today as well as what the international community is doing to combat the threat.
Global epidemics are nothing new; the most infamous one in modern history – the 1918 flu pandemic – is now believed to have originated in China but utilized the close quarters and supply routes of a world at war to spread to every habitable part of the world from remote Pacific islands to the Arctic, killing an estimated 50 million people. The 1918 pandemic is often called the last great plague but in a world where a person can board a plane and arrive on another continent within hours, the threat of a new pandemic is always a possibility.
As Dowell pointed out, the 2003 SARS outbreak served as a wakeup call for the international community to this threat. Due to the delay of the Chinese government in informing the WHO of a possible new infectious disease, SARS spread to neighboring countries and then North America far more rapidly than the global health community was prepared for. Once an infection is detected it becomes a battle against the clock to bring it under control to limit both its geographical spread but also its local impact. SARS demonstrated the deficiencies in the international system and shook countries out of their complacency.
Since then, the profile of the WHO has increased as new systems emerged to combat emerging threats from infectious disease. Two major lessons Fukuda outlined from the SARS outbreak is that no one can expect infections to stop at borders and no one can handle modern outbreaks alone. This makes effective partnerships – with both governments and public health organizations – key to any approach.
The importance of this is evident today with the Ebola epidemic impacting Guinea, Liberia and Sierra Leone. Although the current strain is not the most fatal to ever emerge, the epidemic has now become the deadliest Ebola outbreak in history. Emerging in Guinea in December of last year, it wasn’t until March that it became apparent there was a new epidemic. By then, there were multiple hotspots throughout Guinea and the virus soon spread to Liberia and Sierra Leone. All three countries have a history of political instability with Liberia and Sierra Leone still emerging from years of civil war. As a result, the domestic health systems of all three countries remain incredibly fragile and unprepared for major crises. These domestic systems were particularly unprepared for an Ebola outbreak since this is the first time the disease has been detected in West Africa. Thus, while government has an important role to play, it will take multiple actors to bring the epidemic under control; it remains the responsibility of the WHO to coordinate the response and various health organizations to provide the support needed to government and domestic health officials.
Given the complexity of the current outbreak, Fukuda took the unusual step of personally visiting Guinea and Sierra Leone recently to evaluate the international response and talk with government officials. Although delayed, national leadership is emerging in each country and throughout the region to help stem the spread of the disease. A solution will not emerge overnight, Fukuda cautioned, but contrary to some reports there is hope as progress is made with community education and outreach, a central tenant in getting help quickly to those who need it most.
Going forward more effort is going into developing an effective framework for early detection and containment. Although the WHO member states agreed in 1995 for the need to update the International Health Regulations (IHR) for the first time since 1969, the SARS outbreak brought an increased urgency to the task. The new regulations, binding on all WHO member states since 2007, set out the rights and obligations of countries in reporting public health concerns as well as establishes the coordinating mechanisms utilized by the WHO.
The regulations marked a positive step forward, particularly in establishing means for member states to collaborate on possible threats and strengthen the capacity of all state through both technical and financial support. Such capacity building remains a serious obstacle for many, as Dowell estimated 80% of member states have yet to meet their obligations under the IHR.
For developing states, lack of qualified staff, limited budgets and “brain drain” account for some of this lag and are not issues that can instantly be addressed by any one nation. But a new Global Health Security Agenda launched earlier this year attempts to bridge that gap through public-private partnerships among key states, organizations and interested corporate parties. Dowell highlighted that pilot projects initiated under the agenda in Vietnam and Uganda to improve key capacities have seen real progress in just five months. If successful, these programs can help fortify the fragile domestic health systems of other developing states and bring us closer to creating a truly comprehensive approach to infectious disease surveillance, monitoring and containment for the better security of all.