Pandemic Preparedness: It’s time to end neglect and act

“A global pandemic is one of the major threats we face. We don’t know when it will strike. We don’t know what kind of pathogen we’ll have to deal with. But we know that it will very likely come.”

This is an excerpt from a speech I gave last July, when Merck recognized two researchers for their outstanding work in the field of pandemic preparedness. At the time, the Congo had been grappling with the world’s second largest Ebola epidemic on record for nearly one year. As we now know, the next pandemic threat was just around the corner. The new coronavirus broke out in Wuhan, China only five months later. With tens of thousands infected and more than 1,000 lives already lost, this virus is now at the center of global attention. At the same time, the ongoing Ebola outbreak in the Congo has long since disappeared from the headlines.

Panic, neglect. Experts need only two words to describe the world’s typical, cyclical response to health-related crises. It’s a pattern that seems impossible to break exactly because it’s so innately human. And it may help explain why health, in a remarkable systemic understatement, is still commonly referred to as a “non-traditional” security threat. Haven’t examples such as Ebola, SARS or Zika shown that health poses a serious risk to peace, political stability and the economy globally? Isn’t it true that over the coming decades, pandemics – in addition to costing lives – could cause an average economic loss of $570 billion annually? And from Black Death in the 14th century to the Spanish flu in 1918, isn’t the large-scale devastation caused by outbreaks deeply woven into the human narrative?

Yes, compared to these historic examples, we now have much better infrastructure – and much more effective medical means. At the same time, our world is prone to pandemics like never before in human history.

• As Ebola demonstrates, affected regions often lack adequate health infrastructure and services. Weak and ineffective governance structures also make a successful response much more difficult. An increase in conflict-stricken and refugee populations further aggravates the situation.
• Then, there’s urbanization. It is a challenge for many emerging mega cities to adapt their infrastructure to growing populations. Take the new coronavirus, which is assumed to have spread from a food market in central China’s most populous city. Places like these can provide a hospitable environment for pathogens of all kinds.
• We also have to deal with climate change and with it, more heat waves and floods. These mean a higher prevalence of waterborne diseases and optimal breeding grounds for disease vectors such as mosquitos. 
• On top of that, we are increasingly globally connected. A deadly pathogen travelling through the terminals of a large city airport can spread around the globe within hours, while social networks can spread panic faster than any jet plane.
• Antimicrobial resistance and the rise of non-communicable diseases are becoming ever greater health risks globally.
• Not least, we are facing the threat of bioterrorism. The next pandemic might be caused by a naturally mutated virus. But it might also stem from a biologically engineered pathogen.

All these facts point to one single truth: Pandemic preparedness is a must. How well we are able to respond when the day comes depends on what we do today. We must understand that, as a global community, we are only as secure as the weakest country, to quote Professor Jimmy Whitworth from the London School of Hygiene & Tropical Medicine. Viruses and bacteria don’t respect borders. When it comes to pandemics, there is no “we” and “them” – there’s only “us”. So, what can we do to get prepared as a global community? Surely, there are numerous levers, but I see four key priorities.

One: Achieving universal health coverage continues to be a fundamental aim. Not just because it’s an essential part of the United Nations Sustainable Development Goals, or a clear ethical imperative to provide health services to all people. Capable and resilient healthcare systems are also a critical defense against outbreaks. According to the World Health Organization (WHO), at least half of the world’s population still lacks access to essential health services. We therefore need to urgently strengthen healthcare capacities in low- and middle-income countries.

Two: Research in the field of pandemic preparedness must be promoted. We need to gain a far better understanding of the diseases we already have to deal with. Our means to achieve this are better than ever before. That’s a good reason to be cautiously optimistic. Just think of the sophisticated digital technologies and biotechnology we have available today. With new genetic methods such as CRISPR, for example, researchers are now developing solutions against newly emerging pandemics. These are the tools we need to create truly game-changing technology that substantially improves our odds when the next pandemic strikes.

Three: The importance of pharmaceutical safety and quality cannot be overstated. The growing threat of fake medicines undermines efforts to ensure access to safe and quality health care. According to WHO, an estimated one in ten medical products circulating in low- and middle-income countries is substandard or falsified. Up to one million patients die from toxic counterfeit pharmaceuticals each year. This is why raising awareness, building capacity and partnering with key stakeholders along the entire healthcare value chain remains essential to sustainably combat counterfeit medicines. At the same time, we should do everything we can to develop and bring innovative drugs to patients faster – certainly not by lowering standards, but through collaboration between private and public sector and by reducing unnecessary bureaucracy.

Four: Finally, all of this requires a joint approach. If infectious diseases don’t know any borders, fighting them sustainably means fighting them globally – through close collaboration between authorities, NGOs, healthcare companies, and scientists. To that end, much has already been done, and the private sector has been committed to doing its part for years:

• by working in multi-sectoral partnerships and associations such as IFPMA or EFPIA to help strengthen health systems and combat counterfeit medicines,
• by joining initiatives such as CEPI or the AMR Industry Alliance to promote the development of vaccines and provide sustainable solutions to the global antimicrobial resistance crisis,
• by supporting research in the field of pandemic preparedness, for example via international research grants,
• and by launching individual company initiatives, whether to enhance the availability, accessibility and affordability of healthcare products, boost local capacity building in healthcare or raise awareness in communities.

In my opinion, February 2020 marks a milestone that shows we are headed in the right direction. Bringing together key international stakeholders in global health, healthcare and emergency preparedness, the 5th Health Security Roundtable is being held at the Munich Security Conference this year. Albeit amplified by the current coronavirus, it is still encouraging to see how much the awareness for health threats has grown in the international security community since the Roundtable first came together in 2016. However, this does not mean we can lean back complacently. If we want collective preparedness to break the “traditional” panic-neglect cycle, our work has only just begun.