Press Release: Call for Independent Monitoring
Harvard Global Health Institute Calls for Independent Monitoring of Disease Outbreak Preparedness at the 71st World Health Assembly
Cambridge, MA, 24 May 2018: As over 5,000 doses of an experimental Ebola vaccine are deployed in the Democratic Republic of the Congo (DRC) and U.S. Health and Human Services Secretary Alex Azar announces an additional $7 million in U.S. funding on top of last week’s $1 million, researchers at the Harvard Global Health Institute (HGHI) are appealing once again to the global community to create a more systematic measure of preparedness in between outbreaks. In a paper published today in The BMJ, HGHI calls for robust, sustainable, and independent monitoring of disease outbreak preparedness to reduce the human and economic costs associated with epidemics and to prevent minor outbreaks from becoming regional epidemics. The authors highlight the persistent cycle of panic and neglect characterizing infectious disease outbreaks, one that is both costly and unpredictable. The 2014-16 outbreak in West Africa alone cost $3.6 billion to contain and World Health Organization (WHO) officials estimate that the current DRC Ebola outbreak will cost $26 million over the next three months to quell.
HGHI’s latest publication builds on previous work with the London School of Hygiene and Tropical Medicine (LSHTM), in which the researchers laid out ten essential reforms to avoid repeating the costly 2014-16 Ebola response. To further advance those reforms, HGHI convened a meeting with fifty experts from around the world (in medicine, public health, animal health, government, academia and private industry) at the U.S. National Academy of Medicine in April of 2017 to review and discuss a draft framework to monitor disease outbreak preparedness more systematically. The resulting monitoring framework is the basis for an independent, data-driven mechanism set forth in today’s publication and is designed to track global capacities to prevent and contain infectious disease outbreaks.
Today, the WHO in partnership with the World Bank announced a Global Preparedness Monitoring Board at the seventy-first World Health Assembly (WHA) which will be co-chaired by Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General, and Mr Elhadj As Sy, Secretary General of the International Federation of the Red Cross and Red Crescent Societies. Dr Brundtland explained that the Board is designed to break the cycle of panic and neglect by holding “all actors, from private and public sectors, accountable for building essential public health capacities, generating sustainable financing and ensuring that necessary research and development is conducted.” While further details about the Board have yet to be revealed, it is critical that global monitoring efforts produce regular reports on the state of global preparedness in four key areas: 1) country-level preparedness (how capable are national public health systems to prevent, detect and respond to infectious disease outbreaks?); 2) science, technology, and access (what vaccines, diagnostics and therapeutics are available and affordable to contain current and future outbreaks?); 3) risk identification and communication (what social, behavioral, animal, environmental and other factors increase the risk of infectious disease outbreaks and how can we better manage them?); and 4) strengthening global mechanisms (what international institutions are responsible for outbreak prevention and response and how can we hold them accountable?).
The aforementioned monitoring domains were distilled from a comprehensive review of expert reports following the 2014-16 Ebola crisis and a workshop co-hosted by HGHI and the U.S National Academy of Medicine (NAM) in April 2017. The monitoring framework is ideally suited to be driven by a coalition of independent experts across sectors and to build on (not duplicate) existing data collection and analysis efforts by the Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), WHO, World Bank, the Joint External Evaluation (JEE) Alliance, the EcoHealth Alliance, the John Hopkins Center for Health Security, Nuclear Threats Initiative (NTI), and others. By highlighting critical gaps and successes on a regular basis, the proposed global monitoring framework can increase stakeholder accountability, spur much-needed investments, and sustain global health security as a priority between crises. Regular reporting can also better align human, financial, and technological resources with the greatest needs with increased transparency. Minor outbreaks can and should be prevented from becoming major epidemics and in so doing, millions of lives and billions of dollars can be conserved over time.
With eight million passengers flying around the world each day, an outbreak in one country immediately has global ramifications. Accordingly, although progress has been made in each of the aforementioned areas, we are far from ready to handle the next outbreak of Disease X. When the Ebola outbreak claimed over 11,000 lives in 2014-16, the virus had been around for almost forty years. Yet no vaccine or antiviral therapy existed; domestic public health infrastructure was ill-equipped to contain the outbreak; and infrastructure for communication and coordination between international aid agencies, donors, and institutions was extremely limited. Similarly, a century after influenza claimed 50 to 100 million lives around the world, seasonal influenza epidemics continue to cause 300,000 to 500,000 deaths globally. Despite repeated calls for a universal flu vaccine (and $12 million from the Gates Foundation), research and development in this area continues to be limited.
As Ebola reaches the urban areas of the Congo and as policymakers convene in Geneva for the seventy-first WHA, there is an emerging consensus in the international community that systematic, independent reporting on progress and gaps can spur action nationally and globally. Independent experts from around the world, including from low-income countries, need to be intimately involved in such a process. Consistent monitoring (across sectors) coupled with public reporting is an essential building block for change. Building on and amplifying existing research and data collection efforts, global monitoring should produce one coherent “report card” for policymakers, governments and practitioners. Given the challenges ahead, it is clear that a robust, rigorous, and independent monitoring framework is our best chance at breaking the longstanding cycle of panic and neglect.