Re-thinking Global Health Security
Peter Sands, Executive Director of the Global Fund 27 March 2020
As the G7 and G20 strive to coordinate the global response to the COVID-19 crisis, policymakers are being bombarded with proposals about creating new funds, new institutions, and new initiatives, all requiring billions of dollars.
The core of the global response strategy must be to step up the fight against COVID-19. While massive and coordinated interventions from central banks and finance ministries are an essential component of the global response to mitigate the broader economic and social impact. Ultimately this is a health crisis with massive economic consequences. Unless we do this successfully, the economic impact will simply continue to escalate.
The response to COVID-19 must target two objectives: to stop the loss of life; and to ensure this doesn’t happen again. We must seize the opportunity to break out of the cycle of panic and neglect that has characterised our approach to infectious disease outbreaks.
But a new approach to global health security must embrace a much broader notion of health security than we’ve typically used. To start with, it won’t work if it is only focused on pandemics, since every pandemic starts as a small outbreak. Unless you’re looking at the small sparks, you’ll miss the potential inferno.
Even more importantly, it also won’t work if the definition of health security only encompasses infectious diseases that threaten the lives of people in rich countries. Quite apart from the dubious morality of such a distinction, you’ll never succeed in getting countries and communities to care more about diseases that might kill them than those that are killing them. Dr. Tedros, Director General of WHO, made this point powerfully in a meeting last September, telling a story about visiting a village in the Democratic Republic of the Congo during the Ebola outbreak. Community leaders pointedly asked why a single death from Ebola in their village merited a delegation of visitors in protective clothing, when no one turned up in response to the multiple deaths of children from malaria in previous weeks.
The truth is that the infectious diseases killing most people today -HIV/AIDS, tuberculosis and malaria – were all at one time, pandemics, causing death around the world. Now they’re less of a threat in the advanced economies, they’re addressed more in humanitarian terms than as health security issues.
That’s a mistake from multiple perspectives. Diseases like tuberculosis remain a potent threat to all of us wherever we live. Multi-drug resistant tuberculosis, known as MDR-TB, has been called “Ebola with wings” – equally fatal and much more contagious. Roughly 250,000 people a year die of MDR-TB.
Furthermore, the infrastructure and capabilities put in place to defeat diseases like HIV/AIDS, tuberculosis, malaria or polio, such as medical supply chains, laboratories, community health workers and disease surveillance are what is needed to identify and respond to new outbreaks. For example, the successful response to Ebola in Nigeria leveraged contract tracing capabilities established for polio. The Ebola response in Kivu used diagnostic instruments the Global Fund had deployed for tuberculosis.
Above all, a new approach to global health security will only work if it secures the engagement and support of the most vulnerable communities and countries. We are only as safe as our weakest link. Those living in the countries with the weakest health systems and most vulnerable to new diseases will only buy in to a new approach to global health security if it addresses the threats that matter most to them.
As we step up the response to COVID-19, we should be wary of creating new global institutions or funds. Overstretched health ministers in low and middle income countries don’t have time to coordinate existing development partners, let alone new ones. WHO, UNAIDS, UNITAID, GAVI, GFATM, GFF, WBG, FIND, RBM, StopTB, UCNTD, UNICEF, UNDP –already the fight against infectious diseases involves blizzard of acronyms – and these are just some of the multilaterals involved.
We should adapt and redirect the institutions we have, leveraging their relative strengths. We should reinforce WHO’s leadership role, defining the strategy, gathering the data, setting the norms, and driving the communications. We should channel resources to support the poorest and most vulnerable countries through existing institutions, such as the Global Fund, Gavi and the World Bank, all of which are already responding to COVID-19. We should step up support to collaborative platforms such as CEPI and UNITAID to turbocharge development of new therapeutics and vaccines.
Finally, we should base our approach to global health security on a commitment to solidarity, to our shared humanity. We should not be thinking of people in other countries as disease vectors, but as people. We should channel access to new diagnostics, therapeutics and vaccines based on need, not purchasing power. Engagement of communities and the protection of human rights are crucial to fighting disease threats.
Devising a globally coordinated strategy to combat COVID-19 and creating a radically new approach to global health security will require sustained and determined leadership from the G7 and G20. We need this now.