In December a scientific journal published my paper on global preparedness for a major pandemic. We looked at the information available and other halfhearted efforts which were being done to be ready for next pandemic. Like many other experts in the field we also came to the same conclusion that world is not ready for a major pandemic!
Little that I and my coauthors (experts in global health) knew at that time that while our article is being published there is a major outbreak of a new virus brewing in Wuhan. In just few weeks of first information of a cluster of unexplained cases of pneumonia, the confirmed cases are now more than 30,000 and 600 reported deaths. Nearly all International experts on infectious diseases and epidemiology think that reported numbers are highly underestimated. Very reputable scientists have estimated that more than 100,000 people were already infected. Twenty six countries have identified cases on their own soil. The countries who still don’t have a case do not mean they are free of infection as this is a new virus, so testing kits are not available in most countries. The President of China has declared it as a grave situation and directly assumed the control of operations. China has also allocated $4 billion for the control efforts.
China knows it’s critical to control the outbreak quickly. When a major outbreak or pandemic happens only health is not at stake. Country and global economies take a plunge. Hong Kong lost 2% of GDP in 2003 SARS outbreak which infected 8000 and killed 800. In Ebola outbreak of 2014-2016, 28000 people got infected and around 11000 died. That outbreak cost was around $50 billion. In Wuhan outbreak aftermath’s global financial markets plunged due to fears of a major pandemic. Economists are predicting slowed economic growth for China if outbreak is not controlled. China with its bigger share in world economy could affect global GDP negatively. According to another study an outbreak spanning nine countries could cost $40 billion to US exports and more than a million jobs in export industry in US. That does not include the cost inside those nine countries or global economy.
Why World is not ready? According to the estimates it will cost $4 billion/year on global scale to have a better prepared world. This amount is peanuts as compared to other global investments. However governments find it less attractive to invest in something which could not be seen on the ground. Every country believes that they will not be affected by the next outbreak.But when an outbreak or pandemic hits everyone asks for a public health response. Unfortunately a public health response at a time of crisis required long term investments in epidemic investigation, public health laboratories and surveillance systems. Interventions to prevent or quickly control an outbreak are always a fraction of the cost of response and additionally keep the population healthy. It’s still more important for politicians to lay the foundation of a new hospital than invest in a preparedness program or preventive strategies.According to my own calculations province of Sindh had already spent 1-4 billion rupees on XDR typhoid outbreak back in 2018 when the cases were less than half from now. But the governments don’t know about these indirect costs as no one calculates.
As China is now a major contributor in world economy any negative indicator there will create ripples which everyone in this world will feel
In Pakistan in the last decade I got the opportunity to setup a disease surveillance and outbreak response system through Government of Pakistan, Field Epidemiology and Laboratory Training Program (FELTP). Here too some of senior health officials were very skeptical of any value of an investment which could identify outbreaks and to respond quickly. Many health professionals still seriously believe that all outbreaks are part of a global conspiracy and not a real thing. However many public health officials also supported the program and now the network of FELTP Disease Surveillance and Response Units (DSRU) is working in all provinces. This is the only system of quick detection and response mechanism the country has at this moment and has won many international awards and accolades.
However globally whatever little funding is available for pandemic preparedness is also not being effectively utilized. Due to short term funding mechanisms the interventions planned have limited value and are isolated. As a global health professional we also are at fault that we are unable to do prioritization of critical tasks which needed to be done first. We try to do all and then fail in everything. There is also lack of accountability as impact of a strategy could be seen only after years and by that time person responsible has already moved somewhere. Country ownerships are limited to these programs due to lack of interest and local funding.
Health Security has now become a major concern internationally. A strong country and economy like China has faced a heavy blow of an outbreak. As China is now a major contributor in world economy any negative indicator there will create ripples which everyone in this world will feel. Pakistan also needs to think in long term and invest in health security strategies which will protect not only its population’s health but also economy and national security.
The writer is an Adjunct Professor of Epidemiology at the University of Nebraska, USA and Chief Executive Officer of Global Health Strategists and Implementers (GHSI)