We live in an age of unprecedented interconnectivity, which means it’s increasingly harder to stem the tide of infectious diseases. In the face of rising outbreaks, it is no surprise that many experts claim we are chronically ill-prepared for the next pandemic.
In the past, pandemics such as the 1918 Spanish flu, which killed around 50 million people, spread uncontrollably in between humans and across borders. Recent outbreaks of infectious diseases – such as the Zika virus and Ebola – have served as reminders that devastating infectious diseases are not confined to the history books.
In 2013, a two-year-old boy in Meliandou, Guinea, became infected with Ebola while hunting and playing with bats living in a nearby hollow tree. Four months on from the boy’s death, the village in which he lived had buried a total of 14 residents.
The virus’s initial symptoms – a sudden onset of fever fatigue, muscle pain, a headache and sore throat – could be dismissed as non-life threatening and as such help facilitate its rapid spread. But as the infection progresses, sufferers experience symptoms of impaired kidney and liver function, and, in some cases, internal and external bleeding.
Ebola went on to infect more than 28,000 people in Guinea, Liberia and Sierra Leone, resulting in more than 11,000 deaths. Today, there are over 10,000 survivors of the disease.
As well as Ebola, outbreaks of Zika, SARS, MERS, bird flu, swine flu, Lassa fever in Nigeria, Marburg virus, Rift Valley fever, yellow fever in Brazil, and cholera in Yemen have occurred in recent years.
The perfect storm for pandemics
The age of the Anthropocene will continue to affect the way infectious diseases behave. A trajectory of climate change, resource depletion, biodiversity loss, urbanisation, and drug resistance has consequences. 1998’s Nipah virus outbreak was a direct result of changes in the ways that pigs were farmed in Malaysia, bringing them into contact with a bat-borne virus that infects pigs and humans.
“Many commentators regard the early 21st century as a ‘perfect storm’ for the emergence of new infectious diseases,” says Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh.
“As the term implies, there are multiple contributing factors, but one way of explaining it is that we are changing the world’s ecology and environment faster than ever before, and sometimes those changes happen to suit an infectious agent that we weren’t previously aware of,” he adds.
Rapid response
“Pandemics of similar nature are certainly likely to happen in the future,” Dr Hubert Buczkowski, a research fellow at the University of Westminster who has studied viruses for much of his career, says.
“This risk is certainly recognised by many governments which are now building fast response teams with the main aim of tackling an outbreak in early stages.”
However, as recent epidemic events have demonstrated, governmental and traditional scientific funding cycles are sometimes too slow and unresponsive to time-sensitive global health issues.
“Scientific responses are perhaps harder to mobilise in the same way,” says Woolhouse. “Our funding systems are not geared to rapid responses. Rapid response needs some sort of standing capacity, and that’s very hard to achieve on most research funding models.
“But an even greater challenge is the ever growing burden of bureaucracy of doing scientific research, especially involving human patients. This issue is getting worse not better and I worry that it could seriously impede research during outbreaks, research that may be desperately needed and would ultimately save lives.”
Outbreak response and prevention
A sustainable global health infrastructure is the only way to fully prepare for the unknown.
Tom Frieden, the former director of the Centers for Disease Control and Prevention, recently expressed concern that the world won’t learn from history and Ebola. And he’s not the only one to argue that more needs to be done to get ahead of pandemics.
“Unfortunately, we sometimes seem to be much better at responding to emergencies than we are at preventing them,” says Woolhouse. “The key is to have the surveillance systems in place that will detect epidemics at the earliest possible to stage. Above all, we need to be flexible, and to be prepared to deal with unexpected events.”
Surveillance systems – such as the one developed by the World Health Organization (WHO) and the one effectively used in Nigeria during the Ebola outbreak – pool data from a variety of sources including health facilities, GP surgeries and self-reporting patients. This information is then made available regionally, nationally and internationally, enabling timely monitoring of emerging epidemics so that global health security threats can be dealt with promptly.
Efforts to prepare for the next pandemic do appear to be firmly on the agenda for some governments and NGOs. The WHO’s outgoing director general Margaret Chan reprioritised $130m (£103m) in funding for the new health emergencies programme to ensure its future.
Last year the UK government announced a £20m initiative to help prevent global health emergencies. The initiative means the UK has a specialist team that can be deployed anywhere in the world within 48 hours to fight outbreaks that may escalate into major health emergencies. And the Coalition for Epidemic Preparedness Innovations, a global coalition funded by Germany, Japan Norway, the Bill and Melinda Gates Foundation and the Wellcome Trust was launched earlier this year as a global vaccine development fund, devoted to addressing the next virus epidemic.
“Initiatives like these [on epidemic responsiveness] are welcome and important. But this is a very complex problem and there is no single magic bullet that is going to remove the risk of new diseases emerging,” says Woolhouse.
“Once an epidemic is well underway it becomes far, far more difficult to contain. We need to catch these events early, and we need better diagnostic tools, surveillance systems, infrastructure, personnel and information sharing in order to do that,” he adds.
“And we need all that right around the world, including those regions with [fewer] resources. It’s worth investing, for our own good as well as others, because wherever a new disease emerges it can travel around the world in days.”
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Date of preparation: July 2017 (HIV/IHQ/17-03//1363d)
