David Pratt: What the coronavirus threat says about global health security

Professor Piot, the Belgian microbiologist who helped discover the Ebola virus in 1976 and also a pioneer researcher into Aids, was the go-to expert on the subject and kindly gave his time to talk specifically to me about Africa’s capacity to overcome the problems the Ebola outbreak had caused.

It was an insightful encounter with a medical man who, far from being critical of those African countries in which the epidemic had started, was keen to flag up the positive things about a continent that so often gets a negative press.

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“Africa has lots of possibilities, it’s the cradle of mankind, a source of inspiration, creativity and richness,” insisted Piot who by then was director of the London School of Hygiene and Tropical Medicine.

“We so need to highlight the success stories, the entrepreneurs, the improvements in leadership and democratic transition in places like Senegal,” he told me, clearly passionate about a place where in a professional capacity he had been engaged in fighting a virus that struck fear into the world.

These past days anyone looking for news of the latest epidemic to strike fear at a global level will doubtless have found that Professor Piot has again become one of the media’s go-to experts on the subject.

He and others like him are part of the frontline defenders against those global threats to health security most of us find the thing of nightmares.

For the people of Wuhan, a city of 11 million people in China, those nightmares of course are already a harsh reality. Last week the city became the epicentre of an outbreak of a previously unknown coronavirus: nCoV, as it is known, that has displayed some uncomfortable similarities with Sars, which killed almost 800 people between 2002 and 2004.

This weekend China is marking a sombre Lunar New Year as 15 more deaths from the virus were reported yesterday in Wuhan, bringing the toll across the country to 41.

Just three of those deaths have been outside Wuhan, one in another city in Hubei Province of which Wuhan is the capital, one in Hebei Province, and one in Heilongjiang, near the Russian border.

Nationwide, more than 400 new cases of the virus were diagnosed, officials said yesterday, bringing the total number of confirmed cases in China to nearly 1300.

The virus has caused alarm because it is still too early to know just how dangerous it is and how easily it spreads between people. And because it is new, humans have not been able to build any immunity to it.

That concern has been heightened too given that the virus has already spread to other countries. Currently Thailand has reported five cases, Singapore, France and Taiwan three, Japan, Vietnam, South Korea and the United States two apiece, and Nepal one. Yesterday Australia said the virus had reached its shores.

Other nations including the UK are investigating suspected cases of the outbreak that causes severe acute respiratory infection with symptoms including a fever and cough. While the World Health Organisation (WHO) has not yet classed the virus as an “international emergency”, partly because of the low number of overseas cases, “it may yet become one,” warned itss director-general, Dr Tedros Adhanom Ghebreyesus. Many experts, including Professor Piot agree.

“National authorities and the WHO will need to continue to monitor developments very closely ... there are still many missing pieces in the jigsaw puzzle to fully understanding this new virus,” Piot told the Financial Times on Friday.

This latest crisis, like those epidemics before it, have once again thrown into the spotlight pressing questions over global health security and levels of international preparedness.

In the fast-paced and connected world we live in today, the threat of the transmission of lethal viruses and microorganisms, potentially leading to deaths and disrupting international travel and trade, poses a uniquely formidable challenge. For the simple inescapable fact is that infectious diseases know no boundaries.

Global health experts have long since argued that ease of travel in today’s international community means the world must always be prepared for disease outbreaks. As history itself shows it’s no longer whether an infectious disease outbreak will happen, but when.

As far back as 1918, the Spanish flu pandemic infected about 500m people globally, at that time a third of the world’s population, and caused the death of 20m to 50m victims. The 2009 swine flu outbreak that originated in Mexico and quickly became a global pandemic infected an estimated 11-21% of the global population.

In turn the 2014-2016 Ebola outbreak, about which I interviewed Professor Piot, infected 28,000 and killed over 11,000. Such epidemics bring with them too a huge economic toll in countries often already struggling.

Guinea, Liberia, Sierra Leone and other countries affected by the Ebola outbreak lost $2.8 billion in combined GDP, and the world had to mount a co-ordinated response at the cost of billions of dollars to contain the scourge.

Ebola, of course, along with other infectious diseases continue to be a huge problem. Of late, Ebola and measles outbreaks in the Democratic Republic of Congo (DRC) have killed 2236 and over 6000 respectively. Polio too has made its malign presence felt again in places like Afghanistan and other countries where it had been eradicated.

THE current Ebola outbreak, which began in August 2018, is the second worst on record since the West Africa episode of 2014-16 – even though it took the WHO until July of last year to declare this outbreak what it calls a “public health emergency of international concern” (PHEIC).

That decision by WHO brought a mixed reaction from public health officials with detractors saying it was long overdue and that unnecessary bureaucracy ha prevented the designation sooner.

Part of the problem, say health experts, is that in outbreaks that have dragged on for years, the word “emergency” refers to lots of contributing factors, among them mortality rates, the scale and global distribution of population affected and the capacity to pull together international resources.

According to a report, released in September last year entitled A World at Risk, by experts that make up the Global Preparedness Monitoring Board (GPMB) set up by WHO and the World Bank, the world is largely unprepared for the next outbreak or pandemic.

Described as a “snapshot” of where the world stands in its ability to prevent and contain a global health threat, the report’s findings make for alarming reading and suggest that previous recommendations were either poorly implemented, or not implemented at all, and that serious gaps persist.

“For too long we have allowed a cycle of panic and neglect when it comes to pandemics, we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act,” the report concluded.

It detailed how between 2011 and 2018, WHO tracked 1483 epidemic events in 172 countries.

Among these events the report said, epidemic-prone diseases such as influenza, severe acute respiratory syndrome (Sars), Middle East respiratory syndrome (Mers), Ebola, Zika, plague, yellow fever and others, are “harbingers of a new era of high-impact, potentially fast-spreading outbreaks that are more frequently detected and increasingly difficult to manage”.

Too much talk of preparedness in recent years and not enough action appeared to be the stinging conclusion drawn by the health experts comprising the GPMB.

“After every single major outbreak, and you go back to Sars, H5N1, H1N1, Ebola in 2014-2016, you see the same thing in many of the humanitarian disasters,” insisted Alex Ross director of the GPMB Secretariat.

“A lot of money goes into response and then it simply disappears right afterwards,” Ross told the global development media platform DEVEX reacting to the report at the time.

As the A World at Risk report also highlighted, it is usually the poorest who suffer most. Negative impacts, it points out, are particularly profound in fragile and vulnerable settings, where poverty, poor governance, weak health systems, lack of trust in health services, specific cultural and religious aspects and sometimes ongoing armed conflict greatly complicate outbreak preparedness and response.

Many of the countries and societies most vulnerable are already under strain from some of the world’s biggest killer diseases. Malaria for example, which has killed perhaps billions throughout history, continues to be one of the biggest killers even today. Researchers have pointed to malaria being with humanity for over 500,000 years, with startling claims that the disease has wiped out half the people who ever walked the earth. Speculative historical figures aside, according to the latest data from the WHO, annual malaria deaths are declining, but the disease remains one of the most prolific illnesses with as many as 220m infections in 2017 alone.

Dengue fever is a growing worry too with half the world’s population at risk. Like malaria and Zika, the dengue virus is mosquito-borne, and thus can spread quickly among populations. It’s estimated that there are 390m new infections each year.

Then there is cholera, which researchers have estimate there are 1.3m to 4m cases each year. While easily treatable, cholera outbreaks typically occur when conditions are severe after natural disasters such as floods and earthquakes, making it difficult to treat those who need it. While Ebola and the current outbreak of coronavirus make international headlines other diseases like Aids, flu, tuberculosis and pneumonia rarely grab media attention in the same way but also kill millions around the world.

Though China has now responded quickly to the coronavirus despite earlier criticism of lethargy on the authorities behalf, what the crisis has again exposed is how it only takes one country’s vulnerability and ill-preparedness in the face of infectious outbreaks to spell major problems for nations far beyond its borders.

Citing the 1918 global flu pandemic, the A World at Risk report, in its executive summary, painted a chilling picture of what might happen given parallel circumstances today.

“If a similar contagion occurred today with a population four times larger and travel times anywhere in the world less than 36 hours, 50-80 million people could perish,” was its terrifying summary.

In addition to this tragic level of mortality such a pandemic could also cause panic, destabilise national security and seriously impact the global economy and trade, GPMB findings concluded.

Faced with such potential doomsday scenarios, the monitoring board pulled no punches in what it sees as immediate and required actions. Paramount among these was an appeal to the United Nations to strengthen its global co-ordination mechanisms.

The GPMB also stressed the “WHO should introduce an approach to mobilise the wider national regional and international community at earlier stages of an outbreak prior to a declaration of a public health emergency of international concern”.

This weekend, as of writing, the WHO has yet to declare the coronavirus a global health emergency. The semi-autonomous Chinese city of Hong Kong meanwhile has declared its own health emergency and said schools would be closed until mid-February. And as Wuhan and parts of China remain in lockdown instead of celebrating the Lunar New Year, the crisis grows by the hour.

Back in 2012 Professor Peter Piot published a book entitled No Time to Lose: A Life in Pursuit of Deadly Viruses, which chronicled his work, including the discovery of the Ebola virus.

On Friday, speaking of the coronavirus, Piot stressed again that there was no time to lose and that regardless of the decision not to declare it a global health emergency intensified international collaboration and more resources will be crucial to stopping the outbreak in its tracks.

“There cannot be any complacency as to the need for global action,” he warned, adding that the outbreak was at a “crucial phase”. Only the coming days will tell whether the WHO share that same sense of urgency.