While the COVID-19 pandemic has illustrated the dangers of ill-prepared public health initiatives, a new case study-based report from the global Resolve to Save Lives initiative and its president and CEO Dr. Tom Frieden highlights the numerous ways that governments can invest in and prioritize preparedness efforts to better fight the next infectious disease outbreak.
Frieden, former Director of the Centers for Disease Control and Prevention (CDC) under the Obama administration, spoke during an event sponsored by the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria on Wednesday. He noted that pandemics, while inevitable, need not be exacerbated by being woefully unprepared. Epidemics, he cautioned, do not have to occur if both nations individually and the community globally invest in preparedness efforts.
“Success is possible by having the critical components in place and good governments. We just usually don’t hear about it,” Frieden said.
The Epidemics That Didn’t Happen report sought to turn that around, by charting four case studies from the pre-COVID era and four case studies during the present pandemic. Pre-COVID examples included Yellow Fever, Ebola, anthrax and monkeypox, while the COVID-19 data focused on cases in Mongolia, Senegal, Vietnam and Africa at large. All showed success stories, which Frieden said are critical to understanding what worked then and what might work in the future.
Still, the importance of studying failures was not discounted. There are plenty to study in the realm of public health, by Frieden’s estimation, and the modern world is rife with increasing drug resistance, greater human-animal interaction and the very real possibility that COVID-19 will kill more people in 2021 than it did as it swept the world last year.
To address the issues, Frieden argued for a multi-pronged approach he dubbed TOP: technical, operational and political. While funding is a big part of what the world needs, Frieden granted, it is insufficient on its own. Technical skills, cooperation and management all play their part as well. How to achieve them varies though.
According to Frieden, one path would be creating a global consortium, while another would be regional centers for disease control, such as the Africa Centers for Disease Control and Prevention that have maintained effective operations throughout COVID-19. Nation by nation, though, there needs to be more investment in public health and stronger public resources over all, along with better management and operational capacity to implement and pursue reliable programs.
Frieden, who oversaw the anti-West African Ebola epidemic efforts of 2014, also argued for the continued importance of the World Health Organization (WHO) as an anchor of public health programs, from guidelines to surveillance and support efforts. Last year, the Trump administration attempted to sever ties with the organization over what it called failures and a Chinese alignment, although the Biden administration has since brought the U.S. back into the fold.
He also envisioned the Global Fund, as well as groups like GAVI, the Vaccine Alliance, as important for working within countries, moving resources and procuring others. Such things take care, Frieden noted, as stakeholders vary country to country, and as such, the world needs to measure the success of what’s actually being done, not what might be done. COVID showed the importance of such actions, in his view, as nations that by all accounts should have done well crumbled under poor management.
Early warning and response systems will be critical, and he pointed to the 7-1-7 as the goal of preparation. This refers to the ability to identify suspected outbreaks within seven days of emergence, report, investigate and respond within a single day, and then mount an effective response within seven days.
Frieden has heard many countries bemoan the fact that richer nations only seem to care about them if the diseases they suffer from have a chance of spreading across borders. Often, he admitted, Congress has to be pressured by forcing it to see that what’s happening overseas could affect it, too. While private efforts can help pick up some of the slack, governments remain the most critical player in any response effort, as they are the ones running surveillance and other national efforts.
Nor are things as simple as calling for action. Take tuberculosis, for example. “Tuberculosis control requires persistence,” Frieden said. “I’m glad organizations have called for global elimination, but I’m a little frustrated when entities call for something there’s no current way to achieve. The fact is, we don’t have ways to rapidly control TB. We could do a lot better.”
In particular, nations need to begin investing more into primary care, rather than just hospital care. Such systems are weak almost around the world, and there’s not enough progress being seen. COVID has also highlighted and, in many cases, exacerbated partisan, political tensions the world over.
This won’t be the last pandemic the world sees. Yet effective responses could save millions of lives and trillions of dollars, as they did in the 2014 Ebola epidemic, the largest the world had ever seen. It spread through Liberia, Guinea and Sierra Leone. And yet, in Nigeria, the outbreak was halted within three months, after only 20 cases and eight deaths. It managed it through communication, coordinated response and good leadership. These were the type of examples The Epidemics That Didn’t Happen report sought to highlight.
“It shows us a way forward, where a safer, healthier world is possible,” Frieden said. “The time to start this work is now. There’s never been a more teachable moment than the present.”