The Next Pandemic Will Be Arriving Shortly

Deadly diseases like Ebola and the avian flu are only one flight away. The U.S. government must start taking preparedness seriously.

Medical staff check each other's protective suits before entering the isolation unit at a hospital in Bundibugyo, western Uganda, during a suspected case of Ebola. Aug. 17. (Sumy Sadurni /AFP/Getty Images)
Medical staff check each other's protective suits before entering the isolation unit at a hospital in Bundibugyo, western Uganda, during a suspected case of Ebola. Aug. 17. (Sumy Sadurni /AFP/Getty Images)

There are plenty of security threats that could keep a former homeland security advisor awake. There is the possibility of a terrorist attack, a cyber-cataclysm, or any number of natural disasters—all threats that are capable of visiting destruction on entire communities in a matter of hours. Right at the top of that list is the threat of a deadly pandemic—an outbreak of infectious disease that rapidly crosses international borders.

In January 2017, while one of us was serving as a homeland security advisor to outgoing President Barack Obama, a deadly pandemic was among the scenarios that the outgoing and incoming U.S. Cabinet officials discussed in a daylong exercise that focused on honing interagency coordination and rapid federal response to potential crises. The exercise is an important element of the preparations during transitions between administrations, and it seemed things were off to a good start with a commitment to continuity and a focus on biodefense, preparedness, and the Global Health Security Agenda—an initiative begun by the Obama administration to help build health security capacity in the most critically at-risk countries around the world and to prevent the spread of infectious disease. But that commitment was short-lived.

Pandemic disease is arguably one of the greatest threats to global stability and security. But investments to contend with such outbreaks have declined to their lowest levels since the height of the Ebola response in 2014, with U.S. federal dollars cut by over 50 percent from those peak levels.

The prevailing laissez-faire attitude toward funding pandemic preparedness within President Donald Trump’s White House is creating new vulnerabilities in the health infrastructure of the United States and leaving the world with critical gaps to contend with when the next global outbreak of infectious disease hits.

The investments made after the 2014 Ebola crisis have been slashed in recent proposed federal budgets from the Centers for Disease Control, the agency that works to stop deadly diseases in their tracks, and the U.S. Agency for International Development, which responds to international disasters, including the Ebola outbreak. Moreover, Timothy Ziemer, the top White House official in charge of pandemic preparedness, has left his job, and the biosecurity office he ran was summarily disbanded.

This lack of focus and relative decline in funding is dangerous, given the steady stream of global reports suggesting that transmission of potentially deadly zoonotic diseases, where pathogens move from animals to humans, is rising at an alarming rate. Some attribute this to climate change, with warmer climates everywhere extending the life cycles of mosquito-borne diseases and allowing them to reach higher altitudes and more temperate latitudes. This means that viral diseases such as Zika, dengue fever, and the West Nile virus are transmittable across a larger geographical area later into the year.

As a result, in 2018, it is impossible to reconcile the redirection of funds away from preparing for pandemics with these realities on the ground. Ebola, the quintessential zoonotic killer, has risen again, now in the Democratic Republic of the Congo, with World Health Organization officials describing the outbreak as on the “precipice” of a potential spread to neighboring countries. While this year’s response was far more rapid and effective than responses to prior outbreaks in Africa, cases continue to rise in hard-to-reach places with little health care infrastructure near Congo’s borders with Rwanda and Uganda, prompting fears of regional spread.

Perhaps most terrifying, difficult to treat and highly fatal strains of H7N9 avian influenza are spreading throughout China. This strain of bird flu causes rapid respiratory illness with associated multiorgan dysfunction that’s easily spread by a small droplet. That’s why it’s so difficult to control and why recurrent epidemics continue to crop up: There have been five epidemics of H7N9 since 2013 in China alone, the most recent between the fall of 2016 and fall of 2017. Across these epidemics, among the 1,565 confirmed cases, about 40 percent of infected individuals died.

That is a staggering number that should frighten us all—particularly given that China, unlike other resource-limited states in Asia, has at least some capability to rapidly respond to emerging crises through its own Center for Disease Control and Prevention, which can deploy critical care and other public health emergency services.

Consider that it takes only one infected carrier of bird flu to escape screening or detection at a train station or airport to transform a local health crisis into a global pandemic. As there are over 60 nonstop flights between China and the United States daily, with an estimated total of 30,000 passengers traveling between the two countries each day, this possibility is more than a remote and existential threat. Transmission of bird flu to the United States is just a flight away, which is why durable investments in the Global Health Security Agenda are so important, allowing the U.S. government to address deadly pathogen transmission early and hopefully to do so before it reaches U.S. shores.

The WHO has tried to increase attention and enhance preparedness by strongly supporting the Joint External Evaluation, an assessment of each country’s capabilities in preventing, detecting, and responding to a potential outbreak. According to the first analyses of these results, global readiness to combat the next pandemic is broadly lacking. The starkest finding was that nearly 90 percent of the core public health capacities regarded as essential to pandemic preparedness, across a broad cross-section of countries, are not sufficiently developed to cope with the next major outbreak.

Although countries in Africa and Southeast Asia performed worse, on average, than those elsewhere, preparedness levels were insufficient to varying degrees almost everywhere. The indicators in need of most attention related to antimicrobial drug resistance. The provision of vaccines for preventable diseases was a rare bright spot, with most countries now meeting basic thresholds for coverage of priority diseases among their populations.

This latter finding shows us what can work: Vaccine coverage rates have improved since the early 2000s in some of the hardest-to-reach places in no small part because of the Global Alliance for Vaccines and Immunization (GAVI)—a bipartisan-supported multinational effort dating back nearly two decades. GAVI helps redirect private and publicly allocated philanthropy and technical expertise to countries suffering from high burdens of vaccine-preventable diseases. Their impressive gains have been undeniable, most notably broad reductions in preventable causes of mortality for those under 5 years old from diarrheal and respiratory diseases.

The Global Health Security Agenda was designed, in part, to do for pandemic preparedness what GAVI has done so well for improved vaccination rates. In the wake of Ebola, the goal was to bolster preparedness response and detection and, most of all, to focus on prevention abroad so the United States wouldn’t have to fight a pandemic at home.

Unfortunately, the financial commitments to the agenda have been dramatically reduced under Trump, leaving us all vulnerable to an unparalleled array of emerging health threats the likes of which we haven’t seen since 1918, when an outbreak of a deadly disease known as “Spanish flu” killed nearly 50 million people globally. In the face of clear signs that the world is unprepared for the next outbreak, that devastating epidemics are a flight away, and that funding to combat these realities has been significantly cut back, the failure to take this crisis seriously is potentially deadly.

Global health security should not be seen solely as the pursuit of development do-gooders or international policy wonks. Rather, the clear lessons of Ebola and prior pandemics for the current U.S. administration should be that fighting disease outbreaks requires the sort of consensus-building and galvanization of global resources that last week’s U.N. General Assembly was meant to celebrate and sustain. Cynical critiques of such cooperation ignore the mutual interdependence of our global community, which can’t be overturned by a speech or temporary set of inward-looking policy platforms.

Pandemic preparedness is a matter of national security and needs to be treated that way. The greater the complacency, the bigger the next crisis will be.

Lisa Monaco, who served as homeland security and counterterrorism advisor to President Barack Obama from 2013 to 2017, is a senior fellow at New York University Law School’s Center on Law and Security and Harvard’s Belfer Center for Science and International Affairs.


Vin Gupta, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington and a fellow at the Center for Global Development, also serves as a physician and officer in the U.S. Air Force Medical Corps, where he focuses on the Pentagon’s global health engagement activities. Twitter: @VinGuptaMD

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