“Pathogens know no borders — and with climate change, we have tremendous movement of vectors,” Barry, director of the Stanford Center for Innovation in Global Health, told me during a recent interview. “With globalization and billions of people routinely in flight, we have tremendous health threats traveling first class and coach.”
Wise, a pediatrician and a core faculty member at Stanford Health Policy, and Barry write in an essay in the fall edition of Daedalus that there are 30 civil wars underway around the globe, where civilians are dealing with death and destruction, as well as public health emergencies exacerbated by the deadly march of conflict. I wrote about their work in a recent Stanford Health policy article.
Yemen is battling an unprecedented cholera outbreak which has killed more than 2,150 people this year, with another 700,000 suspected cases of the water-borne disease. The government and a rival faction have been fighting for control of the country, taking 10,000 lives since 2015.
Some 17 children in Syria have been paralyzed from a confirmed polio outbreak in northeastern districts, with 48 cases reported in a country that had not had a case of polio since 1999. The cases are concentrated in areas controlled by opponents of President Bashar al-Assad.
And in the Democratic Republic of Congo — where the civil war officially ended years ago, but thousands of people still suffer from recurrent uprisings and scant infrastructure — a yellow fever outbreak was met last year with a lack of vaccines. The WHO was forced to give inoculations containing a fifth of the normal dose, providing protection for only one year.
And yet today, of the nearly 200 countries on this planet, only six nations — three rich ones and three poor ones — have taken steps to evaluate their ability to withstand a global pandemic.
“The bottom line is that despite the profound global threat of pandemics, there remains no global health mechanism to force parties to act in accordance with global health interests,” say Wise and Barry, who are calling for more global funding, technology and cooperation to contain potential outbreaks.
The only comprehensive global framework for pandemic detection and control is the International Health Regulations treaty, which was signed in 2005 by 196 member-nations of the World Health Organization to work together for global health security.
The IHR imposed a deadline of 2012 for all states to have in place the necessary capacities to detect, report and respond to local infectious outbreaks. But only a few parties have reported meeting these requirements, and one-third has not even begun the process. There have also been efforts to enhance state reporting of health systems capacities through voluntary assessments of countries working through the Global Health Security Agenda consortium.
But both frameworks, Barry said, need financial and political support.
“I see a stronger IHR with more than words — but actual money behind it in order for it to become stronger,” said Barry, noting the Global Health Security Agenda ends in 2018 and she has been asked to sit on a NAAS task force to form its next iteration. “I’m hoping we can move the needle to put money into bio-surveillance and health security, especially in conflict areas.”
A longer version of this piece appears at Stanford Health Policy.
Previously: Stanford expert: Dont eliminate "one of the most effective tools we have to fight global diseases" and We are woefully unprepared for pandemic threat, says economist Larry Summers
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