Health security: is the world better prepared?
A disease outbreak best demonstrates the acute need for a guardian of health. Lessons learned from the West Africa Ebola outbreak in 2014 catalyzed the creation of a new Health Emergencies Programme, enabling a faster, more effective response to outbreaks and emergencies. WHO helps countries implement the International Health Regulations and guides R&D collaboration to develop new vaccines and treatments for epidemic-prone diseases. The response to subsequent outbreaks of Zika and yellow fever has improved but more work is needed to ensure that the world is better prepared to handle the next epidemic.
Managing the global regime for controlling the international spread of infectious diseases is a central and historical responsibility of WHO. The International Health Regulations, administered by WHO, provide the legal instrument for doing so. These regulations are the only internationally-agreed set of rules governing the timely and effective response to outbreaks and other health emergencies that may spread beyond the borders of an affected country. Yet fewer than a third of WHO Member States meet the minimum requirements for core capacities needed to implement the IHR. This is the situation nearly ten years after the regulations entered into force.
At the same time, the factors that govern global health security extend well beyond the mandate of WHO and its capacity to respond. Much responsibility falls to countries. In line with IHR provisions, affected countries need to report unusual disease events promptly and openly. When they do so, other countries need to stop punishing them by imposing unjustified restrictions on travel and trade.
A promise of financial and technical support is a powerful incentive for early reporting, but is often impeded by an inadequate response from the international community. As abundant experience shows, prompt and transparent reporting is compromised when the certainty of economic damage outweighs the prospect of financial and technical support.
"Countries with well-functioning and inclusive health systems are more likely to catch an outbreak early when the chances of rapid containment are best."
Dr Chan, WHO Director-General
Implementation of the IHR requires that countries move out of the sanctuary of national sovereignty in the interest of the common good. For example, countries must be willing to issue visas for foreign emergency responders, let them investigate, and grant them full and unfettered access to data and records. Countries and airlines must agree to send patient samples to WHO collaborating centres with designated expertise in the handling and analysis of dangerous or unusual pathogens. Many WHO-led responses to outbreaks have been delayed or encumbered when countries exercise their sovereign right to refuse international collaboration, regarding it as unwelcome interference with national affairs.
Above all, to prevent another devastating event like the Ebola outbreak in West Africa, countries need resilient and inclusive health systems that extend to rural areas, a sensitive early warning system coupled with rapid response capacity, and informed and engaged communities that trust their government and the health services it provides. Countries also need access to effective and affordable vaccines, diagnostics and treatments (when these exist), outstanding laboratory and logistics capacity, and safe and abundant treatment facilities, properly staffed and equipped.
The world has a long way to go before reaching such a level of preparedness. An estimated 400 million people have no access whatsoever to even the most basic health services. WHO has identified nine severe pathogens that have epidemic potential but no or inadequate medical countermeasures – another glaring gap in the world’s collective preparedness.
Fortunately, recent G7 summits and a growing body of research see a strong mutually-reinforcing compatibility between the goals of universal health coverage and global health security. Countries with well-functioning and inclusive health systems are more likely to catch an outbreak early when the chances of rapid containment are best. Countries with strong health systems are better prepared to cope with the added demands on health services and staff that outbreaks and other health emergencies inevitably bring. Recent history has many examples of fragile health systems pushed to the brink of collapse, often by comparatively mild outbreaks. Finally, the commitment to fairness and protection against financial ruin, embodied in universal health coverage, can inspire the public confidence and trust that underpin compliance with recommended control measures.