Winning the battle against emerging pathogens

Abstract

Technological advances in the life sciences hold out the promise of controlling or eliminating stubborn diseases. They also increase the risk that malevolent actors will learn to produce new and highly dangerous pathogens, a prospect that deeply concerns security professionals in developed countries. In the developing world, meanwhile, where many nations struggle mightily with diseases such as AIDS and malaria, public health concerns tend to focus more on the here and now—or, when it comes to emerging threats, on how to contend with natural rather than human-made pathogens. Authors from four countries—Oyewale Tomori of Nigeria, Louise Bezuidenhout and Chandre Gould of South Africa (2014), Maria José Espona of Argentina (2014), and Iris Hunger of Germany (2014)—explore how governments, institutions, and professionals in both the developed and developing worlds can make the world safer from emerging pathogens, whether natural or human-made.

Governments and scientific communities in the developed world devote considerable attention and study to the emergence and re-emergence of pathogens. But in resource-constrained countries, this is often not the case. Africa is a region especially prone to outbreaks of the diseases naturally transmitted between vertebrate animals and humans (zoonotic diseases); these include Ebola, Rift Valley Fever, and plague. All countries in the region are at risk from these diseases, and cross-border outbreaks are frequent. But African nations are often characterized by an inability—or failure—to effectively address the emergence of new diseases or the re-emergence of endemic ones.

Several reasons for this stand out. Africa’s systems for disease surveillance are weak and laboratory support is poor, making it difficult to produce data needed for assessing disease burdens and responding with appropriate priorities. When good information is unavailable, the emergence of new pathogens is often met with denial—until a disease outbreak reaches epidemic proportions. Once an epidemic is under way, an affected country is invaded by international health agencies, but they operate in panic and crisis-response mode, and their efforts amount to too little, too late. Pathogen outbreaks ultimately become opportunities for foreign researchers and health agencies to fine-tune their skills, leaving scientists in resource-poor countries permanently dependent on outsiders—reduced to mere sample collectors, unable to control the next pathogen outbreak on their own.

How can these challenges be overcome? At the national level, it is essential that each country take “ownership” of systems for disease surveillance, prevention, and control; this allows country-specific response measures to be formulated. Taking ownership of these systems entails making a genuine political commitment to them, and requires that adequate resources, financial and human, be provided for disease surveillance and for laboratory support systems. It is crucial that nations maintain systems capable of detecting, identifying, and containing pathogens that have epidemic potential before they spread too widely.

For governments, taking a proactive role in combating disease also entails implementing appropriate emergency response plans; coordinating collaborative interactions between human and veterinary health surveillance systems; building and sustaining the disease-fighting capacity of local health personnel by providing them training, opportunities to update their skills, and an empowering work environment; and establishing a multidisciplinary approach to disease control, one that allows individuals from diverse fields to bring their expertise to bear on the control of emerging or re-emerging diseases. (Engagement from the private sector, for example, ought to be forthcoming because disease outbreaks threaten everyone’s economic security.)

But too often in Africa, governments simply don’t do their part. In April 2001, member states of the African Union met in the Nigerian capital of Abuja and pledged that, by 2015, each nation would devote at least 15 percent of its governmental expenditures to public health. Prospects for meeting that goal seem poor. As of 2009, the proportion of government expenditures devoted to health had actually declined in 11 African nations (World Health Organization, 2011). As of 2011, though the proportion of government expenditures devoted to health had increased across the continent (to 11 percent from 9 percent), only six countries had reached the 15 percent goal (UNAIDS, 2013).

Many African governments blame inadequate public health funding on poverty. But the real culprits are corruption and misplaced priorities—which guarantee that delivery of health care is poor, surveillance systems to detect emerging and re-emerging pathogens are ineffective, and efforts to control disease often end in failure. The AIDS and Rights Alliance for Southern Africa, a regional network of nongovernmental organizations, runs a campaign that draws attention to the spending choices that African governments make. The alliance reports that some governments, instead of providing adequate funds for health, education, and other services that would better the lives of their people, devote exorbitant sums to frivolous expenditures (AIDS and Rights Alliance for Southern Africa, 2014). The government of Swaziland has spent $500,000 on a luxury car for the king. Uganda has spent $48 million on a private presidential jet. Senegal has spent $27 million on a bronze statue taller than the Statue of Liberty (Walker, 2010)—and a proposed new city gate to Abuja would cost $395 million (Agbo, 2013). None of these nations has met its 2001 commitment regarding health care spending.

In most African countries, implementation of the disease surveillance activities that are required for early detection of emerging pathogens remains defective at both the local and national levels. For example, a recent assessment of disease surveillance and response implementation in Nigeria’s Kaduna State revealed that 38 percent of the state’s health facilities had no standard case definition for priority diseases, 71 percent lacked a computer and printer, and 81 percent carried out no analysis of data they collected (Abubakar et al., 2013). In Africa, poor surveillance and data management mean that months can often pass between the beginning of an outbreak and the time it is first reported to health authorities. Even then, underreporting is likely to be rampant—epidemiological investigations often reveal many more cases than were reported through surveillance systems. The African Union has estimated that corruption costs African economies about $150 billion each year. A fraction of that money could provide every nation in Africa with an efficient disease surveillance system and a high-quality laboratory network to support it.

African and other developing countries must wake up from their dependency stupor regarding health, including disease surveillance and prevention. They must get their priorities in order and be held accountable for their health expenditures. In particular, they must make more vigorous efforts to develop the core capacities required under the International Health Regulations—and countries that don’t meet their agreed targets should face sanctions. Unfortunately, the International Health Regulations don’t allow for sanctions or other accountability measures. But above all, each African country must commit its resources to ensuring appropriate surveillance for emerging and re-emerging pathogens. Meanwhile, developed countries should ease off on the dominance, on their control of the processes of global disease surveillance. Only then can developing countries truly “own” these processes. If each country did what it is really capable of—in enhancing disease surveillance, improving laboratory support, and efficiently managing data—the world would be much safer from emerging and re-emerging pathogens.