It could happen at any moment—a pandemic with the potential to sweep across the globe in just 36 hours, wiping out 80 million people and irreversibly changing society. It would start like any other viral epidemic, with one infected person passing an airborne pathogen along to the next, until we hit a Black Death-level catastrophe that destroys a full 5% of the global economy.
If this happens, will we be ready?
The official answer, according to the Global Preparedness Monitoring Board, an independent body made up of health and emergency response experts from around the world, is no.
Furthermore, it’s not really a matter of “if.” It’s a matter of “when.”
“There’s widespread agreement that it’s virtually certain we are going to be facing another epidemic, or pandemic,” says Scott Dowell, an expert on outbreak response who heads up vaccine surveillance at the Bill & Melinda Gates Foundation (the foundation provides support to the GPMB, and the foundation’s global development president, Christopher Elias, is a member of the GPMB). “The question is how soon—it could be many years. It could be next year.”
If it’s next year, the world is not in good shape, as described in the GPMB’s first “Annual Report on Global Preparedness for Health Emergencies,” released on September 17. The GPMB started this report after the West African Ebola outbreak that took place from 2014 to 2016. The current outbreak in the Democratic Republic of Congo has already resulted in close to 2,000 deaths, with more than 3,000 confirmed cases. Fast-moving, lethal pathogens like Ebola concern the GPMB the most, along with the likes of SARS and similar viruses. “Top of the list is a new influenza strain,” says Dowell.
Cochaired by Gro Harlem Brundtland, the former Prime Minister of Norway and former World Health Organization Director-General, and Elhadj As Sy, Secretary General of the International Federation of the Red Cross and Red Crescent, the board suggests seven steps world leaders must follow to prepare adequately for a health crisis, like the spread of a global respiratory pathogen.
Step one is world leaders committing to International Health Regulations, like inspecting international cargo and ensuring travellers are given the proper vaccines, established in 2005—and investing in these commitments accordingly. “All 195 countries in the world signed on to prepare according to the International Health Regulations back in 2005,” says Dowell, “but as of last year, less than a third of the countries reported that they’ve achieved the preparedness they committed to.” The U.S. is among that minority, and it’s technically in the “green zone” for preparedness, but it’s still “not perfect,” says Dowell.
Step two encourages countries that are monitoring their preparedness to “lead by example.” Step three involves government heads installing high-level coordinators with the authority to conduct simulations—drills, in essence—of what the country must do if a pandemic hits. Additional steps call for investing in vaccines, additional hospital infrastructure, and other possible treatments, as well as upping relevant donations to the medical and emergency fields. Lastly, the report calls for the United Nations to get better at emergency response coordination across countries.
This is all a lot to ask, and implementing it won’t be easy—as we’ve already seen from the 2005 regulations, countries aren’t the best at following through with promises of preparedness. For the GPMB, releasing this report is “an important step,” according to Dowell. He hopes it prompts heads of state and international organizations, like the WHO, to “act more quickly than they have in the past.”
“The board has concluded that the world is not ready for the next global public health crisis, and I think people should take that quite seriously,” says Dowell, particularly because “this is a new independent board that has no stake in the outcome.”
As of last month, 100 countries around the world had agreed to let an external preparedness group assess how well equipped they are to deal with a rapidly spreading medical emergency. “Wealthier countries tend to be more prepared,” says Dowell, a perhaps unsurprising fact.
Between 2011 and 2017, somewhere between 164 and 213 epidemic events have happened each year in the world, according to data from the WHO. A readiness “score card” created by Resolve to Save Lives, an initiative put forth by U.S. nonprofit Vital Strategies, found Australia and South Korea to be the countries best prepared for disease outbreaks, with respective scores of 92. The U.S. is fifth with an 87, while the least prepared are located in Africa—Gambia has a 32, South Sudan has a 30, and both Somalia and Chad got the lowest scores at 29.
“The important point that comes out in the report is that the world is as ready as the weakest link,” says Dowell. “And it’s in everybody’s interest that we ensure there aren’t weak links.”