On Jan. 28, the World Health Organization (WHO) declared a public health emergency of international concern for the quickly spreading coronavirus, similar to those it previously declared for H1N1 in 2009, Ebola in West Africa in 2014, polio in 2014, Zika in 2016 and Ebola again in the Democratic Republic of the Congo (DRC) in 2019.
At this stage, it is difficult to understand the precise impact of this latest virus, but it has already infected more than 1.6 million people and claimed the lives of more than 95,765 to date.
Out of this human calamity has come renewed attention to global health security, calling into question its definition, meaning and the practical implications for programs and policies.
Countries have sealed their borders, closed their companies, malls, schools and banned gatherings. Some declared a state “epidemiological emergency,” while others a full state of emergency.
Despite apparent decisive actions by the governments, doctors and experts across the world have raised questions about the state of the health care systems and vulnerabilities to the new sudden virus, which spread rapidly in more than 209 countries and territories around the world.
It was clear that no country was fully prepared to face this pandemic, although some countries were better prepared to handle an outbreak than others.
The coronavirus pandemic quickly strained health care systems. In less than three weeks, the virus overloaded hospitals in almost every affected country, offering a glimpse of what governments will face if they could not slow the spread of the virus and ‘‘flatten the curve’’ of new cases. This meant allowing the sick to be treated without swamping the capacity of hospitals.
A great concern was for the critical shortage of intensive care facilities and in particular of ventilators, respirators, protective equipment and testing kits.
Another crucial issue that many governments were facing was the difficulty of providing enough doctors, nurses and health care workers.
After deep austerity measures over the last decade, the health systems in some European countries like Italy, Spain, the U.K. and Portugal were struggling to keep up with the ongoing outbreak of COVID-19.
High health care costs and low medical capacity made even the U.S. uniquely vulnerable to the coronavirus and less prepared for a pandemic than other countries with universal health systems.
Pandemic threats, natural, intentional or accidental, in any country can pose risks to global health, international security and the world economy. As infectious diseases know no borders, all countries must prioritize and exercise the capabilities required to prevent, detect and rapidly respond to public health emergencies, assuring neighbors of their capability to stop an outbreak from becoming an international catastrophe.
In turn, global leaders and international organizations bear a collective responsibility for developing and maintaining robust global capability to counter infectious disease threats. This capability includes ensuring that financing is available to fill gaps in epidemic and pandemic preparedness as these steps will save lives and achieve a safer and more secure world.
As years go by, risks are magnified by the rapidly changing interconnected world, increasing political instability, urbanization, climate change and rapid technology advances that make it easier and faster for any virus to spread globally.
In the context of the governance of global health, including WHO reform, it is important to distill lessons learned from the coronavirus pandemic to obtain a more sustainable and resilient society for human health and well-being in the future.
Health security – essentially the protection from threats to health – is recognized as one of the most important nontraditional security issues. As the coronavirus crosses international borders, there is a clear understanding that the outbreak from China was a threat to the world’s health security. Infected people traveled across borders where they have unintentionally caused small chains of transmission far from the epicenter of the outbreak.
The coronavirus crisis has put the spotlight on the importance of reducing the vulnerability of societies to infectious disease threats that spread across international borders within seconds. This aspect of health security – collective health security – has been the focus and the commonly understood foundation of health security for centuries. The second, equally important aspect for health security that the coronavirus outbreak has tragically highlighted was individual health security. This security comes from access to safe and effective health services, products and technologies. The coronavirus had affected people from all over the world, from rich and poor countries, and what was clear is that health care is not always effective, not always accessible and that health security is in these circumstances is at risk.
The concept of collective health security against infectious diseases was already clear in the 14th century when quarantine was first used in an attempt to prevent the bubonic plague from crossing borders. As international travel and trade increased, a series of international treaties and conventions were developed to attempt to stop the cross-border spread of the plague and three additional infectious diseases, cholera, smallpox and yellow fever. In 1969, the International Health Regulations set up a collaborative global framework to enhance the world’s health security against these four infectious diseases with a reporting requirement and predetermined actions to be implemented at borders.
After the outbreak of SARS in 2003 and the strong reminder that border controls cannot stop the international spread of disease, International Health Regulations were broadened in scope. They now require reporting of any public health emergency of international concern and real-time dialogue among affected governments and the WHO to propose real-time, evidence-based actions at borders. They also require countries to strengthen the core capacities in public health aimed at more rapid detection and response to public health events where and when they occur. Although these requirements have not been met in all countries, the regulations provide an agreed global framework for the enhancement of collective health security, a framework for investment by countries and development agencies to strengthen public health so that outbreaks caused by infectious organisms such as the coronavirus can be rapidly detected and contained.
Security for the vulnerable
A great challenge is ensuring the health security of refugees and those living in conflict and post-conflict situations. They often face the same health security risks, as well as more risks associated with interruption of access to health services or violence. This challenge needs additional study and resolution. Existing international regulations, treaties, conventions and other means of ensuring stronger health security must be sustained and new ones developed to address their specific needs. International health regulations must be put in place with a new strict framework under which the world can work together to better ensure collective health security and develop and strengthen the core capacity in public health for these fragile communities through permeant assistance and national funding.
The Global Health Security (GHS) Index 2019 analysis showed that national health security is fundamentally weak around the world, that no country is fully prepared for epidemics or pandemics, and every country has important gaps to address.
Many countries lack the health security and capabilities needed to prevent, detect and respond to significant infectious disease outbreaks.
The average overall GHS Index score among all 195 countries assessed is 40.2 of a possible score of 100.
Among the 60 high-income countries, the average GHS Index score is 51.9. In addition, 116 high and middle-income countries did not score above 50.
Overall, the GHS Index found severe weaknesses in countries' abilities to prevent, detect and respond to health emergencies. It also found severe gaps in health systems and vulnerabilities in political, socioeconomic and environmental sectors that can confound outbreak preparedness and response. There was also a lack of adherence to international norms.
Specific scores for the GHS Index categories showed that fewer than 7% of countries score in the highest tier for the ability to prevent the emergence or release of pathogens.
Only 19% of countries received top marks for detection and reporting, while fewer than 5% of the countries scored in the highest tier for their ability to rapidly respond to and mitigate the spread of an epidemic.
The average score for health system indicators was 26.4 out of 100, making it the lowest-scoring category.
Less than half of the countries have submitted confidence-building measures under the Biological Weapons Convention (BWC) in the past three years, an indication of their ability to adhere to important international norms and commitments related to biological threats.
In January, the WHO released a list of urgent, global health challenges. This list which was developed with input from experts around the world and reflected deep concern that leaders are failing to invest enough resources in core health priorities and systems. This puts lives, livelihoods and economies in jeopardy. None of these issues are simple to address, but they are within reach.
We need to realize that health is an investment in the future. Countries invest heavily in developing military technology and nuclear weapons but not against the attack of a virus, which could be far more deadly and far more damaging economically and socially.
The lesson that the coronavirus has provided us was the shared threat and the shared responsibility to act.
This means advocating for national funding to address gaps in health systems and health infrastructure, as well as providing support to the most vulnerable countries. Investing now will save lives – and money – later. Governments, communities and international agencies must work together to achieve these critical goals.
Recalling what World Bank Group former President Jim Yong Kim once said: “Good health is the foundation of a country’s human capital, and no country can afford low-quality or unsafe health care.”
* Palestinian author, researcher, freelance journalist and recipient of two prizes from the Palestinian Union of Writers
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