Preparing For the Unknown — International cooperation and local capacity building are needed to prepare for ‘the next pandemic’

With the end of the Cold War and the fading threat of global nuclear destruction, both scientific and popular discourse have focused on the threats posed to humanity by climate change and epidemics. Emergent problems inspire apocalyptic scenarios in entertainment, politics and global health. They are extraordinarily horrifying and complex because neither rising sea levels and desertification nor mosquitoes, viruses and germs stop at national boundaries. Their effects may reinforce each other; for example, the mosquitoes carrying malaria are predicted to spread with increasing temperatures and higher degrees of humidity.

While we know that infectious and contagious disease, as well as climate change, affect the world’s poor adversely, global health is confronted with a further spectre of emerging and mutating diseases. Modelled at a level of maximum risk, they are configured not to be a threat to local populations but to humanity.

Image Courtesy of The CDC via U.S. Department of Health and Human Services © 2018, some rights reserved

One of the most dreaded known viruses is influenza. A flu virus in 1918, when the global population was 2 billion, killed between 50 and 100 million people. Albeit a known type of virus, influenza returns in different variations annually which makes vaccinations for the general population redundant. Today, with an almost quadrupled world population, a severe outbreak is modeled to kill up to 33 million people in 250 days.

The Bill and Melinda Gates Foundation has launched a program to develop a general influenza vaccination that tackles the virus’s most stable part. A such vaccination would protect from any mutations of the influenza virus. It may furthermore be instructive for vaccinations against other highly mutative viruses, such as HIV. Bill Gates stressed the importance of cooperation over technological advancements. Screening, preparedness and response systems on an international level are key for a global pandemic response.

This is a fact more so since the nature of the next pandemic is unpredictable. It may be influenza, but it might just as well be any other known or unknown mutated virus with a potential severity even higher than that modelled for influenza. Therefore, health organisations do not work to prevent the next pandemic but rather to be prepared for it.

The most successful public health campaign for preparedness was ‘Zombie Preparedness’ by the Centres for Disease Control and Prevention (CDC). Originally designed as an eyecatcher, it uses the iconography of a zombie apocalypse to disperse strategies before natural disasters or epidemics hit. It raises awareness by asking people to store an emergency kit at home and to decide on emergency contacts and evacuation routes.

Anthropologists use the next pandemic to explore what it means to be human. In a world where Will Smith is the only survivor of a pandemic, outcompeted by lions while hunting food in a New York reclaimed by proliferating nature (from I am Legend), ‘humanity’ has lost its meaning. The next pandemic will not necessarily make humans extinct, but it will interrupt everyday life, infrastructure and humans’ capacity to make sense of their lives. The pandemic will override any form of civilised coexistence. What then, in a world not yet experiencing but only anticipating the next pandemic, are the human implications for preparedness?

Firstly, the “One Health” approach to global health promotes a focus not only on humans but their interaction with the natural world. A lot of diseases spreading from human to human originate from animals or nutrition in our environment. The WHO works closely with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) to minimize infection risk from unsafe food and zoonoses (disease transmission from animals to humans). For example, monitoring rabies in dogs provides information to prevent it in humans.

Secondly, basic hygiene standards, especially washing one’s hands, are an extremely effective way to halt the spread of disease.

Thirdly, not only international cooperation but also the use and strengthening of local capacities are important. Preparedness campaigns and response mechanisms that can quickly be introduced and handed over to communities will benefit from the communities’ workforce and their knowledge of infrastructure, customs and the population. In this way, trust is built more easily.

Disappointingly, in a world ravaged by political conflict, international organizations like the WHO are heavily underfunded, leaving epidemic management largely to the CDC of the United States. While military expenses are large worldwide, national health expenses are smaller. Yet even smaller are those made by governments for the shared good of global, human health.


Banner image: Image Courtesy of NIAID via Flickr © 2018, some rights reserved