It's time to protect the US and the world against global pandemics

It's time to protect the US and the world against global pandemics
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The current administration is undermining efforts to follow the science and prepare for threats of the future at a time when a new study finds that not one country is prepared for a pandemic. 

As the chief medical officer for the President’s Emergency Plan for AIDS Relief (PEPFAR) at the U.S. Department of State during the Obama administration, I was fortunate to serve at a time in which we had the opportunity to leverage U.S.-sponsored scientific gains to accelerate the scale-up of global interventions that saved lives and decreased the spread of infection.

In the aftermath of the 2014 Ebola outbreak, the U.S. began building systems that could better respond to future infectious disease outbreaks. Yet the current administration has repeatedly proposed cuts to these programs and prospects for true U.S. leadership in this area have dimmed as agencies face shortfalls.

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In fact, these shortsighted budget cuts along with reversals of U.S. commitments to combatting climate change are creating precisely the right conditions for the next infectious pandemic to thrive.

If a highly contagious airborne epidemic, similar to the 1918 flu pandemic, were to occur today, it could kill nearly 33 million people in just 6 months. And climate change is making future infectious pandemics not only more likely, by expanding the territories where disease-carrying mosquitoes thrive, but also making populations less able to combat the damage from an infectious pandemic.

Unless our political leaders act soon, the post-mortem conducted after the next big pandemic will provide a damning portrait of failed leadership, misguided priorities, and an insufficient belief in the power of science to protect humanity.

The good news is that upcoming elections provide an excellent opportunity for our political leaders to commit to bold U.S. leadership to protect humanity. The 2020 U.S. presidential candidates should commit to:

1. Doubling-down on America’s scientific leadership and investing in a “Manhattan project” for the next generation of technologies to detect, prevent and treat pathogens most likely to cause large outbreaks or pandemics that spread around the world. 

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The greatest advances in global health have typically been built around a scientific advance, whether polio or smallpox vaccines, penicillin or treatments for HIV or TB. Even the best health infrastructure cannot realize its true promise without the next generations of vaccines, diagnostics and therapeutics.

The U.S. has begun down the road of investing in such new technologies, and one of the most exciting is NIH’s co-investments in a universal flu vaccine, which according to the NIH could offer “long-lasting protection for all age groups from multiple influenza subtypes, including those that might cause a pandemic.” 

The U.S. has also made early investments in supporting next generation antibiotics needed to maintain our advantage over infectious pathogens despite increasing antimicrobial resistance. These and other efforts such as CEPI are under-funded relative to their importance to our nation’s and world’s security. 

2. Committing to ending existing pandemics of HIV, TB and malaria while increasing investments in pandemic preparedness and response. I was stationed in Zambia during the 2014-2015 West Africa Ebola outbreak, fighting existing diseases like HIV, TB and malaria while also preparing for Ebola.

It was in that setting that I witnessed the power of investing across these responses, from cross-training health workers, building community trust and involvement in public health responses, and sharing laboratory capacity and information systems.

To give a sense of the scale involved, the costs of pandemic preparedness are only $1-2 per person, globally, and along with funding to end AIDS, TB and malaria, are estimated to be less than one percent of the recent tax cut. And our recent paper found that these strategic investments in a coordinated global-pandemics initiative would likely return between $17 and $20 on every $1 spent. 

Our U.S. health system spends $10,739 per person per year and yet would be severely tested by a widespread infectious pandemic. How many of us would not want to see an additional few dollars per year committed to prevent or at least contain the next Ebola, Influenza or Zika outbreak?

3. Re-engaging in multi-lateral partnerships. No pandemic infectious disease response has ever been successfully conducted by a single country. Successes in polio eradication (including the recently announced eradication of one of the two remaining wild strains) highlight the importance of collaboration. Presidential candidates should commit to playing a leading role in bilateral and multi-lateral efforts, including greater support for the World Health Organization.

A global infectious pandemic is highly likely in the years to come. It is my hope that the opportunity to save humanity the trauma, loss of life and cost of a global pandemic will motivate presidential candidates to make bold proposals to invest what is needed to end the pandemics of today, and prevent devastating global pandemics in years to come.

Charles B. Holmes, M.D., MPH, is a faculty co-director at the Center for Global Health Practice and Impact and professor of medicine at Georgetown University.