Solving And Leading On Global Pandemics: Part Of The Commander In Chief Test

Global pandemics such as the Ebola crisis of 2014 are a question of “when” not “if,” and the United States and the world are not fully prepared. Failing to contain pandemics like Ebola will have massive implications for U.S. foreign policy, U.S. homeland security, global economic growth, and U.S legitimacy as a global leader. These were the big takeaways from the Global Pandemic Policy Summit held by the Scowcroft Institute at the George H.W. Bush School at Texas A&M from September 16-18.

If the last fifteen years are any guide, the next U.S. President will face at least one global pandemic disease outbreak. The world has looked to the United States to lead global coalitions to confront the spread of pandemics.  We need to be prepared to assume this role before the next global emergency.

The way in which the next president is perceived to manage a pandemic situations will have electoral consequences, as it did for President Obama in October of 2014. Ebola was the October surprise as the Obama Administration was perceived to be mishandling the crisis. The prospect of an outbreak generated significant fear but not a panic within the United States. Ultimately there were a total of four cases in the United States, and the fear of a domestic Ebola crisis dissipated. Ebola has a fatality rate of approximately 50 percent, and there were early projections done by the CDC in 2014 that estimated the spread of Ebola to reach as high as 1.4 million people. The total number worldwide infected was far less than that, and is currently estimated to be nearly 30,000and the number of fatalities to date has been 11,284 – of course a terrible tragedy.

The threat – both of Ebola and of looking unprepared – generated a bipartisan consensus, and the Ebola Emergency Response Act passed with unanimous consent. The Act provided $1.8 billion in aid and preventative measures on top of the President’s Emergency Appropriations Request for $4.64 billion for immediate needs and $1.54 billion in contingency funding.

Ebola Screening
Screening for Ebola at Chicago’s O’Hare Airport. Image used under Public Domain.

While the immediate risk of an Ebola pandemic may have passed, the chance of a global pandemics is increasing as new diseases emerge. With urbanization skyrocketing, the growing global middle class wants more protein in its diet. That means more chicken, dairy and beef – and more farmers exposed to animal-borne pathogens. In 2009 H1N1 was transmitted to humans from swine, MERS is associated with camels and unpasteurized camel milk, and H5N1 (Avian Flu) originated in poultry. Since 75% of emerging infectious disease that affect humans are of animal origin (“zoonotic” transmission), the threat to those in close contact with livestock is the greatest.

 The World Health Organization (WHO) is the go-to agency for global health crises. Unfortunately, the WHO has a structure and a culture that sets itself up for failure. Although the WHO has many competent technical people, these challenges leave many to conclude that the WHO is unprepared to act quickly or efficiently enough to handle a global outbreak. One of the shortcomings that hampers the WHO’s ability to react quickly to a pandemic disaster is its reporting system – the WHO relies on local governments to report outbreaks. When these outbreaks begin in rural areas without access to testing at high-tech laboratories, as is often the case, the WHO system breaks down before it begins, leaving developing countries unaware of the pandemic growing within their borders. The United States is in the process of setting up a separate U.S. funded and run early warning system for outbreaks just as the United States funds and manages an early warning famine system in many developing countries.

The WHO issued a review of its response to Ebola, concluding that the world is unprepared to handle a severe influenza pandemic or any “similarly global, sustained and threatening public-health emergency.” In order to overcome this unpreparedness, the WHO and other global health and emergency response organizations must prioritize interoperability and communication. Decisions in reaction to a global pandemic must happen quickly.

The U.S. interagency system also had troubles responding to the international Ebola crisis. The Office of Foreign Disaster Assistance (OFDA), which took the lead on emergencies such as the 2004 tsunami and the 2010 Haitian earthquake, has had limited engagement with the U.S. Government agencies responsible for global health, including the Center for Disease Control (CDC). OFDA has strong and long term ties to the Department of Defense with established protocols. It should seek to replicate that relationship with agencies like CDC in preparation for a future pandemic outbreak.

In a domestic context, the Ebola crisis revealed that U.S. emergency laws do not offer an effective response in the case of a major pandemic outbreak. Pandemics demand an even higher level of capability and capacity than an earthquake or a major storm. One suggestion was that there was a need for a “state of infectious disease emergency” legal framework that would offer the government different sorts of powers than available under a normal state of emergency. There are a host of difficult unanswered questions that local governments must confront in the event of a pandemic outbreak such as:

  • Who is in charge? The local or federal government?
  • Who will take care of the families affected by the outbreak? Where will they live if they have to evacuate an infected home or apartment?
  • How do hospitals deal with infected waste? How do families of diseased persons deal with it?

The United States has made some progress in the last twenty years. Concerns about pandemics and bioterrorism skyrocketed starting with the mid 1990s Aum Shinrikyo attack in Tokyo. September 11th and the anthrax attacks increased the attention to the issue within the United States. There were supplemental requests for funding in 2005, 2006, and in 2014 to confront pandemics. The $7.1 billion request in 2005 and the additional $3.8 billion in 2006 were used for accelerating research on vaccines, the creation of new vaccines, preparation and strengthening basic public health countermeasures.

 As part of the summit at the Bush School, the participants visited one of the Centers of Innovation in Advanced Development and Manufacturing, set up through U.S. Government funding. One of the three CIADM facilities is housed at Texas A&M due to A&M’s deep strengths in agriculture, veterinary sciences, and its growing life sciences corridor. These three facilities will give the United States a massive surge capacity, producing hundreds of millions of flu vaccines within four months to cover the needs of the United States in the event of a super flu. The facilities in theory could also be used to “pivot” to producing a vaccine for some other pandemic threat such as another Ebola outbreak. Before the development of these facilities, the United States did not have that kind of vaccine production capacity. It is unclear if any other country has this capability.

A final thought: during the Ebola outbreak, as the numbers of infected shot up in West Africa, the U.S. government developed Ebola scenarios that contemplated different levels of infectiousness and lethality. The scenarios were ranked from 1 through 4. There was a 5th level which the planners were told to leave out of planning documents because it projected a) 1918 flu levels of death – which infected a quarter of the American population and killed roughly 50 million people worldwide – or b) a scenario where Ebola “went airborne” (a possibility as it mutates) rather than being transmitted through bodily fluids. This level 5 scenario was dismissed because it was deemed “too terrible to consider.”  In order to be prepared for future pandemics, we are going to have to consider and plan for scenarios that are “too terrible to consider.”

Article Published in Forbes.com on September 24, 2015.

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