Infectious disease outbreaks that turn into epidemics or pandemics can kill millions of people and cause trillions of dollars of damage to economic activity, says a new report from the international, independent Commission on a Global Health Risk Framework for the Future. Few other risks pose such a threat to human lives, and few other events can damage the economy so much. The Commission estimated the global expected economic loss from potential pandemics could average more than $60 billion per year. Yet, nations devote a fraction of the resources to preparing, preventing, or responding infectious disease crises as they do to strengthening national security or avoiding financial crises.

Ebola Virus Disease
SEM revealed some of the ultrastructural morphologic features displayed by the Ebola virus/CDC

The Commission recommended an investment of approximately $4.5 billion per year – which equates to 65 cents per person – to enhance prevention, detection, and preparedness. The biggest component of this investment is to upgrade public health infrastructure and capabilities for low- and middle-income-countries, which is estimated to cost up to $3.4 billion per year. The second biggest component of the $4.5 billion figure is $1 billion per year to fund accelerated research and development in a wide range of medical products. The balance relates to financing the strengthening of the World Health Organization’s (WHO) capabilities and funding WHO and World Bank contingency funds.

“We have neglected this dimension of global security,” said Commission chair Peter Sands, former group chief executive officer, Standard Chartered PLC in London, and senior fellow, Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy school in Cambridge, Mass. “Pandemics don’t respect national boundaries, so we have a common interest in strengthening our defenses against infectious diseases in every part of the world. Preventing and preparing for potentially catastrophic pandemics is far more effective – and ultimately, far less expensive – than reacting to them when they occur, which they will.”

For example, in the past 15 years, the world faced several infectious disease crises, including Ebola, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), and the influenza virus known as H1N1.The Commission’s own estimates suggest that at least one pandemic will emerge over the next 100 years, with a 20 percent chance of seeing four or more.

To protect against these threats, the top priority must be to reinforce the first line of defense against potential pandemics, public health capabilities, and infrastructure at a national level, even in failed or fragile states, because regional or global capabilities cannot compensate for deficiencies at a national or local level. This requires governments to prioritize investment in their health systems, as part of their fundamental duty to protect their people, the report says. It also requires effective engagement of communities, given the vital role they play in outbreak detection and response. Countries like Uganda have demonstrated that even where resources are scarce, it is possible to strengthen health systems and contain infectious disease outbreaks.

The Commission recommended that WHO lead the development of a definition and benchmarks for core public health capabilities and functions by the end of 2016. WHO should also establish an independent, objective, and transparent mechanism to evaluate country performance against these benchmarks and publish the results. This will enable governments to monitor their own progress, civil society to hold their governments accountable, and financial markets to assess economic vulnerability to infectious disease risk. The Commission emphasized the importance of all countries agreeing to participate in this assessment process and proposes incentives to encourage this, including making World Bank support for strengthening health systems conditional on participation. The Commission also recommended that the International Monetary Fund include pandemic preparedness in its country economic and policy assessments.

The Commission said stronger international coordination and response mechanisms are also essential, given the significant shortcoming revealed during the Ebola outbreak. The Commission concluded WHO must take the lead in the international system to identify, prevent, and respond to potential pandemics, but to play this role effectively, it must make significant changes. By the end of 2016, WHO should create a Center for Health Emergency Preparedness and Response, under the oversight of an independent Technical Governing Board. The Center should be funded through an increase in WHO core contributions from member states. In addition, the Commission called for the United Nations and WHO to establish mechanisms for coordination and escalation for health crises and for WHO to enhance means for cooperation with non-state actors. WHO should also generate a high-priority watch list of outbreaks that have the potential to become international public health emergencies, which should be shared daily with national authorities and made public on a weekly basis. The Commission supported the proposals for WHO’s $100 million Contingency Fund for Emergencies and the World Bank’s $1 billion Pandemic Emergency Financing Facility.

Accelerating research and development across a wide range of medical products – including vaccines, therapeutics, diagnostic tools, personal protective equipment, and instruments – is also vital, the Commission argued. To ensure more effective prioritization and coordination of such efforts, WHO should establish an independent Pandemic Product Development Committee comprised of leading research and development experts from across the world to oversee mobilization and deployment of resources. Furthermore, the Commission believed additional investment in research and development should be made this arena. To accelerate deployment of new products, the Commission also recommended significant work on harmonizing clinical protocols and approvals processes.

“This bold report is independent, forward-looking, comprehensive, and timely,” said Victor J. Dzau, president of the U.S. National Academy of Medicine, which provided leadership and guidance for the study. “It highlights pandemics as a threat to global security, recommends important changes in global health governance, and addresses essential issues in financing, public health, and R&D. Importantly, it boldly assigns dollar figures and timelines to its recommendations. I believe this report is exactly what is needed to drive progress in this critical issue of global health and security.”

The Commission on a Global Health Risk Framework for the Future – comprising 17 members from different countries and various areas of expertise – is funded by the Paul G. Allen Family Foundation, Ford Foundation, Bill & Melinda Gates Foundation, Mr. Ming Wai Lau, Gordon and Betty Moore Foundation, Rockefeller Foundation, United States Agency for International Development, and Wellcome Trust. The report is a product of the independent Commission and not of the U.S. National Academy of Medicine (NAM), which provided only expertise and project management as secretariat for the study. The Commission’s process was guided by an International Oversight Group, which determined the scope of the study, addressed conflict-of-interest concerns, and informed the peer-review process.