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Global Structure Needed on Infectious Diseases

By Harvey Rubin and Nicholas Saidel. We can no longer qualify certain threats as problems “over there.” Local phenomena can create consequences that involve the entire world. Nowhere is this better illustrated than in the control of infectious disease.

In response to the death of almost 1,000 people in West Africa caused by the Ebola virus, the World Health Organization announced an “international public health emergency.” This declaration came days after two American medical workers were flown home from Liberia for treatment after being infected by this highly lethal virus. While governments and other stakeholders scramble to coordinate an effective response to this growing threat, the question is justly raised: Why is there no overarching global structure coordinating efforts to prevent and mitigate the damage from infectious diseases?

Global infectious disease control is currently a disjointed, incoherent effort riddled with gaps and inconsistencies that limit our ability to meet challenges optimally. The inadequacy of the system is borne out by facts: About 20 percent of annual deaths worldwide are caused by infectious disease, a percentage that rises substantially when focusing on the developing world. Almost three million people die every year from vaccine-preventable deaths, many of them children. In the United States this year, there have been three separate instances in which pathogens – anthrax, smallpox, and H5N1 (bird flu) – were either incorrectly inactivated, handled, or stored, potentially posing a danger to the American public. Such alarming information means we can no longer wait for some catastrophic catalyst to mobilize us into action.

We have proposed in a number of international venues that a Global Governance Structure for Infectious Disease (GGSID) be established based on the need to:

  • Collect, analyze, and share infectious disease information in real time on an interoperable platform;
  • Identify funding mechanisms to encourage private-sector innovation to develop and distribute affordable antimicrobial therapeutics, vaccines, and diagnostics to the poorest nations as well as to the developed world;
  • Establish and integrate a network of international basic science and translational research centers that will support fundamental investigations into the pathophysiology of certain microbial threats;
  • Harmonize, monitor, and anticipate changes in international standards for the best laboratory, regulatory, and ethical practices.

These four components would fall under a judicial forum through which stakeholders would seek advisory opinions or bring disputes for adjudication.

The GGSID would also operate under a governing principle of “common but differentiated responsibility.” This principle acknowledges that while all participants have a common responsibility to infectious disease control as a public good, they do not have the same capability. Therefore, involvement and incentives within the structure would vary.

One model for vaccination distribution is our Energize the Chain (EtC) project, which was reported in the New Scientist in 2012. The project tackles the supply-chain issue regarding vaccination spoilage in rural areas where there is little to no electricity.

Vaccines need to be kept within a certain narrow range of temperatures in order to be effective. In the most remote areas of the world, where energy sources are scarce, proper refrigeration of vaccines is nearly or entirely impossible. The result is that entire villages of children do not receive their proper immunizations and are consequently highly susceptible to vaccine-preventable deaths.

EtC’s solution is a partnership between the ministries of health in these regions and the private mobile-phone industry. In many instances, we directly access the electricity upon which these mobile-phone towers rely to power the vaccine refrigeration systems and use the connectivity of the towers to monitor in real time the temperature and operation of the refrigeration systems.

EtC has partnered with Econet Wireless in Zimbabwe to use energy generators at mobile-phone tower sites and other remote, off-grid locations to power vaccine refrigerators, thus preserving the vaccine cold chain and enabling local health workers to deliver vaccines to underserved populations.

The need for a GGSID is manifestly clear. Some countries have incentives to underreport outbreaks, whereas others simply do not have the ability to report accurately. The current system does not properly incentivize the private sector to invest in the development of vaccines that would only serve a small population. It is simply not profitable. The GGSID addresses both the underreporting and the lack-of-market issues through creative incentive frameworks, as well as through international research centers that would be dedicated to finding cures for scourges like Ebola.

The proposed GGSID needs to be presented for comment and eventual endorsement by international groups, including but not limited to the Organisation for Economic Co-operation and Development, the G20, the United Nations, and the World Economic Forum. Following these presentations, formal submission to specific countries will be undertaken.

The time is ripe for the establishment of a GGSID. We must marshal our forces now, before we return to the perilous state of complacency exhibited prior to these numerous wake-up calls.

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