Thursday, May 25, 2017

World Bank: World Ill-Prepared For A Pandemic


During the middle of the last decade (2006-2008) there was a decided push for global pandemic preparedness as H5N1 bird flu loomed large in Asia and the Middle East. Here in the United States every state, and every federal agency, was tasked with developing a written plan.

But it wasn't just here in America. Around the world governments, agencies, and large businesses invested in preparedness.  A few examples (out of hundreds) include:
Hong Kong : Exercise Redwood - 2009
Pandemic Video Roundup - 2009
UK Exercise: PPE Usage In A Pandemic –2008
Singapore: Public Involvement In Financial Sector Pandemic Drill –2008
UK: Lessons Learned From Winter Willow – 2007

Then the preparedness movement was hit by a double whammy.  
  • First, the financial crisis of 2007-2008, which forced many private sector entities to put pandemic planning on the back burner. After all, it is hard for a company to justify worrying that the creek might rise when their business is already in flames. 
  • And second, the 2009 H1N1 pandemic.  One that - while bad - was less severe than originally feared.  This convinced some that the fears over H5N1 were over hyped, and placated others who felt we'd `had our pandemic', and another one wasn't likely for decades. 
In the wake of the 2009 pandemic, H5N1 - which had spread rapidly during 2005-2008 - had begun to pull back to a handful of countries (Egypt, Indonesia, China, Vietnam, etc.).   The number of reported human infections dropped from 115 in 2006, to 48 in 2010, to only 32 in 2012.

There were other threats emerging - like MERS-CoV on the Arabian Peninsula - and the occasional oddball viral discovery (see mBio: A Mammalian Adapted H3N8 In Seals, CDC: Bat Flu Q&A), along with the ever growing threat from antimicrobial resistant bacteria (see EID Journal: Extensively Drug Resistant NDM Bacteria In The Environment – Dhaka, 2012).
But outside of the corridors of major public health agencies like the CDC, WHO, OIE & FAO, and CHP, and the conference rooms of major think tanks like CIDRAPTFAH, The World Bank, and the UK Civil Threats Registry, the threat of a major pandemic  pretty much fell off the world's threat radar. 
That is, until 2014, when MERS flared in Saudi Arabia, Ebola erupted in West Africa, and a trio of new HPAI bird flu viruses (H5N8, H5N6, H7N9) - along with a revived H5N1 virus - began to wreak havoc around the globe.

Ebola infected at least 28,000 people, killing more than 11,000MERS in 2014 saw a 5-fold increase (n=960) over the previous year.  And 2014 saw 320 H7N9 cases in China, and an increase in H5N1 cases in Egypt prior to their record-setting 2015 outbreak.
Since then we've seen the spread and devastation from mosquito borne viruses like Zika, Chikungunya, Dengue and Yellow Fever, new genotypes of bird flu viruses emerging in both China and Europe, two major epizootics (2015 North America and 2016-17 Europe), this year's record H7N9 epidemic wave, and the emergence of new bacterial resistance (mcr-1) and even a new resistant fungal threat (C. auris).
Suddenly, the threat of a global pandemic seems far more imminent, and since then we've seen a rise in the number of cautionary reports. 

Are We Prepared to Help Low-Resource Populations Mitigate a Severe Pandemic?
Community Pandemic Mitigation's Primary Goal : Flattening The Curve
WHO: Candidate Vaccines For Pandemic Preparedness
The Blue Ribbon Study Panel Report on Biodefense
World Bank Poll: Majority Believe World Is Not Ready For A Pandemic

Today, we've a 131 page working paper from The World Bank, which warns that far too many nations have let pandemic preparedness slide, and that the world remains ill-prepared to face even a moderately severe pandemic.

Given its size, I've only had time to quickly peruse this document, but what I've seen looks promising.


After Ebola and Zika, Most Countries Still Not Prepared for a Pandemic 
May 25, 2017

New report outlines how to break the cycle of ‘panic and neglect’ and finance country-level pandemic preparedness

GENEVA, May 25, 2017 – Despite progress made since the Zika and Ebola crises, a report released today by the International Working Group on Financing Preparedness (IWG), established by the World Bank, shows that most countries are not adequately prepared for a pandemic, and the world is still doing too little to finance recommended actions to strengthen pandemic preparedness. 

The report, entitled From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level, lays out 12 recommendations to ensure the adequate financing of the capabilities and infrastructure required to prevent, identify, contain, and respond to infectious disease outbreaks. Many countries chronically underinvest in critical public health functions like disease surveillance, diagnostic laboratories, and emergency operations centers, which enable the early identification and containment of outbreaks. So far, 37 countries have completed the rigorous peer-reviewed assessments, called the Joint External Evaluation (JEE), of their preparedness capacities to identify their gaps and needs. But that leaves 162 countries that have not. Moreover, only two of the countries that have completed this assessment have used the results to devise costed plans. The report urges national governments to prioritize financing preparedness in their domestic budgets, as should international donors. 

Not investing enough in pandemic preparedness puts lives at risk and is bad economics. A severe pandemic could result in millions of deaths and cost trillions of dollars, and even smaller outbreaks can cost thousands of lives and cause immense economic damage. The most conservative estimates suggest that pandemics destroy 0.1 to 1.0 percent of global GDP, on par with other global threats such as climate change. Recent economic work suggests that the annual global cost of moderately severe to severe pandemics is roughly $570 billion, or 0.7 percent of global income.

(Continue . . . )

The abstract and link to the report:

From panic and neglect to investing in health security : financing pandemic preparedness at a national level (English)

Abstract Deadly infectious pandemics will mark humanity's future, as they have shaped its past. Neither individual governments nor the global community can entirely prevent the emergence of infectious threats. But we can be much better prepared.
This report by the International Working Group on Financing Preparedness (IWG) proposes ways in which national governments and development partners can finance investments in country and regional preparedness and response capacities for pandemics and other health emergencies. Preparedness for pandemics refers to health and non-health interventions, capabilities, and capacities at community, country, regional, and global levels. Their purpose is to prevent, detect, contain and respond to the spread of disease and other hazards, mitigating social disruptions and limiting risks to international travel and trade
  • 2017/05/01 15:05:01
  • Working Paper
  • 115271
  • 1
  • 1
  • World
  • The World Region
  • 2017/05/24 15:04:56
  • Disclosed
  • From panic and neglect to investing in health security : financing pandemic preparedness at a national level