Wednesday, September 18, 2019

WHO/World Bank GPMB Pandemic Report : `A World At Risk'

Scheduled airline traffic around the world, circa June 2009 – Credit Wikipedia


Just over a year ago the World Health Organization announced the Global Preparedness Monitoring Board convenes for the first time in GenevaThey described the fledgling GPMB as: `. . . .a new body set up to monitor the world’s readiness to respond to outbreaks and other health emergencies.'
Fast-forward 12 months and the GPMB has released their first major report and threat assessment on the next great pandemic.
It will come as no surprise that they believe the threat is very real, and world remains ill-prepared to deal with a severe pandemic. First the download links to the main report and the Executive Summary (available in 6 languages).

I'll have a postscript when you return.

Annual Report
From the foreword by Co-Chairs H.E. Dr Gro Harlem Brundtland and Mr Elhadj As Sy: “For its first report, the Global Preparedness Monitoring Board reviewed recommendations from previous high-level panels and commissions following the 2009 H1N1 influenza pandemic and the 2014-2016 Ebola outbreak, along with its own commissioned reports and other data. The result is a snapshot of where the world stands in its ability to prevent and contain a global health threat. Many of the recommendations reviewed were poorly implemented, or not implemented at all, and serious gaps persist. For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act.” 
  1. 1. Heads of government must commit and invest. Heads of government in every country must commit to preparedness by implementing their binding obligations under the International Health Regulations (IHR (2005). They must prioritize and dedicate domestic resources and recurrent spending for preparedness as an integral part of national and global security, universal health coverage and the Sustainable Development Goals (SDG).
  2. 2. Countries and regional organizations must lead by example. G7, G20 and G77 Member States, and regional intergovernmental organizations must follow through on their political and funding commitments for preparedness and agree to routinely monitor progress during their annual meetings.
  3. 3. All countries must build strong systems.Heads of government must appoint a national high-level coordinator with authority and political accountability to lead whole-of-government and whole-of-society approaches, and routinely conduct multisectoral simulation exercises to establish and maintain effective preparedness. They must prioritize community involvement in all preparedness efforts, building trust and engaging multiple stakeholders (e.g. legislators; representatives of the human and animal health, security and foreign affairs sectors; the private sector; local leaders; and women and youth).
  4. 4. Countries, donors and multilateral institutions must be prepared for the worst. A rapidly spreading pandemic due to a lethal respiratory pathogen (whether naturally emergent or accidentally or deliberately released) poses additional preparedness requirements. Donors and multilateral institutions must ensure adequate investment in developing innovative vaccines and therapeutics, surge manufacturing capacity, broad-spectrum antivirals and appropriate non-pharmaceutical interventions. All countries must develop a system for immediately sharing genome sequences of any new pathogen for public health purposes along with the means to share limited medical countermeasures across countries.
  5. 5. Financing institutions must link preparedness with economic risk planning. To mitigate the severe economic impacts of a national or regional epidemic and/or a global pandemic, the International Monetary Fund (IMF) and the World Bank must urgently renew their efforts to integrate preparedness into economic risk and institutional assessments, including the IMF’s next cycle of Article IV consultations with countries and the World Bank’s next Systematic Country Diagnostics for International Development Association (IDA) credits and grants. Funding replenishments of the IDA, Global Fund to Fight AIDS, TB and Malaria (Global Fund), and Gavi should include explicit commitments regarding preparedness.
  6. 6. Development assistance funders must create incentives and increase funding for preparedness.Donors, international financing institutions, global funds and philanthropies must increase funding for the poorest and most vulnerable countries through development assistance for health and greater/earlier access to the United Nations Central Emergency Response Fund to close financing gaps for their national actions plans for health security as a joint responsibility and a global public good. Member states need to agree to an increase in WHO contributions for the financing of preparedness and response activities and must sustainably fund the WHO Contingency Fund for Emergencies, including the establishment of a replenishment scheme using funding from the revised World Bank Pandemic Emergency Financing Facility.
  7. 7. The United Nations must strengthen coordination mechanisms. The Secretary General of the United Nations, with WHO and United Nations Office for the Coordination of Humanitarian Affairs (OCHA), must strengthen coordination in different country, health and humanitarian emergency contexts, by ensuring clear United Nations systemwide roles and responsibilities; rapidly resetting preparedness and response strategies during health emergencies; and, enhancing United Nations system leadership for preparedness, including through routine simulation exercises. WHO should introduce an approach to mobilize the wider national, regional and international community at earlier stages of an outbreak, prior to a declaration of an IHR (2005) Public Health Emergency of International Concern. 
After nearly 15 years writing this blog, I've learned there are basically two types of people in the world; those who continue to warn that the next pandemic is inevitable, and those who don't want to hear it.  
And the former is considerably outnumbered by the latter. 
About once a year we see a grave pandemic warning (see WHO: On The Inevitability Of The Next Pandemic and World Bank: The World Ill-Prepared For A Pandemic) and a call for action. 
Followed by the sound of crickets. 
Nearly 15 years after agreeing to the revised 2005 IHR regulations - where WHO member countries pledged to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events in a timely manner - fewer than half the countries of the world self-report having met the core requirements.

But even among those who have - timely and complete reporting continues to be problematic for a variety of political, economic, and societal reasons.

Most humans like to believe that today will be pretty much like yesterday, and tomorrow will be pretty much like today.  That big changes only come over time, not overnight, and there will always be time to prepare.

While it may take 50 years for climate change to kill us, or 30 years before our machine overlords decide to enslave us, a deadly respiratory virus could radically change our world in a matter of days or weeks. 
The 1918 pandemic spread around the globe in a few months, without the availability of air travel. The reality of life in the 21st century is that a new respiratory virus could spread globally in a matter of days.
We continue to ignore that reality at our considerable peril.