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The Lancet: Can the Ebola outbreak rejuvenate global health security?

The Lancet

The west African Ebola epidemic has rekindled interest in global health security, but it has also highlighted a troubling lack of political commitment to public health, and it is far from clear whether the crisis will be enough to rejuvenate global health security, say leading global health experts writing in The Lancet.

Through a series of essays [1], the review, which is published as part of a special issue on global health security, explores different perspectives on the wider lessons that can be drawn from the outbreak, including how it has demonstrated the importance of securing individuals' access to health care as part of the pursuit of global health security.

The essays discuss whether the Ebola crisis is likely to increase political commitment to advancing health security and provide insight into the relevance to global health security of several issues, from counterfeit medicines and antimicrobial resistance, to armed conflict, natural disasters and migration.

"The Ebola epidemic has clearly illustrated the importance of protecting societies from infectious disease threats that spread across national borders," [2] says David Heymann, lead author of the Review, Head of the Centre on Global Health Security at Chatham House, and Professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, London, UK.

"Throughout history, the approach to threats like this has been to focus on rapid detection of outbreaks and rapid response -- this has been the commonly understood conceptualisation of health security for centuries. But the crisis has also highlighted a second, equally important but less-appreciated aspect of global health security -- ensuring personal access to health services and products around the world. This needs to be better recognised as part of the scope of global health security." [2]

One essay argues that, despite having been formerly catalytic in raising the prominence of global health in world affairs, global health security has suffered years of political neglect by countries, downgrading within WHO, and legal non-compliance in the decade preceding the west African Ebola outbreak. It also highlights how the Ebola crisis has exposed WHO's shortcomings and damaged its credibility.

Another essay discusses how the Ebola epidemic is only the most recent event to have exposed how ill-suited the medical research and development system is to tackle the world's health priorities, arguing that improving access to diagnostics, drugs, and vaccines cannot be left to market forces. Three-quarters of new medicines reaching the market provide no added therapeutic value, and the authors argue that too often promising leads which could address public health priorities are not pursued, and a system that prioritises development according to unmet health needs, rather than profit prospects, could play a key role in improving global health security.

Moreover, as the authors of another essay point out, with a quarter of medicines in low-income countries believed to be substandard or counterfeit, the global trade in fake medicines drastically undermines the capabilities of governments to curb both infectious and non-communicable diseases (NCDs), while eroding public confidence in governments and international institutions.

Just as noteworthy are the challenges that stem from the rising prevalence and soaring costs of NCDs, which increasingly undermine the ability of governments to implement universal health coverage (UHC). One essay argues that non-governmental organisations should lead efforts to improve the population's health by holding major corporations to account, in the same way that climate change activists have driven improved greenhouse gas emissions and climate change strategies for more than 3000 major corporations worldwide. [3]

While the international response to the Ebola outbreak has shown how much concerted global action can achieve, say the authors, only an increased commitment to improving individual access to affordable, safe and effective health services, products, and technologies -- the goal of universal health coverage -- can make health security a reality for all.

"The central message of this collection of short essays is that there is no simple definition of health security," write Lancet Editors Dr Pam Das and Richard Horton in a Comment linked to the review. "It means, variously, human security, the prevention and control of infectious diseases, attention to non-communicable diseases, revitalising research and development to produce global public goods, dealing with substandard and falsified drugs, considering conflict and disaster settings, addressing international migration, and building stronger health systems through universal health coverage. The complexity of global health security should not induce paralysis. But it should make us pause before we argue for quick solutions."

Writing in another review published as part of the special issue, Professor Lawrence Gostin and Professor Eric Friedman from O'Neill Institute for National and Global Health Law at Georgetown University Law Center, Washington, USA, say that the Ebola crisis provides a rare political opportunity for sweeping reforms. They propose a blueprint for a transformed global health system with robust, equitable national health systems at its core; an empowered WHO taking a more prominent leadership role, with member states doubling its budget to US$8 billion over 5 years to achieve this goal; and strong International Health Regulations that can hold member states to account.

"These reforms would not only keep populations secure against epidemic threats, but would also ensure that everyday health needs were met through universal health coverage," says Gostin. "If the WHO fails to lead an effective, well-funded, and coordinated response when the next epidemic strikes, it could have devastating consequences in rich and poor countries alike." [2]

Finally, in a Viewpoint paper accompanying the special issue, Dr Margaret Kruk from the Harvard T. H. Chan School of Public Health, Boston, USA, and colleagues, look at what can be learnt from the Ebola epidemic to make health systems more resilient, by being better prepared to withstand and respond to severe global health crises, minimise social and economic disruption, and recover more quickly.

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The special issue of The Lancet is accompanied by a new interactive infographic, which can be found at http://www.thelancet.com/infographics/global-health-security [Please do not share this link or make it otherwise publically available until the embargo has lifted].

NOTES TO EDITORS:

[1] For this paper, The Lancet invited a group of respected global health practitioners to reflect on lessons learned from the Ebola outbreak, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed, and the paper is split into ten essays, with titles and contributors as follows [page references refer to the full paper, available to journalists here: http://press.thelancet.com/globalhealthsecurity.pdf]:

The true scope of health security [page 1] - David L Heymann Ebola: lessons in human security [page 4] - Lincoln Chen, Keizo Takemi The Ebola outbreak and the future of global health security [page 5] - David P Fidler Global health security agenda: building resilientpublic health systems to stop infectious disease threats [page 6]- Jordan W Tappero, Mathew J Thomas, Thomas A Kenyon, Thomas R Frieden The effect of non-communicable diseases and population ageing on health security [page 8] - Derek Yach, Sania Nishtar, Alex Kalache Health security and rights in times of emerging health threats: towards a new way of doing essential health research and development [page 9] - Piero L Olliaro, Peter Horby, Els Torreele Substandard and falsified drugs: a threat to human and global security [page 10] - Lawrence O Gostin, Margareth Ndomondo-Sigonda, Daniel Carpenter Conflict, disaster, and health security [page 11] - Simon Rushton, Louis Lillywhite, Bhimsen Devkota

International migration and global health security: five lessons from the Ebola crisis [page 13] - Khalid Koser Universal health coverage and global health security [page 15] - Rob Yates, Ranu S Dhillon, Ravi P Rannan-Eliya [2] Quotes direct from authors and cannot be found in text of paper. [3] The Carbon Disclosure Project, founded in 2000, represents some 822 global institutional investors, with a combined asset base of more than US$95 trillion. As an independent not-for-profit organisation, CDP collects key climate change data from more than 3000 major corporations globally and has assembled the largest corporate greenhouse gas emissions database in the world https://www.cdp.net/en-US/Pages/HomePage.aspx

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