Three years after news of the first cases of Covid-19 infections and deaths began to appear, the global response to pandemics remains in a sluggish, reactive mode, waiting until dire threats emerge before initiating action. Take the latest Ebola outbreak in central Uganda. It’s been more than a month since the last case has been found, and a two-month lockdown of two districts west of the capital, Kampala, ended in mid-December. After containing the outbreak to “only” 55 deaths, everyone is ready to move on — without planning for the future.
The threat of this outbreak almost restarted efforts to test a new vaccine for the strain of Ebola that generated these infections. The work had previously been abandoned due to lack of financing, profit, and political will. The outbreak ignited a spark of hope, but it looks to have subsided before the vaccine trials could be implemented.
We are in an age of epidemics and pandemics. Ebola was the latest in the wave of global contagions seen in the first decades of the 21st century, which Covid-19 has put an exclamation point on. Since SARS emerged in Asia in 2002, there have been outbreaks of swine flu, Middle East respiratory syndrome (MERS), mpox, Zika, and several bursts of Ebola. Some of these have come and gone, but others are entrenched, like the ongoing seventh cholera pandemic, which started in 1961, and the continuing HIV/AIDS pandemic, which began 20 years later.
With the ease of global travel today, the growth of cities, deforestation, and the impacts of climate change, the risk of infectious disease outbreaks is increasing with no end in sight.
I see four gaps in the global response to Covid-19 — diagnostics, vaccine supply, vaccination, and leadership — that highlight the international community’s failures. The first three are straightforward technical and funding propositions; the gap in pandemic leadership is at once the broadest and most intractable.
The first gap is in diagnostics. If you don’t know who has a disease or how many people have it, then no one is motivated to take preventive measures or use a vaccine, especially not in the face of global misinformation campaigns. The U.S.’s response to Covid-19 is a perfect example: experts agree that the government’s caseload numbers underestimate the full impact of the virus and so, as a new variant begins to take hold, there is no urgency to get the latest booster — only 15% of Americans have received the latest booster.
The second gap is manufacturing capacity. If a country is not manufacturing its own vaccines and is dependent on other countries for them, it may not be able to secure enough vaccine to quash an outbreak. This happened with Covid-19, as some wealthy countries procured more doses than they actually needed, leaving less-fortunate countries without them. Manufacturing is concentrated in the U.S., Europe, India, and China, with vaccine nationalism laws allowing the country of manufacture to appropriate vaccines intended for other countries.
The third gap is vaccination. Even if the first two gaps are fixed, but the solutions do not reach large parts of the world, then nothing has really been fixed. This is a deeper and more inherent problem, involving weak health systems, complex logistics, and vaccine hesitancy.
The fourth gap, leadership, is the biggest one that must be bridged. In the World Health Organization’s global COVAX scheme, the Coalition for Epidemic Preparedness Innovations develops vaccines, Gavi purchases them, and the WHO is responsible for tracking disease and coordinating response. No one entity is accountable for results. And there is no agency with the political muscle, funding, agility, and experience to implement at pandemic speed — or to ensure that the world is prepared for whatever comes next.
Covid-19 was the first disease for which humanity attempted to vaccinate everyone, everywhere, all at once: not just the 130 million children born each year but all 8 billion people on Earth. Today, more than 13 billion doses of Covid-19 vaccines have been delivered. And while the percentage of people who have received at least one dose is significant — slightly more than two-thirds — the rates in low-income countries are stuck at around 20%.
The world needs leadership that can enforce a more equitable and timely distribution of vaccines or, at the very least, ensure that all doses are used before their expiration dates. Infectious diseases do not respect national borders. COVAX is being phased out, but the role it should have played remains unfilled.
To survive a new century of contagions, the world needs a Global Health Security Council, a public-private partnership empowered, funded, and accountable to ensure global pandemic preparedness and response. Akin to the United Nations’ Security Council, but without obstructing veto power, it could direct an expandable secretariat to create and empower a Pandemic Response Task Force as needed. In the absence of a pandemic, the organization would plan exercises and training specific to anticipated requirements.
It would need to be placed within an organization that would allow countries, philanthropies, and nongovernmental organizations to have a place at the table. This stakeholders’ council would need to address the inequities — in diagnostics, research and development funding, vaccine manufacturing, vaccine supply, and vaccination — that hobbled global efforts during the Covid-19 pandemic.
The question isn’t whether this can be figured out before the next global contagion arrives. Instead, the question is: How many contagions will it take before the world finally stops tolerating preventable deaths on a massive scale?
Jerome H. Kim is an infectious diseases physician, the director general of the International Vaccine Institute, and a visiting distinguished professor at the College of Natural Sciences at Seoul National University in South Korea.
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