Panel
After Ebola and Zika: Preparing for the Next Pandemic
Milken InstituteCristina Alesci, Anthony Banbury, Dara Erck, Raul Ruiz, Rajeev Venkayya, Michelle, Aaron Bedtru, Susanna Amos, John Thomas
- The global community faces a high probability of future pandemics originating in resource-poor settings lacking infrastructure, with uncontained outbreaks like Ebola potentially infecting 1.4 million people within three months.
- By 2050, the world may encounter a "pre-penicillin" scenario where common infections become fatal due to antibiotic resistance, driven by bacterial mutations and the need to halt routine antibiotic use in beef markets.
- Vector-borne diseases are projected to spread rapidly due to climate change and mosquito migration, including the Zika virus expanding across the United States during summer months, posing specific risks to pregnant women for fetal microcephaly and individuals bitten by infected mosquitoes for Guillain-Barré syndrome.
- A "huge funding gap" of approximately $250 million annually exists for tuberculosis vaccine development, while a specific request of $1.9 billion is needed for the U.S. President to combat Zika, requiring fast Congressional action.
- Innovative financing vehicles, such as "disaster risk insurance" and "pandemic insurance policies," are expected to be pursued by the World Bank and governments using actuarial triggers, potentially including a "percent of people infected" metric or a WHO Public Health Emergency of International Concern declaration.
- The Coalition for Epidemic Preparedness is expected to produce concrete recommendations on R&D, structure, and financing by the next World Economic Forum, while the G20 meeting in Germany is seen as essential for U.S. leadership in establishing future capabilities.
- Without "push incentives," "co-funding," or "risk-sharing" mechanisms from governments or foundations like the Gates Foundation, pharmaceutical companies are unlikely to invest in low-probability, high-consequence pandemic preparations due to unappealing economics.
- Current global response capabilities are deemed insufficient, with the WHO functioning primarily as a normative policy-setter rather than an operational entity, necessitating a new mechanism to determine leadership and avoiding the creation of "purpose-built" structures during crises.
- Countries may hesitate to report outbreaks within the required 24 hours due to economic and political risks related to tourism and border closures, potentially delaying funding triggers for insurance models.
- Limited global resources and production capacity pose a risk of inequitable vaccine access, where only populations that can afford them receive supplies, necessitating a "reserve of affordable vaccine" available from the first doses off the line rather than at the pandemic's end.
- Successful deployment requires close involvement of local communities and partners, particularly in regions like South Africa, and the use of mobile devices to track vaccine distribution and prevent diversion.
- Future responses require standard, pre-established mechanisms and coordination between European or American regulators and WHO pre-qualification to ensure international acceptance, while avoiding the perception of experimenting on vulnerable populations.
- Policymakers are urged to view pandemic threats through a security context to prioritize action, though this must not absolve the moral obligation to care for populations in West Africa, Asia, and other developing nations.
- Political leadership at a "Davos-level" and strong U.S. Congressional leadership are expected to be essential to prevent partisan delays and ensure funding, as global responses risk being solved by a few countries if the U.S. cannot secure domestic support.
- Diagnostic tools must be funded upfront to identify and count infections, as underdeveloped communities currently lack the infrastructure to identify pathogens, and low-cost community healthcare worker investments could have prevented past spread.
- The medical community and policymakers must implement the "responsible use of antibiotics" to prevent resistance expansion, while the global community must maintain a level head in crises to avoid undermining confidence in the medical community through unverified therapies.
- Global financing systems must be international and global to avoid partisan politics, with private markets and insurance companies diversifying risk to ensure low financial exposure while mobilizing funds when threats materialize.
- Companies must be guided by global risk assessments from the WHO to allocate capital among competing priorities, focusing on high-consequence threats like hemorrhagic fever viruses, coronaviruses, and vector-borne diseases, unless external investment removes the need to factor in economic return.
- Misperceptions that diseases "never happened" if not on the news, or "draconian" reactions by pockets of leadership not based on objective risk assessments, are significant risks to international cooperation and effective response.
- Military readiness and economic interests, including investments and infrastructure developments, are at risk if pandemic threats are not addressed as national security threats, with travel posing a direct threat to national security due to global connectivity.