An Ounce of Prevention is Worth a Pound of Cure
As Congress aims to finalize FY 2020 appropriations and as the FY 2021 budget process begins, it should consider new and strengthened investments in global health security to protect the U.S. public from the most pressing health security threats. A global pandemic could have vast human and economic costs. Yet with small, strategic investments in critical areas, we can prepare ourselves for the inevitable.
Today, a series of social and environmental forces are converging to increase the likelihood of a deadly global health security emergency. Population growth, urbanization, and the mass movement of populations are forcing more people into overcrowded and unsanitary living conditions, creating ideal conditions for the emergence and spread of infectious diseases. Deforestation is fueling an increase in animal-human interaction, exposing more people to new pathogens. The rise in global temperatures allows disease vectors like mosquitoes and ticks to thrive over greater geographic areas. It is also driving increased rainfall and surface runoff, which facilitate the spread of water-borne diseases like diarrhea and cholera. These environmental changes can displace human populations, and the resulting migration can contribute to disease spread.
Globalization and the rise of international trade and travel mean that an outbreak in a disordered setting with a weak health system can quickly become a pandemic, threatening the United States and the rest of the world. The 2014-2016 Ebola outbreak in West Africa is a stark reminder of this reality. The outbreak overwhelmed the health systems in Guinea, Sierra Leone, and Liberia, killing more than 11,300 people and ultimately spreading to 7 additional countries. A handful of cases in the United States spurred national panic.
Beyond the devastating loss of human lives, the West Africa Ebola outbreak had enormous social and economic costs, with global repercussions. The U.S. government spent nearly $2.4 billion in emergency funding to support the international Ebola response. A recent study estimates that the outbreak ultimately cost the global economy more than $53 billion, an average of more than $1.8 million per Ebola case. Other recent outbreaks have proven even more costly. The MERS outbreak in South Korea in 2015, a mere 186 cases, cost South Korea $10-13 billion—more than $50 million per case.
Despite the havoc these outbreaks wrought on families, communities, and economies, neither the SARS outbreak nor the Ebola outbreak was historic in its scale and severity. The 1918 flu pandemic, by comparison, spread worldwide and left over 50 million people dead, inflicting more casualties than World War I. There is broad consensus in the scientific and policy communities that pandemic influenza is the most severe health security threat we currently face. The random mutation or combination of influenza viruses could cause an unanticipated influenza pandemic, resulting in devastating human and economic consequences if we are caught unprepared. Recent studies have shown that an influenza pandemic akin to the 1918 flu pandemic could cause $80 billion in annual economic losses and $490 billion in annual costs tied to illnesses and premature deaths, for a total of $570 billion per year.
The good news is that it is remarkably cost-effective to invest in preparedness, and we know what works. The cost of baseline preparedness is estimated at about $1.00 per person per year—and building and sustaining preparedness need not be an open-ended donor commitment. Countries are capable of transitioning to self-reliance with the correct incentives and support.
The Global Health Security Agenda (GHSA), launched in 2016, is a multilateral partnership of more than 65 nations, international organizations, and nongovernmental stakeholders to help build countries’ preparedness capacities. The $1 billion that the U.S. government has committed to the GHSA (FY 2015-FY 2019) has gone a long way in helping countries to prevent and stem the spread of infectious disease outbreaks. As of July 2019, 100 countries have completed Joint External Evaluations (JEEs), country-led, voluntary, multisectoral assessments of a country’s health security capabilities. Of these, more than 50 have developed National Action Plans designed to address the gaps identified in the JEE.
Several U.S.-assisted GHSA countries have experienced infectious disease outbreaks in recent years, and the improved health system and preparedness capacities built with the help of the GHSA and its partners proved critical in their responses. In October 2017, a U.S.-assisted laboratory confirmed a positive case of Marburg virus in eastern Uganda. Marburg is a severe and highly fatal virus in the same family as Ebola, and its pandemic potential is widely feared. This laboratory confirmation proved the first critical step in a rapid and effective Uganda-led response. While three confirmed cases died, a rapid response team deployed by the Uganda Ministry of Health and staffed in part by U.S.-supported Field Epidemiology Training Program (FETP) graduates was able to halt the spread of the virus through effective contact tracing and community education.
The investment case for global health security and pandemic preparedness is clear. In the coming weeks, the CSIS Commission for Strengthening America’s Health Security will release a proposed U.S. doctrine for global health security. The report contains a package of cost-effective, bipartisan recommendations to ensure continuous prevention, protection, and resilience against today’s most pressing health security threats. The Commission urges Congress to consider this proposal as it finalizes FY 2020 appropriations and begins the FY 2021 budget process.
In total, the Commission report proposes investments of $905 million above current funding levels. It is important to note that this recommended investment includes about $500 million of one-time initial investments in contingency funds to be maintained with smaller annual replenishments in subsequent years. For comparison, the U.S. Department of Defense FY 2019 enacted budget was $685 billion. Total U.S. global health funding in FY 2019 was $11 billion. The proposed investments comprise a fraction of current spending and would have a significant impact in critical areas such as strengthening the speed of outbreak response, building resilient health systems abroad, enhancing our ability to operate in disordered settings, and accelerating technological innovations to secure the future.
By supporting the Commission’s recommendations, Congress would be continuing a long history of bipartisan support for global health security. While the current administration has targeted foreign assistance and global health spending, Congress has consistently rejected proposed cuts and put forward new global health security legislation on a bipartisan basis. The Pandemic and All-Hazards Preparedness and Innovation Act, signed into law by President Trump in June 2019, strengthens the U.S. government’s ability to prepare for and respond to a range of public health threats. The proposed bipartisan Global Health Security Act would affirm the U.S. government’s commitment to global health security and codify its approach. Further proposed legislation addresses the ongoing Ebola outbreak in the Democratic Republic of the Congo, vaccine hesitancy, antimicrobial resistance, and development of a universal flu vaccine.
Over the past decade, the executive branch has also shown strong leadership on global health security, from the Obama administration’s support of the launch of the GHSA to the Trump administration’s issuance of an updated National Biodefense Strategy and new Global Health Security Strategy.
Despite this considerable progress in policy formulation, there are still critical gaps in global health security preparedness, and the threat of a deadly pandemic is growing.
Congress should build upon the stable bipartisan consensus and commit to consistent, strengthened, strategic investments in global health security to ensure continuous prevention, protection, and resilience against health security threats. We can afford to invest in global health security—and simply cannot afford not to.
Anna Carroll is an associate fellow with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Samantha Stroman is a program coordinator and research assistant with the CSIS Global Health Policy Center.
Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
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