The writer is a professor of global health at the University of Toronto
The coronavirus outbreak is on the verge of becoming an official pandemic. Since December, the disease known as Covid-19 has spread from China to infect more than 81,000 people in more than 40 countries, killing more than 2,700 people.
No country alone can cope with rapidly spreading pandemics; we need to develop a global response. Timely access to data is vital. The local government in Wuhan probably missed a window to shut down this outbreak by failing to act in early December, after detecting a cluster of lung infections among workers from one market.
Singapore provides exemplary reporting on the transmission details of each case. However, similar data from China are not yet available. Canada fell short in initial reporting during the 2003 Sars epidemic but has substantially revamped its data systems.
To address this issue, the world should consider establishing a global surveillance facility, modelled after the hugely successful Gavi, the vaccine alliance. Such a facility, based in the World Health Organization but with independent accountability, would provide countries with funding and technical assistance during outbreaks. It would help to build resilient systems before epidemics strike. If the world’s largest economies collectively contributed $2bn a year, that would allow us not just to build the fire station and pay firefighters but also to prevent fires.
Countries are, in theory, supposed to report outbreaks to WHO through the International Health Regulations. While the IHR is a legal obligation, political incentives or fear of economic disruption means timely reporting doesn’t always occur.
Public health systems can learn lessons from the global financial sector, which has appropriated epidemiological terms such as contagion or surveillance. In the 1960s, the IMF made its lending contingent on national income accounts. It invested heavily in helping countries improve their data allowing it to track financial flows. Bank regulators now stress test banks, and a new epidemics body could use the IHR to test whether countries can provide complete, quick and transparent reporting.
The World Bank has a specialised agency to sell political risk insurance to companies. A similar system could provide no-fault epidemic insurance to responsible countries with strong and open health data systems. That would provide incentives to report data, instead of hiding it. Increasing the size of the World Bank’s pandemic bonds and linking them to improved data gathering could play a role.
Tackling the dramatic means fixing the routine. Only 3 per cent of the world’s children who died in 2010 had a proper medical certificate of death. The new global surveillance facility could strengthen routine reporting, by replicating innovations such as India’s Million Death Study, which tracks a random sample of all homes to reliably document the causes of death. The facility could also help countries apply modern genomics to test samples and monitor antimicrobial resistance.
Flu shots are updated annually because more than 80 labs around the world share information on the preceding years’ strains. A system to study new infections in hunters or others exposed to animal viruses could provide early warning of emerging threats.
Investing in tracking and controlling diseases saves money. Smallpox eradication cost $300m, but generated more than $27bn in savings. An outbreak of the plague in India in 1994 cost up to $2bn. Quick action in 2001 averted a smaller plague outbreak in northern India by applying cheap, basic 19th-century public health practices to trace contacts and enforce quarantine.
Viruses do not respect borders. Science also needs to think beyond them to implement global solutions that will keep us safer, healthier and richer.
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