By Amanda McClelland and Emmanuel Agogo, Resolve to Save Lives
Definitions: A disease outbreak spreads beyond an expected threshold for the disease, but is within a localized area. An epidemic is the same, but crosses local borders. A pandemic is an epidemic that has spread across the world.
SARS, Ebola, H1N1, HIV and COVID-19 are a few of the highly infectious pandemics that have dominated headlines across the globe in recent years. But the novel coronavirus was only one of more than 70 infectious disease outbreaks detected by the World Health Organization last year, and the only outbreak declared a Public Health Event of International Concern (PHEIC).
Far too often, we highlight the failures—the diseases that caused thousands of deaths, cost billions of dollars and permanently changed our world. But just as noteworthy are the successes—the disease outbreaks that were swiftly and effectively contained due to strong leadership, prompt response by public health care workers and prioritization of the right public health interventions.
Consider the West African Ebola virus epidemic, which had more than 28,000 cases, caused more than 11,000 deaths and cost an estimated $2.8 billion across Guinea, Liberia and Sierra Leone between 2013 and 2016. In July 2014, Ebola hit Lagos, Nigeria, a city of 21 million people. Within one month, nearly one thousand people had been exposed to the virus. But thanks to effective communication, coordinated response and dedicated leadership, officials contained the outbreak in less than three months, after 20 cases and eight deaths. Because of a strong public health response, the West African Ebola virus epidemic did not happen in Nigeria.
Our organization, Resolve to Save Lives, an initiative of Vital Strategies, has studied examples from around the world of successful epidemic preparedness and response systems. Our new report, Epidemics That Didn’t Happen, highlights eight case studies that provide valuable insight into what has worked. They illustrate successful examples of seven key preparedness factors:
- Risk assessment and effective planning by officials;
- Strong emergency response operation systems at the national or local levels;
- Effective surveillance of infectious disease threats in humans and/or animals;
- Sophisticated national laboratory systems in place to surveil these threats;
- National legislation policy and financing for preparedness and response;
- Investment in human resources and/or
- Risk communications built on trust with the public
Detecting public health threats early and rapidly responding to them saves lives and prevents small outbreaks from becoming global pandemics.
No one response is perfect, and we do not advocate for a one-size-fits-all approach to epidemic preparedness. However, compiling data on what has worked will aid in decision-making as we begin to consider: What will preparedness look like for the next pandemic?
An anthrax outbreak in rural Kenya, for example, was identified and brought under control in just over one month because of a community-based surveillance (CBS) system and a trained Red Cross volunteer who took immediate action.
Anthrax broke out in Narok, Kenya after three people consumed meat from a dead cow. The Red Cross volunteer sent an SMS alert to the Kenya Red Cross Society's CBS system, which triggered a chain of notification up to the government’s national surveillance system. Government officials visited the town to assess livestock health and, within days, had vaccinated more than 20,000 cattle and sheep. To build trust with the community, the Red Cross and government officials convened community dialogues about the threat anthrax posed. As a direct result of the outreach work, the community began to finance its own animal vaccinations. In just over a month, the outbreak was contained after four human cases and one death.
This case study, along with three other “epidemics that weren’t,” show us how we can do better in the fight to prevent epidemics.
And the COVID-19 pandemic has demonstrated that, in order to mount an effective response, countries need a combination of strong epidemic preparedness and a readiness to act when epidemics strike. Our report counters the narrative that the pandemic has largely been a story of failure with four case studies of successful initial responses, particularly in low- and middle-income countries.
The Africa Centres for Disease Control and Prevention was ready for COVID-19, crafting a continent-wide strategy for the pandemic, accepted by all African heads of state, that emphasized collaboration over competition.
Across Africa, case and death counts have been quite low, with just over 3 million cases and 80,000 deaths, compared to more than 30 million cases and 500,000 deaths in the United States, which has less than one-third the population. Indeed, many high-income countries failed in their initial responses to COVID-19. In studying where elements of the response have been successful, we can consider what other countries might have lacked. What would have happened if, for example, the United States had adopted a more collaborative strategy like Africa CDC? Would states and the federal government have needed to compete for personal protective equipment?
If we prioritize sustained investment in epidemic preparedness and recognize and learn from strong examples of what has worked, then we can stop epidemics before they happen. Without proper investment, costly epidemics will continue to happen. It only takes a relatively small annual investment to offset the losses epidemics cause. Yearly investments of $1.9-$3.4 billion to strengthen environmental, animal and human public health surveillance and response systems would yield a return on investment of more than $30 billion annually: An ROI of at least 9-to-1 and up to nearly 16-to-1. We can afford investment in health security; we cannot afford another devastating pandemic.
Simple but important lessons have been learnt from detecting and responding to infectious disease outbreaks. While these successes—primarily in low- and middle-income countries—may not be the usual headliners, they do tell valuable stories.
In our globalized society, an infectious disease outbreak can spread around the world in just 36 hours. It is therefore on
all of us to prevent epidemics—to save lives, money and avoid global tragedy.
Amanda McClelland is the senior vice-president of the Prevent Epidemics team at Resolve to Save Lives, an initiative of Vital Strategies. A Registered Nurse, she has more than 20 years of experience in primary health care, global health and responding to natural disasters, conflict and epidemics in more than 15 countries including the West Africa Ebola response.
Emmanuel Agogo is the country representative for Nigeria at Resolve to Save Lives, an initiative of Vital Strategies. He oversees efforts to prevent epidemics and improve cardiovascular health in Nigeria. Agogo previously served in leadership roles at Nigeria’s National Agency for the Control of HIV/AIDS and the Nigeria Centre for Disease Control. He is a subject matter expert on Joint External Evaluation missions and has practiced primary care and family medicine in Nigeria and the United Kingdom.
Tune in to Aspen Ideas: Health (April 27-29) to learn more from Resolve to Save Lives about their new Epidemics That Didn’t Happen report.