Lawrence Summers is a professor at and past president of Harvard University. He was treasury secretary from 1999 to 2001 and economic adviser to President Obama from 2009 through 2010. Gavin Yamey, head of the Evidence-to-Policy Initiative at the University of California at San Francisco, and a member of the Global Health 2035 commission, contributed to this column.
Epidemics and pandemics are like earthquakes. Tragic, inevitable and unpredictable. It starts as a random event. A virus jumps species from a bird, bat or other animal to “patient zero” — who passes it on to other human beings. More likely than not, over the course of this century we will face an influenza pandemic similar to the one in 1918 that killed an estimated 50 million people .
President Obama’s first chief of staff, Rahm Emanuel, said in the wake of the global economic meltdown that “you never want a serious crisis to go to waste.” Crises are opportunities to learn. They point to measures that will prevent the collapse of institutions when they are under extreme pressure.
While the focus now is understandably on responding to Ebola, it is equally important that the crisis serve as a wake-up call with respect to inadequacies that threaten not just tragedy on an unprecedented scale but the basic security of the United States and other wealthy nations. As with climate change, no part of the world can insulate itself from the consequences of epidemic and pandemic.
The Global Health 2035 report by the Commission on Investing in Health, which I co-chaired, points up three crucial lessons. First, collective action must be taken to build strong health systems in every corner of the globe. In West Africa, Ebola was a “stress test” on national health systems, and in Sierra Leone, Liberia and Guinea the systems could not cope. There were too few trained health professionals, too little equipment and supplies, and too little capacity for public health surveillance and control.
Nigeria’s success in containing the virus after the first case was diagnosed there in July is instructive. Its success, hailed by the World Health Organization as a piece of “world-class epidemiological detective work,” is explained by its aggressive, coordinated surveillance and control response. It already had a polio surveillance system, with skilled outbreak specialists who could be quickly put to work tackling Ebola. While much of Nigeria’s health system, such as primary care services, remains very weak, on Ebola the surveillance and control system worked. Every country needs this kind of system. Prevention is cheaper than cure, and leads to better outcomes.
Building these systems takes time and money. Our research, conducted with an international team of economists and health experts and published last year in the medical journal the Lancet, suggests that the price of this “systems strengthening” would be about $30 billion a year for the next two decades. The good news is that we have the funds to pay for this through a combination of aid and domestic spending. The cost is well under 1 percent of the additional gross domestic product that will be available to low- and lower-middle-income countries due to increased GDP growth over the next 20 years.
The second lesson is that the lack of investment in public health is a global emergency. The WHO’s slow response to Ebola was not surprising, given its recent staff cuts. For that, we all share the blame. Since 1994, the WHO’s regular budget has declined steadily in real terms. Even before the Ebola crisis, it struggled to fund basic functions. Its entire budget for influenza was just $7.7 million in 2013 — less than a third of what New York City alone devotes to preparing for public health emergencies.
It takes just one infected airline passenger to introduce an infection into a country. We need the WHO more than ever. It alone has the mandate and legitimacy to serve as a health protection agency for all countries, rich and poor. Starving it of funds is reckless.
The third lesson concerns scientific innovation. When it comes to discovering and developing medicines, vaccines and diagnostic tests, we have largely ignored the infectious diseases that disproportionately kill the world’s poor. Consequently, we still have no medicines or vaccine for Ebola. All we can do is provide basic life support, such as fluids and blood pressure treatment. For prevention, we have to rely on old-fashioned measures such as quarantine.
Margaret Chan, the WHO’s director-general, has explained the reason for this neglect. Doctors were “empty-handed,” she said, because “a profit-driven industry does not invest in products for markets that cannot pay.” Ebola affects poor African nations, so drug companies see no profit in working on it. Nor is there an adequate incentive to invest in prevention. No society will allow companies to reap huge profits when disease is spreading rapidly.
Rich governments and donors need to step up. Investing several billion dollars a year, less than 0.01 percent of global GDP, could be decisive in preventing tragedy on the scale of world war.
Some issues are even more important than recessions and elections. Ebola is a tragedy. Let us hope that it will also be a spur to taking the necessary steps to prevent the far greater one that is nearly inevitable on the current policy trajectory. The next Ebola is just around the corner.