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Pekka Puska (International Association of Public Health Institutes):

You can always say that the world is not prepared enough. A particular problem is that, in spite of general and important preparations, many emergencies seem to be unlike the previous ones and have unexpected features. High-income countries in particular are rather well prepared for the ‘known’ epidemics and emergencies. The problem is in low- and middle-income countries, where health services and

society as a whole encounter significant difficulties in dealing with such things. The big challenge in global public health is to do a better job in preventing or restricting the spread of new epidemics in the areas of their origin. This calls for support for both specific activities and more general development assistance, particularly in low-income countries.

Dr Sam Friedman (National Development and Research Institutes, USA):

I agree with this statement, and current responses around Ebola underline the problem. Public health has undergone severe belt-tightening, as has research and many medical services. In wealthier countries, military budgets absorb vast resources to defend against mild or non-existent threats or to conquer other lands, and media attention focuses on human interest stories, international affairs and the

alleged problems of waste in medical services, while our defences against epidemics are weakened. To aggravate this, global warming and corporate incursions against forests and savannahs lead to increased exposure to pathogens that may become epidemics.

I do not think that the solutions to this situation are primarily scientific or medical, although we must do what we can. There is a need for social,

economic and political change, and achieving this may, like the AIDS crisis of the 1980s, require massive social movements to force the issues.

I think a transdisciplinary focus in which large-scale social processes are combined with epidemiology, immunology and virology (and bacteriology), considered alongside social-organisational, community and patient-orientated interventions, can help. Without larger-scale changes, however, I fear that we will remain very vulnerable.

Dr Masoud Dara (World Health Organization, Regional Office for Europe):

I fully agree with this statement. Today’s world seems more concerned with growth and development than saving people’s lives. As a result, less attention is paid to building stronger health systems and resilient communities. In national budgets, insufficient resources are often allocated to prevention, health education, ensuring motivated human resources and cross-border collaboration. Take the example

of the current Ebola outbreak in West Africa: in order to address public health crises adequately, there is a need to strengthen all of the above, as well as intensify and coordinate research and innovation to foster rapid discovery, introduction, uptake and access to new medicines, preventive measures and vaccines.

Craig McClure (UNICEF):

This is not an easy question to answer. I think Dr Chan is correct in that the world is rather ill-prepared to deal with an extended public health emergency, but I believe there are lessons to be drawn from the HIV response over the last 30 years. This has demonstrated that for a disease that requires chronic daily therapy, treatment can be provided in even the poorest countries with the

To what extent do you agree with this conclusion and, in your opinion, how might the situation be ameliorated in virology?Q.

Throughout the ages, epidemics have devastated nations. The 14th Century Black Death killed between 30 and 50 per cent of the world’s population; the 1918 Spanish flu is thought to have killed more people than died in World War I; and HIV/AIDS continues to claim millions of lives. Viruses that reach pandemic proportions are united by an uncontrollable and invisible spread

and, historically, poorly understood methods of contagion.

In her address at the 64th session of the World Health Organization Regional Committee for Europe, Director-General Dr Margaret Chan stated: “The world is ill prepared to respond to any severe, sustained and threatening public health emergency”. Here, International

Innovation asks a selection of health experts to comment on this declaration

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weakest health systems. This shows that it is possible to deliver complex medicines that require daily use over a lifetime to very poor people in countries with very poor systems.

The other thing the HIV response has taught us is that protection of human rights is fundamental to dealing with any public health crisis. To some degree, this is where we have failed in our valiant efforts. The communities infected by HIV continue to be those at the margins of society; whether they are gay or bisexual men, people who inject drugs or those who sell sex.

I believe Dr Chan is saying that in the context of the current Ebola epidemic, we still have so far to go in terms of addressing global health in a world that is increasingly interconnected through air travel or virtually via the internet; we cannot isolate ourselves in high-income countries with good health systems from countries that have poor health systems. It’s in all of our best interests to work towards a world where there are fundamental basic systems in place to protect people’s health.

Professor Maryna Steyn (University of Pretoria, South Africa):

You only have to look at the Ebola epidemic for an answer to this statement! With overcrowding, poverty and differential access to medical resources, infectious disease is likely to remain a major concern. Obviously, the fast-moving viral diseases for which we have little in the way of a cure is a major threat, but so are the old, chronic diseases of which we think we know a lot, but still have much to learn!

Dr David Wilson (Global HIV/AIDS Program, World Bank):

We fully agree with Margaret. We must invest in health systems, and especially a trained, equipped and supported workforce, to deliver care. We also agree with the importance of science. The core lessons of the AIDS response apply equally to Ebola. We ensure that there is investment in treatment for all diseases, including those most prevalent in developing countries, and we must ensure that treatment is available

to all global citizens, regardless of location or means. Together, AIDS and Ebola both attest to the transformative importance of scientifi c progress, melded with global solidarity.

Professor Elisabetta Tanzi (National Institute of Respiratory Diseases, Mexico):

Speaking at the 2014 International Meeting on Emerging Diseases and Surveillance in Wien about the Ebola virus outbreak in West Africa, Dr Adriano Duse (University of Witwatersrand, South Africa), reported: “Health of humans is inextricably linked to the health of animals and the environment. More broadly, the environment not only encompasses physical, geographical, climatic, ecological, agricultural and

veterinary dimensions, but also the social, cultural, political and religious factors that infl uence the human behaviours that shape it. Addressing

What is an epidemic?

A pandemic occurs when an epidemic disease outbreak spreads across the globe. For example, HIV/AIDS is one of the most destructive global pandemics in history.

Infl uenza pandemics have occurred multiple times:

• Spanish infl uenza killed 40-50 million people in 1918

• Asian infl uenza killed 2 million people in 1957

• Hong Kong infl uenza killed 1 million people in 1968

A disease outbreak is classed as an epidemic when an infectious pathogen spreads to many people. For example, in 2003, the severe acute respiratory syndrome (SARS) epidemic took the lives of nearly 800 people worldwide.

What is a pandemic?

This is the occurrence of a disease in greater numbers than is expected or normal in a given community or region, over a given season. It can occur in one community or extend to several countries; and last from days to years. It can involve the infection of many people or just one individual, if the disease is new or unknown to a community or has been absent from the population for a long time. The Ebola outbreak, for instance, has thus far infected more than 14,000 people and killed over 5,000.

Defi ning disease

What is a disease

outbreak?

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the connections between health and the environment requires an urgent expansion of interdisciplinary collaborations and strong political and global will.”

I completely agree with Dr Duse. I think that the scientific world is prepared to respond to any emergency in public health. An example of this was in 2003, when in just two weeks the World Health Organization (WHO) laboratory network was able to isolate the severe acute respiratory syndrome (SARS) coronavirus, contributing significantly to the containment of the health emergency. The reasons for success have been of a different nature: technical support (development of specific molecular assays), international collaboration, continuous awareness of the risk of the emergence of new pathogens/new infectious diseases and, thus, continuous surveillance.

Sometimes you have to be confronted with different social, cultural and political realities that make it arduous to develop preventive and defensive strategies acting to control a potential emergency. It would be advantageous to improve interdisciplinary collaborations to intervene appropriately and timely if necessary.

Mark Sullivan (Medicines Development for Global Health, Australia):

I agree strongly with the statement. Most viral diseases will become pandemics and the recent outbreak of Ebola, not the most infectious of conditions, demonstrates that we are ill-prepared. The problem appears to be one of poor availability of local resources for basic healthcare. For example, the use of IV fluids, proper hydration and electrolyte balance can help to ameliorate Ebola and

tide patients over, but in Africa trained personnel and isolation facilities are too thin on the ground.

Political will remains an issue with local, national, regional and global factors influencing success. Funding care to these regions needs to be beyond the hands of politicians – a clear role for the World Health Organization (WHO). Vaccines remain the most impactful method of preventing viral disease spread – for smallpox and polio for example – and they need drive to be developed, better coordination and more investment to succeed. Incentives to encourage contributions from multinational pharmaceutical companies are also necessary. There needs to be a better funding mechanism in place to develop new vaccines and drugs that is not reliant on a few generous donors and countries – this requires international funding and coordination.

Dr Lena Serghides (Toronto General Research Institute and Sandra Rotman Centre for Global Health, Canada):

I think the current handling of the Ebola outbreak is proof that this statement is at least partly correct. The response to this emergency by the World Health Organization (WHO) and those in charge at the local level has been less than stellar. Managing public health emergencies is a difficult task that requires mounting an appropriate and timely response, while

managing public perception and minimising public fear. This is difficult enough at the local level and a Herculean task at the global level. What is inexcusable is to allow political and economic concerns to drive the response.

Beyond containment of the spread of infection and management of the patients, quick and accurate diagnostics and effective preventive and curative treatments are needed to handle public health emergencies. The scientific community can be a significant asset in this task, and it is important that sufficient funding is provided to allow this work to happen. The research community has suffered through substantial funding cuts in recent years. This is an extremely shortsighted approach that damages our ability to prepare for public health emergencies.

Dr Adrian Martin Pohlit (National Institute of Amazonian Research, Brazil):

The Ebola virus outbreak in West Africa is making us aware, once again, that the world’s preparedness and willingness to deal with such a serious disease are limited. Mustering the political, financial, technical and human resources internationally for affected nations is proving difficult and the estimates are of a protracted epidemic. Ebola has been in the public eye through periodic outbreaks over several decades. Yet it was not perceived as

being a grave threat to non-African countries and people (and largely still is not considered to be).

In general, we must gear research in virology towards the development of affordable, reliable vaccines, thus making preventive treatments more viable alternatives for Ebola, HIV/AIDS, Dengue fever among other viral diseases. Viral scourges of previous generations have been controlled or eradicated largely, if not entirely, by vaccination programmes – most markedly those for smallpox, yellow fever, poliomyelitis and measles.

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