As scientists race to thwart the novel coronavirus, little is being done to protect people from the significant vulnerabilities that arise from our policies, fractured health systems, and interlinked economies.
The devastation of health systems and economies are two significant hazards of a burgeoning epidemic. Both forms of collateral damage are worsened by political maneuvering, mismanagement, lack of resources, lack of transparency, corruption, and purposeful disinformation campaigns.
The current coronavirus outbreak demonstrates how hospitals and clinics, when overwhelmed, leave a significant portion of the afflicted population unattended. Of the more than 70,000 cases reported in China, many of those in need have not had access to even the most basic health interventions due to lack of equipment, medicines, or interminable waiting times. Moreover, car accidents, complicated labors, and routine infections are all more lethal when health care is unavailable. Front-line health workers are also vulnerable to illness, depleting the workforce when it is most needed. And perhaps most lethal: In the ensuing panic, the legitimacy of the health system and political leadership can be undermined when people stop cooperating with those trying to contain the outbreak.
China’s central position in the world economy — the scale and scope of its global trade and transit — places billions of livelihoods around the world at risk when an outbreak occurs there. Hair-trigger decisions are often made by politicians intent on demonstrating a dramatic response to their constituents. For example, travel bans and quarantines can make responding to an outbreak even more challenging by exacerbating the economic devastation of outbreaks and wreaking havoc on local communities. These impacts can be debilitating well beyond the time of the outbreak.
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As health security emergencies become more frequent and their consequences graver, a new holistic approach to policy is required that can match the complexity of the threats they present.
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We encourage an approach that is tantamount to building a global immune system: one comprising multi-sector governing bodies and effective and well-resourced health systems to prevent and mitigate health security threats.
Currently, global health emergency leadership primarily rests with the World Health Organization. In order to confront the dangers of health emergencies, security, diplomatic, and economic issues need to be concomitantly addressed through a collaborative and ongoing process. These cross-agency relationships are required so that when health emergencies occur, partners across sectors have a playbook with which they have buy-in and trust.
This is not a matter of the WHO hosting regular cross-sector meetings. Rather, trade, travel, finance, and economic policy organizations need to create administrative structures establishing protocols in advance of a crisis. A standing body would catalyze international security interventions and post-crisis reconstruction efforts enabling health security to be implemented in durable ways. Otherwise, we risk perpetuating cycles of panic and neglect when confronting dangerous outbreaks.
Weak health systems create extreme challenges in managing disease outbreaks. In the most vulnerable parts of the world, particularly in post-conflict settings, investments over the past 40 years have favored outsourcing of health delivery to private and nongovernmental organizations — instead of building essential enduring state capacity. The result has been that unregulated, fractured, inequitable, and critically insufficient health services have replaced governed health systems. Outbreaks are able to incubate and then spread unchecked. We need a paradigm shift in our approach to foreign aid — one that focuses on supporting state capacity to manage health systems, even (and particularly) during times of crisis and strife.
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Here at home, our broken policies create an equal vulnerability. The high costs of health care delivery and inadequate sick leave policies pose a major threat to our public health security. Underinsured populations without access to care will continue to work when ill, exposing others, and eventually overwhelming emergency care systems — a less efficient and more costly care option.
As the world waits for more complete information about the properties of coronavirus, we have an opportunity to reimagine how the collective global community can work together to mitigate the collateral damage of future health threats, with the goal of avoiding health system and economic failures. This is solvable if we are willing to confront the failures of our current approaches and recognize that health security rests on our economic, aid, labor, security, travel, and trade policies — not just health.
Juliette Kayyem is faculty chair and Dr. Margaret Bourdeaux is research director for the Security and Global Health Program at the Harvard Kennedy School Belfer Center for Science and International Affairs. Dr. Vanessa Kerry is faculty chair and Annmarie Sasdi is program director for the Global Public Policy Program at Harvard Medical School, Division of Global Medicine and Social Change.