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OPINION

We need health security, not just health care

That means thinking about threats to health and how to combat them, not simply responding once people are already sick.

A researcher works on virus replication in order to develop a vaccine against the coronavirus COVID-19, in Belo Horizonte, state of Minas Gerais, Brazil, on March 26.
A researcher works on virus replication in order to develop a vaccine against the coronavirus COVID-19, in Belo Horizonte, state of Minas Gerais, Brazil, on March 26.AFP via Getty Images

The immediate global priority is to slow the spread of COVID-19 to save lives and to allow time for a viable vaccine to be developed. But the pandemic must also prompt a fundamental shift in our thinking toward health security.

Health security means thinking about threats to health and how to combat them, not simply responding once people are already sick. This mindset shift is the prerequisite for any determination never again to allow a global pandemic to take hold.

There’s little doubt that some countries are better prepared to deal with the consequences than others, and the gaps in health coverage are rapidly being revealed. But no health system can ever be fully prepared to deal with a pandemic of this nature and scale.

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No doubt, in years to come, countries will keep strategic reserves of medical masks, ventilators, and so on. But being well prepared for the fallout is not the same as being secure in the first place.

We expect governments to defend our physical security, so why not our health security? With nuclear weapons, humankind has stockpiled the means to destroy the world many times over. We accept the idea of massive investment in warheads and missiles that we hope never to use. In sharp contrast, no country possesses the capability to save the world from novel infectious diseases.

That’s why it’s time to build a global pathogen shield — a rapid-response capability to develop and deploy new vaccines in reaction to novel diseases such as COVID-19. With the right scientific expertise and investment, the time scale could be as short as three months. Given that the threat is to all humankind, it is an obvious arena for global collaboration and burden-sharing.

Making such an investment in a rapid-response capability will have to be government-led. While there is an enormous repository of talent and expertise in industry, there is by definition no market for vaccines or therapies that we hope never to need.

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The cost-benefit impact of investing in a rapid-response capability is obvious. As well as the human cost, the economic cost is staggering. Governments are already starting to put their national economies on life support. Investing hundreds of billions of dollars would still amount to a fraction of the costs of not acting.

But health security could also be a way to radically rethink our approach to health more broadly. Across the world today, we have sickness systems, not health systems. We treat people once they have a defined disease, not before. A health security mindset would refocus investment on interventions to prevent, delay, or derail disease in the first place.

Focusing on pre-disease — the period before diseases such as diabetes, cancer, autoimmune disorders, or chronic breathing difficulties manifest themselves, when conditions could be reversed or slowed — could prevent a huge proportion of the global disease burden.

Precisely the same cutting edge scientific knowledge and technologies that are focused on treating illness could be applied to addressing pre-disease and so maintaining health. But today, no regulatory or payment framework exists to further this goal. The world spends $8 trillion on health care, but just a fraction on health security.

Imagine if the world invested 10 percent in health security. That $800 billion globally could pay for a global pathogen shield of dozens of vaccines and a rapid-response capability to answer unexpected threats, new and better early-detection testing technologies, and more interventions that would deter and delay disease.

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In times like this, we are not only reminded of our human fragility but also of our limitless capacity for ingenuity. Improving our health security demands not just a change in what we do but also a change in how we think. Thinking in terms of health security is the first step to protecting our world from another pandemic, ensuring the financial sustainability of our health systems, and improving our lives for good.

Noubar Afeyan is a biochemical engineer, inventor, and CEO of Flagship Pioneering, an institutional innovation firm focused on life sciences. Ara Darzi is chair of surgery at Imperial College London and a member of the House of Lords.