Global health agencies face a difficult challenge in protecting people from pandemic threats: They rarely know in advance what the specific disease outbreak will be.
“When you’re preparing for something that hasn’t happened yet, and then you have to respond to something that actually has happened, you are not necessarily prepared for the exact thing that’s going to happen,” said Tony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Devex spoke to Fauci about what his institute is doing — and what global health organizations need to do — to better prepare governments and health systems for those inevitable, unpredictable threats.
Here’s an excerpt from our conversation, edited for clarity and length.
Can our global health architecture and the various institutions that we’ve had since the end of World War II be reconfigured and reshaped to deal with the pandemic threats that we face? Or do we need to come up with completely new ideas, new institutions and rethink leadership and capabilities in a fundamental way?
One of the things that is really important is to have a greater inter-digitation of surveillance. It’s been referred to as the “global health security network.” Namely, to have throughout the world, the capability — even if it isn’t highly technically advanced, but is diffused enough — to be able to recognize, diagnose and communicate in a transparent way. If we had done that with certain other outbreaks, we would have gained two, three, sometimes four months of a head start. Remember, the first child that got infected with Ebola was in December 2013. It wasn’t until March 2014 that the world said, “my goodness, we have a problem here.”
The other [priority] gets more technical, and that has to do with having the technical capability of responding rapidly — particularly in the arena of vaccines. Generally, vaccines take years to develop. When you’re dealing with a pandemic, an outbreak, you need to cut that down to months to a year. What we’ve been doing is, first, to try as best as possible to anticipate what’s lingering out there that we may want to start preparing for now. You make an investment that you may never use. You create a small stockpile of vaccines.
[The second approach] is to develop platform technologies for vaccines that are essentially adaptable to any pathogen that occurs. With Zika, we developed what’s called the DNA platform, which is a plasmid of DNA in which you can readily insert the gene of whatever particular microbe you want. It could be the capsule of Zika. It could be the West Nile virus. It could be dengue, or it could be any of the above. But you’ve created it and perfected it so that it’s there, so that when we have an outbreak of Zika, instead of saying, “we’ve got to grow the Zika virus up, we’ve got to inactivate it, we’ve got to attenuate it, and the we’ve got to produce it in a vaccine,” here all you need is the sequence. You don’t even need to isolate the virus. You just get the sequence, you pull out the gene, you stick it in, and bingo, you’ve got a vaccine. We can get sequences in a day. That’s the advanced technology that we didn’t have at the end of World War II.
The other thing that you may have heard me arguing for on television multiple times during the Zika outbreak is a public health emergency fund. We have a [Federal Emergency Management Agency] fund for hurricanes, a FEMA fund for earthquakes. We don’t need new agencies. We need a fund so that we can rapidly get money and mobilize people.
What was the cost of that eight month delay in Zika funding?
It was opportunity cost. Rather than slow us down, we took money from other things that we would have done. In the beginning, I had to reprogram about $12 million from malaria, tuberculosis and HIV. Then when we got to the point of making the vaccine, we went back and asked, “Where’s the money?” They didn’t give it to us. So we moved about $47 million out of the Ebola funds that were going to build infrastructure in sub-Saharan Africa. When we ran out of that money, the secretary utilized her 1 percent transfer authority, and she told the NIH director to take $33 million from cancer, heart disease and diabetes and give it to us for Zika. So, it was three levels of opportunity cost — one from our own institute, one from Ebola, and one from other institutes. So nothing slowed down, but other things suffered.
A lot of surveillance is contingent on building up health systems in countries where they’re currently very weak. How can we help them transition toward a strong surveillance system?
You help them. You meet them halfway. For example, you could not ask for a more poor country than Liberia, with an almost nonexistent health care infrastructure. When we went there to develop vaccine therapy and natural history studies, we made a commitment to invest in sustainable infrastructure that would be there when we left. We renovated the Redemption Hospital and we renovated parts of JFK Hospital. We didn’t just go in, do our thing, and leave. We helped them to build sustainable infrastructure.
We didn’t do it all alone. When they saw that we were willing to ante up tens of millions of dollars, they said, “well maybe we should put in tens of millions of dollars.” We’ve done it in Mali, we’ve done it in Rwanda, we’ve done it in a bunch of places.
Of those components you mentioned, what do you see to be the weakest link at the moment?
The weakest link is countries themselves, their commitment to health versus other things that they do — like militaries and corruption. If countries take seriously that health care infrastructure needs to be one of the most important things that they invest in, we would be much, much better off.
What is something concrete that the Donald Trump administration could do to tackle pandemic security?
I think it can continue to support the kinds of things that we’re doing — including the global health security network PEPFAR. We want to make sure that global health is high on the priority agenda. We do live in a global community. Particularly when it comes to health, we live in a global community. The step change I’d like to see is the global health emergency fund, and we don’t have that yet. I testified to Congress about 16 times in the Zika epidemic, begging for money. It became a political issue: We’re not going to give you money unless you do this. We’re not going to do this unless you give us money. It became a stalemate. It happens. You can’t complain about it. You’ve just got to keep trying.
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