Editor’s Note: Dr. Sten Vermund is dean of the Yale School of Public Health, the Anna M.R. Lauder Professor of Public Health and professor of pediatrics at the Yale School of Medicine. He has founded two non-governmental organizations fighting the HIV epidemic in Africa. The views expressed in this commentary are his own. View more opinion on CNN.
As the coronavirus continues to accelerate its spread through China, the US, and a host of other countries, global scientists have accelerated their work to develop a vaccine, effective antiviral drugs and, more immediately, contain the Wuhan 2019-nCoV strain from spreading further. The Chinese government has reportedly taken a stopgap measure by treating coronavirus patients with HIV drugs – an oral two-pill combination of antiretroviral drugs along with an inhaled medication.
Coronaviruses, like HIV, are RNA viruses. China learned from prior coronavirus epidemics (SARS and MERS) to repurpose antiretroviral and antiviral medications for partial treatment of this newest global health scare, which may have made the leap to humans from Chinese snakes or other animals. This is a perfect illustration of why long-term epidemic preparedness and investment matters. Investing in one epidemic can have an impact that spans other diseases, future years, distant continents and disparate health systems.
We need the kind of visionary, proactive leadership that will make global health and disease prevention a priority. Unfortunately, the current administration disbanded its health security team in 2018 and has repeatedly suggested cuts to the very government agencies and programs that fight epidemics. As cases of coronavirus have begun popping up around the US, some presidential candidates have been silent on this issue – though to their credit, others have called attention to the issue of preventing infectious diseases.
Elizabeth Warren recently released a plan to prevent and contain infectious diseases, and Joe Biden published an op-ed pledging to “reassert U.S. leadership in global health security.” Other candidates have called attention to the issue.
The President has acknowledged the challenges that the US faces but specific plans are unclear: Voters and journalists alike would do well to ask the administration and the many candidates who seek office in 2020 to outline their plans to fight coronavirus and prevent other pandemics. It is not enough to enact emergency spending measures in the middle of an outbreak – we need consistent, robust leadership around these issues before the next crisis hits.
I have seen the importance of preparedness first-hand in four decades of public health and medical research and teaching, first in tropical diseases and then on HIV and AIDS. When Ebola arrived in the densely populated city of Lagos, Nigeria, in July 2014, for example, many of us thought that thousands would die in that mega-city, and spread globally. Nigerian and international experts have documented the benefits accrued from these prior disease control and prevention investments, building laboratory capacity. In part, as a consequence of these investments, Nigeria was able to contain the virus to just 19 cases and stop it from spreading further.
How? In part because the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the global Polio Program had been making important investments in Nigeria for years – most notably a laboratory training program and a modern virology laboratory at Lagos University Teaching Hospital.
The existence of that infrastructure, and the highly trained technicians that emerged from it, meant that teams of Nigerian specialists were able to trace the outbreak to a single air traveler from Liberia. In addition, the specialists were able to test Ebola samples in their own labs instead of flying them out of the country. The simple technological investments that the US and others made to fight HIV and polio in Nigeria ended up being a key reason why the country was so effective in containing Ebola.
This is the approach we need to take for global health: an investment in one epidemic is actually an investment in health structures that can fight whatever comes next. Acute care investments can be redeployed for chronic disease control and then can be available for the next acute emergency.
Whoever becomes our next president will have the power to shape the world’s response to both current and future infectious pandemics. Currently, pandemic-related global health program spending is just 0.19% of the US budget; a doubling of that investment would be a good start to face our present and future challenges. We need a sustained and substantial presidential commitment towards global control of infectious threats, including some of today’s biggest infectious killers, HIV and AIDS, tuberculosis and malaria.
History has shown that the right investments can make all the difference. Instead of short-sighted, last-minute funding for a disease already at pandemic levels, we can contain and prevent outbreaks from turning into global emergencies. What we cannot do is cut funding or personnel as soon as the crisis is over, or isolate infectious disease responses so that lessons from one are not applied to another.
The question is, can our our next president meet this challenge? Let us all ask these questions of all our candidates on the campaign trail.