2019-nCoV: Spread of coronavirus highlights need for strengthened global health security

The following is a guest post by Judith Wasserheit, M.D., M.P.H. FIDSA and Krutika Kuppalli, M.D. With the dawn of a new decade, the world is confronted with a new infectious disease challenge, in the spread of a novel coronavirus that has rapidly infected more than 24,000 people in 25 countries and resulted in more than 490 deaths. The 2019 novel coronavirus -- 2019-nCoV -- epidemic, however, is just the latest manifestation of a threat we have seen unfold with increasing frequency and severity over the last 40 years, with the emergence of HIV, drug-resistant tuberculosis, SARS, H1N1 influenza, MERS-CoV, Nipah, Ebola, and Zika. The emergence of these diseases has brought profound human, social and economic consequences here in the U.S. and around the world. Yet, nearly 20 years after the SARS outbreak revealed how under-prepared the world is to effectively respond to outbreaks of high consequence pathogens, the World Health Organization estimates 70% of countries remain unprepared to meet the threat today. When WHO declared a Public Health Emergency of International Concern -- a PHEIC -- in response to the 2019-nCoV outbreak on January 30, Director-General Tedros Adhanom Ghebreyesus noted that the potential impact of the virus in resource-limited countries with underdeveloped and unprepared healthcare systems added impetus his decision to convene the emergency committee and declare a PHEIC. Once again, we must marshal an emergency response to a rapidly evolving pandemic, having failed to sufficiently prepare, by strengthening capacities to prevent detect and respond to outbreaks, particularly in the places where infectious disease threats emerge. Pandemics have repeatedly reshaped the course of civilizations at extremely high costs. The Black Death killed approximately 60% of the European population from 1347 to 1351. European settlers introduced smallpox, measles, plague, typhus and syphilis that led to the death of up to 90% of the indigenous American population. HIV has infected 75 million people worldwide and resulted in 32 million deaths since the start of the epidemic, with U.S. spending on global and domestic HIV responses nearly $35 billion in 2019. The 2014-2016 West Africa Ebola crisis led to approximately 28,620 illnesses and 11,310 deaths at an estimated cost of $53.19 billion. And, every year, influenza epidemics in the U.S. result in up to 45 million illnesses, 810,000 hospitalizations and 61,000 deaths, with a total economic burden estimated at $87.1 billion. We continue to see the multifaceted, profound impacts of global epidemics, yet we continue to tackle them largely as individual, unrelated events. The world has changed, and while some of those changes are key ingredients for the explosive growth of infectious diseases outbreaks, others offer unprecedented opportunities to prevent and respond. We have changed the way we live and the planet on which we live, including the way we interface with natural and built environments and with animals, the way we travel, and our climate. In the process, we have increased the reproductive rates of pathogens, vectors, and some animal hosts, amplifying opportunities for the emergence of new strains, new organisms and new exposures. Simultaneously, advances in biomedical and information technologies as well as analytic capacities have dramatically accelerated our ability to identify these emerging pathogens, sequence their genomes, develop diagnostic tests, drugs and vaccines, and share data across the globe. As infectious disease physicians, we have critical roles to play both in the response to this 2019-nCoV epidemic, and, more broadly, in moving from our current pathogen-specific responses to develop more integrated systems and approaches that enhance our ability to prevent, detect, and respond to future outbreaks before they become national or global epidemics. This means working not only here in the U.S., but also with partners in low- and middle-income countries where novel pathogens are likely to emerge, but unlikely to be recognized and reported quickly due to fragile surveillance and health care systems. U.S. investments in strengthening global capacities to prevent, detect and respond to infectious disease threats in resource-limited settings have helped move us toward meeting global pandemic preparedness goals. Our agencies, however, are not being funded at the levels needed to ensure success. Sustained resources are needed for the U.S. Centers for Disease Control and Prevention to support low- and middle-income countries to strengthen disease tracking and reporting systems, laboratory systems, infection control efforts, and healthcare workforce training, among other essential global health security activities. The CDC also needs more resources to help state and local public health programs become better prepared to respond to outbreaks that now include 2019-nCoV. Current funding falls short for the USAID programs that detect emerging zoonotic infections and work to prevent growing antimicrobial resistance. Funding for the National Institutes of Health should also increase to allow for expanded research on emerging and reemerging infections, particularly in low- and middle-income countries, and for research training programs, including those of the NIH’s Fogarty International Center, to ensure robust capacity to develop new tools and approaches to prevent, detect and respond to infectious diseases with pandemic potential.