Publicação: 28 de outubro de 2020
Short-termism, market failures and misinformation are hampering efforts to prepare
When business executives, officials and scientists met three years ago at the World Economic Forum in Davos, they had no inkling of the current coronavirus pandemic, but they were deeply concerned about sluggish progress in preparing for emerging fatal diseases.
Inspired by the recent failure of the international community to swiftly tackle Ebola, which threatened to spread from West Africa before ultimately receding through luck rather than design, they created the Coalition for Epidemic Preparedness Innovations (Cepi). “The stimulus was the tragedy that we had a near 100 per cent effective vaccine that languished in development for more than a decade and arrived too late to prevent the damage,” says Richard Hatchett, chief executive of Cepi, which has since become a pivotal mechanism to fund and accelerate vaccines to guard against Covid-19.
Ebola in Africa was just one of nearly a dozen new infectious outbreaks so far in this century that could have provoked large-scale global health and economic devastation. Sars, Mers, Zika and several influenza strains caused concern among health specialists before ebbing away.
Each time, worry gave way to complacency and remedial action faded in the aftermath of unrealised disasters. Political commitment and funding consistently waned, against a backdrop of accusations of crying wolf and more pressing short-term priorities.
John Bell, Regius professor of medicine at the University of Oxford, says: “Western developed societies have managed to pretend they are interested in the problem but not do anything about it. The abject failure of most to be prepared for a pandemic is a pretty bad story.”
John Bell: ‘All the big public health challenges are getting left on the sidelines’ © F. Hoffmann/Roche Ltd He cites examples of slow progress in meeting calls to build an emergency vaccine manufacturing facility in the UK. Elsewhere, the French sold off stocks of personal protective equipment before Covid-19, and, in the US, President Donald Trump undermined the Obama administration’s pandemic preparation mechanisms.
Destabilising infections from HIV to drug-resistant tuberculosis continue to impose a heavy toll on medical systems around the world, yet resources are skewed to non-communicable diseases. Even in lower-income countries, there has been an increase in the burden of long-term conditions such as diabetes and hypertension, driven by more sedentary lifestyles and less healthy eating habits.
Sir John, who is also a non-executive director of Roche, the pharmaceutical company, highlights a market failure: healthcare systems and drug companies alike are not incentivised to invest in preventing and preparing for future infectious disease threats.
As a result, companies focus in large part on speciality medicines such as cancer treatments which command high prices and for which there is clear current demand. “All the big public health challenges are getting left on the sidelines,” he says. “In the absence of a business model that works, governments need to pay up front.” Almost exactly a century after the “Spanish flu” pandemic at the end of the first world war, coronavirus has provided a striking reminder of how little has changed in disease response, with a focus on infection control measures led by travel restrictions, quarantine and social distancing.
But some factors have since increased the likelihood of a more frequent emergence and spread of infections. Prof Martin McKee at the London School of Hygiene and Tropical Medicine highlights the intersection of human hunger and animal diseases: climate change, deforestation and industrialisation are bringing people and wildlife into closer contact and competition. “We are all interdependent,” he says. “The rest of the world is paying for the profits of people making money from the wild animal trade.”
If international alliances to track and tackle these threats have long been underfunded and underpowered, they are now also facing more direct political attacks, such as Mr Trump’s scapegoating of China and his apparent resolve to stop funding the World Health Organisation (WHO). Ed Kelley, director of integrated health services at the WHO, also points to the recent phenomenon of the “infodemic” of social media exacerbating contemporary epidemics.
“There’s tons of misinformation out there,” he says. This has provoked false advice and conspiracy theories, and helped fuel a wider trend of populism and nationalism. More positively, Sir John points to signs of recent progress. “It’s been a good era for the life sciences industry and its ability to work with the public sector towards greater partnership,” he says.
Rival pharmaceutical companies have formed unprecedented alliances while working alongside governments, international organisations and philanthropists.
Sir John is part of one such consortium: academics at Oxford with seed funding are developing an experimental vaccine with funding from Cepi, while working in alliance with UK pharmaceutical company AstraZeneca for testing and development, and Serum Institute of India for low-cost manufacturing, in close consultation with regulators.
Similar co-operation is taking place for a number of new drugs and diagnostics, with support from international donors. Yet funding is still far from what is needed to share the benefits globally, while the political atmosphere remains febrile.
As Mr Hatchett at Cepi notes: “A pandemic is a transnational threat requiring collaboration. Countries focusing exclusively on protecting their own populations will not end it without a global effort.”