A global pathogen shield: the health security step to ‘never again’

In the name of strategic defense, the world’s nations have amassed enough nuclear weapons to destroy human civilization. We accept the massive financial investment involved. Yet no country has developed the capacity to protect itself against a novel, lethal infectious disease. It’s time to start.

Last week marked the start of a global pledging marathon that has so far raised more than $8 billion to end the Covid-19 pandemic. The hastily assembled coalition of governments, industry, and philanthropic organizations, backed by the G20, last month announced its aim to accelerate the development, manufacturing, and distribution of Covid-19 treatments, vaccines and diagnostic tests, making them accessible to everyone, worldwide.

It is a vitally important initiative, but has it come too late? Several high-profile countries declined to join the initiative, including the United States, which said it was already supporting many of the programs set to benefit from the new fund, underlining the challenge of creating a united front against the disease.

The world has been caught fatally off guard by Covid-19, and it has taken catastrophic advantage of our complacency. Its emergence has forced us to implement radical defensive measures, globally and nationally. The pledging marathon, a historic collaboration, is the latest of these. Across the globe, governments are revolutionizing the way health care is provided to take account of the new reality.

When the immediate crisis is over, we need a similar revolution in our approach to health security. No health system, however sophisticated, can ever be fully prepared to cope with a pandemic of this nature and on this scale. We urgently need to build a global pathogen shield: a rapid response capability primed to develop new treatments and vaccines against novel diseases such as Covid-19 and deploy them at scale.

Diseases pose threats to the health security of countries in the same way as invading armies threaten their national security. We rely on governments to protect us against the latter; should they not protect us from former as well?

Doing that would be far better for all of us than the “protection” provided by mutual assured destruction.

One obvious weakness in protecting health security is poor data capability. In the United Kingdom, the government’s response to Covid-19 has been guided by a model of the outbreak based on computer code written 13 years ago to predict an influenza pandemic. Numbers are important to help the public and politicians understand the scale of the threat, but they need to be credible.

In the early days of the H1N1 swine flu outbreak in 2009, President Barack Obama’s science advisers predicted that the virus would cause 900,000 to 1.8 million hospitalizations and 30,000 to 90,000 deaths. A year later, there had been 274,000 hospitalizations and 12,000 deaths.

Once we have a robust idea of the threat, we need to invest in protection and accept, as we do for nuclear deterrents, we may never use it. The WHO has a pandemic preparedness plan designed to ensure countries have equal access to antiviral medicines, vaccines, and diagnostic tests. But there is no provision within WHO to build a global rapid response capability to develop and manufacture the protection we will need.

The threat posed by pandemic viruses is to all humanity, not just to a country here and a country there. A global defensive shield of the kind we propose, sharing scientific expertise, manufacturing capacity, and distribution networks, must be constructed in advance.

Governments would have to lead the project as, although there is a huge pool of talent and expertise in the biotech and pharmaceutical industries, there can be no market for drugs and vaccines that we hope we will never need.

The cost would be significant. But we are already seeing the staggering human and economic costs wreaked by Covid-19. In the context of the $8 trillion U.S. spent globally on health care, a 10% levy would provide an $800 billion war chest sufficient to deliver dozens of vaccines, new and improved early detection techniques, and more interventions to counter pathogens and delay their spread.

As the coronavirus has swept the world, forcing us to hide away in our homes, it has reminded us of our human fragility. Now we must demonstrate our ingenuity and strength. We need to expand our focus — from treating our own sick to protecting global health. Our collective future depends on it.

Ara Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. Noubar Afeyan is a biochemical engineer and founder and CEO of Flagship Pioneering, a life sciences innovation company based in Cambridge, Mass.