A world at risk? A role for evaluators in strengthening Global Health Security.

‘We are not prepared for the threat of a fast-moving respiratory pandemic that could spread across the globe within 36 hours and eventually kill up to 80 million people.’

These chilling words called for action in a recent annual report on global preparedness for health emergencies by the Global Preparedness Monitoring Board (GPMB), an independent group of 15 experts convened by the World Bank and WHO after the first Ebola crisis. The report said that “all parts of society and the international community have made progress in preparing to face health emergencies” but also cautions that “current efforts remain grossly insufficient” ¹.

History of pandemics

Pandemics have occurred throughout human history, the deadliest probably being the Bubonic plague, also known as the ‘Black Death’, that killed between 75 to 200 million people between 1347 and 1350, and the so-called ‘Spanish Flu’, that infected an estimated 500 million people worldwide in 1918, 10% of which died as a result ². The risk of rapid spread of infectious diseases across national borders is however at an all-time high today, due to the ever-increasing pace of globalisation and international travel.

Epidemics in the 21^st century

In the first two decades of the 21st century alone, we have had outbreaks of Severe Acute Respiratory Syndrome (SARS), meningitis, chikungunya, influenza, cholera, measles, Middle East Respiratory Syndrome (MERS), Ebola, Zika, and yellow fever which has spread across different countries ².

In addition to tragic levels of mortality and morbidity, a pandemic could cause widespread panic, destabilise national security (due to increasing looting and violence), destroy already fragile health systems, and seriously impact the global economy and trade.

Low-and Middle-Income Countries are paying the highest price 

Low-and Middle-Income Countries (LMICs) are at the same time more at risk of outbreaks and would bear the highest costs in case of a widespread pandemic. They are at higher risk for a number of reasons:  countries in the tropics are at more at risk of vector-borne diseases such as dengue and malaria because mosquitoes and other insect vectors thrive in these regions. Many LMICs are also at higher risk of zoonotic disease because of common farming practices such as keeping chickens and pigs in backyards, and lastly, these countries often have weak health systems and are less prepared to prevent or swiftly detect or respond to outbreaks ².

All of this means that, in the event of a large epidemic, the human costs for LMICs would be catastrophic. It is estimated for example that if a pandemic like the 1918 Spanish Flu were to hit today, 96% of the deaths would be in LMICs ². A pandemic of this sort would likely undo decades of development efforts.

So what does the report suggest?

In the face of such a gloomy scenario, the recent GPMB report urges countries, regional and multilateral institutions to:

1. Commit to preparedness by implementing their binding obligations under the International Health Regulations [(IHR (2005)] ⁶ prioritising and dedicating sufficient domestic resources and recurrent spending for preparedness.
2. Lead by example by following through on their political and funding commitments for preparedness and agreeing to routinely monitor progress.
3. Build strong systems and to prioritise community involvement in all preparedness efforts, building trust and engaging multiple stakeholders.
4. Be prepared for the worst by ensuring adequate investment in developing vaccines and therapeutics, broad-spectrum antivirals and other appropriate non-pharmaceutical interventions.
5. Link preparedness with financial risk planning. Funding replenishments of the International Development Association (IDA), The Global Fund and Gavi should include explicit commitments regarding preparedness.
6. Create incentives and increase funding for preparedness for the poorest and most vulnerable countries to “close financing gaps for their national actions plans for health security as a joint responsibility and a global public good”.
7. Strengthen coordination mechanisms through the United Nations under the leadership of WHO to mobilise the wider national, regional and international community since the earlier stages of an outbreak ¹.

The role of evaluation in strengthening Global Health Security

Itad, as a leading provider of monitoring, evaluation and learning services across multiple thematic areas including Public Health and Global Health Security, is providing strategic advice to some of the key players currently involved in efforts to increase LMICs’ capacity to prevent, detect and respond to disease outbreaks of any size and nature.  The box below presents a few examples. This work supports interventions so that they can maximise their contribution to their intended impact and be even more effective in building capacity to respond to the next big pandemic.

While we can only anticipate to a limited extent where and when an outbreak that could cause the next big pandemic may occur, based on our experience in the sector, we agree with the GPMB report in that national, regional and international institutions should continue to work together and invest resources to ensure that the world is adequately prepared to detect and respond to the next outbreak, whenever that will occur. This requires deep thinking about how change occurs in a complex, ever more closely connected world, where one actor’s interventions may be necessary but are unlikely to be sufficient to affect the changes necessary in the time we have left. Evaluators in this field have a big role to produce and communicate insights, analysis and suggestions in a robust, timely and useful way so that interventions to contribute to Global Health Security efforts are as efficient, effective and equitable as they could possibly be.