In early December 2013, a 2-year-old child in Guinea’s low-lying mountains experienced a sudden onset of abnormal symptoms, including high fever, bloody diarrhoea, and repeated vomiting. In the remote village of Meliandou on December 6, a young boy tragically lost his life within the confines of his own home. Tragedy struck Emile’s family when his 4-year-old sister, along with their mother and grandmother, succumbed to death, all displaying similar symptoms shortly after.
Scientists finally pinpointed the cause of the fatalities in March as the Ebola virus. By that point, another several fatalities had occurred. By the time the outbreak had spread to neighboring Guinea and Sierra Leone, the death toll was nearing 200.
In the earliest stages of what would eventually become the deadliest Ebola outbreak in recorded history, Between 2014 and 2016, the Ebola crisis devastated healthcare systems in Guinea, Liberia, and Sierra Leone, placing an unprecedented strain on already fragile well-being programs. Several countries beyond Europe and North America, including nations in Asia, reported Ebola cases, primarily affecting healthcare professionals and travelers who had recently visited West Africa.
More than 60,000 people lost their lives.
Unheralded, the pandemic swept across the globe, starkly revealing the planet’s vulnerability to contain and mitigate infectious diseases. The Centers for Disease Control and Prevention’s (CDC) Division of Preparedness swiftly coordinated with international partners and health organizations to launch a massive, unprecedented outbreak response effort, marking a significant milestone in global public health crisis management.
The Ebola crisis unexpectedly boosted long-term U.S. government funding for global health security, a comprehensive framework encompassing initiatives aimed at preventing, detecting, and responding to infectious disease threats, such as training healthcare professionals and establishing laboratories equipped to test for diverse pathogens.
Before the 2014 Ebola crisis, the CDC and various US authorities agencies were actively engaged in global outbreak response efforts. However, this unprecedented event solidified a more permanent and sustained approach to building long-term international capacity for responding to infectious disease threats. In 2014, the Centers for Disease Control and Prevention (CDC) furthered its commitment to global health security by establishing a dedicated division, the Global Health Security Division, focused exclusively on protecting the public’s health from infectious disease threats at home and abroad. US authorities joined over 70 countries in launching the, providing a framework for enhancing global health security worldwide.
Prior to joining Vox as a colleague, I worked as an epidemiologist specializing in infectious diseases and a global health safety advisor in Africa. There appear to be numerous inefficiencies in the US authorities’ program. It was disheartening to realize that we had been lavishing countless taxpayer dollars and missing a chance to revolutionize global health by combating infectious diseases effectively. To gather insights from professionals with extensive experience in global health safety, I conducted interviews with individuals who have made significant contributions to various sectors of this critical field, seeking to understand the root causes of challenges and identify opportunities for improvement moving forward.
Over the past decade, the US government has committed significant funding to the Centers for Disease Control and Prevention, the United States Agency for International Development, and the Department of Defense to support their global health security initiatives. The proposal excludes additional emergency funds allocated for Zika and Ebola outbreak responses, the Covid-19 pandemic, as well as support for various infectious diseases such as HIV, tuberculosis, and malaria, which were considered threats anywhere, implying that every country’s global health security capacity needed enhancement.
The Ebola crisis, along with previous pandemics like the 2009 swine flu outbreak, served as a warning sign for future health challenges: a resurgence in infectious diseases, including COVID-19 and other global health crises that would test the world’s preparedness and response capabilities. Despite adequate funding, the world remains woefully unprepared to respond effectively to emerging infectious disease threats.
Between 2017 and 2018, I worked as a contractor for the Centers for Disease Control and Prevention’s (CDC) Division of Global Health Protection. In the latter half of that period, I also filled a brief role as a global health security technical advisor with the United States Agency for International Development (USAID). Despite notable progress, the US has largely fallen short of achieving many of its intended goals.
While world wellbeing safety may be compromised by a shortage of unity. U.S. authorities have employed a traditional national security approach to wellness and safety, prioritizing domestic protection from external threats over addressing global issues comprehensively. US authorities and businesses often struggle to understand or engage with local needs, instead dictating how “partners” in foreign countries should develop health security capabilities without meaningful local input or ownership, thereby undermining the effectiveness of global partnerships and perpetuating a culture of domination rather than cooperation.
Last year, the Biden administration released a comprehensive plan outlining its global health security objectives for the next five years. Despite emphasizing the importance of collaboration, territoriality, and evidence-driven strategies, the methodology fails to explicitly outline how organizations can effectively adopt and implement these fundamental principles. While the unwavering commitment to global health security remains crucial, it is essential that the US government addresses fundamental flaws underpinning its programming to prevent infectious diseases from claiming hundreds of thousands of lives each year and wreaking havoc on economies.
What if Emile Ouamouno’s initial visit to a rural health clinic in Guinea coincided with doctors’ familiarity with identifying symptoms of Ebola infections? Wouldn’t it be likely that they would immediately isolate him in a designated area, separated from the other patients in his household, to prevent any potential transmission or contamination? What if the nurses had donned hazmat suits and gloves, gathered a blood sample from Emile, then dispatched it down the corridor for a laboratory technician to test for the presence of any potential viruses or microorganisms causing his affliction? Wouldn’t it be remarkable if, just hours after detecting Ebola in a patient’s blood sample, the lab technician had promptly notified healthcare officials nationwide, prompting an immediate response to contain the outbreak to a single village?
Countries need four essential components to swiftly detect and contain infectious disease outbreaks: according to Dr. Richard Hatchett, a renowned expert in infectious diseases epidemiology at the London School of Hygiene and Tropical Medicine, who has previously contributed to Ebola outbreak responses in Africa while working with the Centers for Disease Control and Prevention (CDC).
Regrettably, a majority of countries globally fall short across multiple dimensions.
A global research collaboration has led to the development of an innovative framework, capable of thoroughly evaluating a country’s capacity to prevent, identify, and respond effectively to infectious disease outbreaks. Despite significant investment and resources dedicated to combating COVID-19 in 2021, it was revealed that every country remains woefully unprepared to confront future epidemic and pandemic threats.
According to the index’s findings, it was revealed that out of the 195 international locations surveyed, nearly two-thirds (126) lacked a comprehensive national public health emergency response plan in place, while almost two-thirds (128) had no standardized protocol for testing novel pathogens during a public health crisis, and nearly three-quarters (169) failed to incorporate measures addressing zoonotic disease risks within their nationwide health safety plans. In countries with rapidly developing economies, healthcare programs often struggle with a severe shortage of skilled staff. In many African countries, severe shortages of healthcare professionals persist, resulting in limited access to quality medical care for millions globally.
Within the realm of global health security, a plethora of intricate transfer mechanisms exist. Generally the problem appears insurmountable. The Centers for Disease Control and Prevention (CDC) has publicly acknowledged that global public health is a collective endeavor, yet critics argue that their current approach remains paternalistic, ultimately marginalizing key partners in the process.
Global health security demands unwavering cooperation, which tragically remains elusive.
While the US government’s global health safety funding partially fulfills a humanitarian mission by improving lives and livelihoods worldwide, critics argue that it prioritizes an American-centric approach focused on keeping diseases out of the US rather than fostering genuine international collaborations and building capacity globally?
Examples of what exist numerous. Despite significant investment from US authorities in developing at least one FDA-approved remedy for Ebola, these medicines remain largely confined to US stockpiles for national security and biodefense purposes, unavailability being a hallmark during Ebola outbreaks worldwide.
The COVID-19 pandemic serves as yet another exemplar of Heymann’s principles in action. While global criticism mounted over the unequal distribution of COVID-19 vaccines between the US and Europe, African public health officials faced a distinct set of challenges. In 2021, Heymann sought input from African public health leaders to identify the most critical vaccine for their region. It was actually a malaria vaccine they brought up. Researchers attributed reluctance to receive the Covid-19 vaccine to a perceived lower risk due to the toll decreasing when compared to other illnesses, potentially related to the fact that African populations tend to be younger and have fewer underlying health conditions. The lack of testing undoubtedly led to a decrease in reported instances and deaths. Heymann’s officials perceived the vaccination drive as “a North initiative to safeguard its own interests by compelling us to get vaccinated,” he noted.
The prevailing perception suggests that global well-being security is often viewed as a United States-led initiative pursuing a distinctly American agenda, or more broadly, an endeavour primarily benefiting the Global North. According to a top official at the organization, native officers and organizations have little faith in the effectiveness of international health safety measures, including those from America and Europe.
The notion of limited resources and competing priorities is a significant motivator for why international governments often fail to prioritize global health safety, neglecting to allocate domestic funds towards initiatives supported by donor countries like the US. While many countries ranked highly in the 2021 International Health Security Index lacked domestic funding for epidemic threats. Competing financial priorities and a common dearth of disposable income also play a significant role.
In reality, you can only make investments pay off or build assets up to a point; beyond that, there are limits to what you can achieve until another country decides to join the game, saying, ‘You know what? We’re not just going to use this investment and asset base, but we’ll take it over and make it our national priority.’ “We’re committed to investing in this initiative and providing the necessary support,” said Madad, highlighting the ongoing struggle to ensure its success.
While the US government’s significant investment in global health security over the past decade may not yield tangible results immediately, it is establishing a crucial foundation for future endeavors. Developing comprehensive wellness and public health programs necessitates a sustained effort to proactively prevent, detect, and respond to infectious diseases in a continuous cycle of growth and improvement.
“The essential prerequisites globally for achieving significant advancements are considerable.” The vastness of the universe is truly awe-inspiring. According to the director of the Johns Hopkins Center for Health Safety, the situation is extremely susceptible to infectious disease transmission. However, transitioning to tangible readiness proves challenging.
The US authorities must establish genuine collaborations with international governments where ideas are shared reciprocally and both parties coalesce to build comprehensive health security capabilities. The US government must secure commitments from international nations for native buy-in and financial backing, thereby ensuring that the regions where American taxpayer funds are allocated are genuine priorities in those countries.
As Heymann explained, “Our primary task now is to dismantle our own colonial biases and prejudices.” “He emphasized that partnerships require a mutual commitment: ‘You don’t just get funding from us; you need to make a request for it, and then both parties contribute their portion.'” “Why should we invest in projects that don’t have buy-in from international locations?” They’re being coerced into doing something unnecessary.
The US government should consider allocating additional direct funding to frontline clinics and community-based organizations, already overwhelmed with epidemic response efforts, rather than channeling these resources through larger institutions like the Ministry of Health or the World Health Organization. She advocates for concentrated training at the primary healthcare level, such as rural clinics, where Emile Ouamouno received medical attention after contracting Ebola.
“Most healthcare initiatives start with primary care,” he emphasized. “When a robust primary care foundation is in place, backed by a well-trained workforce, the ability to rapidly identify and respond to emerging infectious diseases improves significantly,” she explained. “If we’re willing to invest in global primary care, providing the necessary resources and personnel to deliver it, we’d be significantly better off.”
