Rewiring Outbreak Preparedness and Response

If the Ebola and Zika virus outbreaks have taught us anything, it’s that merely throwing money at the problem simply doesn’t fix it. Funding is the first step in combatting the threat of infectious diseases, but we also can’t forget the importance of strategic planning and product management.

Kendall Hoyt and Richard Hatchett argue that these international efforts to combat emerging infectious diseases “should build on lessons learned from US programs to develop closely related biodefense products.” In many ways, public health response involves running from fire to fire, desperately trying to put it out before the next one begins. The economics of public health emergencies support the age-old saying that “an ounce of prevention is worth a pound of cure.”

SARS was responsible for 800 deaths but cost $40 billion globally and Ebola has cost West African economies $6 billion plus an additional $4.3 billion in international contributions. Now, consider the cost of developing a vaccine. Hoyt and Hatchett point out that at the most expensive point, it can cost $1.8 billion to develop a vaccine (others argue that is it much closer to $500 million).

Sadly, these are points that public health officials have been making for years. Spending money upfront on prevention and detection will save substantial dollars and lives in the long-run. Truly, the horse was beaten and put to rest years ago…and yet nothing has changed.

The term “biodefense” tends to conjure images of anthrax attacks and something out of a Richard Preston book. In truth though, biodefense encompasses natural and man-made public health emergencies. Since the Amerithrax attacks in 2001, the U.S. has poured billions of dollars and untold resources into building up American biodefense. Despite these efforts, many wonder; can these efforts and lessons be applied to naturally occurring outbreaks?

Hoyt and Hatchett note that there should be three elements of the U.S. biodefense approach that are utilized to help develop medical countermeasures: “mechanisms to coordinate stakeholders, define priorities and direct resources; an incubator to provide hands-on product development support to private sector partners; and institutional and technical platforms to accelerate response times.” Institutional and technical platforms to support and streamline efforts must be incorporated into these processes. Whether it's a vaccine or diagnostic test, the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) must have a more efficient and effective capacity for rapid response.

The Biomedical Research and Development Authority (BARDA) may be a significant role model for public health agencies. BARDA has both “practical experience and the international capabilities to support advanced research and development”, which makes it unique. While private pharmaceutical companies may have these capabilities, public health should remember that private companies have an ultimate goal of profit, when considering them as flagships for response. An international steering committee, increased accountability and transparency, and a dash of participation would make the perfect recipe for combatting the case of delayed countermeasures.

Studying and applying the lessons from U.S. biodefense programs and products may be the most vital tool for international efforts. Overall, the response to SARS and Ebola revealed a deep lack of international strategic planning. Despite these failures, there is still potential for the successful application of existing lessons from U.S. biodefense programs.

Kendall Hoyt and Richard Hatchett, “Preparing for the next Zika”, Nature Biotechnology, 34:4 (April 2016).