Urgent vs Important, a quandary in global health: Opinion by Dr Roger Glass

May / June 2016 | Volume 15, Issue 3

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from Fogarty Director Dr. Roger
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We spend much of our time at the NIH pondering how to improve human health, but give much less consideration to the issue of planetary health. At the recent Consortium of Universities for Global Health (CUGH) annual meeting, the bravura keynote address framed the situation in stark terms. In a provocative manifesto delivered by The Lancet's Dr. Richard Horton, we were encouraged to view the two concerns in a holistic manner. For if the planetary systems continue to be compromised at the current rate, no vaccines we produce will preserve our health.

That spurred me to ponder how we prioritize the issues we face and how we determine the difference between "important" and "urgent" global health problems. I view "urgent" problems as those that present suddenly and are responded to in crisis mode. We saw that with Ebola, when numerous organizations and governments sent floods of health care workers, epidemiologists, portable labs, treatment centers and other resources to West Africa.

Much of the assistance, unfortunately, came after the virus had already spread through cities and villages, taking an enormous death toll and making it more complex to trace the contacts of those infected, which was necessary to contain the outbreak. We're seeing it now with the Zika virus, which has been around for a while but suddenly started causing heartbreaking cases of microcephaly in infants and Guillain-Barré syndrome, which can be very serious and even fatal in adults.

"Important" global health problems seem to me to be those big issues - HIV, malaria, TB, polio - that we've been working on for a long time, require sustained effort and commitment, and can produce fatigue on behalf of the donors, as well as implementers. The burden of disease they cause is huge - for TB alone it amounts to 4,000 deaths per day. This mortality dwarfs that for most of the diseases that are considered "urgent." We have grown more complacent in thinking that these major killers here defined as "important" are not also "urgent."

Since we don't have the resources currently available to fix all the global health problems, we must prioritize. Politicians and health officials responded unreservedly to the public's fear of Ebola, particularly when Americans became infected, which is understandable. At the same time, it's important to note that globally, more people died from HIV in three days than from Ebola during the entire outbreak. And it's imperative that we all work together as quickly as possible to learn what we can about the Zika virus, figure out how to control the mosquito population and develop a vaccine. But we also must keep our eye on the long-term need to strengthen research capacity and health systems in low-resource countries. In terms of infectious diseases, we have seen that we are all only as safe as the weakest link. And we know that preparedness is less expensiveto support than emergency response.

Quote by Roger Glass, repeated from text

We need to prepare for future outbreaks, of whatever agent arises. At Fogarty, our core mission is to build research capacity in low- and middle-income countries - and I believe that's a long-term investment that pays huge dividends. If we look at the case of the Ebola outbreak, the countries with little or no infrastructure suffered the most, and the cost of unpreparedness soared above $1 billion. The amount needed to sufficiently strengthen local institutions, train health leaders and link them to the global network of experts would take just a fraction of this. We know people with Ebola traveled across borders into some of the countries surrounding Guinea, Liberia and Sierra Leone. Why didn't outbreaks occur there? Because well-trained epidemiologists, lab technicians and others were on hand, prepared to identify and treat those who were infected, and ensure the disease did not spread. They were linked to global resources, and had access to technical advice and support.

This expertise is essential for responding to pandemics. That's why Fogarty issued a call for applications to spur partnerships that will create sustainable research capacity in the Ebola-affected countries. Only by addressing the "important" issue of global capacity development, can we hope to be prepared for the next "urgent" pandemic that is sure to come.

This column, Important vs. Urgent, first appeared in the Global Health NOW news bulletin from the Johns Hopkins Bloomberg School of Public Health. Subscribe to Global Health NOW email notifications.