24 Jul 2019

The Ebola, Zika and bird flu outbreaks in recent years are stark reminders to the international community of the urgent need to control the spread of infectious diseases.

While current policies by governments and multilateral organisations have helped tackle this issue, more action is needed to improve overall global governance, says Professor Tikki Pangestu, a global health expert and visiting professor at the Lee Kuan Yew School of Public Policy.

The world faces a “governance gap” when it comes to cross-border epidemics, Prof Pangestu, a former director at the World Health Organization’s (WHO) research policy and cooperation department, tells Global-is-Asian.

This governance gap, he explains, refers to the lack of a coherent and coordinated plan among key stakeholders, especially in developing countries, to deal with infectious diseases. Aside from creating robust national policies, it is imperative for states to liaison with international organisations for technical, financial and logistic support as well as capacity building. Otherwise, the emergence of a fatal virulent virus or bacteria which spreads rapidly and easily “would quickly overwhelm healthcare systems, especially in developing countries,” he warns.

The impact of infectious diseases

Aside from the obvious health implications, cross-border diseases such as measles, yellow fever and swine flu (also known as the H1N1 virus) carry significant social, economic, security and environmental challenges. They also have varying consequences for morbidity, mortality, urbanisation and climate change.cost-of-diseases health governance

West Africa’s Ebola scare in 2014, for example, led to an estimated US$53.19 billion in economic and social costs for regional economies, according to a 2018 study published in the Journal of Infectious Diseases. Not only did tourism greatly suffer, private sector growth, agricultural production and trade also plunged. In comparison, the 2003 Severe Acute Respiratory Syndrome (SARS) crisis cost an estimated US$40 billion, while the 2015-2016 Zika virus outbreak in the Americas caused US$20 billion in social costs, the study said.

Less discussed are the more indirect health outcomes. When a country’s healthcare resources are tied up with one disease, the treatment of other illnesses often experience setbacks. During West Africa’s Ebola crisis, there were an estimated 10,600 additional deaths from HIV/AIDS, tuberculosis and malaria, while healthcare services were reduced by 50% in Guinea, Liberia, and Sierra Leone, according to The Centre for Disease Control and Prevention.

Meanwhile in the United States, a growing opioid epidemic has increased the growth of certain infectious diseases, including HIV/AIDS and hepatitis, officials warned in April.

Global impact

The effects of easily communicable illnesses are not just limited to the impacted areas. However, their repercussions are felt on a global scale. African swine fever, which is currently wreaking havoc across parts of Europe and Asia, has dramatically disrupted the global pork market. The culling of affected pig herds has hit global pork supplies and increased prices, creating knock-on effects for farmers and consumers. The fatal illness has already caused a spike in consumer price inflation in China, one of the world’s biggest pork consumers.

Similarly, global developments and changes in societal behaviour also impact diseases.

Take the Zika virus — researchers recently discovered that climate change plays a major role in the spread of Zika. Warming temperatures cause Aedes mosquitoes, which spread dengue, Zika and other yellow fever viruses, to bite and breed more, thus increasing the spread of disease.

In many Western societies, more people are cultivating a growing aversion towards vaccinations which have also contributed to a measles resurgence, analysts have found. Known as “vaccine hesitancy,” the phenomenon was listed as one of the WHO’s top ten threats of 2019.

The need for collective action

Given the deeply interconnected nature between disease and the global environment, a truly global response is warranted. Whilst existing treaties such as the WHO’s International Health Regulations require countries to work together in combating infectious diseases, a governance gap still remains, Prof Pangestu warns.

Many countries are too preoccupied with national interests to consider more comprehensive solutions, he tells Global-is-Asian. “There must be a spirit of solidarity and mutual trust among nations within which effective public policies must operate. This is necessary for collective global action and strong political will in the face of diverse global health threats which can affect all nations.”

At present, nations suffer from “a lack of trust and empathy, strong anti-science sentiments and an unwillingness to consider the global good,” he says.

And this view is shared by many industry experts. Former WHO Director-General Dr Margaret Chan and senior consulting fellow at Chatham House Dr Charles Clift, said in 2015 that “the highest barrier to global health governance is the conflict between the rights of sovereign states and the need for global solidarity.”

However, increasing protectionism, as embodied by the United States, is only exacerbating the issue. The current rise of populism and nationalism goes hand-in-hand with the gradual erosion of multilateralism, and that has made it difficult to deal with global problems, says Prof Pangestu.

For example, Washington’s “America First” programme and its related trade wars and rising protectionism could “affect the access and affordability of medicines and also the free movement of health workers,” he adds. Policy restrictions on defence and foreign affairs may also “prohibit the US military from helping poor countries during a major epidemic.”

Closing the governance gap

In order to instigate a multilateral, coordinated response to health crises, states should identify a key coordinator such as the WHO to help, says Prof Pangestu. Governments then need to support the WHO’s mandate with political commitment.

Good health governance is dependent on national governance so the responsibility falls on states to enact relevant reforms and update regulations as necessary. At present, most societies operate on a state-centred health system but as the WHO recommends, governments must break out of their policy silos and work with global, regional, national and local actors. The intertwined nature of health issues, according to the WHO, calls for a collaborative approach whereby government agencies should liaison with community groups, businesses, foundations and international bodies.

Some countries have already taken that to heart. Singapore, for example, amended its Infectious Disease Act in late 2018 to allow the health ministry to share individual data with third-party researchers if the information is necessary for scientific investigation. South Africa, meanwhile, holds regular training workshops for health professionals to learn about infection prevention and control. Down Under, the government of South Australia has established regional health networks to increase accessibility to services and overall responsiveness. And over the past year, Greece has rolled out more than 100 new community-based primary health units that are free at the point of access.

Identifying other key players, like the militaries of rich countries that have the capacity for a rapid and substantial response could also help, Prof Pangestu advises.

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