Plague

   After the global Ebola crisis, the momentum of public-private cooperation has rebounded. In May 2016, the World Health Organization (WHO) formulated the “Blueprint for Research and Development Actions for the Prevention of Infectious Diseases”, with the goal of having all parties work together to find countermeasures before the next plague strikes. In response to the problems exposed during the Ebola virus outbreak, the project committee proposed various solutions, including speeding up the testing and approval of experimental drugs and vaccines, providing liability insurance for experimental drugs, and guaranteeing the availability of information and samples through contracts. Sharing etc.
   But the main goal of the project is to advance the research on several high-threat pathogens. WHO will learn from the experience in the development of malaria vaccines and promote the research of related vaccines and medicines production and testing technologies. WHO hopes that these products must be affordable for ordinary people. This means that their prices will be “decoupled” from high development costs, and companies will be compensated in other ways. This has not yet been implemented, but has been included in the discussion in the development of new therapies.
   It is not just the WHO who is concerned about the development of new vaccines. The Alliance for Epidemic Prevention Innovation (CEPI) is a newly established international organization at the World Economic Forum held in Switzerland in January 2017. It has received initial investment from Norway, Germany, Japan, the Wellcome Foundation and the Gates Foundation. The first goal of CEPI is to develop vaccines against Nipah virus, Middle East Respiratory Syndrome (MERS) virus and Lassa fever virus, and to help effective experimental vaccines pass phase II clinical trials as soon as possible. In addition, this organization also plans to invest US$1 billion in the next five years to support the development of new technologies for vaccine production.
   However, even with the support of these projects, the Phase III clinical trials that require more participation are still difficult to complete successfully. Moreover, we will not know how effective the vaccine is until a certain virus breaks out.
   Rapid response, to work together
   even if a vaccine in hand, we can not sit back and relax. If infectious diseases can be effectively prevented, they will not develop into plagues. We must prepare a complete emergency plan so that we can respond quickly and effectively when the plague breaks out.
   The spread of the epidemic is increasing exponentially: at first the number of infections increased slowly, but later it rushed like a rocket. Therefore, when relevant agencies deal with infectious diseases, this situation often occurs: at first, people thought that this was a fuss, but later they complained that the authorities were too slow. In order to better predict the outbreak of epidemics, WHO has organized a professional team to analyze the “big data” of climatic conditions, vaccination status, and population immunity; at the same time, it has also established a network of social scientists and anthropologists. Explore how to improve communication when the plague strikes. Poor communication is one of the main reasons for the ineffective response to the Ebola epidemic. The first and most important reason lies in the monitoring of the disease: before the large-scale spread of Ebola virus, no one noticed the first few cases.
   The leader of the Global Alliance for Vaccines and Immunization (GAVI, a nonprofit organization that helps poor areas obtain vaccines), Berkeley, said that in order to prepare for a large-scale epidemic, we need a large number of health workers who can reach every corner of the world. If you are familiar with the local situation, you can realize what went wrong at the beginning of the outbreak. In addition, we also need laboratories that can detect viruses and teams that can quickly respond to the epidemic. According to the International Health Regulations signed in 2005, all 194 member states of the World Health Organization must establish a complete monitoring mechanism to identify serious infectious diseases that may cause international travel or trade restrictions and report them in a timely manner. However, no country or region—including Europe and the United States—has accomplished everything required by the treaty. As the origin of many dangerous viruses, Africa has the lowest degree of project completion.
   To fill these gaps, not only the efforts of governments of all countries, but also the support of the international community is needed. The Ebola epidemic has made more and more people realize that any regional epidemic may develop into a global plague. In February 2014, 27 countries including the United States, China, Russia and multiple international organizations jointly launched a global plan for the prevention and control of infectious diseases called the “Global Health Security Agenda” (GHSA), which aims to establish an international epidemic A network for rapid disease detection, information sharing and rapid response to limit the spread of infectious diseases in humans and animals, reduce loss of life, and reduce the impact of epidemics on the global economy.
   The WHO has made a series of reforms to improve its response speed when an emergency occurs. Compared with the previous assessment of the risk of emergencies by independent offices in various countries based on their own judgment standards, now WHO has staff who conduct standardized risk assessments around the world. They can set up emergency teams within 72 hours of a crisis and quickly Expand the scale. In order to coordinate deployment on a global scale, these staff members can report directly to the Geneva headquarters, which is the first time in the history of WHO.
   WHO has also cooperated with the World Food Program to establish a global supply chain for masks, syringes and other equipment. The Inter-Agency Standing Committee is also one of the important partners of WHO. The main function of this organization is to coordinate the world’s emergency response to wars and natural disasters. Since 2016, they have included emergency response to pandemics.
   However, no matter how timely virus detection methods are available, or how effective vaccines and drugs are, how to produce and deploy them is still a difficult problem. We cannot build a vaccine factory in an instant when the virus breaks out. The production line is like a reserve army, which requires early preparation, regular exercise and renewal.
   In the case of limited production capacity, you may wish to refer to the flu vaccine production experience. Influenza viruses have frequent outbreaks and mutate rapidly, and the viruses that cause each flu are not exactly the same. Therefore, the influenza vaccine is composed of an unchanged standard influenza virus protein and two characteristic proteins (from the influenza virus that was circulating at the time). The flu vaccine is updated every year, but there is no need to design a new production line and pass a full set of approval procedures. In a similar way, we can build a vaccine production line for a mutant virus that has not yet appeared.
   This work has not yet begun. Whether the WHO can raise enough funds to continue its work is still unknown. “The most important thing is to know what is at stake.” Berkeley said. He believes that the pandemic is an “evolutionary necessity.” “If people understand the risks, they will want to build a complete system to deal with it. The cost of doing so is really insignificant compared to the cost of ignoring it.”
   We have got rid of blind complacency, but there is still much to do. The Ebola epidemic has made the world aware that the epidemic is the biggest uncontrollable risk factor for the global economy and security. We are not fully prepared yet, but we must do better than before.
   Impact of the epidemic on the world economy
   as the global economy are becoming increasingly close, the epidemic spread faster, further expand the sphere of influence. Some scholars believe that in this era, the greatest risk of epidemics is the threat to the global economy. Whether it is out of necessity or fear, many people try to minimize their contact with dense crowds, virtually reducing a lot of consumption. The tourism and trade industries will be affected first, followed by shopping malls and restaurants. In 2003, the SARS epidemic broke out and caused 774 deaths worldwide. The cost of quarantine and economic losses (tourism, trade, etc.) caused by it reached 54 billion U.S. dollars. The World Bank estimates that if an influenza epidemic as severe as the 1918 pandemic occurs again now, the world’s GDP will fall by 5%, causing an economic recession of 8 trillion US dollars. The faster we respond to the epidemic, the smaller the loss, so we must prepare early. Of course, these preparations require cost. So, who will pay for it?
   One possible solution is a new financing mechanism. In May 2016, the World Bank launched a new “Plague Insurance” (Pandemic Emergency Financing Fund). Many epidemic outbreaks start in poorer countries. Poor countries cannot afford medical resources, while rich countries fear the spread of the plague. This fund is mainly invested by more developed countries, and can quickly release up to 500 million US dollars to the poorest countries to respond to large-scale epidemic outbreaks. It also provides funds to these countries to strengthen health systems and prepare for future outbreaks.