The world is generally not prepared for a severe pandemic, whether natural or bio-engineered to evade known variants of vaccines and medical countermeasures. According to the Global Challenges Foundation, pandemics are among the key likely causes of the collapse of human civilisation, defined as a “drastic decrease in human population size and political, economic/social complexity, globally and for an extended time.”
A recent estimate by the Bill and Melinda Gates Foundation suggests that an outbreak of a magnitude similar to the Great Influenza of 1918, could result in 360 million deaths, despite modern vaccines, antivirals and antibiotics. According to a report by the RAND Corporation, “the spread of infectious disease can be worse than world wars.”
The complete costs of a severe pandemic are difficult to estimate, given the potential array of social, political, agricultural, and economic impacts. A World Bank analysis put the minimum cost of the recent Ebola crisis in Liberia, Guinea and Sierra Leone at $2.8 billion in GDP. But a subsequent analysis of the total economic and social costs of the same outbreak was estimated at $53.19 billion.
In a new paper, I explore the nature of pandemic risk as a threat to human and civilisational security and discuss the shortcomings of the currently accepted international strategy for pandemic preparedness. In its place, I propose a comprehensive pandemic risk management system (CPRMS), including a practical roadmap for its institutional implementation.
The current system
Academic and public assessments confirm a lack of global preparedness. In May 2018, the Johns Hopkins Centre for Health Security conducted a pandemic simulation called “Clade X”, in which a bioengineered microbe ended up killing 150 million people within 20 months and producing devastating impacts across the US. The exercise found that many vulnerabilities, including leadership challenges, were “hardwired into the American system.”
Established in the wake of the early 21st century crises with avian influenza, SARS and Ebola, the current international pandemic strategy aims to improve preparedness by strengthening the capacity of national public health systems. This is pursued via appeals to compliance with the standards of the International Health Regulations, as part of an emergency framework designed to prevent outbreaks with infectious disease from becoming international health crises.
While such efforts are appropriate and necessary, they are centred primarily on the health sector, with less focus on the global multisectoral, multidimensional risks and impacts of pandemics. The current strategy also remains primarily country-focused and reactive, and as such is not cost-effective, allocatively efficient, or sustainable for preventing and managing the large-scale impacts of severe pandemics.
A comprehensive pandemic risk management system (CPRMS)
A new cost-effective system is needed to manage the spectrum of multisectoral pandemic risk to both national and global security. Such a comprehensive pandemic risk management system (CPRMS) would constitute a genuine global public good. As a complex-systems-based paradigm, the strategy would help prevent and manage both the direct human security risks to health and ensure a critical continuity in the flow of essential services and infrastructure, sustaining interconnected global socio-economy, on which human security depends.
Characteristics of an effective CPRMS
Human security: The conceptual grounding of the approach includes but transcends the currently dominant, state-oriented framework of global health security, in favour of a multidimensional concept of human security.
Full-spectrum risk management: The CPRMS assumes an integrated system of prevention, preparedness, response and mitigation, with universal, pre-emptive vaccine protection against prioritised microbes that threaten the human genome. It must also mitigate the drivers of cross-species contagion within human society and secure the functional continuity of essential services and infrastructure critical to global human security.
Principal characteristics: As a strategically coherent system, the CPRMS must be risk-based and grounded in evidence derived through the emerging discipline of complexity science. The approach must be long-term and multisectoral, integrating prevention, preparedness and response in health, essential public services and enabling critical infrastructure. It needs to be financially and politically sustainable to meet 21st century challenges at national and global levels.
Organisational framework: Institutionally, a CPRMS would also be structured as an organised operational system whose structure and functions embody the six critical elements of all institutional systems: harmonised leadership and governance; sustainable financing; information systems management; requisite human resources; essential commodities and related logistics; and a capacity for operational interventions and service delivery. Crucially, governance of the CPRMS must be envisioned in the broader, increasingly urgent context of managing a growing complex of existential risks.
The global transformation of risk: The proximate drivers underlying pandemic risk include a growing human and domesticated animal population, a large-scale animal food industry, intensive transportation networks, advances in widely accessible biotechnology, and increasing interface among animal and human habitats.
However, these drivers are part of a broader process in which the nature of global risk is undergoing transformation. This macro-process includes accelerating climate change; resource depletion; environmental degradation; extinction of species; planetary ecosystem overshoot; limits on growth; and unsustainable increase in debt. This ominous complex contributes to an atmosphere of growing crises, political turmoil, societal polarisation, waning multilateralism, increased competition for limited resources, and diminishing resilience.
The current international approach to pandemic preparedness is primarily committed to improve emergency response capacity, largely viewed as a health security issue, restricted to the human and animal health sectors, and with most responsibility focused on sovereign states – all beset with multiple conflicting priorities and limited resources.
An elusive paradigm for global governance: waning multilateralism and growing nationalism: Existing attempts to establish effective models of governance for the risk management of manmade pandemics at global and national level have been centred on individual national security priorities – a reflection of a seemingly irresolvable conflict of interest between the global public good and national security.
A novel paradigm for global governance models is needed, backed by adequate multilateral political will and commitment to operationally manage the risk of pandemics and other existential threats. This requires an international strategic consensus on the global public good, backed by a coordinated multinational institutional strategy and commitment of financial, human, and operational resources at global, regional and national levels.
What is envisioned is not a planetary “world government”, but rather a broad, multisectoral cooperative and collaborative, UN-based, public-private, global governance network. Such a paradigm of governance based on consensus and effective global mobilisation is theoretically possible, though certainly not guaranteed.
A roadmap and next steps
The Global CPRMS provides the overall vision, leadership and coordination of global policy and action, with a related agenda at global, regional, and national levels. The overall goal of the CPRMS would be to protect human and civilisational security from the direct and indirect risks of pandemics to human welfare. At this level, the principal focus should be the effective management of risks to global health and to the continuity of essential services and infrastructure, as a global public good.
The CPRMS represents a paradigmatic shift emphasising systems thinking, integrated risk management, and the development of an inclusive, public-private governance and leadership network in structure and function at global, regional and national levels. In each of these geographic dimensions, the integrated CPRMS includes the six institutional system attributes that engage to effect intentional change. A discussion of innovative global system approaches to sustainable financing, information and human resource, commodity and operational service delivery to support the global CPRMS agenda is provided.
Next steps: The roughly illustrated approach to a new CPRMS model presented in this paper requires an inclusive international and in-depth exploratory process to generate international stakeholder consensus on the broad goals and objectives of an international governance framework, and on its effective and sustainable practical engagement.
Pursuant to the Roadmap for the Global CPRMS, the paper outlines a multisectoral, multidisciplinary, and research-based effort to inform an initial process of high-level global, regional and country stakeholder consultations. This would begin the exploration and development of a strategic CPRMS framework, to include its goals and objectives, as well as to agree on the critical model of governance and leadership for the system at all levels, global, regional, and national. In a subsequent phase, the consultative process would address the remaining structural, functional, and operational system components, to include financing, human resources, information and knowledge management, logistical and material capacity as well as its operational service mechanisms. The steps ahead would also advocate for the continuity of promising existing international pandemic preparedness efforts and recommend a series of additional interim steps by the collective of international stakeholders.
Nicholas G. Studzinski, MA, MPH, is a Visiting International Research Fellow at the Policy Institute, King’s College London.
After a career with the US. Foreign Service as a Senior International Public Health advisor and pandemic coordinator with the US Agency for International Development (USAID), he was liaison to the US. Department of State Avian Influenza Action Group, and subsequently consulted with the World Bank Group on aspects of pandemic preparedness financing. He has an abiding interest in pandemics as complex systems, and in other global systemic threats. He is a member of the Advisory Board of the Geneva Global Initiative, dedicated to the study of and preparedness against large-scale systemic risk.