In recent years, the strides made in public health are recognised as a key driver of economic growth worldwide, improving productivity and increasing life expectancy.
Yet, humanity still remains ill-equipped to combat emerging infectious diseases. Alarmingly, novel infectious diseases are being discovered at a rate of three a year – and the human race is forcing this accelerated evolution of infectious disease.
Our combined actions have created an environment that allows common infectious micro-organisms to more quickly and easily acquire mutations, making them more dangerous and able to spread rapidly. Ironically, the diffusion of technology and medicines is partially responsible for our vulnerability to novel pathogens, and for creating antimicrobial resistance (AMR).
The World Economic Forum describes the emergence of AMR as one of the most significant threats to human health. In “The Dangers of Hubris on Human Health”, a case study in the Global Risks 2013 report – which is on the agenda in Dalian this week – the Forum states that “the problem can only be addressed through international cooperation.”
This challenge is ours to take. Like other threats to humanity, we have the ability to do something about it, if we act together.
We propose looking at the problem from a structured perspective, and across the continuum of care, to understand how multiple efforts and entities can be woven together for a more effective response.
- Collaborative stakeholder ecosystem – Success requires collaboration, partnerships and incentives across the ecosystem of organizations that play an integral role in responding to the threat. At a high level, these organizations fall into the following stakeholder communities: public sector, private sector and healthcare provider.
- Comprehensive and balanced approach – The other dimension of our framework is the nature of the approach, requiring the detection of novel pathogens and disease trends, development of more efficacious antimicrobials, and delivery of healthcare services and medicines efficiently. Success isn’t only about the level of resources dedicated to each of these pillars but also how effectively the efforts are integrated.
Countering the threat of AMR requires coordinated action in each of these three areas:
Detect. Early warning systems and prompt intervention are essential to containing an outbreak and limiting potential loss of life and economic damage. Regarding the latter, the US$ 770 million losses in trade and tourism resulting from the cholera outbreak in Peru in 1991, and US$ 1.7 billion from the 1994 plague epidemic in India, remind us how the damage can escalate if not tackled quickly and decisively. “Detect” also requires the timely sharing and synthesis of information across the ecosystem of stakeholders, allowing them to understand and more accurately predict the emergence and impact of novel pathogens (e.g., virulence, at-risk populations, case fatality rate) and to trigger a timely response.
Develop. Cross-sector and commercial collaboration such as product development partnerships, consortia and other innovative business models are responsible for growing the R&D pipeline of new candidate antimicrobial therapeutics, as well as preventive healthcare products such as vaccines. While these partnerships address a somewhat altruistic public need, they also involve the necessary incentives that make them practical. The strategies used by these stakeholder communities support the innovation needed to bolster the armamentarium of antimicrobial products and tools available to combat novel pathogens.
Deliver. To optimize impact in the delivery of healthcare, stakeholders must coordinate their efforts. This is especially important in making sure that antimicrobial drugs and diagnostic are accessible and available around the world; that the use of antimicrobials is responsible and judicious, and that governments and organizations establish effective infection prevention and control policies.
An imbalance in any of these elements, represented by insufficient resources or outcomes, will result in an incomplete and ineffective solution. For example, governments may build state-of-the-art bio-surveillance capabilities, but without medicines to treat the problem or an effective mechanism for delivery, the root causes contributing to resistance will not be addressed and the problem will persist or even worsen.
The medicines we use to treat infectious diseases are becoming increasingly less effective. Unchecked, and without changing our behaviours, we risk regressing to a state where we can no longer fend off common infections, let alone new hospital superbugs, viral pandemics and even genetically engineered microbes.
A structured approach, synergy and shared knowledge are critical. They increase the likelihood of success, sustainability, social and economic impact and resource savings.
Chandresh Harjivan is a Partner at PwC specializing in public health, writing in collaboration with colleagues Shabana Farooqi and Anthony Ho. More information on PwC’s resilience work is available here.
Image: Two laboratory plates coated with an antibiotic-resistant bacteria called Klebsiella (Reuters/Suzanne Plunkett)