The Strategic Foresight Initiative and the US National Intelligence Council (NIC) held a joint workshop, “Pandemics and the End of Globalization” on February 1 to inform the NIC’s Global Trends 2030 report.

What is the likelihood of a major pandemic outbreak in the next two decades? How could such an outbreak potentially spread and impact the global community?

NIC Counselor Mathew J. Burrows explained that the day’s discussion regarding pandemics would hopefully highlight its intersection with other global trends and its implications for global governance, as well as its ability to prevent pandemics or minimize their spread and mortality. Barry Pavel of the Atlantic Council stressed that the threat of pandemics must be viewed as a national security issue as well as a health issue and has increasingly been viewed as a high priority by the US government, as reflected in recent remarks by Secretary of State Hillary Clinton. NIC Program Director for Global Health, Christopher Decker, emphasized the importance of linking questions of public health to economic, political, and social drivers of government policy.

Nathan Wolfe of the Global Viral Forecasting Initiative provided an overview of the natural threats that the world faces in the next twenty years and the approaches currently employed to learn more about potential pandemics. Wolfe explained that the world is experiencing increasing interconnectedness between humanity and animals that can be carriers of disease. As shown by the rapid spread of the H1N1 virus in 2009, diseases that emerge in one region of the planet can have a global impact on human and animal populations. Global response to the threat of pandemics and their spread can be greatly improved by creating international information and collaboration networks and supporting local laboratory capacity building in developing countries linked to the global scientific community.

D.A. Henderson of the Center for Biosecurity, University of Pittsburgh Medical Center, elaborated on the potential threats facing the global community, including both natural pandemics and bioweapons such as smallpox, and the institutional capacity currently employed to address this issue. Dr. Henderson, who led the successful effort several decades ago to eradicate smallpox, expressed concern that most people no longer have immunity to smallpox since vaccinations were halted years ago, but that the smallpox virus could conceivably be stolen from one of the two laboratories where it is secured and be turned into a bioweapon. He noted that this concern has led the US government to support building vaccine stockpiles but that US companies are only just beginning to once again produce small pox vaccine. H5N1 is the latest strain of influenza that poses a grave threat to humans, with a mortality rate of 50% compared with only 2% for the Great Influenza of 1918 that killed more than 100 million people worldwide. Scientists have been able to develop a virus with H5N1 that could spread from ferret to ferret, which suggests that it is quite possible for an H5N1 strain to be developed by scientists as well as in nature that could spread rapidly from human to human with a devastating impact. Now, what should we do with this research developed by responsible researchers knowing that if results are published it could lead others, less responsible or even with malevolent intent, to repeat or modify this research? There also has been concern that halting publication of this material could amount to government censorship and could prevent others from continuing this line of research to advance our understanding of the virus and the potential to develop vaccines against it. The ultimate question is who should have access to this information, what role should the government play in these studies, and what is the likelihood of viruses escaping the proliferating laboratories and numbers of researchers with access to lethal pathogens?

Lone Simonsen of the Department of Global Health, The George Washington University, addressed how observational data from historical pandemics reveal important patterns not captured in current models. Strains of influenza, undoubtedly the clearest global pandemic threat, have a number of signature features that can be traced through historical outbreaks. Namely: animal to human transmission, high transmissibility, high susceptibility and global spread, mild to catastrophic mortality, mortality age shift, and multiple waves – with second and third waves typically being the most deadly. This insight leaves a number of open questions for the scientific community to address: why are there several waves within every outbreak of influenza? Why is mortality higher in later waves? Is there a pattern to predict a pandemic virus? At the same time, the scientific community should have learned the lesson from the SARS outbreak and other pandemics not to remain narrowly focused on the flu since non-influenza-based viruses also pose lethal pandemic threats to humans.

Armen Donabedian of the Biomedical Advanced Research and Development Authority (BARDA), US Department of Health and Human Services, put forth a broad vision of preparedness with a focus on BARDA’s program to deal with influenza through the use of new technologies, especially those that can boost capacity to produce large quantities of vaccine much more quickly than traditional methods. Through public-private partnerships, BARDA hopes to spearhead efforts to build capacity for universal vaccines as well.

Jack Chow of Heinz College, Carnegie Mellon University, provided a perspective on the challenges and opportunities for international health funding and World Health Organization (WHO) reform. The WHO faces a number of key challenges within the broader landscape of international public health institutions, particularly the question of “statism” and state-ism – the former referring to its antiquated structural limitations as a UN agency reliant on certain funding streams, and the latter referring to its sole reliance on national governments for enforcement. Further, with a non-centralized confederate system of regional authorities, Chow is skeptical that such architecture allows for coherent dynamic policy solutions for pandemic threats. As the global public health community moves forward and looks upon the WHO for solutions, the WHO should look to forging public-private partnerships and rejuvenating itself organizationally to meet the challenges of 2030.

Laurie Garrett of the Council on Foreign Relations broadened the scope of the workshop’s conversation, illustrating the way in which questions of global health intersect with global trends ranging from urbanization, to increasing food demand, water scarcity, and global governance. She emphasized that one of the greatest challenges looking towards 2030 and even 2050 is that very few people can think strategically beyond present controversies and political deadlock. The threat of pandemic outbreak is only growing in the meantime. Bio-Security Level (BSL)-3 and BSL-4 laboratories where the most deadly pathogens are studied could be sources of major accidents or bioterrorism, and the number of these laboratories worldwide is rapidly increasing, including in some of the most unstable regions of the world. Ultimately, the only reasonable way to approach solutions to global health is to think through inclusive global partnerships. There needs to be a global community contributing to this conversation with an understanding of shared risks, shared benefits – and shared responsibilities.

Banning Garrett of the Atlantic Council wrapped of the day’s discussion, commenting that social media and big data are likely to grow exponentially and could make our current governance models like the WHO ineffective and outdated by 2030. Billions if not trillions of sensors, including sensors in or near our own bodies, that are connected to the Internet – the Internet of Things—will provide huge amounts of data on health and health related phenomena. Overall, emerging technologies are likely to profoundly change approaches to health, health systems, health institutions, and health policy.

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