This outbreak must be a wake-up call for strengthening public health care systems. Strong public health systems ensure crisis preparedness and are necessary for universal health care.
The World Health Organization (WHO) was alerted to several cases of pneumonia in Wuhan City, Hubei Province of China on 31 December 2019. It was noted that the virus causing this did not match any other known virus. A week later, it was confirmed that this is a new virus which is similar to viruses such as the severe acute respiratory syndrome-related coronavirus (SARS-CoV) which causes the SARS, a viral respiratory disease. An outbreak of SARS between November 2002 and July 2003 involved 8,098 cases resulting in 774 deaths reported across 17 countries.
From Wuhan to the world; a spreading epidemic
The new virus has temporarily been named Novel coronavirus (2019-nCoV). The WHO has been working closely with governments, particularly in China where it originated, to learn more about the virus, including how it spreads and how it can be treated to enable countries to respond to the outbreak adequately.
What is known presently is that the spread of the outbreak is fast becoming global. Cases have been reported thus far in; China, France, Japan, Australia, Thailand, Canada, United States, Malaysia, Nepal, South Korea, Taiwan, Singapore, Vietnam and Switzerland. And while the possibility of human-to-human transmission was initially considered limited, there is increasing evidence of this means of transmission in Vietnam, Germany, Japan and Wuhan China.
The rate at which infection is spreading is equally alarming. As at 25 January, WHO reported a total of 1,320 confirmed cases worldwide. These included 23 confirmed cases outside China in nine countries. Forty-nine deaths were also reported, all of these in China.
In barely 24 hours the figures had risen drastically, yet again – as it has been doing over the last few weeks. By 26 January, there was a total of 2,014 confirmed cases of which twenty-nine were reported outside China in ten countries. And the death toll had risen to 56 persons. Thus far, just two days after, the death toll appears to have risen to 106. The number of confirmed cases again more than doubled in two days to 4,593 by 28 January according to the WHO.
Not yet a PHIEC – but of increasingly worsening cause for concern
Taking due note of the situation, the WHO Director-General convened a meeting of the International Health Regulations Emergency Committee. Medical and health experts comprising the members and advisors of the Emergency Committee deliberated extensively, from 22 to 23 January. There were divergent views on whether the ongoing outbreak presently constitutes a Public Health Emergency of International Concern (PHIEC) or not.
But, there was a general consensus that the situation is severe and all countries were urged to “be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection”. The committee of experts is to be reconvened by the first week of February (when the WHO Executive Board will, incidentally, be holding its 146th session) or earlier if the Director-General is convinced of a need for that.
A resolution to review the International Health Regulations (IHR) was adopted by Member States of the WHO at the 48th World Health Assembly in 1995. (The subsisting International Sanitary Regulations (ISR) which the IHR replaced in 1969 were agreed upon by diplomats from 12 European countries in 1851!)
The review process was hastened after the emergence of SARS in 2003 (and immediately after that the avian influenza (H5N1) outbreak). And the new International Health Regulations was adopted at the 58th World Health Assembly in 2005.
The conceptualisation of a common understanding of Public Health Emergency of International Concern (PHIEC) introduced into the IHR was influenced by the experience of the SARS outbreak. The epidemic had spread for several months before the Chinese government opened up on how serious the situation was. It ended up claiming 700 lives, with more than 8,000 confirmed cases recorded in 37 countries, before it was brought under control.
Building strong public health systems – beyond quick fixes
Heightened public concern on the spread of 2019n-CoV is not out of place, especially as there is still a lot to know about this new virus. But it is important for us not to lose sight of some important facts in the frenzy of the moment.
The main bastion for crisis preparedness is a strong public health system. Government after government have been drastically cutting the funding of public health, including for disease control and prevention. Throwing money into public health emergencies when they happen, such as this outbreak is not enough. What is required is sustained funding of the public health system towards ensuring universal public health care.
Institutionalised fire brigade approaches also mask neglect of the daily management of global health threats. Money trees will suddenly grow on the soils of “donor fatigue” which undermine the implementation of WHO programmes meant to battle less “celebrated” diseases faced by poor people, particularly in low and middle-income countries.
Massive funds are likely to be deployed by wealthy governments, especially if the outbreak is eventually designated a PHIEC. These will be the same governments that have sharply cut public funding of health.
Member States of the World Health Organization have to make the difference if they are really serious about commitment to universal health coverage, as Dr Andreas Wulf of Medico International points out. The global health system has a structural problem. At the root of this problem is the application of neoliberal values and measures to policy and practice of healthcare delivery.
Epidemics that capture global attention become like the too big to fail corporations which governments can find money to bail out whilst failing to address those day-to-day economic and health problems confronting millions of people and which regularly claim tens and hundreds of thousands of lives, every year.
As Satya Sivaraman of the People’s Health Movement says:
"Pandemics teach us that all human beings are born equal and therefore mortal in the same way. In line with this, the danger of a global pandemic can only be averted if the concept of "health for all" is finally realized and the simple truth is recognized everywhere in the world that every public health system is only as strong as its poorest patient."
As much as all hands need to be on deck to stop the spread of the 2019n-CoV, this outbreak must be a wake-up call. We must go back to the spirit of the Alma-Ata declaration to win health for all. This requires adequate funding and organisation of public health.
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