Written evidence submitted by Prof. Sarah Cleaveland OBE BSc VetMB PhD MRCVS FMedSci FRSE FRS (GHS0026)
I am a veterinary epidemiologist, based at the Institute of Biodiversity, Animal Health and Comparative Medicine at the University of Glasgow, working on a range of emerging and endemic disease problems affecting human, animal and ecosystem health, primarily in East Africa. I am submitting evidence on two of the highlighted points to provide a rationale for more integrated approaches to pandemic prevention and response within the Global Health Security Agenda as well as to identify opportunities for UK leadership, particularly through FCDO.
What should a ‘global pandemic early warning system’ look like? What role should the UK Government play in its creation.
It is not clear that creation of a new global pandemic early warning system is warranted. The UK Government should continue to provide support for the existing global pandemic early warning systems, including the Global Outbreak Alert and Response Network (GOARN), coordinated through the World Health Organization (WHO), and involving more than 250 partner organisations around the world.
Having said that, there is a need for new thinking around strengthening capacity for detection and response to emerging disease threats. An early warning system is of no use unless linked with capability for an effective response. This capability cannot be constructed in a crisis situation – it must be developed, supported and deployed in ‘peace time’. Programmes to tackle emerging disease threats are therefore best supported by strengthening of core capacities to respond to on-going, endemic infectious disease problems. Many core elements of pandemic response – e.g. laboratory diagnostic capacity, procurement, logistics and planning capability, inter-sectoral communication, community engagement – can all be established by responding to endemic disease problems. In addition to strengthening technical capabilities, this approach has the added advantage of building trust among health authorities and affected communities, which is well-recognised as a critical element of successful and effective responses to emerging disease outbreaks (seen for example in the responses to Ebola virus disease and COVID-19).
The UK Government, particularly FCDO, could play a critical and leading role in developing and supporting this approach which aligns prevention of pandemic threats with several other targets within the Sustainable Development Goals1.
How might this work? I take, as an example, action on rabies prevention, although it should be noted that there are many other diseases that could provide similar exemplars.
Rabies is a fatal zoonosis, with the vast majority of human deaths transmitted to people from domestic dogs in low- and middle-income countries of Asia and Africa where is it widely endemic. The disease is of great concern, both locally and nationally, as shown by recent prioritisation exercises carried out through the U.S. Centers for Disease Control and Prevention’s Global Health Security Agenda in which rabies was frequently ranked in the top five zoonotic diseases (ttps://www.cdc.gov/globalhealth/security/actionpackages/zoonotic_disease.htm).
Although rabies does not have high pandemic potential, action on rabies (and other endemic diseases) could provide a powerful tool for strengthening capability for response to emerging zoonoses, such as COVID-19 and Ebola virus disease. The rationale for this is as follows:
Has the UK effectively used its position in multilateral organisations to promote international collaboration in response to COVID-19 and the global health security agenda?
The UK has the opportunity to provide further leadership of the global health security agenda through linked actions on the environment, wildlife conservation and health. Emerging zoonoses are typified by spillover transmission from wildlife reservoirs and there is a growing body of evidence to indicate that land use change, including the degradation of primary habitats, increases zoonotic disease risk2. The UK has taken a strong leadership position in relation to environmental issues and wildlife conservation, which would be further reinforced through advocacy and action for environmental protection to prevent future pandemics.
The UK could also play a leadership role in promoting international collaboration to address risks of spillover transmission as a result of wildlife trade. Live wild animal markets in Asia have been implicated in the emergence of several emerging diseases, including COVID-19, with much discussion of sustainable solutions for controlling wild animal markets in Asia. However, much less attention has been given to the global movement of live wild animals, which is still poorly recognised. The UK, for example, imports about 10 million live wild animals every year (excluding fish) from 90 countries across nine global regions3. The vast scale of these movements poses a clear risk in terms of disease transmission (as well as concerns in relation to biodiversity loss, invasive species and animal welfare). If animals are to be kept for the exotic pet market (as applies to the vast majority of imports), there should presumably be scope for animals to be sourced from domestic breeding programmes. Leadership from the UK in addressing the international wildlife trade, including consideration of a ban on the importation of live wild animals into the UK, would send a powerful and unambiguous signal about the risks, not only in relation to emerging diseases but also biodiversity loss and animal welfare.
In summary, many opportunities and benefits are likely to be provided by developing a more integrated and expanded approach to pandemic prevention. One Health provides a valuable framework for linking across sectors and scales to realise these multiple benefits.
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