Bugs don't recognize nationality

By Chelsea Clinton and Devi Sridhar

Science matters. In a moment in which facts can apparently have factual and alternative flavors, it feels important to state that unequivocally. We recognize that in an era of growing insularity and retrenchment, it may seem strange to argue for more global health investments and cooperation. But, we hope that, regardless of individual or even national views on the larger debate of insularity or openness, consensus exists – or at least could emerge – that cooperation is necessary in global health. Microbes have not yet met an ocean, wall or national border they could not permeate. Zika once again has demonstrated that large and small countries, relatively wealthy and relatively poorer countries all are dependent on a larger infrastructure for their national health security – even the United States cannot rely solely on itself to fight an outbreak or protect itself and Americans from the next outbreak.

While Zika is off the front pages now, it continues to pose a serious threat to communities across our hemisphere. It was not eradicated from any country where it appeared – including the U.S. – and Zika has now expanded its geography to include additional countries in the Pacific and Southeast Asia. Between November and January alone, the U.S. Centers for Disease Control counted close to 4,000 new cases in the U.S. alone (Puerto Rico, the U.S. Virgin Islands, American Samoa and the continental U.S. plus Hawaii).

Huge research gaps continue to persist around Zika, ones that would be best addressed through cooperation rather than competition. We need to know more quickly the number of cases emerging across the world, where such cases are developing, which vectors can carry the virus, what epidemiological evidence exists along routes of transmission (mosquitos, sex, saliva?), how likely an outbreak is to spread based on the above, what risks the virus poses to pregnant women and their babies (the relative risks of microcephaly and other neurological and non-neurological developmental disorders by trimester), and whether co-infections such as with dengue affect risk. The good news is that more of this incomplete list is happening than was true even a couple of months ago – and there are now close to a dozen Zika vaccine trials underway and at least one is moving into early phase human studies.

To do the activities above requires money, including continuing the vaccine trials. The world stands at a crucial point in terms of Zika funding. As Zika continues to spread while funding fails to be delivered, we worry it is both a warning sign and a proof point of the world entering a period of ‘disease appeasement’ – a reality where outbreaks, lives affected and babies lost are the new normal. What is most surprising is that the U.S. is failing to generate domestic funding to manage an outbreak, which contrasts with the role that it has played over the past two decades, as a major leader in global initiatives to tackle HIV/AIDS, tuberculosis, malaria and vaccine-preventable diseases. The frustrations of short-term domestic politics points to the crucial role international agencies and a larger health security infrastructure can play in ensuring health challenges are confronted with sustained long-term vision.

At the global level, the World Health Organization is the key agency to lead on this with a constitutional mandate from its 194 member states to address health emergencies. But given its fumbling of Ebola in which the agency was harshly criticized for its slow initial response, little trust exists to fund and ultimately empower the WHO. We share this frustration but after much deliberation our only hope is to use the dreaded R word and for member states to push through key reforms of the agency to be able to do this important work. Only through successfully managing such crises will WHO be able to reestablish its credibility.

The upcoming Director-General election in May 2017 provides an opportunity for governments across the world to support a strong leader with a clear vision for the agency’s future. We tend to forget that across centuries, controlling infectious diseases has continued to bring countries together. Ultimately outbreaks are about humans – regardless of nationality, religion or skin colour – versus microbes, and the only way to defeat them is to work together.


Profs. Chelsea Clinton (Columbia U) & Devi Sridhar (Edinburgh U) are co-authors of the book Governing Global Health: Who Runs the World and Why? (Oxford University Press, Feb 2017).