Before Preparing for Pandemics, We Need Better Evidence of Risk

Before Preparing for Pandemics, We Need Better Evidence of Risk A high quality report prepared for Brownstone Institute to evenhandedly assess pandemic risk MERYL NASS JAN 20 https://brownstone.org/articles/before-preparing-for-pandemics-we-need-better-evidence-of-risk/ By REPPARE January 19, 2024 Perceptions of threat The world is currently reorienting its health and social priorities to counter a perceived threat of increased pandemic risk. Spearheaded by the World Health Organization (WHO), the World Bank, and the Group of 20 governments (G20), this agenda is based on claims of rapidly increasing infectious disease outbreaks (epidemics), driven largely by an escalating risk of major “spillover” of pathogens from animals (zoonosis). To be globally prepared for such pandemic risk, many quarters have pushed for comprehensive and urgent action, to avert an “existential threat” to humanity. The G20 has been central to promoting this sense of urgency. As it states in the G20 High Level Independent Panel report ‘A Global Deal for our Pandemic Age:’ “without greatly strengthened proactive strategies, global health threats will emerge more often, spread more rapidly, take more lives, disrupt more livelihoods, and impact the world more greatly than before.” Moreover, “…countering the existential threat of deadly and costly pandemics must be the human security issue of our times. There is every likelihood that the next pandemic will come within a decade…” In other words, the G20’s report suggests that pandemics will rapidly increase in both frequency and severity unless urgent action is taken. In response, the international public health community, supported by scientific journals and major media, is now focused on the task of preventing, preparing for, and responding to pandemics and the threat thereof. Over $30 billion annually is being proposed to be spent on this issue, with over $10 billion in new funding – three times WHO’s current annual global budget. Reflecting a sense of urgency of living in a “pandemic age,” countries will vote on new binding agreements at the World Health Assembly in May 2024. These include a set of amendments to the International Health Regulations (IHRs) as well as a new Pandemic Agreement (formerly known as The Pandemic Treaty). The aim of these agreements is to increase policy coordination and compliance between Member States, particularly when the WHO declares that a Public Health Emergency of International Concern (PHEIC) represents a pandemic threat. It is prudent to prepare for public health emergencies and pandemic risk. It is also sensible to assure that these preparations are reflective of the best available evidence concerning pandemic risk, and that any policy response is proportional to that threat. One hallmark of evidence-based policy is that policy decisions should be substantiated by rigorously established objective evidence and not based merely on ideology or common belief. This enables appropriate allocation of resources among competing health and economic priorities. Global health resources are already scarce and stretched; there is little doubt that decisions about pandemic preparedness will have significant implications for global and local economies, health systems, and well-being. So, what is the evidence on pandemic threat? The G20 declarations from 2022 (Indonesia) and 2023 (New Delhi) are based on the findings of its High Level Independent Panel (HLIP), laid out in a 2022 report informed by the World Bank and the WHO, and analysis commissioned from a private data company, Metabiota, and the consulting firm McKinsey & Company. The report summarizes the evidence in two annexes (Figure 1 below), noting in its Overview that: “Even as we fight this pandemic [Covid-19], we must face the reality of a world at risk of more frequent pandemics.” while on page 20: “The last two decades have seen major global outbreaks of infectious diseases every four to five years, including SARS, H1N1, MERS and Covid-19. (See Annex D.)” “There has been an acceleration of zoonotic spillovers over the last three decades. (See Annex E.)” By “zoonotic spillovers,” the report refers to the passage of pathogens from animal hosts to the human population. This is the generally accepted origin of HIV/AIDS, the 2003 SARS outbreak, and seasonal influenza. Zoonosis is assumed to be the major source of future pandemics, barring laboratory releases of pathogens modified by humans. The basis of the G20 HLIP report’s sense of urgency is these annexes (D and E) and their underlying data. In other words, it is this evidence base that supports both the urgency of establishing robust global pandemic policies, and the level of investment that these policies should involve. So, what is the quality of the evidence? Despite the importance the HLIP report gives to the data in Annex D, there is actually little data to assess. The Annex presents a table of outbreaks and the years they occurred, with no attribution or source provided. While Metabiota and McKinsey are quoted elsewhere as primary sources, the relevant McKinsey report does not include this data, and the data could not be found when conducting searches of publicly-available Metabiota material. To better understand the implications from the data in Annex D, we created a corresponding “best-fit” table of pathogen outbreaks and year (Figure 1), with official mortality data for the entire outbreak per pathogen (some extend beyond 1 year – see sources in Table 1). In order to address an apparent oversight in the Annex D table, we also included the 2018 and 2018-2020 Ebola outbreaks in the Democratic Republic of Congo in our analysis, since there were no large outbreaks of Ebola reported in 2017. This is likely what “Ebola 2017” was intended to denote in the Annex D table. In our analysis (Figure 1) we exclude Covid-19 since its associated mortality remains unclear and its origin (laboratory-modified or natural) is contested, as discussed later. When comparisons are made between the HLIP outbreaks table and our table of the last two decades, one mortality event dominates – the 2009 Swine Flu outbreak that resulted in an estimated 163,000 deaths. The next highest, the West African Ebola outbreak, resulted in 11,325 deaths.