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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Why Should We Evaluate Global Pandemic Preparedness?

We may think written plans and the occasional table-top exercise are making us more prepared to handle a pandemic, but true preparation goes far beyond that. The ability to prevent, detect, respond, and control outbreaks is a hefty investment that countries are still struggling to make, and as a new report recently revealed, a paltry amount of countries may be ready for a pandemic.

A recent report from the World Bank found that only 6 countries have taken efforts to truly evaluate their capacity and capability to withstand a global biothreat. Given the amount of biothreats countries around the world are faced with every day, these data are shocking.

Curious as to which 6 countries went above and beyond to evaluate their readiness for a pandemic?

You may be surprised to learn that although 3 were wealthy countries—Finland, Saudi Arabia, and the United States—the rest were poorer countries—Eritrea, Pakistan, and Tanzania.
These results say a lot in terms of overall country wealth and the sad prioritization of health security. It is not enough to fund biodefense and global health security efforts. Furthermore, blindly funding these efforts, without assessments such as a Joint External Evaluation and other assessment tools, can be tragically ineffective and deadly. These evaluation efforts are pivotal in revealing significant gaps within critical infrastructures that are vital during pandemics. What this new report has found, however, is that few countries are taking these important steps.

The new analysis, and subsequent report, are joint efforts between the World Health Organization and the World Organization for Animal Health (OIE). This information was the result of an international working group working to “propose ways in which national governments and development partners can ensure adequate and sustainable financing for actions to strengthen pandemic preparedness, and thus, enable effective compliance with the International Health Regulations (IHR), as well as OIE standards.” The report addressed gaps and provided an estimation of funding needs, sources of finance, and the means for mobilizing them for preparedness, etc.

Analyses like these have been more common since the Ebola outbreak in 2014-2015, which highlighted considerable disparities in nations’ public health and healthcare infrastructure, that are heavily reliant on government support and funding.

You might wonder, “if it was really necessary, more countries would be doing it.”

Sadly, like most preventative acts, countries tend not to realize the cost of failure. How much do these biothreats cost us? The World Bank estimates that the 2014-2015 Ebola outbreak cost $2.2 billion in GDP in 2015 for Guinea, Liberia, and Sierra Leone. Moreover, a 2016 National Academies of Medicine report estimated that a moderate to severe pandemic would cost $60 billion, while other estimates have come in as high as $80 billion. The World Bank report notes that “even the most conservative estimates (0.1% to 1.0% of global GDP) suggest pandemic risks are on par with other high-profile economic threats that concern business leaders and policy makers, such as climate change (0.2% to 2.0% of global GDP, according to IPCC 2014) and natural disasters (0.3% to 0.5% of global GDP and 65,000 deaths per year, according to UNISDR 2015).”   

The report estimated country-level vulnerability to economic loss from pandemics (meaning that in the event of a pandemic, such as severe acute respiratory syndrome (SARS), it would cost each country a certain amount per citizen), and found that the expected annual pandemic loss per capita was $9.42 for the Democratic Republic of Congo, $897.74 for Romania, and $247.79 for the United States. That's right, in the event of a pandemic, each citizen of Romania would cost the government nearly $900, which can be extremely financially taxing.

These numbers are startling and point to reveal the devastating consequences of a pandemic. It behooves us to not only invest in global health security, but also evaluate our efforts at every step of the way to ensure we are not only using the most effective and efficient tools, but also making smart investments. 
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Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.
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