A global prescription for a global outbreak

If the SARS outbreak has taught us anything, it is how interconnected the world is and how vital is the need for global cooperation on public health issues.

So says Ilona S. Kickbusch, Ph.D., head of the division of global health at the School of Public Health. “This isn’t just an issue for developing countries,” she says. A case in point is how, in a matter of weeks, travelers spread the disease from China’s Guangdong province throughout Asia, Europe and North America. “When the SARS outbreak spread to Canada we saw just how close to home it really was.”

Although it falls largely to the World Health Organization (WHO) to provide international public health oversight, prior to the emergence of SARS, Kickbusch says, the agency’s hands were tied economically and statutorily. The WHO budget has been stagnant at $800 million a year (less than it takes to run the average hospital in the United States) for the past 15 years. (It has another “voluntary budget” of about $800 million, but that money must be spent on projects identified by the contributing countries.)

What’s worse, if an outbreak occurred, the WHO had to get permission from the host country to investigate. “For political and economic reasons, some countries weren’t as compliant as one might wish,” she says. Also, countries only had to report named illnesses, not atypical syndromes, so a new illness like SARS could go unreported.

As a result of SARS, though, the World Health Assembly, WHO’s governing body, voted to give the WHO more latitude in responding to global health threats. A resolution adopted by the assembly in May requests that WHO consider information about epidemics from nongovernmental sources and conduct on-the-spot studies within affected countries to ensure that control measures are adequate to prevent international spread of the syndrome. Kickbusch says that’s a good start, but more must be done, including intensified global surveillance and laboratory work, funded in part by public/private initiatives.

Kickbusch would also like to see more well-trained public health professionals working at the ground level, and she says there need to be clearly stated consequences, such as economic sanctions, for those countries that withhold important public health information or fail to act as responsible global citizens.

“It’s a matter of global security in the widest sense,” she says.