Proposing A New Global Compact For Infectious Diseases

Main Category: Infectious Diseases / Bacteria / Viruses
Article Date: 09 Jul 2008 - 2:00 PDT

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The following is by Harvey Rubin, M.D., Ph.D., Director of Institute for Strategic Threat Analysis and Response (ISTAR) University of Pennsylvania School of Medicine:

The World Health Assembly (WHA), the decision-making body of the World Health Organization, recently recommended that member states develop a plan of action for enhanced and sustainable health research and development for diseases that disproportionately affect developing countries; a treaty that could save millions of lives.

This recommendation is laudable, and should be acted upon quickly, but the root problem is much greater than indicated by the WHO. The collective failure, with a few notable philanthropies aside, to respond to the crisis of communicable diseases on a global scale has implications for the economic, political and social well-being of not only the developing countries but for economically advantaged communities as well. Without question infectious diseases play a key role in the perpetuation of poverty, destroying family structures and limiting economic and educational opportunities. To be clear, infectious diseases are a symmetric threat that imperils all nations.

Medical and popular literature is replete with reports of life-threatening infections that are increasingly resistant to existing drugs. Kate Jones of the Zoological Society of London and her colleagues recently analyzed the global temporal and spatial patterns of 335 emerging infectious diseases events from 1940 to 2004. As expected, they found "hotspots" for zoonotic and vector-borne infectious diseases at lower latitudes. Significantly, they also identified hotspots for emerging infections in northeastern United States, Western Europe, Japan and southeastern Australia, concluding that socioeconomic factors including population density and antibiotic drug usage are major determinants of emerging infectious diseases. In an earlier report, The Infectious Diseases Society of America, referring to bacterial infections contracted in hospitals stressed, "... in a growing and frightening number of cases, these bacteria are resistant to many approved drugs, and patients have to be treated with new, investigational compounds or older, toxic alternatives."

Clearly there is an urgent need for a new approach to the global problem of infectious diseases. Over the past year we have intensified our call for a new strategy based on the creation of a four-part Global Compact for Infectious Diseases. Participants in the Compact would build and maintain a data and knowledge architecture that integrates basic scientific, clinical, epidemiologic, policy and economic information. The Compact would also establish and maintain a network of international basic research centers that address microbial threats, work to harmonize regulatory best practices for drug and vaccine production and work to increase the production, distribution and safety monitoring of these agents.

An international treaty, as suggested by the WHA, has the advantages of providing for an international legal basis for enforcement, creating a body of durable "hard law" around an issue and drawing on the power of governments to regulate and license within their jurisdiction. However, treaty ratification is generally a very slow process, limiting action on urgent issues and states may perceive enforcement clauses of treaties as an unacceptable burden or a threat to their sovereignty. The Compact, on the other hand, is a soft law approach that is a proven governance structure for issues of international concern. The Compact allows a relatively fast start-up time, provides a framework for action that brings together a broad coalition of partners around a central issue, and promotes voluntary compliance by the parties. In fact, hard law treaties can often emerge from soft law compacts.

Implementation of the Compact would greatly minimize the profoundly negative impact of infectious diseases on national and international health, social and economic development and international security. The Compact drives innovation and progress in four interconnected core areas by linking compliance with benefits: a strong foundation of basic science feeds the anti-infective and vaccine pipeline which is rapidly shrinking; an effective shared epidemiologic/surveillance system can help predict the most significant microbial threats, which in turn increases our ability to create countermeasures; information technology and knowledge sharing will lower the barriers to entry to the field enabling the discovery and development of new drugs and vaccines; standardized regulatory regimes can modify and inform production and distribution initiatives that will change global epidemiological patterns, beginning the cycle again. Participation by stakeholders from the developing world as well as the developed world in all four missions of the Compact will ensure its enforceability.

Controlling communicable diseases on a global scale is a problem of deep complexity with many interdependent parts that can only be solved with an integrated approach that generates powerful incentives for participation. Most importantly, it has to be done as a partnership and it must be done soon.

Institute for Strategic Threat Analysis and Response
http://www.istar.upenn.edu