World Health Day – The Fight to End Pandemics

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In honor of World Health Day, our Larry Brilliant writes on how to tackle pandemics. This article first appeared in Forbes and the Skoll World Forum online as part of a series on global health.

World Health Day – April 7 – honors the creation of the World Health Organization (WHO) in 1948. Each year, we celebrate the advances in global health and the role that the WHO plays both in improving health and elevating health on the global agenda.

Today, even as many had thought we could finally turn our attention to the increasing importance of chronic diseases like diabetes, cancer and heart disease, infectious diseases like malaria and tuberculosis, as well as the continuing pandemic of HIV/AIDS, remain stubbornly high on the global agenda.

We are reminded daily of the role that the WHO plays in fighting these top three infectious disease killers. At the same time, an alphabet soup of influenzas, including the new H7N9 outbreak in China, smoldering incidents of H5N1 bird flu in Southeast Asia, and even periodic reminders of the 2009 H1NI swine flu pandemic, remain front of mind. On top of that, global health workers must confront other zoonotic diseases, including new SARS-like coronaviruses detected from countries as diverse as Saudi Arabia and the UK, as well as old nemeses like Hantavirus, which recently showed up unexpectedly in California’s Yosemite National Park, and countless other epidemics.

For historical importance on today’s WHO birthday list, however, nothing tops the heroic struggle to eradicate polio. This ancient scourge has been beaten back, village by village, country by country, so that, remarkably, it is now endemic in only three countries: Pakistan, Afghanistan and Nigeria. India, one of the ancient homes for polio, has mustered millions of volunteers to join a national polio eradication campaign supported by the WHO, UNICEF, Rotary, the Bill and Melinda Gates Foundation and others. It has had remarkable recent success: there has not been a single case of polio in India in two years. While eradicating polio is a huge, complex, global team effort, we cannot overstate the importance of the WHO’s leadership role in the polio eradication campaign.

As someone who is almost the same age as the WHO, and whose first job out of medical school was working for the WHO smallpox program, I reflect with collective pride on the success of the WHO program that eradicated smallpox three decades ago, the organization’s crowing achievement to date. But eradicating polio would mean “two” instead of “one” disease eliminated from the list of humanity’s woes–proving that eradication is not a unique event. So this second disease eradicated might be even be sweeter. It has taken a very long time, cost a great amount of treasure, and no small number of public health workers lives. But we are getting very close on polio, and I am optimistic.

In fact, I’m optimistic broadly about our ability to effectively tackle nearly all of our communicable diseases foes, old and new. Why?

The arc of my career – from physician to public health practitioner, from government to business to philanthropy – has given me a unique view into public health trends over the last four decades. One key change in global public health over this time has been the rise of non-state actors. Decades ago, global public health was almost synonymous with the annual World Health Assembly in Geneva, largely the domain of health ministers setting goals and policies for WHO staff to implement. It would have been unthinkable for the NGO sector, let alone individuals, foundations, companies or even universities to play much of a role. Today, it’s vastly different, with public advocacy groups, civil society players that span the globe, and foundations like Bill and Melinda Gates, Rockefeller and others joining UN agencies and bilateral donors in the global health conversation. Over the last ten years, much innovation has come from these newer players. Social entrepreneurs, advocacy groups, and nimble non-profits are creating new systems, new technologies and developing new models for delivering health care, particularly to underserved populations.

Thanks to recent changes in the International Health Regulations, we’ve seen another type of non-state actor emerge: digital data players. Since 2007, countries have been obligated to increase their reporting on a wide range of newly emergent diseases with the potential to spread beyond borders. For cash starved health ministries, this additional obligation might have been an economic burden. But the new rules also provided new tools: countries can now tap into informal sources of disease information as part of their official reporting. This has spurred the creation of new tools and new organizations, ramping up disease surveillance capacity significantly.

Examples of these digital data players include:

  • GPHIN, which scrapes the web for media reports on diseases outbreaks;
  • ProMed, an Internet based expert community that reports on and organizes responses to outbreaks;
  • Google Flu Trends, which maps flu based on Internet search terms;
  • INSTEDD, which builds epidemic control and communication systems;
  • and HealthMap, which combines elements of several of these systems to display real time maps of diseases around the world.

 

These are a few of dozens of examples of the new tools that can help piece together what’s happening worldwide on contagious diseases. They and others like them have helped reduce the lag between a disease outbreak and its detection. A study published several years ago in the Proceedings of the National Academy of Sciences reported that the lag time from the first occurrence of a new pandemic potential disease was over 5 months—167 days —in 1996; but by 2009 it had dropped to 23 days, just over 3 weeks. When we find outbreaks faster, we can limit their spread.

At the Skoll Global Threats Fund, we’ve recently helped launch (in partnership with the APHA and HealthMap) a tool that goes one step further – getting people to actively participate in public health by self reporting each week on symptoms. Flu Near You now has nearly 80,000 users in the US. Each week, participants receive an email (or mobile app notification) where they click on a link to report whether they’ve experienced any of eight symptoms related to flu, or, alternatively, were symptom free. This then populates a map showing flu prevalence geographically in real time, as well as pointing users to nearby flu resources, for example, pharmacies with vaccines. This follows other similar systems, FluTracking in Australia and Influenzanet in Europe. We’re exploring together whether this type of participatory surveillance can help us find and react to outbreaks even more quickly. Of course, it is not just about flu; the hope is to learn how to work worldwide with a host of diseases in the next few years.

As far as infectious diseases, global public health has never been stronger than it is today. But our challenges remain substantial. The speed of travel and just-in-time global supply chains means a pandemic can spread faster than ever before, with greater economic and health impacts than even before. But advances in surveillance tools like the ones I’ve mentioned, improvement in point of care diagnostics, and the emergence of regional surveillance structures in key regions, all give us a more than fighting chance against new and old communicable disease.

At the Prince Mahidol Awards Conference in Bangkok this January, a new organization was launched called CORDS (Connecting Organizations for Regional Disease Surveillance). Made up of six regional disease surveillance networks in the Middle East, Southern and East Africa, South East Asia and Eastern Europe (each of which are in turn partnerships of several national health ministries), CORDS has the potential to speed best practices and help innovate rapid disease detection and response. The group that funded and partnered to create CORDS includes the Rockefeller Foundation, NTI, Fondation Merieux, Peter G. Peterson Foundation, the Bill and Melinda Gates Foundation, and our own Skoll Global Threats Fund. And getting back to World Health Day, key multilateral organizations working together with CORDS include the Food and Agriculture Organization, the World Organization for Animal Health, and the most important global health agency of all, the WHO.

That WHO, global foundations, NGOs, government health ministries and regional networks around the world are all working together is a great take-away for today’s World Health Day. While there may be a never-ending supply of new viruses jumping from animals to humans, we now have innovations in technology and governance more than equal to the challenge. In fact, we may be at a stage where we can realistically talk about not only eradicating our “second” disease, polio, but even ending pandemics.

And that is something worth celebrating. So join me today on World Health Day, put 65 candles on that birthday cake, make a wish that polio joins smallpox in the dustbin of history and that we work together to prevent any new infectious disease nightmares, and let’s celebrate WHO and the role it has played–and will continue to play–year after year, birthday after birthday.

Happy World Health Day to all of us!

Talking Water Security on World Water Day

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Today is World Water Day.   Our president, Larry Brilliant, has co-authored a piece with Dr. Andrew Steer, president of the World Resources Institute, on some of the big challenges the world currently faces on water.  This originally appeared on McClatchy News.

Navigating the ‘vast sea of unknowns’ of water risk

We know less about one of world’s most pressing challenges today than we did 10 years ago. It’s no secret that water – or the lack thereof – will be one of the defining issues of the 21st century. And yet, the United Nations World Water Report, in 2009, stated that when it comes to water, “less is known with each passing decade.”

The World Economic Forum recently named the water supply crises as one of the top risks facing the planet – edging out issues like terrorism and systemic financial failure. Water risks permeate almost every aspect of global society. We got a taste last year with crops scorched by drought, shipping lanes threatened and energy plants shut down by low water levels, and coastlines devastated by flooding. Exacerbated by climate change and population growth, such crises will become more common and costly. Yet, the world largely lacks the data we need to monitor, understand, and respond to these water challenges. We are flying blind when it comes to global water issues.

History shows us the power of information to avert crisis. For example, as a result of a dramatic increase in data, the public health community has transformed its ability to identify and respond to a pandemic. Less than 20 years ago, it took, on average, 167 days to detect and verify a disease outbreak.

Today, it takes less than 20 days largely because of advances in data collection and availability, including leveraging passive data through tools like Google Flu Trends and web scrubbers like the Global Public Health Intelligence Network. The health sector has invested in better information to detect pandemics. It’s time for the water sector to invest in better water data to respond to devastating water-related disasters and increasing water risks.

Unfortunately, directly observed data on water is patchy at best, non-existent at worst. The Global Runoff Data Centre is the closest thing to an international clearinghouse for information on how much water is in rivers worldwide. But the number of data collection stations reporting to the Centre has fallen steadily since the 1980s; only about one-third of the observing stations report their data to the Centre. Many stations are no longer being maintained, have been eliminated, or are reluctant to publicly share the data. Of particular concern are the region’s most at risk – the Middle East, South Asia, and Africa – where publicly available water data is nearly absent.

Even in the United States, the story is not so different. The country is still recovering from impacts of Superstorm Sandy, which cost over $60 billion, and the ongoing drought, which may turn out to the be the costliest natural disaster in U.S. history.

Meanwhile, the U.S. Geological Survey reported that between 1980 and 2004, over 2,000 stream gauges to measure river levels were shut down, a loss of more than a quarter of the nation’s total network. These gauges help predict floods and droughts and provide the data needed to monitor changes in water stress. The current budget “sequestration” could force USGS to shut down an additional 375 gauges.

To prepare for an increasingly water-insecure future, we urgently need to bridge this data gap.

The good news is we do not have to start from scratch. Using available data from satellites and state-of-the-art modeling techniques, it is possible to collect critical information needed to monitor and evaluate emerging water risks across the globe.

One example is Aqueduct, the global water risk mapping tool recently released by the World Resources Institute, with the support of the Skoll Global Threats Fund, and multinationals like Goldman Sachs, GE and Shell. Aqueduct offers free and open data, across twelve indicators of water risk, ranging from floods and droughts to access to clean drinking water. It also provides the ability to project changes in water risks in the coming years, according to the effects of climate change, and population and economic growth.

While Aqueduct represents an important resource, it is not enough. There is no substitute for directly observed, locally collected data. Bringing together such information can be a daunting task, but there are several important steps that must be taken to improve water data. We need increased investment in gathering local water data; and more stream gauges need to be installed, rather than shuttering those we already have. We need to meter groundwater, so we know how quickly these water suppliers are being depleted. We need to take advantage of new technologies, such as satellite remote sensing and crowd-sourced data, to fill the gaps. And perhaps most important, we need to change the paradigm from secrecy to transparency by negotiating ways to make existing data held by governments, companies and academic institutions freely available.

In 2012, a UNESCO report compared our understanding of water to “islands of knowledge in a vast sea of unknowns.” As we mark World Water Day 2013, it’s clear that this is no way to handle one of the defining challenges of our generation. Now more than ever, we have the capability to address our woeful lack of water data. We just need the will to do so.

Taking Stock of U.S. Climate Engagement

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Over the last several months, our climate change director, Amy Luers, led a research effort to characterize the landscape of U.S. climate engagement efforts in order to help inform our approach. She and her team spoke to a wide range of players in the climate arena, as well as commissioned some dedicated research on specific aspects of engagement. We pulled together some of the more interesting take-aways from this research in a discussion paper, “Taking Stock: U.S. Climate Engagement.”  We hope this will be useful to others in the climate engagement field. You can read it by clicking on the the image below.

Larry Brilliant on Regional Climate Security in South Asia

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Our president, Larry Brilliant, recently gave a keynote address at the 2013 Delhi Sustainable Development Summit focused on regional climate and water challenges in South Asia. He lays out how the region is deeply interdependent due to its transboundary water flows, and how climate and water variability are likely to increase tensions. He also recommends several areas for work to reduce those tensions. Watch it below.

CORDS Launches as Independent Entity to Improve Disease Surveillance

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CORDS, an organization dedicated to improving disease surveillance worldwide, launched today at the Prince Mahidol Award Conference in Bangkok. The Skoll Global Threats Fund is one of the cornerstone supporters of this new entity. CORDS (Connecting Organizations for Regional Disease Surveillance) is a unique, international non-governmental organization building information exchange among disease surveillance networks in different regions of the world. CORDS promotes global exchanges of best practices, tools and strategies, training courses, innovations, case studies and technical data to improve disease surveillance worldwide.

CORDS works on four primary objectives to improve global disease surveillance: improving capacity; advancing One Health (human, animal and environmental health together); promoting innovation; and building sustainable networks. CORDS complements the work of the leading global human, animal and food health organizations. The World Health Organization, the World Organization for Animal Health and the Food and Agriculture Organization of the United Nations have all welcomed the creation of CORDS (see their joint letter here).

Funding of CORDS as an independent entity comes from the Rockefeller Foundation, the Bill & Melinda Gates Foundation and the Skoll Global Threats Fund following initial project support from the Nuclear Threat Initiative, the Peter G. Peterson Foundation and the Rockefeller Foundation.

The six founding networks of CORDS are

-       The Asian Partnership on Emerging Infectious Disease Research
-       The East African Integrated Disease Surveillance Network
-       The Mekong Basin Disease Surveillance Network
-       The Middle East Consortium on Infectious Disease Surveillance
-       The Southeastern Europe Health Network
-       The Southern Africa Center for Infectious Disease Surveillance

More details on CORDS, as well as case studies from several of its member networks, can be found in a special supplement to the Emerging Health Threats Journal here (or via PDF). For more information, visit www.cordsnetwork.org. Follow CORDS on Twitter at @CORDSNetwork.

ABC World News Talks Flu Near You

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ABC World News with Diane Sawyer ran the segment below last night on this year’s early flu season. It includes a reference to our Flu Near You project.  John Brownstein of Healthmap, one of our partners (along with the American Public Health Association) on Flu Near You, has a clip in the segment. Great stuff. We hope this drives more users to Flu Near You!