Kigali– To say a virus has gone viral, is of course, a tautology because – viruses are by definition, viral. But Covid-19 has, most definitely gone viral. It has shut down economies, caged humans, overwhelmed medical services, shut down global transport, supply and distribution chains. Viruses are strange. They exist in that murky area between living and nonliving – bits of RNA or DNA that cannot be said to be alive and yet – are not dead. If there is a purgatory, it must be the world of viruses and when they breakout of their purgatory as they periodically do, viruses and other microbes bring us to the swift realization that Lao Tzu was right when he said: “Heaven and earth are ruthless and treat the myriad creatures (on earth) as straw dogs”. Consider the facts. The Ebola outbreak of 2014-2016 devastated West Africa and should have been a wakeup call to the Global Community. The ZIKA outbreak of 2016 devastated Latin America. Ebola returned to the DRC in 2017. That same year, Madagascar was hit by pneumonia plague and at the same time, Marburg virus disease hit Eastern Uganda and then Nigeria was hit by Lassa fever in 2018. Now we have all been affected by Covid19. Covid is the latest virus to escape its purgatory and seek hospitality among homo sapiens Sapiens. I wish I could say it is the last. Alas, it is not. The Coalition for Epidemic Preparedness (CEPI), a global alliance financing and coordinating the development of vaccines against emerging infections as well as the World Health Organisation, have identified at least 11 pathogen of epidemic potential. These include: Chikungunya, Corona Viruses, filo viruses, rift valley fever, west Nile fever, Lassa virus, Nipah virus, Crimean Congo heamoraegic fever, plague, paratyphoid, and MERS. What keeps me awake at night is what they have called disease X – a totally new pathogen – whose biology and epidemiology would be totally unknown – or perhaps unknowable. So, in the purgatory from whence Covid19 emerged – other pathogens exist. And they will attack. It is not a question of whether but of when. – And one doesn’t successfully fight an epidemic during an epidemic. Countries that succeed are those that prepare during the inter-epidemic period. Those that invest resources in the science that enables them to react nimbly and rationally to outbreaks that threaten their people. As Prof John David Kabasa has so aptly put it, historically we have had warriors who had spears to combat larger physical threats that could be seen. We are now at war with things that we cannot see and we risk losing the battles. In this era, it is the scientists who are the warriors and their weapons are micro and nasoscopes. This era demands new policies and practices to sufficiently fund the warriors for the battles they must fight. In 2018, Marie Paule Kieny of Institut National de la Santé et de la Recherche (INSERM) and I, co-chaired an International Vaccines Task Force (IVTF) – convened by CEPI and the World Bank Group, to examine how we can better support our new warriors for the battles to come. The recommendations are particularly relevant at this time. I will share just two: 1.Countries should conduct or participate in clinical research to address their public health needs. (I strongly believe that Africa should not continue to simply be a recipient of research directed by and carried out by others. It should build own capacity to meaningfully participate and protect the lives of her citizens). 2. Of course building capacities requires resources. Therefore the World Bank Group was asked to encourage IDA countries to establish or leverage existing regional partnerships for developing clinical research capacity using the IDA Regional window funds combined with domestic commitments. The World Bank Group should highlight progress and develop a robust case for inclusion of prioritized regional clinical research partnerships as a thematic area under IDA19. Some of the resources availed under IDA and other bank lending instruments may be converted into grants under a robust, buy down program with broad participation by governments, development agencies, philanthropic organizations, the private sector and others, agreed prior to disbursement. The program would be contingent on clear indicator milestones and deliverables agreed a priori. Clearly, there is a glaring need for a global response to global pandemics. A country by country approach is a recipe for disaster – as Covid19 – and earlier outbreaks have shown us. I am confident we shall emerge victorious against Covid19 – but at what cost? And with what lessons learnt? This is the time to draw up battle plans for the next outbreaks. Then and only then, can we all sleep at ease, confident that we are ready for the inhabitants of purgatory – including pathogen X. @rsezibera The views expressed in this article are of the author.
