|Building a defense against Ebola: Kenyan officials at Nairobi airport check temperatures of arriving passengers (top); lack of basic supplies to protect against infection felled Sierra Leone’s top Ebola doctor Sheikh Umar Khan|
NEW HAVEN: The Ebola epidemic in West Africa receives daily international coverage, with good reason, as the human and economic crisis intensifies in four nations – Liberia, Sierra Leone, Ghana and Nigeria. The World Health Organization has called for international cooperation to halt the spread of the deadly virus, advocating for a massive emergency response. With no approved vaccine or therapeutic, treating infected individuals is that much more difficult, and the question arises on how to better prepare for the next pandemic.
One approach to fight pandemics would be to establish a fund earmarked for two purposes: An immediate-response fund would provide assistance to countries with weaker health infrastructure to fight present outbreaks while other funds would be channeled for research and development of vaccines, therapeutics, or diagnostics for emerging diseases such as Ebola, Middle East Respiratory Syndrome and Chikungunya.
The United States should take the lead in establishing such a fund by requiring a tax on airline tickets for all passengers traveling in and out of the country. Extra charges are not unprecedented with passengers already paying a tax on tickets to pay for homeland security. The US Department of Transportation Statistics reports 181,413,042 international passengers departed or arrived at US airports in 2013 – most with round trips. Adding $3 per international ticket would amount to about $500 million per year.
Why single out international tickets? Because international travelers can be vectors or carriers for infectious microorganisms, this charge would be a fair form of insurance that would contribute to reducing the likelihood of pandemics.
Countries can lead on pandemics by starting a research fund with a small tax on airline tickets.
In response to the current Ebola crisis Paul Allen, a co-founder of Microsoft, recently donated $9 million to the US Centers for Disease Control and Prevention, and the Bill & Melinda Gates Foundation gave $50 million to provide supplies and scale up emergency operations. Funds generated from the tax on international travel would achieve a similar effect providing similar flexible money before a crisis requiring a massive response occur without waiting for major donors. This would also reduce the need of governments to redirect funds earmarked for other purposes. Responses would be quicker.
Throughout human history infectious organisms such as smallpox and the black plague have led to epidemics and economic contraction. The challenge today, however, is the ability for such infections to spread globally more rapidly. International air travel has become a commonplace part of life for many, creating a so-called “global village” wherein a virus can leap from even the remotest areas to urban centers that are home to millions and create a global crisis within months. The world’s experience with SARS illustrated this. The disease emerged in Southern China in mid-November 2002 and spread to Canada within four months, after being carried by an international airline traveler. Individuals from many parts of Asia and Australia were infected by asymptomatic air travelers. By the time the SARS epidemic subsided, less than a year later, a total of 8,098 people worldwide had been infected, the disease killing about 10 percent of them. The estimated cost to the Far East alone was roughly $30 billion.
Ebola’s economic impact is already significant, costing millions in tourism and trade, for the countries fighting the disease. People are being advised not to travel to the affected countries. Airlines are also hurt economically when such events occur. During the 2003 pandemic of SARS, severe acute respiratory syndrome, Asia-Pacific carriers lost $6 billion in revenue and North American airlines lost $1 billion, Reuters reported.
The challenge today: Infections spread globally more rapidly. International travel has created a “global village.”
One of the problems in fighting Ebola is that the Western African countries have a relatively weaker health infrastructure, lacking in adequate supplies and personnel. The New York Times described a desperate search by a prominent doctor in Sierra Leone, Sheik Umar Khan, for basic supplies such as protective clothing, chlorine for disinfection, salt solutions to fight dehydration and body bags before succumbing to the disease himself. The United Nations and the aid group Doctors Without Borders have issued urgent appeals for international aid to contain the outbreak. An emergency fund provided by the new tax would be available as an immediate resource. The White House, relying on recommendations from the US Centers for Disease Control and the State Department, could decide how to distribute the funds.
Considering the barrage of news reports on medical research, many may assume that sufficient funds are available to research microbes behind emerging infectious diseases. However, pharmaceutical firms and government agencies tend to fund research and development on infectious diseases that affect large numbers of people because of greater impact or commercialization potential. Research on a vaccine, therapeutic or diagnostic for a relatively rare infectious pathogen in a developing country poses greater financial risk if the outbreaks are limited. With the recession of 2008 and budget sequestration in 2013, the resources available to the National Institutes of Health and other funders of such research in the United States, have been reduced. Providing a new source of revenue, a form of economic stimulus, could help smaller companies to work on high-risk projects involving pathogenic infectious organisms.
With increased funds, researchers can also take advantage of modern technologies. Originally vaccines were composed of either attenuated or weakened forms of a pathogen or inactivated pathogen. Using recombinant DNA technology, it is now possible to isolate single genes from a pathogen. Researchers can simply produce the protein made from that gene for immunization or place the gene in a non-pathogenic virus for immunization. An example of a new type of vaccine is the US Food and Drug Administration–approved Flublok influenza vaccine from Protein Science Corporation, which uses the viral protein hemagglutinin protein for immunization. The traditional vaccine that contains inactivated influenza virus is likely to be replaced. Current vaccines for human papilloma virus and hepatitis B were developed in similar ways.
Western Africa nations have a weak health infrastructure, with limited supplies and personnel to fight Ebola.
Many of these viruses live in host species, called reservoir species, where they are non-pathogenic. When the virus is transmitted to another species, the virus can become lethal as is the case for humans with Ebolavirus. The filoviruses, including Ebolavirus and Marburgvirus have been linked to bats. The bat becomes infected with the virus, and the virus multiples in the bat before being shed into the environment. However, the bat makes an effective immune response, suffering no harm, in contrast to humans where infection by the Zaire Ebolavirus is 60 to 90 percent lethal. Understanding how the bat makes an effective immune response to Ebola could provide clues for new strategies to fight the virus.
Wealthier nations with the strongest scientific infrastructure, such as the United States, must take the lead in combatting pandemics. People traveling internationally should be part of the solution by paying a tax that would provide immediate help with epidemics caused by infectious organisms and fund the development of long-term solutions for future outbreaks – critical for human well-being in the age of global travel. Hopefully the governments with the capacity to administer such funds will heed this call and take action. Ebola will not be the last epidemic.