Connecting Science and Policy for a Healthier World Pandemics Working Together for an Effective and Equitable Response A report from the Pacific Health Summit Seattle, USA June 12-14, 2007 Published in the United States of America by The National Bureau of Asian Research 1215 Fourth Avenue, Suite 1600 Seattle, Washington 98161 206-632-7370 Phone 206-632-7487 Fax [email protected] E-mail http://www.nbr.org © 2007 by The National Bureau of Asian Research This publication may be reproduced for personal use. Otherwise, its articles may not be reproduced in full without the written permission of NBR. When information from this report is cited or quoted, please cite The National Bureau of Asian Research. The views expressed in this publication do not necessarily reflect the views of the institutions that support NBR. NBR is a nonprofit, nonpartisan research institution that focuses on major policy issues in the Asia-Pacific and their im- pact on the United States. Major themes in NBR’s research agenda include stra- tegic and diplomatic relations, regional economic integration and development, trade, globalization, terrorism, energy, and health. Drawing upon an extensive network of the world’s leading special- ists and leveraging the latest technology, NBR conducts advanced, policy-ori- ented analysis on these issues and dis- seminates the results through briefings, studies, conferences, television, and e- mail fora. NBR is a tax-exempt, nonprofit corporation under I.R.C. Sec. 501(c)(3), qualified to receive tax-exempt contributions. Printed in the United States of America. Summit photos by Mark Weeks. Other photos from Corbis and Getty Images. An avian influenza pandemic: How afraid should we be? 2 Reason for optimism: Tangible progress 6 Aligning policy with shifting realities: Are we meeting the challenges? 10 Summit impact 16 Pacific Health Summit 2007 leadership 20 PACIFIC HEALTH SUMMIT 2007 1 An avian influenza pandemic: How afraid should we be? “I can guarantee you, there will The sense of ur- be chaos.” Margaret Chan, Direc- gency at the Summit tor-General of the World Health was palpable. The Organization (WHO), was speak- devastating effects of ing with the voice of experience the 1918 Spanish flu about the challenges of coordina- pandemic, as well as tion and communication during a more recent global public health emergency. Having health crises such as managed the responses to the first the spread of HIV/ avian influenza outbreak in 1997 AIDS and tuberculo- and the SARS (Severe Acute Respi- sis and the SARS outbreak of 2003, were sober- ratory Syndrome) outbreak in Hong ing reminders of the potential consequences of Kong as Director of the Hong Kong a new pandemic. There was little doubt among Department of Health, Dr. Chan Summit participants that another global influ- understands full well the multiple enza pandemic is likely. The question on every- difficulties that a highly lethal, com- one’s mind was, will we be ready? municable disease presents. The 1918 flu pandemic occurred before the Dr. Chan was speaking to world leaders in era of widespread global travel and world trade. global health gathered in Seattle for the third As Tachi Yamada, President of Global Health Pacific Health Summit. The purpose of the -an at the Bill & Melinda Gates Foundation, pointed nual Summit is to connect top decision-makers out, recent models built from data from 1918 sug- in science, policy, industry, medicine, and public gest that upwards of 62 million people could per- health to chart a course toward a healthier future. ish in a 21st century pandemic, with 95 percent of While this year’s Summit theme was pandemics, those deaths occurring in the developing world. participants also discussed how to improve health According to the World Bank, a new pandemic systems for the ultimate goal of keeping people could cost the global economy between $800 bil- healthy and reducing the human and financial lion and $2 trillion. An avian flu pandemic would cost of disease. In this respect, the pandemics make the difficult issues of resource allocation dilemma became a case study in prevention and even more urgent, with the potential to pit the na- preparedness, one that has many lessons for a tions and peoples of the developed world against wide variety of human health challenges. those that lack the infrastructure and other re- Voices of the Summit [Our common enemy] is right here, right among us, and within us. That common enemy is disease, disease that affects all of humankind indiscriminately, without regard for race, sex, or geographic location. – Andrew von Eschenbach, U.S. Food and Drug Administration 2 PACIFIC HEALTH SUMMIT 2007 Can the world afford to leave vast populations vulnerable to the high morbidity and mortality that accompany pandemics? Margaret Chan, Director-General of the WHO The Pacific Health Summit Every June the Summit welcomes global health leaders to Seattle to discuss how to connect science and policy for a healthier future. sources to cope effectively. Yet a global pandemic This year’s Summit theme was “Pandemics: Working Together for an requires a coordinated, global response. As Dr. Effective and Equitable Response.” Participants gathered for two days Chan asked, “Can the world afford to leave vast of discussion and debate focusing on avian flu and other threaten- populations vulnerable to the high morbidity and ing communicable and non-communicable pandemics. Informing the mortality that accompany pandemics? Is it not Summit discussion was the underlying desire to develop and encour- in our collective best interest to strive for more equitable protection?” age appropriate policies for the prevention, early detection, and early The consensus was: there is much to fear. The treatment of all disease. The yearly meeting is co-partnered by The danger of a global pandemic is real, and the tools, National Bureau of Asian Research (NBR), Fred Hutchinson Cancer knowledge, and resources required to avoid or Research Center, and Bill & Melinda Gates Foundation. But the Sum- greatly reduce the threat are complex, expensive, mit is more than a yearly event. As Michael Birt, Director of the NBR and require effective cooperation at every level of Center for Health and Aging and Executive Director of the Pacific human society—from the smallest village to the Health Summit, noted: “We view the Pacific Health Summit halls of international bodies such as the United Nations and the WHO. as a process, one where ideas can be translated into Participants argued that we must begin by action, and we hope that there will be many new shifting our assumptions about prevention and projects and actions taken as a result of preparedness, and by asking tough questions. As our meetings here.” Laurie Garrett, Senior Fellow for Global Health at the Council on Foreign Relations, noted during the Summit, even if you create an effective avian No single country or institution can meet this threat alone… Unless there is a real sense of engagement and sovereignty on the part of the person who is right there dealing with the first case, either in terms of reporting it or addressing it, you’re going to have things spin out of control before the national or global authorities will be able to weigh in. – Nils Daulaire, Global Health Council PACIFIC HEALTH SUMMIT 2007 3 Preview Dinner The night before the official opening of the Summit, George F. Russell, Jr., Chairman Emeritus of the Russell Investment Group and Chairman of The National Bureau of Asian Research, and William H. Gates, Sr., Co- Chair of the Bill & Melinda Gates Foundation, hosted a dinner featuring remarks by former U.S. Senator Sam Nunn of Georgia. Russell and Gates are also Co-Chairs of the Summit’s Senior Advisory Group. The evening’s program was moderated by Maria Cattaui, who as Leroy Hood, President of the former Secretary-General of the International Chamber Institute for Systems Biology in Seattle, described his vision of of Commerce and Managing Director of the World making 21st-century medicine personal, predictive, and preventive Economic Forum in Davos, Switzerland, both engaged during the lively moderated dinner guests in a lively discussion and set out key themes discussion. for the ensuing two days of meetings. flu vaccine, how do you successfully immunize from such companies as GlaxoSmithKline (GSK), people in the poorest and most remote parts of Merck, Pfizer, and Novartis wondered how they the world if the vaccine requires refrigeration and can manufacture enough vaccine in their current must be delivered in two injections? How do you or planned facilities, maintain a sustainable busi- supply the required syringes? Without the nec- ness model, and still address concerns about liabili- essary planning, investments, infrastructure, and ty. Jean Stéphenne, President and General Man- communication, human society could still suffer ager of GSK Biologicals, stressed that a pandemic untold consequences, even when an effective vac- vaccine developed using a strain from the specific cine exists. outbreak would most likely take too long (four to Joe Hogan, President and CEO of GE Health- six months) to manufacture and be made available care, observed that during the SARS outbreak, “our after a pandemic is declared. “That’s why within x-ray capacity was overwhelmed in two weeks.… the industry we think about a vaccine that can be I think we know that industry cannot respond to prepared in advance—a pre-pandemic vaccine.” even a medium-sized pandemic from a capac- Representatives of regulatory agencies such ity standpoint.” Pharmaceutical industry leaders as Andrew von Eschenbach, Commissioner of Voices of the Summit What we desperately need is an entirely new architecture for global health that involves a vast array of institutions that are not now formally involved.