Important vs. Urgent

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During a Consortium of Universities for Global Health conference session earlier this month, Fogarty International Center Director Roger Glass asked the panelists how they distinguish between important and urgent in their global health work. His question struck us as an essential one. We followed up with him, and the result is this commentary, which considers the difference between urgent and important, the issue of prioritization and a path for the future.—The Editors

The difference between “important” and “urgent” global health problems
I view “urgent” global health problems as those that present suddenly and are responded to in crisis mode.  We saw that with Ebola, when numerous organizations and governments sent floods of health care workers, epidemiologists, portable labs, treatment centers and other resources to West Africa. Much of the assistance, unfortunately, came after the virus had already spread through cities and villages, taking an enormous death toll and making it more complex to trace the contacts of those infected, which was necessary to contain the outbreak. We’re seeing it now with the Zika virus, which has been around for a while but suddenly started causing heartbreaking cases of microcephaly in infants and Guillain Barré syndrome, which can be very serious and even fatal, in adults.

“Important” global health problems seem to me to be those big issues—HIV, malaria, TB, polio—that we’ve been working on for a long time, require sustained effort and commitment, and can produce fatigue on behalf of the donors, as well as implementers. The burden of disease they cause is huge—for TB alone it amounts to 4,000 deaths per day. This mortality dwarfs that for most of the diseases that are considered “urgent.” We have grown more complacent in thinking that these major killers here defined as “important” are not also “urgent.”

Setting Priorities
That’s difficult—we don’t have the resources currently available to fix all the global health problems, so we must prioritize. Politicians and health officials responded unreservedly to the public’s fear of Ebola, particularly when Americans became infected, which is understandable. At the same time, it’s important to note that globally, more people died from HIV in 3 days than from Ebola during the entire outbreak. And it’s imperative that we all work together as quickly as possible to learn what we can about the Zika virus, figure out how to control the mosquito population and develop a vaccine. But we also must keep our eye on the long-term need to strengthen research capacity and health systems in low-resource countries. In terms of infectious diseases, we have seen that we are all only as safe as the weakest link. And we know that preparedness is less expensive to support than emergency response.

Charting a path forward
We need to prepare for future outbreaks, of whatever agent arises. At Fogarty, our core mission is to build research capacity in low- and middle-income countries—and I believe that’s a long-term investment that pays huge dividends. If we look at the case of the Ebola outbreak, the countries with little or no infrastructure suffered the most, and the cost of unpreparedness soared above $1 billion. The amount needed to sufficiently strengthen local institutions, train health leaders and link them to the global network of experts would take just a fraction of this. We know people with Ebola traveled across borders into some of the countries surrounding Guinea, Liberia and Sierra Leone. Why didn’t outbreaks occur there? Because well-trained epidemiologists and lab technicians and others were there, prepared to identify and treat those who were infected and ensure the disease did not spread. They were linked to global resources, and had access to technical advice and support.

This expertise is essential for responding to pandemics. That’s why Fogarty issued a call for applications to spur partnerships that will create sustainable research capacity in the Ebola-affected countries. Only by addressing the “important” issue of global capacity development can we hope to be prepared for the next “urgent” pandemic that is sure to come.

Roger I. Glass, MD, PhD, MPH is the director of the Fogarty International Center and the associate director for Global Health Research at the US NIH. A rotavirus expert, he has studied the prevention of gastroenteritis from rotaviruses and noroviruses through the application of novel scientific research. His work has included development of several rotavirus vaccines and the study of their introduction. He has received numerous honors including the CDC’s Charles C. Shepard Lifetime Scientific Achievement Award, the Charles Merieux Award and the Albert B. Sabin Gold Medal Award.

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