PQMD Forum Summary Challenge Panel 4: Microbial Threats 101: What’s Mine is Yours

Panel Description: Since the emergence and/or re-emergence of SARS, H1N1 influenza, MERS and Ebola many public – and private-sector leaders have seen a need for improved management of global public health emergencies. The consequences of such events on health, education, commerce, transportation and beyond, have increased interest in building coordinated global responses to infectious threats, many of which could globally disrupt health and markets. Panelists will share their thoughts on improving international management and response to outbreaks.

Chair: Julie Varughese, Chief Medical Officer, Vice President Technical, Americares


  • Pranav Shetty, Emergency Medicine, UCLA
  • Thomas Cihlar, Vice President, Virology, Gilead
  • Damiano de Felice, ATMI
  • Duncan Blair, Vice President, Global Health Initiatives, Abbott
  • Richard Allan, CEO, Mentor Initiative
  • Cassandra Kelly-Cirino, Director of Emerging Threats, FIND

Microbial threats continue to be a significant global health, security and economic concern affected by broad and often inter-related factors such as climate change, rapid and unsustainable urbanization, increasing global interconnectedness, vulnerable and limited supply chains and degraded public health infrastructure as a result of conflict and war. Weak health systems impact not only the ability to effectively respond to infectious outbreaks, but also to provide essential primary care and other services during times of acute emergencies.  We saw this in 2014 where over 11,000 people died from Ebola and an additional 10,600 were estimated to have died from other causes as a result of the reduced availability of services during the outbreak.  Additionally, over the next decade, the growing issue of antimicrobial resistance will be a major threat to the entire global community in terms of lives lost and economic impacts.To date, many of our activities to infectious outbreaks and emergencies have been ad hoc and reactionary – as emergencies occur, financial and non-financial resources are poured in with a rapid fire and fragmented approach in amounts far greater than would have been needed for prevention and preparedness.  Rather than remaining reactive, proactive strategic action is needed – before any one of these microbial threats outpaces the global community’s ability to respond.  Stronger, more resilient health system infrastructure and preparedness systems with appropriate technical and practical capacity are needed along with drug, vaccine and diagnostic developments to improve our ability to prevent, detect and control emergent, but also everyday microbial threats. Cross sectoral collaborations amongst clinical and veterinary medicine, academia, industry and other public and private partners are critical to achieving the shared goal of security from infectious disease threats for all people.

Julie Varughese from Americares leads the Microbial Threats panel.

Varughese asked Pranav Shetty, experienced in infectious disease response in insecure environments, about creating effective and sustainable interventions. He stated the best system to respond to an acute emergency is a system that works well at baseline. There have been multiple lessons learned from the Ebola outbreak and disasters – weak health systems cannot deal with a shock like a disaster or infectious disease outbreak, adding that shocks are not limited to health crises. Two thirds of countries are not prepared to respond to the framework developed by the WHO. We do not need to start over, but focus on execution. Health systems strengthening is complicated, but it cannot be separated from infectious disease response. Epidemics grow exponentially but our response is linear. It is important to adapt to local context.

An expert in diagnostics, Kelly-Cirino believes the biggest threat to global health security is systems. Varughese asked about the biggest challenges to diagnostic developers. Kelly-Cirino said that during the Ebola and Zika outbreaks, developers stepped up and took risks themselves. Nobody bought the diagnostics until another outbreak, but then the diagnostics were not being manufactured. There is an opportunity to design diagnostics to run every day then change those to address developing outbreaks. Innovative thinking lead to GAVI and SEPT, so we need to change the way of thinking about diagnostics before outbreaks.

The Microbial Threats panel at the 2019 PQMD Global Health Policy Forum.

Tomas Cihlar from Gilead, a company developing drugs to address Ebola and other diseases, emphasized the importance of partnerships. Gilead worked with a number of NGOs to expand access, and was impressed how many partners worked together to implement randomized control trial for managing Ebola infection. The private/public sector should sit at the table together to form partnerships – all components are important. We need abilities to predict where future outbreaks will be and what factors might influence, including climate change. Partnerships can yield those abilities. In an outbreak situation, Cihlar said, patients need support to avoid eroding trust in the healthcare system. It is important to offer what a patient needs, not what an Ebola response needs. We do not have good models for community engagement.

Allan from Mentor Initiative has spent the last 17 years responding to outbreaks in war zones. His organization’s response is to address immediate needs in a delivery mode to develop capacity. He wonders whether the investments made in response leave a gulf when the response stops. In his experience responding to leishmaniosis in Syria, he found health workers didn’t know how to use or distribute health supplies, so it is important supplies must be understandable and usable by those on the ground. Allan also posited that Ebola may not be the pandemic we need to worry about. He pointed out that mosquitoes are the best carriers of disease in the world, and currently there is only one mosquito-borne disease with a vaccine. Dengue fever is spreading rapidly and should be a concern, especially since we do not have diagnostics.

Antimicrobial resistance is a growing threat, said DeFelice from ATMI. Most of what we’ve discussed are complex issues – it is easy to become everybody’s problem then becomes nobody’s problem. We should look at what all sectors are doing and making sure each organization knows what it needs to do. We need to define what “good” and “better” look like. It is important to have multi stakeholder response and to have a platform to work from for roles and responsibilities.