It’s been 10 years since the worst Ebola outbreak in history was declared in West Africa. Despite the efforts of humanitarian organizations like Doctors Without Borders/Médecins Sans Frontières (MSF), this outbreak ravaged the health care systems of Sierra Leone, Guinea, and Liberia, killing more than 11,000 people, and spreading to multiple countries outside of West Africa, including the US.
Our staff did the best they could without any available vaccines or treatments since companies hadn’t seen the value in investing in them before. Our only option was to prevent the spread of infection by keeping hospitals clean and to treat sick people with supportive medical care like fluid IVs.
Following this global health crisis, rich countries like the US invested hundreds of millions of dollars in research and development (R&D) for Ebola vaccines and treatments in the name of pandemic preparedness and global health security.
The results of these investments were clear when I arrived in Democratic Republic of Congo (DRC) as part of an MSF team responding to an Ebola outbreak in 2018—the second worst in history. There were Ebola vaccines and treatments that were highly effective at reducing the spread of the virus and people’s risk of dying. But the limited number of vaccines meant they had to be rationed only to people who had the most direct and serious exposure, and treatments were only given to people under strict protocols since they hadn’t yet been approved for wider use.
Despite being designated by the World Health Organization (WHO) as a “pathogen of pandemic potential”—one that could fuel the next pandemic—the vast majority of medical tools to prevent and treat Ebola are still sitting in warehouses or stockpiles in countries like the US while people living in Ebola-endemic countries like DRC go without.
While the failures of previous outbreaks like Ebola and the COVID-19 pandemic should have been a wake-up call to world leaders, persistent inequities in outbreak prevention, preparedness, and response continue to leave us unacceptably unprepared for future international public health emergencies.
For the past three years, world leaders have been negotiating a “pandemic accord”—one that’s expected to finally be adopted at the WHO 77th World Health Assembly in May. This agreement, along with a revision of WHO’s International Health Regulations stating what countries should do during public health emergencies, is meant to prevent, prepare, and respond to future infectious disease outbreaks, epidemics, and pandemics.
With what’s likely to be the final round of negotiations underway this week, the Biden administration has the opportunity to reassert US leadership in global health and help ensure a safer, healthier future for the entire world.
1. Do more for vulnerable and marginalized people
The US must do more for vulnerable and marginalized people during the negotiations. That means specifically identifying and addressing their needs and access to care in the accord, ensuring that first responders like MSF have unimpeded access to these communities during times of crisis, and recommitting to international humanitarian law in these contexts. What we learned from COVID-19 is that unless humanitarian needs, access, and law are all taken into account and included from the very outset of an emergency response—just like in communities surviving conflict—they will be forgotten.
2. Attach concrete, equitable, and enforceable access conditions
The US must demand the accord requires countries to attach concrete, equitable, and enforceable access conditions for all of the funding they give pharmaceutical corporations for medical tools to prevent, prepare for, and respond to the next pandemic. Time and time again, we have seen a lack of access to essential medical products for our patients even though the public has paid for many of them. For example, the US government heavily supported R&D for an Ebola treatment called mAb114, but then it gave one company, Ridgeback Biotherapeutics, an exclusive license to manufacture it without demanding any access conditions in the contract, as far as anyone is aware. In nearly six years since the license was granted, Ridgeback has produced almost no treatments, including for places where Ebola is endemic, like DRC.
3. Ensure access for participants in clinical trials
Any new products that hit the market must be available to those who participated in key clinical trials that paved the way for their approvals. In the case of mAb114 for Ebola—the same treatment that received financial support from the US government—MSF worked alongside communities across DRC to trial this and other treatments. These communities were then shamefully denied full access to these drugs once they were developed.
4. Require well-established stockpiles
The US must demand the accord require well-established and managed stockpiles at national, regional, and global levels—particularly of medical products that are in scarce supply globally—to ensure rapid deployment and equitable allocation of lifesaving medical products when emergencies occur, especially for people in humanitarian settings. There must also be rules against hoarding products like we saw wealthy countries do during COVID-19.
5. Demand transparency
Lastly, the US must demand transparency across the board. A lack of access to information—whether it’s concerning prices, the terms of contracts and funding agreements, or even about overall supply—has historically hindered global health emergency responses. It is critical to have all the information we can get from governments and pharmaceutical corporations to best negotiate prices and demand access to lifesaving medical tools.
The US and other governments must recognize their responsibility to everyone around the world and ensure that these negotiations improve our collective preparedness, prevention, and response to international health emergencies. If they don’t, we will never be ready for the next outbreak, epidemic, or pandemic.
