The new coronavirus epidemic has starkly exposed the weaknesses of countries' health systems. Yet great progress has been made combating epidemics worldwide since the SARS outbreak in 2003, says Gilles Poumerol, a Geneva-based international public health expert.
With each new pandemic, the World Health Organization (WHO) finds itself in the hot seat, accused of either doing too much or too little. It is caught between the demands of its member states, especially its biggest donors, and its role as coordinator of global health policies. But step by step, WHO is improving global responses to new epidemics, explains Poumerol.
swissinfo.ch: The world is facing a major challenge with the rapid spread of this new coronavirus from China. How are new viruses changing the situation?
Dr Gilles Poumerolexternal link is an international public health specialist. He worked with the World Health Organization (WHO) fexternal linkor 30 years in various capacities at country, regional, and global level. He has extensive experience in the Caribbean, in Asia, in the Pacific, and in Africa on the epidemiology and control of HIV/AIDS, sexually transmitted infections and tuberculosis. In the past 10 years he was in charge of International Travel and Health (ITH) and the revised International Health Regulations (IHR). He is presently consultant for IHR and Global Health Security trainings at the Geneva Centre for Security Policy.
Gilles Poumerol: Over 60% of emerging viral infections in humans come from animals. The “One Health Initiativeexternal link” launched at the beginning of the 2000s underlines that all living beings live together and that our health is highly interdependent.
Yet these transmissions of viruses from animals to humans are taking on major proportions. The phenomenon is linked to the way societies evolve and to the increase in the world population, which slowly eats away at the territory of wild ecological systems.
Improved hygiene and the development of antibiotics have lowered the threat of infections such as cholera. But we still face new viruses originating from animals for which we have no medicines.
swissinfo.ch: So, like the rest of the living world, viruses are evolving and adapting to changes in their natural environment?
G.P.: Exactly. In order to survive, viruses need the cells of living organisms which they exploit. In some cases, a balance is struck between the virus and the living organism, and they exist in harmony. This is the case with bats, which carry numerous viruses but don’t get sick or die from them; however, they can pass on the viruses to humans.
There are now over 126,000 cases of coronavirus globally, after the World Health Organization called the outbreak a pandemic for the first time on Wednesday, and over 4,600 have died, according to a Reuters tally. In Switzerland, there were more than 800 known cases and six confirmed deaths. Statistics for 12.03.2020.
swissinfo.ch: Medicine and hygiene have made great progress over the past century. What does the current epidemic tell us about such developments?
G.P.: If we are able to live to the age of 80, it is thanks to progress in hygiene, vaccines and antibiotics. This helps control many infections.
The viruses behind recent epidemics may have existed before. But today we are able to detect them much quicker and to better monitor them. This is also one of the reasons why we feel we are being regularly attacked by new viruses. We are also reaching certain limits in treatments, even though the production of new vaccines is progressing.
Covid-19 has revealed another problem. Many countries have not yet properly understood the dangers of these epidemics. They have not equipped themselves with early detection and rapid response systems to contain the emergence of these new infections.
swissinfo.ch: How has WHO responded to recent epidemics?
G.P.: In recent years, we have done a lot of work at WHO to put in place International Health Regulationsexternal link to alert countries to the need to have appropriate response capacities. New health regulations were developed in 2015 in response to the Severe Acute Respiratory Syndrome (SARS), which had a relatively big economic impact, despite its rapid containment. Certain countries worked together to finalise an international agreement on how to work together during such crises, such as sharing information, helping each other and the correct way of responding, for example.
Slowly progress is being made. With this new coronavirus and its economic impact, every country should understand the importance of having detection and warning systems to deal with it. If we had such detection and warning systems in every country, it would allow us to act as quickly as possible to prevent a spread of viruses like Covid-19.
It is a bit like fighting fires. There are fire stations that are not used very often. But they are ready to respond to a fire which stops it from spreading.
swissinfo.ch: Do such shortfalls only affect poor countries?
G.P.: No. There are countries that are wealthy enough, but which have not invested sufficiently in preparations and the ability to respond quickly to new epidemics. And when a virus emerges in these countries, it is almost impossible to prevent it spreading to the rest of the world. The epidemic can be slowed down, but not stopped.
swissinfo.ch: How long will this epidemic last?
G.P.: There are still many unknowns. Is it contagious before signs of the disease appear? It appears so. How many days before? Is the virus contagious if you don’t develop symptoms?
The mortality rate is estimated at around 2%. But maybe this rate will be reviewed when we have all the data.
As to China, the virus peaked two months after it began spreading in late December. And since the end of February, it has been declining. This follows the particularly drastic measures the authorities implemented, including the quarantining of 50 million people.
It is still too early to know to what extent these measures have been decisive and whether in the other countries affected, we will see the same two-month rise, followed by a stabilization and a descent. If this is the case, in Europe and the northern hemisphere, the epidemic is likely to a become a minimal risk from around May or June, as many viruses struggle to survive when the temperatures rise.
The epidemic will probably continue in the southern hemisphere during the winter season, and then return to the northern hemisphere next winter. But these are just hypotheses.
swissinfo.ch: Could Covid-19 become endemic?
G.P.: This is a possibility. The hope is that we can find a vaccine that can protect a large part of the population at risk within the next six to 12 months.
International Health Regulations
The International Health Regulations (IHR)external link is an agreement between 196 countries, including all WHO member states, to work together for global health security.
The IHR were revised in 2005 following the AIDS and SARS epidemics. The signatory countries have agreed to build their capacities to detect, assess and report public health events. WHO plays the coordinating role in IHR and, together with its partners, helps countries to build capacities.
Following the adoption of the IHR and the H1N1 pandemic in 2009, Switzerland revised its Federal Law on Epidemicsexternal link, which was adopted by Swiss voters in 2013 following a referendum. This law, which came into force on 1 January 2016, is the legal basis on which the government is now responding to the current coronavirus epidemic.
Translated from French by Simon Bradley