Planning for the entire disease cycle

So far in this roundtable, the authors have presented a number of valid and largely correct arguments. But the conversation has been atomized, with each author focusing on issues that fall within his or her own experience or area of expertise. This atomization is symptomatic of problems within the global health system, where inadequacies in communication and coordination can plague efforts to control emerging pathogens. Often, stakeholders in health systems don't know who the other key players are, what those individuals' responsibilities are, and how to go about working together.

To remedy this, nations must establish systemic approaches to battling pathogens. One way to make efforts systemic is to organize them around the stages of a disease's evolution—that is, to make plans corresponding to the times before, during, and after an outbreak.

Before an outbreak, the most important issues are to evaluate readiness and to predict the needs that will emerge once an outbreak occurs. Accordingly, officials must gather good statistics regarding past and present epidemiological conditions. Needs for equipment and personnel must be identified, and those responsible for resource allocation must make appropriate decisions. Scientists, medical doctors, nurses, and even politicians must receive the education and training that they will need in the event of an outbreak; all stakeholders must be included. Response plans must be formulated in line with plausible outbreak scenarios. Finally, those responsible for treating disease (doctors, nurses, and administrative personnel) and those who study disease (scientists in research laboratories) must prepare to work collaboratively, and they must be provided incentives as necessary. Changing health care's need-to-know culture into a need-to-share culture is fundamental.

Outbreaks put to the test the steps taken during the preparatory stage. During an outbreak, officials once again must gather good statistics. They must decide where to allocate emergency resources including money, equipment, instruments, professionals, and so on. Political decision makers must provide support for disease-fighting efforts. The mass media must do its part to provide necessary information to the public.

The aftermath of an outbreak amounts to a learning opportunity, a chance to judge the adequacy of plans made before the outbreak and of implementation during it. Evaluations made at this time—not only of health care itself, but also of communications efforts and the political aspects of disease response—should be fed back into planning for the next outbreak. Thus a new cycle begins.

All this sounds fairly straightforward, but pathogens' refusal to stay within one country complicates everything. Regional and international cooperation is imperative—but if it's difficult to build a successful response program within a single nation, doing so across several nations presents enormous difficulties. This is where the World Health Organization, with its ability to coordinate national efforts, plays a very important role.

In any event, it is critical that the goals of disease-fighting efforts be defined in objective terms; that an appropriate level of commitment be given to meeting those goals; and that individuals responsible for following through on plans be held accountable if they fail to fulfill their duties. In the struggle against emerging pathogens, there is a lot to lose and a lot to gain. Winning the battle depends on making good plans, implementing them well, assessing successes and failures, and incorporating what is learned into plans for the future.