Does the international community need a Charlie’s Angels of global health?
You remember Charlie’s Angels. Kate Jackson, Farrah Fawcett, and Jaclyn Smith were three detectives in Los Angeles who worked for a never-seen Charlie. Charlie would call the Angels whenever there was some sort of emergency, and they would go wherever in the world in order to take care of the problem. They were highly competent and glamorous, though we can rightfully criticize the show for emphasizing the Angels’ sex appeal over their crime-fighting skills. I mostly remember the show for being on WGN in the afternoon when it wasn’t pre-empted by the Cubs. (Cubs baseball also frequently pre-empted Super Friends, leading to my distaste for the Cubs to this day…but that’s neither here nor there.)
Leaving the show’s problematic gender politics aside, the underlying idea of Charlie’s Angels—skilled workers who could be deployed at a moment’s notice to take care of serious problems—speaks to the current needs in the global health space.
Think about the situation the world faces when it comes to global health.
We know that there will be more infectious disease outbreaks in the future. That’s for certain.
The scary part is how much is uncertain. We don’t know where the outbreak will occur. We don’t know when. We don’t know what will cause the outbreak—or if it will even be of a disease that we have seen before.
These realities lead to two big issues. The first is that we need to be able to respond quickly to any sort of outbreak anywhere in the world in order to keep it from getting out of control. The second is that our response structures need to be incredibly adaptable. An Ebola outbreak requires a different response from SARS, which requires a different response from whistling pony disease (which will be the most adorable outbreak if it occurs)—but since we can’t know ahead of time which disease will present the next outbreak, our response system needs the flexibility to adapt to a wide range of diseases.
In the aftermath of the 2014-2016 Ebola outbreak in West Africa, the World Health Organization came under all sorts of criticism for its slow, lackadaisical response. One of the glaring problems is that WHO lacks personnel. It can’t deploy health care workers to outbreaks until member-states make them available. That slows down a response while WHO goes around and asks for contributions, which just allows an outbreak to gain a foothold and become that much harder to address.
One of the key suggestions from the Ebola Interim Assessment Panel was that WHO should establish a stronger global health emergency workforce to be available on standby in the event of an outbreak. Think of it is a rapid ready response force of epidemiologists and health care workers. (There is no word in the report on whether they would have snazzy uniforms.) WHO already maintained a registry of Emergency Medical Teams, but it announced in the aftermath of Ebola that it needed to build more such teams with expanded capabilities to respond to complex health emergencies.
WHO is not the only organization getting involved in these efforts, though. The US Centers for Disease Control and Prevention (CDC) created its own Global Rapid Response Team in 2015. In 2016 alone, GRRT personnel spent more than 9000 person-days in more than 90 different response situations like Zika, yellow fever, and polio. Interestingly, the CDC specifically talks about GRRT as an element of national health security—it deploys teams to treat outbreaks so that they don’t reach American shores and to uphold the country’s Global Health Security Agenda. This raises interesting questions about a country’s motivation to address global health. Is it primarily about a humanitarian impulse to better health outcomes as part of a general right to health, or is it more of a self-interested strategy? If it’s the latter, does that limit responses to only those diseases that could threaten the US and/or have security implications?
In a forthcoming article in Emerging Infectious Diseases (a great open access journal, but not necessarily the most calming thing to read before bed), the CDC describes the lessons it has learned and the areas still needing improvement. GRRT’s large personnel roster gives it a wide diversity of people from which it can draw, but deployments in non-English-speaking countries have highlighted the need to address language skills and training. There’s also a need to continuously improve connections with in-country partner institutions to ensure a shared sense of mission and tactics.
Charlie’s Angels responded to whatever requests they received from Charlie, but we never really saw how Charlie got those requests in the first place. (Did Charlie place ads in the Yellow Pages?) More importantly, though, the Angels proved themselves adaptable to any situation and ready to jump in at a moment’s notice. This is exactly what we need to address infectious disease outbreaks in global health. The big issue, though, is funding such a program in a sustainable, ongoing manner. Charlie’s clients paid him (we assume; the glitz and glamor of accounts receivable was not part of the TV show), and that gave him the money to have the Angels on retainer. We know that WHO’s budget is incredibly tight, and Trump has proposed cutting the US’ global health budget, so where will the money come from? If we want a global system that respond rapidly to disease outbreaks of any kind at any time, the international community will need to come through with the money.
The Angels didn’t work for free. Neither can a global health care worker emergency force.