New England Journal of Medicine
March 31, 2016 Vol. 374 No. 13
http://www.nejm.org/toc/nejm/medical-journal
Special Report
The Neglected Dimension of Global Security — A Framework for Countering Infectious-Disease Crises
Peter Sands, M.P.A., Carmen Mundaca-Shah, M.D., Dr.P.H., and Victor J. Dzau, M.D.
N Engl J Med 2016; 374:1281-1287 March 31, 2016 DOI: 10.1056/NEJMsr1600236
[Initial text]
Pandemics and epidemics have ravaged human societies throughout history. The plague, cholera, and smallpox killed tens of millions of people and destroyed civilizations. In the past 100 years, the “Spanish Flu” of 1918–1919 and HIV–AIDS caused the deaths of nearly 100 million people.

Advances in medicine have transformed our defenses against the threat of infectious disease. Better hygiene, antibiotics, diagnostics, and vaccines have given us far more effective tools for preventing and responding to outbreaks. Yet the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the recent West African Ebola outbreak show that we cannot be complacent (Figure 1). Infectious-disease outbreaks that turn into epidemics and potential pandemics can cause massive loss of life and huge economic disruption.

Indeed, Ebola demonstrated how ill-prepared we are for such infectious-disease crises. There were failures at almost every level. Identifying the outbreak in the community and raising alerts took too long. Local health systems were quickly overwhelmed. Response teams did not adequately engage communities and deepened distrust in health authorities. The international response was slow, cumbersome, and poorly coordinated. Rapid diagnostics, protective equipment, effective therapeutics, and a vaccine were lacking. Ultimately, the crisis was contained, thanks to the courage and commitment of medical staff and communities on the ground and a massive deployment of international resources. Yet the cost in human lives and economic and social disruption was far greater than it should have been.

In this context, the Commission on a Global Health Risk Framework for the Future was initiated in the spring of 2015. Eight sponsors came together to support the initiative. The U.S. National Academy of Medicine provided leadership and guidance. An International Oversight Group comprising 12 leaders in science, business, and government was established to set up and guide the Commission…