By Louise Richardson
The coronavirus pandemic itself reflects a failure of international institutions as well as national governments. Multiple warnings preceded the outbreak in China in late 2019. The SARS epidemic of 2002 and 2003 is believed to have originated in a Chinese wet market. But wet markets continued to operate there and in other countries, and there is some evidence that the new coronavirus outbreak may have begun in a wet market as well. The Ebola epidemic of 2013–16 should have served as another warning. Since all but one of the more than 11,000 people who died during that crisis did so in West Africa, however, wealthy Western nations largely ignored the lessons—chief among them that international cooperation is necessary to contain outbreaks of infectious disease.
Though confronting the coronavirus demands international cooperation, the mechanisms for delivering it have been systematically weakened.
Some nations eschewed multilateralism altogether. After decades of rising inequality, disaffected voters in dozens of countries have elected populist leaders in recent years. Once in power, these leaders turned inward, shrugged off international obligations, and sought to remove the constraints imposed by international institutions. Though confronting the coronavirus demands international cooperation, the mechanisms for delivering it have been systematically weakened—and there is evidence that the pandemic is reinforcing this nationalist trend.
Far below the haute politique of international relations, other global institutions are in the trenches working to find a vaccine, develop therapeutics, and expedite mass production so that effective treatments can be distributed as widely and as equitably as possible. As political leaders around the world have fortified their borders and enacted new trade restrictions in order to hoard lifesaving medical supplies, these institutions have embraced unprecedented levels of cooperation with counterparts from around the world, including in the developing world. These institutions are, of course, universities.
SCHOLARS INTO THE BREACH
At universities around the world, international teams of researchers are working around the clock to find a cure for, and mitigate the impact of, COVID-19, the disease caused by the novel coronavirus. During this time of global need, these scientists and scholars have become increasingly connected and interdependent, disregarding traditional concerns such as academic credit. They are sharing data and collaborating across national borders in extraordinary new ways. I can speak directly only to the work of my own university, the University of Oxford. But our researchers’ efforts are being aided and informed by the work of countless others, thousands of miles away from the medieval streets of Oxford.
At Oxford’s Jenner Institute, one of the largest academic centers for vaccine research in the world, a team led by Sarah Gilbert has identified a nonreplicating viral vector vaccine candidate and is aiming for efficacy in humans by late June; recruitment of volunteers for human trials is already underway, with human testing set to begin by April 22. Vaccine development is a famously slow process, and the speed with which Gilbert and her colleagues have produced a viable candidate would likely have been impossible if it were not for the support of a broad international effort: the vaccine is being simultaneously tested in animal models by Rocky Mountain Laboratories in the United States and by the Commonwealth Scientific and Industrial Research Organisation in Australia. There are plans for large-scale production in Italy, India, and China.
During past outbreaks, delays in the publication and dissemination of clinical data have hindered response efforts.
During past outbreaks, delays in the publication and dissemination of clinical data have hindered response efforts. The infectious disease specialist Peter Horby, who led Oxford’s work in response to SARS and Ebola, recognized early on that open data sharing would be crucial to containing the novel coronavirus outbreak. His team has been collaborating with the Chinese Academy of Medical Sciences and the Chinese Center for Disease Control and Prevention since the beginning of January. In addition to conducting a clinical trial to test the effectiveness of the HIV drug lopinavir-ritonavir and the steroid dexamethasone in the treatment of COVID-19 patients, Horby has led efforts to create an international resource to facilitate the rapid collection and sharing of standardized clinical data, as well as a free toolkit of clinical research resources available to anyone studying the novel coronavirus outbreak.
COVID-19 IN DEVELOPING COUNTRIES
While the United States, the United Kingdom, and other rich countries have committed eye-watering sums to mitigate the pandemic’s impact on their populations and economies, they have committed only derisory sums to the developing world. Although African countries are not yet reporting large numbers of confirmed cases, that is likely because they lack the means to test; their health-care systems are seriously under-resourced at the best of times.
It is precisely at times like this that strong international institutions are needed to share information, insist on reliable data, and ensure that the poorest countries and their populations are not forgotten in the rush for an effective response. But in their absence, universities are stepping into the breach: along with colleagues from academic institutions around the world, scientists from Oxford are working with local scholars and public health researchers in developing countries, seeking to build local capacity and to develop better methods for confronting the threat of COVID-19 in low-resource settings.
In the absence of strong international institutions, universities are stepping into the breach.
Patterns of infectious disease spread often look somewhat different in the developing world, so experience matters. Oxford researchers have been based at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya, for over 25 years, working across three main hubs in that country and in Uganda. Led by Oxford Professor Philip Bejon, KEMRI-Wellcome is now testing for COVID-19, building on years of experience working on Rift Valley fever, yellow fever, and Ebola. Its long history of working in the region has yielded critical insights into patterns of contact and transmission: if a healthy male in a rural Kenyan homestead tests positive for COVID-19, the program has the data to predict how many people he will have been in contact with. As Bejon put it to me recently, “You can’t decide to start doing these things when the crisis strikes, you have to be there already.”
Very few COVID-19 vaccine trials are planned in the developing countries of Africa, Asia, and South America. The KEMRI-Wellcome team has argued forcefully that this must change in order to generate evidence to ensure that the specific needs of resource-poor settings are adequately met and that any interventions are affordable and adaptable to health-care systems and populations in the developing world.
THE NEXT PANDEMIC
Many experts warned of the world’s vulnerability to a pandemic prior to the coronavirus outbreak. Bill Gates’s 2015 TED talk, in which he contrasted the vast sums spent on nuclear deterrence to the paltry funding for pandemic preparedness, has been viewed more than 26 million times. But governments mostly preferred to see security in military terms, and production of vital pharmaceuticals was outsourced to the cheapest providers in the name of private profit and public economy. Only strong international institutions can ensure that this pandemic does not exacerbate global inequities and can marshal the resources needed to contain effectively future global crises of this sort. Throughout history, new international institutions have been forged in the wake of major military conflicts or financial disruptions in the hope of preventing such disasters from recurring. This will not be the last pandemic. With more effective international institutions, rich and poor countries alike can ensure that the next one is less disastrous.
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