Make your
policy impact with FIPRA
policy impact with FIPRA
Analysis
The Next Public Health Threat for Europe: Why Mpox Is the Tip of the Iceberg
With infectious diseases continuing to threaten global health, is Europe ready to respond to the next pandemic? At FIPRA, our health security team is on high alert with insights and analysis for industry leaders. Emma Loebler and Sorina Chivu from our healthcare team offer their expert views to ensure your team can meet the moment.
The COVID-19 pandemic was the defining moment of a generation and brought the security risks from health threats firmly into public consciousness. This resulted in a flurry of national and EU governmental activity aimed at improving preparedness for future health crises.
As time passes, the public memory of the pandemic is fading, replaced with the more tangible security threats of the Russian invasion of Ukraine and Israel-Gaza war. Complacency, however, is a mistake.
Just this summer the WHO declared the outbreak of Monkeypox (Mpox) in several African nations a Public Health Emergency of International Concern. This year has also seen the intensification of outbreaks of H5N1 avian influenza in poultry, dairy cows and other animals in the US with an associated risk in the number of human cases.
These examples just scratch the surface on the potential health threats facing Europe. So, what should industry leaders in healthcare be looking out for, and how should EU Member States be prepared to respond?
Disease in conflict settings
The Russian invasion of Ukraine and now the war between Israel and Gaza has brought conflict directly to the borders of Europe. Three of the eight Public Health Emergencies of International Concern (PHEIC) declared by the WHO have emerged in conflict zones: Ebola (2018-2019) and Mpox (2024) in the Democratic Republic of Congo, and Polio (2014) in Pakistan. In August, Gaza reported its first case of polio in 25 years in a 10-month-old baby.
While conflict is generally associated with traumatic injuries, it damages key health and sanitation infrastructure creating an environment for disease to spread. Conflicts that target civilians and healthcare workers also lead to loss of an effective medical response, extensive population displacement and overcrowding. In this environment, infectious disease outbreaks often go unnoticed before reaching epidemic levels, the spread of which is fuelled by the migration of displaced people.
While highly transmissible infectious diseases often dominate the spotlight in these situations, slower-moving health threats with the potential for greater long-term impact, such as anti-microbial resistance (AMR), can also spin out of control. The lack of health infrastructure, toxification of the environment and unpredictable availability and quality of antibiotics create a particularly favourable environment for AMR in conflict settings. In this situation, the maintenance of strict AMR protocols in medical settings remains imperative to avoid the further development and spread of disease.
The terror threat
An increase in deliberate acts of warfare or terrorism should also be considered. With the increasing complexity of the geopolitical landscape, the risks from the use of biological weapons are increasing. The break-down of the relationship between Russia and the West, the war in Ukraine and Middle East tensions are particularly concerning.
We know Russia is not afraid to use chemical weapons, evidenced by the Novichok attack in Salisbury in 2018, and now again in the invasion with Ukraine. It has also been assessed that Russia possesses an active offensive biological weapons programme, raising the question of when, rather than if, such an attack was to take place.
The advent of synthetic biology has also increased the ease with which diseases could be weaponised. In 2016, a group of Canadian researchers synthesised the horsepox virus in just six months using mail-order DNA services and $100,000. It is not improbable that malicious actors could use similar techniques to create lethal and contagious viruses, resulting in a scale of death significantly higher than that of conventional weapons.
Disease emergence
Separate from any geopolitical challenge, new diseases often mutate out of existing animal reservoirs to infect humans, as seen with both avian flu and mpox. This is an ongoing threat as humans and wildlife are brought into contact in new ways, exacerbated by climate change.
This is also true of vector-borne infectious diseases. Mosquitoes capable of transmitting viruses, such as dengue and west nile virus, are expanding their range in line with changes in climate and have now established self-sustaining populations across 13 EU/EEA countries.
How institutions are responding
Post-pandemic, the establishment of a new Health Emergency and Response Authority (HERA) at the EU level highlighted just how seriously the EU was prepared to take threats to its health security.
Since its establishment, initiatives such as the development of specific rescEU reserves for dealing with Chemical, Biological, Radiological and Nuclear (CBRN) threats as well as key regulatory revisions to impose the development of Member State national preparedness plans has stepped-up the EU’s response capability.
As we move into a new legislature, it is essential that health security remains high on the agenda for the next Multi-Financial Framework, not just to support research and development but also to ensure a sustainable level of funding for the procurement and stockpiling of medical countermeasures. Former Finnish President Sauli Niinistö’s report on the European Union’s crisis resilience will be crucial to understanding what’s required here. The EU should also aim to bring its experience in collaboration to key global initiatives, including the WHO Pandemic Treaty.
Health threats do not respect borders and successful preparedness of the EU bloc depends on the collaboration and preparedness of countries across the globe. This includes alignment with NATO’s own CBRN and medical competencies. Although should the US see a second Trump presidency, NATO may no longer be relied upon.
What industry can expect
- Increased Preparedness: European authorities have significantly improved their preparedness for future outbreaks. Robust structures and processes, such as the Joint Procurement Agreement and the establishment of HERA, are now in place to respond rapidly to health crises. More still needs to be done to ensure that adequate stockpiles of medical countermeasures are available to respond to known threats.
- Industry collaboration: There is a growing willingness among national and European authorities to collaborate closely with industry, recognising it as a crucial ally in developing, manufacturing and distributing vaccines, therapeutics, and medical supplies during health emergencies.
- Geopolitical influences: The global geopolitical landscape plays a pivotal role in disease emergence, particularly in conflict zones where health systems are disrupted. The EU must enhance its local preparedness to respond swiftly to outbreaks that may spread beyond regions where control at the source is difficult or impossible.
- Cross-border coordination: The importance of cross-border coordination and data sharing has become evident, leading to the enhancement of platforms like the Early Warning and Response System (EWRS) for better communication and joint action among EU Member States. EWRS is an institutional tool used by ECDC, DG SANTE and Member States to monitor public threats in the EU and anticipate threats coming to the European continent.
- Resilient supply chains: Covid-19 underscored the need for resilient and diversified supply chains for essential medical goods. The EU and Member States are developing stockpile strategies to secure supply lines for various threats.
- Public trust and communication: Effective public communication has been identified as crucial in managing health crises. Future preparedness strategies will likely focus on building public trust through transparent and consistent messaging, as well as combating misinformation.
- Focus on research and innovation: The rapid development of Covid-19 vaccines has highlighted the importance of investment in research and innovation. The EU is expected to increase funding for research into emerging infectious diseases and the development of new technologies for rapid diagnostics, treatments, and vaccines.
- Holistic health security approach: There is a growing recognition of the need for a One Health approach that considers the interconnectedness of human, animal, and environmental health in preventing and managing pandemics. This will likely influence future EU policies on health security.
Ready to engage?
FIPRA arms healthcare leaders with expert strategy to meet the challenges posed by the latest health security threats. Step up and step forward with our health security team at your side, led by Peter Tulkens together with special advisors Steven Chatfield and Erwin Dhondt.
Let's talk!
