Lessons from a pandemic: The 4 things coronavirus taught us about society and health care
Compared to the resources devoted to mitigating other global risks such as terrorism, climate change, or war, the world invests strikingly little in infectious disease outbreak preparedness. The problem is not a lack of knowledge, as the public health community knows what steps are needed to mitigate risk, say experts. However, preventive measures are rarely prioritized, a lesson that countries have painfully learned during the ongoing coronavirus pandemic. So what has the COVID-19 pandemic — which has killed over 154,270 and sickened over 2,249,700 — taught us so far?
Preparing for future outbreaks
In 2019, experts issued a stark warning: a deadly global pathogen could kill 50 to 80 million due to countries' unpreparedness. But no one listened. The COVID-19 pandemic, say experts, has reiterated the fact that every country must be prepared for the unexpected, the worst. And they can do so only by building resilient systems.
According to Dr Tom Koch, professor of medical geography at The University of British Columbia, and author of 'Disease Maps: Epidemics on the Ground,' a key lesson is that countries have “learned the foolishness” of not preparing for an epidemic. “After SARS, there were lots of reports about lessons supposedly learned. Many governments developed stockpiles of necessary goods and plans for their distribution. But then we forgot. Stores were dispensed and the probability of a new pandemic was ignored,” Dr Koch told MEA WorldWide (MEAWW).
The systematic inability to listen to experts highlights the trouble that leaders — and people in general — have figuring out how to act in dire, highly complex situations where there’s no easy solution, says a Harvard Business Review report.
Researchers say preparedness issues that must be addressed include ensuring adequate equipment, supplies, and personnel to mount an effective response to COVID-19 resurgence or perhaps another severe disease outbreak, while operational issues include meeting pent-up demand for delayed healthcare services and transitioning to increased use of telehealth.
Experts say the world needs a public health approach that includes far more than the drafting of general plans. “We need a detailed operational blueprint of the best way to get through 12 to 24 months of a pandemic. What if an H5N1 influenza pandemic began not now but a year from now? We would still need to plan with fervor for local nonmedical as well as medical preparedness,” says an article.
Preparedness is hampered by the lack of continued political will at all levels. Experts call for bold and timely leadership at the highest levels of the governments that can recognize the economic, security, and health threats posed by the next outbreak and invest accordingly. “Government leadership that can be trusted is critical in times of pandemics. And countries must cooperate better with each other and their information must be trustworthy,” Dr John Swartzberg, clinical professor, emeritus, UC Berkeley-UCSF Joint Medical Program (Infectious Diseases & Vaccinology Division), tells MEAWW.
Ensuring recurrent spending for preparedness is a key articulation of political will and leadership. “Long-term, sustained community engagement is crucial for detecting outbreaks early, controlling spread, ensuring trust and social cohesion, and fostering effective responses,” says a WHO report.
Investing in public health infrastructure
Human public health systems have been grossly under-financed for decades in many countries. The resulting poor performance of these core systems has worsened public health, say experts, and this must change. Reactive, short-lived external financing, which favors emergency responses over core capacities for prevention, has further reduced sustainability and effectiveness, says a report led by Harvard Global Health Institute.
“Underfunding public health is dangerous, that's the position we are in now. We should fund public health like we fund the military. Public health always needs to be prepared,” says Dr Swartzberg.
Experts say it may not be easy to predict when and where the next pandemic will begin, but countries can prepare. Public health systems perform the core functions of detecting, preventing, and responding to infectious disease outbreaks. Scientists say when there is little information on the capacities and how well they perform their functions, the economic and health risks to populations could be unacceptably high. This has been widely demonstrated during the ongoing pandemic, which exposed how severely unprepared public health systems were across countries. Knowing the performance of public health systems is the first essential step toward health security, just as vehicle inspections are the mainstay of road safety, say experts. They recommend thoroughly reviewing, and, if necessary, rebooting the health systems infrastructure across nations.
The key questions that must be asked and addressed include: Are core capacities to detect, prevent, and respond to outbreaks credibly assessed? Do authorities seek to improve the performance of core functions by preparing and implementing action plans based on the assessments? Experts also emphasize the need for a clear commitment to invest in human capital, without which the entire fabric of the public health system is ineffective.
Experts say while building strong systems, countries, and policies must also take into consideration the poor. “Income inequalities and structural inequalities are deadly. Not for the first time, we find that the effect of a bacterial or viral epidemic strikes more fiercely among the poor. We know why this is but we do not see the issue as one of the general health needs, just an economic inconvenience,” says Dr Koch.
Early warning systems and surveillance
Why do we fail to adequately invest in the prevention of disease outbreaks? Scientists say it is known that major disease outbreaks have an expected economic cost of tens of billions of dollars annually. Yet, little preventive action is taken. Surveillance is an early-warning system for diseases and must be the first link in the chain of public health action, as it is an essential element for any disease control or eradication effort, say experts. The capacity of a country to prevent and control outbreaks depends substantially on what occurs within its communities, both where outbreaks start and where they may ultimately spread.
According to experts, the COVID-19 pandemic has highlighted the need to focus on surveillance. Big data analytics coupled with artificial intelligence should be employed to predict the onset and spread of a viral outbreak. Analyzing data on infection rates can also tell which groups will be affected, the extent of herd immunity and the next wave of infections, say experts.
A World Economic Forum blog highlights the need for an early warning system. “Too clearly, we learned how much we need an early warning system for future crises, whether from climate change or pandemics. Having a system we can trust is critical,” says the article.
More focus on diagnostics, vaccines, and therapeutics
Countries are currently racing to find a vaccine or treatment for COVID-19. Dr Lee W Riley, chair of the Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley tells MEAWW that a vaccine, if it does become available and shown to be effective, will help to prevent future local transmissions of SARS-CoV2, but it may not prevent future pandemics of new strains of SARS-CoV.
According to experts, preparedness and response systems and capabilities for disease outbreaks are not sufficient to deal with the enormous impact. There is insufficient R&D investment and planning for innovative vaccine development and manufacture, broad-spectrum antivirals, appropriate nonpharmaceutical interventions, targeted therapeutics, and systems for sharing sequences of any new pathogen. These are critical areas and must be answered. Therefore, continuing research even after an outbreak or pandemic dissipates is critical. “More research and development is needed in the areas of rapid diagnostics, vaccines, and therapeutics,” says Dr Wartzberg.
Dr Koch says that what the pandemic has demonstrated is that countries have become complacent when it comes to doing more research on vaccine development. “There will not always be a vaccine at the ready, or a medication that can mitigate a disease. We have grown complacent in this way, assuming technical medicine can handle anything. It can’t and we need to accept that microbes evolve in relation to the ways we live. And sometimes, that evolution brings forward something for which we were unprepared,” says Dr Koch.
"The ability to rapidly develop and deliver vaccines when new 'unknown' diseases emerge offers our best hope to outpace outbreaks, save lives and avert disastrous economic consequences,” say scientists.
Attention must also be given to diagnostics. It is important not just for the treatment of individuals, but also to assess the efficacy of vaccines and treatments and to gauge the speed and breadth of disease spread, say experts.
Barney Graham, the deputy director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), tells Vox what “needs to be done for the viruses that we don’t understand as well — that still have pandemic potential — is just fill in the database, to study those viruses, understand the structure of their proteins, understand the way antibodies work against them.”
Sustained monitoring to drive preparedness
The typical pattern of infectious disease preparedness today can be characterized as a cycle of panic and neglect: a flood of resources during outbreaks followed by a lack of interest and diminished investments. The resulting dependence on crisis-response is both costly and ineffective in preventing the next outbreak.
One way to spur action is to implement a global monitoring mechanism that tracks preparedness over time and holds key stakeholders accountable, according to the Harvard-led study. “A global monitoring program can highlight weaknesses in our global efforts, and where additional resources or efforts may be needed. As political attention on pandemics fades, there is a corresponding loss of momentum on investments that can help keep the world safer. Therefore, sustaining and enhancing the energy that policymakers expend on this topic is vitally important. An independent, objective monitoring mechanism is one way to do so,” says the analysis.
The proposed framework includes strengthening public health core capacity as a foundation; improving science, technology, and access; reinforcing risk analysis and incentives for action, and strengthening global mechanisms. “Routine, transparent, and objective monitoring will ultimately help ensure sustained financial support and effective prioritization from international organizations, donor agencies, national governments, and the private sector,” says the report.