Toward better pandemic preparedness
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- Authors: JAY PATEL, DEVI SRIDHAR
- Published: December 2, 2021
Key observations: pandemic performance versus preparedness metrics
- The Global Health Security Index in 2019 ranked the United States as best prepared and the United Kingdom as next best prepared; two years later the United States had endured the highest global death toll from COVID-19, with more than 700,000 deaths.
- The United Kingdom recorded seven times more deaths than the 20,000 that its government chief scientific adviser suggested in March 2020 would be a “good outcome.”
- Based on a 2018 WHO self-assessment of IHR implementation, 86 percent of countries in Europe were deemed at the highest levels of pandemic preparedness on paper.
- In practice, Europe experienced the second highest death rate from COVID-19 of any region, at 1,294 per million people.
- Conversely, WHO judged just 15 percent of countries in Africa to be adequately prepared, yet fewer than 205 deaths per million have been reported in Africa.
- Predictive metrics failed to capture the value of prior outbreak experience, cross-country collaboration, and community-based response capacities (examples: Liberia, Sierra Leone, Senegal).
What went wrong in seemingly resilient systems
- Effective health care requires four elements: “staff, stuff, space, and systems.”
- Example of mismatch: the UK built seven Nightingale Hospitals at a cost of $736 million that largely went unused because trained staff were insufficient.
- Large health systems were overstretched: examples cited include Italy’s Servizio Sanitario Nazionale and Brazil’s Sistema Único de Saúde.
- Routine essential health care provision remains fragile in these countries.
Successful country practices and capacity building
- Community-based, bottom-up approaches helped many countries avoid harsher measures in 2020:
- Thailand: four decades of volunteer recruitment mobilized for logistics and remote area coverage.
- Vietnam: use of existing local governance for community-based coordination of quarantines and self-isolation.
- Japan: rapid training of public health nurses enabled thorough retrospective and prospective contact tracing to identify main clusters within weeks.
- Senegal: Institut Pasteur de Dakar was one of only two laboratories in Africa able to test for SARS-CoV-2 in February 2020; free tests yielded results within 24 hours or less; by April 2020, 43 African countries had the capacity to effectively diagnose COVID-19.
- Adaptations from Ebola responses (2014–16) in West Africa improved community-based care and quarantine measures.
Economic case for prevention and preparedness
- Estimates cited: by 2025, COVID-19 will have a global economic burden of $16–$35 trillion (McKinsey & Company and an independent G20 panel).
- Even modest reductions in this cost from better preparedness would yield substantial absolute returns on investment.
- Investing in health delivers two types of dividends:
- Immediate: better responses to acute public health emergencies, including antimicrobial resistance.
- Long-term: healthier and more equitable societies, which improve everyday health care and fiscal protection and speed economic recovery (example: Finland).
Science, vaccine equity, and manufacturing
- Rapid development of multiple safe and effective COVID-19 vaccines reflects decades of investment in scientific research.
- Governments must continue support for science and technology, including during uncertain periods, to accelerate future responses.
- The COVAX Facility has underdelivered: lacking financial power to lower prices, forced to the back of the queue and reliant on donations.
- Example of hoarding: Canada ordered doses equal to 10 times its population.
- Recommendation: build and scale up vaccine manufacturing hubs in low-income regions to end the acute phase sooner and provide infrastructure for other infectious diseases.
Global governance, IHR, and WHO
- The International Health Regulations (IHR) legally bind 196 countries to develop capacities to rapidly report and respond to disease outbreaks.
- During the pandemic many countries complied only in part, due to incomplete awareness or deliberate flouting of the regulations.
- A revamped IHR should:
- Adopt a more nuanced alerting mechanism.
- Empower WHO to continually review and improve member states’ compliance.
- WHO needs adequate financial support, authority, and trust to ensure better compliance.
- Specific funding suggestion: an increase in funding of $1 billion a year in assessed contributions for the WHO would be a start.
Conclusions and imperative
- Successes and failures in the COVID-19 pandemic clarify actions needed to be better prepared for the next pandemic.
- Investing in prevention and preparedness, strengthening local public health capacity, supporting science, building regional manufacturing, and reinforcing global health governance are central priorities.
- Quotation framing the article’s message: Benjamin Franklin—“An ounce of prevention is worth a pound of cure” and “By failing to prepare, you are preparing to fail.”
Source: Toward better pandemic preparedness, JAY PATEL and DEVI SRIDHAR, December 2021.
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