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The following are the issues that have to be explored when tackling Pandemic Preparedness and response:
Diagnostic Testing, Vaccines and Therapeutics
COVID-19 vaccines have been successfully developed at a remarkable pace. COVID-19 lockdowns have helped many countries and regions keep its spread under control (while subsequently easing those measures has had the opposite effect). However, this has had tremendous economic and social costs - and is unsustainable for the long-term. More radical ways to fight the virus are therefore now coming to the fore, including vaccines and therapeutics.
The quality of information has largely determined the success (or failure) of containing the disease; speedy and correct diagnosis is the first step towards efficiently and effectively curbing its spread. Testing has therefore been crucial for those countries that have been relatively successful in this regard.
A variety of diagnostic kits are being endorsed by different governments to encourage aggressive testing, though accuracy and affordability remain challenges. While mass testing helped quickly contain the outbreak in South Korea, in countries like the US testing has been limited. Meanwhile vaccine development has progressed at relatively breakneck speed - with the first doses being administered before the end of 2020, a timetable that few experts felt comfortable predicting not long ago.
Vaccine research and development is time consuming, and requires three phases of clinical trials before something can be made publicly available. By April 2020, the World Health Organization had published a statement on behalf of a group of scientists, physicians, funders, and manufacturers aiming to speed the availability of a COVID-19 vaccine, which pledged to develop something as rapidly as possible. Still, most experts believed effective vaccines would not be offered to the public before 2021.
Effective therapeutics will still therefore be crucial; investigation and development have been undertaken on a range of therapies designed to help treat COVID-19 patients. Remdesivir, a drug originally designed to fight the Ebola virus, has demonstrated some ability to speed up recovery time for these patients. Their ultimate availability depends largely on economics, however, and distribution to and affordability for marginalized groups are likely to remain challenges.
The COVID-19 Therapeutics Accelerator, a philanthropic initiative, has coordinated therapeutics efforts, though a cautious approach is necessary. This was illustrated by hydroxychloroquine, a malarial drug that was initially endorsed though studies were later published that dismissed its value.
Public-Private Cooperation on Pandemics
Efforts to maintain global health have been undermined by persistent inequality and a lack of cooperation. Responding more effectively to outbreaks like COVID-19 will therefore necessitate significant changes to how we track and respond to public health crises. The diverse, far-reaching impacts of COVID-19 necessitated effective partnerships between the public and private sectors.
GAVI, the Global Alliance for Vaccines and Immunization, an international public-private partnership, was founded at the Annual Meeting of the World Economic Forum in 2000 with the backing of the Gates Foundation, the WHO, pharmaceutical companies, and governments in order to bring vaccines to children who lack access - and is a good example of what is possible. GAVI has co-led the COVAX Facility, an effort to pool resources in order to effectively distribute COVID-19 vaccines to low-income countries.
Global demographic shifts, environmental degradation and climate change, humanitarian emergencies, technology innovation, and a growing global commitment to a universal right to healthcare are all driving change in different ways. Multilateral organizations like the World Health Organization have a vital role to play in guiding and addressing this change, while multi-stakeholder partnerships are meanwhile meshing the strengths of the public and private sectors to play a positive role.
Rather than relying solely on traditional partners and ways of working, new ideas and partnerships that harness the potential of technology are necessary to adequately address the many distinct challenges stemming from global crises like COVID-19. More effective frameworks could help address these challenges and better leverage the benefits of public-private cooperation.
Emerging technologies spawned by the Fourth Industrial Revolution, in the fields of biomedical research and digital communications and often developed by non-traditional actors, are creating opportunities to more effectively fight COVID-19. Mechanisms that better bring together public and private players are likely to help put these technologies to good use, and to help both national and local decision-makers and healthcare workers when it comes to early detection and timely response.
Pooling resources, expertise and capabilities can better enable the private sector and public sector to raise awareness of public health needs, and to scale up ways of building resilience to better tackle and prevent future pandemics. However, many public-private partnerships in the health sector have faced challenges in terms of accountability, neutrality, and impact evaluation.
Pandemic Supply Chain Management
Clinical Practice
The supplies essential for fighting a pandemic rely on complex global value chains, where raw materials are sourced from one location, processed and manufactured in another, and distributed in yet another. The supply of essential medicines and medical equipment was severely disrupted by COVID-19, resulting in shortages.
A disruption of this process in one direction can result in disruption in the other. The reduced mobility of goods caused by COVID-19-related lockdowns and travel restrictions, limited shipping options, and export restrictions imposed by governments intended to boost domestic supply have caused delays, interruptions, and shortages.
While it is traditionally the world’s manufacturing hub, the shipping companies that bring goods from China to the rest of the world have drastically reduced their number of vessels in operation due to a pandemic-related decrease in demand, thereby cutting off distribution channels.
Developing countries, smaller economies, and countries with limited manufacturing capacities are especially vulnerable to supply chain shocks. Raw materials for medicines and the production of personal protective equipment are usually limited to a few hubs such as China, which represented 28% of the global manufacturing output in 2018 (valued at $4 trillion), according to data published by the United Nations Statistics Division.
This has drastically reduced the global supply of products, and forced countries to compete against one another to procure those that are particularly scarce. A survey conducted in April in the US showed that among 978 health and medical facilities, 8.4% had no supply remaining of face shields, 34% had no thermometers, and 19% had no gowns left. Nearly all had no supplies remaining of at least one form of personal protective equipment.
Technology advancements have been reshaping the way goods are shipped and delivered, and can help address COVID-19-related challenges. Innovation in terms of warehousing, such as robotization (automation) and the use of augmented reality, are increasing the speed, efficiency, and accuracy of order picking operations, for example, and will be key aspects of supply chain management long into the future.
Already-difficult international trade relations have been worsened by the pandemic, and supply chain management and distribution is a challenge for both global and regional businesses. It requires greater international cooperation, procurement transparency, the removal of trade barriers, diversified supply chains, increased resilience, and the efficient management of distribution portals.
An expanding trove of data and research is shaping the response to COVID-19. As the COVID-19 crisis has unfolded, related research efforts and front-line experience have been expanded and refined. As a result, information and guidelines conveyed to the public have evolved significantly in the midst of a public health emergency, and rules and prescribed protocol have come together in a patchwork manner. As of July 2020, new research was still emerging on the airborne transmission of SARS-CoV-2, the virus that causes COVID-19.
If established and recognized internationally, this research may impact public guidance - as researchers arguing for the significance of aerosols ask public authorities to implement measures specifically to reduce this route of transmission. This could include recommendations against air re-circulation in buildings, and against overcrowding. New standards for effective ventilation and potentially higher-performing air systems - or the use of ultraviolet light - might be needed.
Evidence-based guidelines and protocols for clinical staff are essential for ensuring the appropriate protection of COVID-19 patients, for helping people take the right preventive measures, and for mitigating the risks faced by frontline workers. However, the speedy dissemination of accurate guidelines and useful tools has been a challenge.
With a significant number of students and trainees fast-tracking into the healthcare workforce to handle the increased workload, the appropriate training of medical practitioners and volunteers - including doctors and nurses - is essential. Providing the right tools for clinical workers including personal protective equipment, leveraging virtual and digital tools, and establishing guidance for advising patients (both before and after visits) can go a long way towards effectively tackling COVID-19.
The accelerated timeline of the outbreak has created an urgent need to share experiences from the frontlines, in place of potentially limited scientific literature - in order to help tailor the right guidelines for dealing with the specific nature and epidemiology of COVID-19.
Given the unprecedented nature and rapid rate of infection of this disease, frontline workers have had limited access to related academic and scientific information that has been through traditional peer review. In response, Frontiers, an open access publisher and open science platform pioneering innovative peer review models, claims to have shortened the average time from the submission of a scientific article to a final decision on it to 90 days.
Innovation and Health Technology
Public Health Response
Technology and new tools can help prevent and manage pandemics. Health technology innovation has given us tools as basic as the electronic medical record, and as futuristic as robotic surgery and precision medicine designed to deliver care based on a patient’s genetic profile and environment.
As part of their efforts to combat COVID-19, several countries have developed and promoted contact tracing apps designed to help people determine whether they have been in close contact with others who have been infected, though these have raised questions about striking the right balance between protecting public health and an individual’s right to privacy.
According to a report published by the World Health Organization, by 2015 70% of European Union member states had national eHealth policies or strategies, and nearly all of them had programs offering financial support specifically for implementing these efforts.
Expanding access to health services around the world remains a challenge, and the use of mobile technology in particular presents intriguing related opportunities. Contactless digital payments enabled through mobile phones can limit physical proximity and the potential exchange of viruses, for example, and mobile operators in sub-Saharan Africa have begun to position themselves to facilitate health payments that are made via mobile devices.
In Kenya, for example, the operator Safaricom has partnered with insurer Changamka Microhealth to enable health care payments via the M-PESA mobile money service.
Telemedicine, where healthcare services are delivered virtually, has helped facilitate contactless patient and care-provider interaction. However, in 2018, the European Commission published a communication on the digital transformation of health and care, which cited slow and varied uptake of digital health solutions within the EU.
Now, the COVID-19 pandemic has the potential to spur the greater adoption of digital health solutions. While there are serious ethical issues related to the growing prevalence of digital innovation within the health sector, not least the need for greater privacy protection and the potential for data to be misused, policy-makers and business leaders need to work together to develop responsible rules. These can be applied to speed the adoption of precision medicine, for example, which could become far more prevalent - and many governments are investing significant amounts in related research and development.
According to the World Health Organization, COVID-19 infects people of all ages - though older people and those with underlying medical conditions are at a higher risk of getting a severe form of the disease (which is why they have been frequently prioritized for vaccination). Evidence-based responses to COVID-19 that prioritize health over economic and social pressures are called for.
In addition, the WHO has acknowledged evidence of the airborne transmission of the coronavirus that causes COVID-19. Rules requiring people to isolate at home were implemented around the world as the disease initially spread - and while these were later relaxed in many parts of the world, in a number of cases they had to be re-instituted after social gatherings served to once again start triggering increases in confirmed cases.
Advisories issued by health bodies including international organizations and government agencies have often contradicted one another during the pandemic, despite a genuine desire to aid response strategies. Some rules and recommendations communicated with varying degrees of effectiveness have included frequently washing hands while avoiding touching one’s face as hands can pick up viruses from surfaces, maintaining physical distancing, and wearing masks.
Timing is of the essence for controlling outbreaks. Countries including India, Australia, China, and South Korea therefore enforced localized lockdowns down to the city block level - sometimes targeting specific businesses or schools. Scientific and expert advice inform any public health response, though in some cases scientists have clashed with elected officials and international organizations like the WHO when it comes to measures to combat COVID-19.
While countries have adopted different measures, many acted quickly in the early stages of the outbreak by enabling mass testing and providing coherent, actionable information to the public. New Zealand, for example, has been relatively successful in terms of limiting infection. There have been abundant examples of irresponsible behavior; mask hoarding became an issue, at the expense of health workers and patients, and questionable advice has been delivered by public officials regarding treatments for and prevention of the disease.
Widespread vulnerability to COVID-19 will unfortunately remain a fact of life until every country is able to vaccinate a sufficient portion of its population against the disease, garner an adequate number of healthcare workers for the purposes of distribution and care, and develop the information systems and infrastructure necessary to track the administering of doses.
Resilient, Inclusive and Effective Healthcare
Even after the development and distribution of COVID-19 vaccines, uncertainty and risk will remain. Ensuring access to vaccines and proper care is essential to contain COVID-19, but it remains a challenge. Inequality in terms of access to both testing and vaccination continues to be a global concern - compounded by early vaccine purchases dominated by wealthy countries.
The economically and socially disadvantaged, including refugees and ethnic minorities, have suffered disproportionately, and the pandemic has created new demands on systems that were already stretched to capacity to meet needs related to chronic diseases, age-related conditions, and disabilities. Addressing this for the long-term will require new models of care and payment, robust data analysis of novel methods, and structural change for workforces.
In addition to issues of capacity, there are related concerns about pricing and access above and beyond COVID-19. While medical advances have the potential to substantially improve health around the world, these benefits can only be truly realized if access is broadly available. Otherwise, disparities will only increase, and health systems will collapse due to a lack of adequate governance. International and national oversight, including efficient policy frameworks, can strengthen capacity in preparation for future pandemics.
In July 2020, the US submitted notice to withdraw from the World Health Organization, and it has frozen its funding for the organization (though a subsequent change in administrations is likely to reverse course on this). Still, such sentiments can have serious implications for international health governance, and for responses not just to the current pandemic but also to non-COVID-19 diseases such as malaria, AIDS, tuberculosis and polio. For low-income countries with limited national capacities, the WHO is the only international body currently present and working on the ground; it is, for example, addressing the measles outbreak in the Democratic Republic of Congo and a cholera outbreak in Yemen.
And, there will be future pandemics - they are now occurring with greater frequency, due to increasing urbanization (the number of city dwellers will increase by 2.5 billion by 2050, according to the United Nations), more frequent global travel (the number of international tourists is expected to reach 1.8 billion by 2030 compared with 25 million in 1950), and the effects of climate change. Global health policies should ensure we are better equipped. However, global cooperation has faltered.
PANDEMIC PREPAREDNESS & RESPONSE
The healthcare sector plays a crucial role in the response to COVID-19, and in efforts to prevent of future outbreaks by bolstering the resilience of the global health system. As businesses, governments, civil society organizations, and experts share insights and experiences gained during the pandemic, they are pursuing three primary phases of action to combat it: a ”flatten” phase of attempting to keep casualties low to avoid overwhelming health systems, a “fight” phase of balancing economic, health, and social impacts while distributing vaccines, and a “future” phase of turning related business transformation into opportunity while optimizing healthcare systems.