Monday October 18, 2021

Averting a pandemic

September 22, 2021

Covid-19 caught the world off guard; the speed at which it spread and the extent of its impact on people’s lives came as a great shock. Many experts had long been warning about the risks of a new pathogen and its global spread but they were not taken seriously and hence the disaster unleashed.

History informs that more than six distinct influenza pandemics and epidemics have struck in just over a century. Ebola viruses have spilled over from animals about 25 times in the past five decades. At least seven coronaviruses, including SARS-CoV-2, have brought illness and death. Despite all the advances in science and medicine, the risk of pandemics is actually increasing. It’s not a question of if there will be a next pandemic but ‘when’.

Averting the next pandemic requires a strategic reset of our preparedness system. Fine tuning and investing in strengthening the surveillance system, vaccine and supply chain, communication, health governance, global collaboration, innovation and adequate financing is likely to pay off.

The world’s largest Ebola epidemic was spreading for more than a month before anyone diagnosed it. Similarly, scientists opine that China had probably been infected by SARS-CoV-2 for several weeks before officials reported a mysterious pneumonia in Wuhan. This was partly due to limited laboratory facilities in the region, but also because of the absence of an efficient disease surveillance network.

Early detection of an outbreak can bring it under control and end it quicker, but to do so resilient national response systems need to be in place once the alarm bell has been sounded. As Covid-19 has shown, when an outbreak escalates into a pandemic, the increased pressure it can place on health systems can cause them to quickly buckle, even in the wealthiest countries. A sensitive, efficient and responsive surveillance system is the key.

Better data would have helped epidemiologists to determine more quickly and confidently that SARS-CoV-2 spreads through the air and that it could be transmitted without symptoms. Resultantly scientists in the early phase could have advocated for measures such as widespread testing and face masks.

Many criticised China for being less than forthcoming at the beginning of the pandemic, but it hasn’t been alone. In India, local journalists exposed the fact that officials were not sharing the case numbers in a timely manner. Arvind Subramanian, an economist at Brown University, estimated that India had under-reported deaths by three million or more from the start of the pandemic to June 2021.

Sharing epidemiological and genomic data in an outbreak might have political dimensions that must be negotiated at high forums, similarly to the 2011 influenza framework and other multilateral treaties. Disease modelling had predicted well before an impending pandemic and could guide the course in the future adequately.

With Covd-19, the speed and response from the scientific community has been incredible. From the moment the genome of the SARS-CoV-2 virus was published, it took just 327 days for the first vaccine to be developed, tested and authorised for emergency use. Today 19 vaccines have been authorised, 110 in clinical trials and further 184 vaccine candidates in pre-clinical development.

The irony is that, despite all this, the world has made little progress when it comes to distribution of Covid vaccines as less than five percent of people in low-income countries have been vaccinated so far.

We’re still hampered by vaccine nationalism and export restrictions that plagued us during the 2009 swine flu pandemic.

To avoid a repeat of this we need to develop a system that can ensure vaccine delivery within just 100 days after a pandemic has been declared.The best course is to build on our existing global supply chains, such as that of routine immunisation programmes.

Fighting the infodemics: We witnessed confusion at the start of this pandemic and at times it seemed as if the mandated agency for safeguarding world health itself was the least informed.In Pakistan ministers in televised interviews didn’t recommend face masks until mid-2020. In Brazil, President Jair Bolsonaro trivialised Covid-19, calling it a “little flu”.

In May 2020, the WHO passed a resolution in which countries agreed to combat misinformation at home. A committee of experts listed some key approaches – working with data scientists and social-media companies to amplify the reach of credible messages from mandated credible sources; social media handles be bound to remove disinformation; a crisis communication cell at the central level to harmonise the flow and content of information.

Investing in primary healthcare and making universal health coverage a cornerstone of the national health policy is a simple recipe for success.

Granting public-health departments more power during health crises, along with more stable budgets, would pay dividends. Similarly building and retaining surge technical capacity at all levels of the health spectrum is necessary for an effective response. Improved health governance, meritocracy and a multi-purpose coordination platform like the NCOC would serve the purpose.

World leaders now recognise the devastation that health crises create. A report from a G20 panel calls for $75 billion in international financing for pandemic prevention and preparedness – twice as much as current spending levels. A stronger alliance between low- and lower-middle-income countries would yield much.

Galvanising global entities for vaccine equity, debt wavering, global standards and solidarity demand champions that can fuel the momentum.

While fundraising during a crisis is less than ideal, there is clearly a need for a more coordinated approach to funding pandemic preparedness in advance.

Innovations like the mRNA vaccines, establishment of COVAX, CEPI are great leap forwards and a global pandemic response fund with equity implanted as the main pillar would serve the world better.Despite the complexity, one can hope on the global consciousness awakened by the huge cost of the pandemic.

The writer is an internationally recognised health and development expert, who has had an illustrious career with UN, USAID, World Bank, Gates Foundation, and various governments.

Email: Nadeemjan77