Key principles for the next pandemic: Global lessons from COVID-19

The COVID-19 pandemic has and continues to wreak havoc upon the global community. Marginalised groups face disproportionate negative impacts due to their socioeconomic status, gender, and race along with an inequitable global distribution of PPE and testing equipment. However, hope for a reprieve has arrived with the ongoing distribution of multiple safe and effective vaccines, which allows for the beginning of an economic recovery and addressing the ongoing social and health effects of the pandemic. It is at the cusp of this recovery that we are presented with an opportunity to evaluate our response thus far, and to build an effective model for future outbreaks that will undoubtedly emerge in the future.  


Jorge Santayana’s famous aphorism “Those who cannot remember the past are condemned to repeat it” — remains eternally true, and it is in this spirit of remembrance that several key principles can emerge to help us avoid the tragic loss of lives and livelihoods from the past year.

Proactive response

The early stages of the pandemic were characterised by reactive responses, wherein nations scrambled for scarce PPE and testing resources, delayed travel restrictions, and introduced robust policy responses too late, if at all.

Credit: David McNew
Copyright: Getty Images 2020
https://fortune.com/2016/04/30/donald-trump-hands/

Many nation-states with action plans that were expected to manage COVID-19 effectively failed to contain the virus. This may be due in part to sclerotic and myopic political leadership that resulted in insufficient and delayed responses, or outright denial in the case of the United States. This may partly be the result of a perceived juxtaposition between economic and health outcomes, with the false assumption that less restrictive public health policies would be better for economic well being.


Greater preparation would have created the capacity for a rapid response that wouldn’t overwhelm hospitals and have made containment more viable. This was partly seen in the early responses of Taiwan, South Korea, and Singapore, which had learned from previous failures when facing the 2003 SARS and 2015 MERS outbreaks by establishing necessary systems in advance. For example, South Korea implemented a process after the MERS outbreak that better enabled authorities to enact a sophisticated contact tracing program involving data analytics and anonymised outbreak data. Knowing that previous outbreak experience can enable more effective responses informs the view that lessons can be learnt on a global scale from the COVID-19 pandemic.

Credit & Copyright: Reuters in Arab News
https://www.arabnews.com/node/1805751/world

However, merely experiencing a previous outbreak does not solely guarantee a proactive response. SARS in 2003 and H1N1 in 2009 should have been heeded as grave warnings for this possibility and triggered a global response to proactively prevent future pandemics, rather than responding reactively with varying degrees of vigour and success. 

There are a variety of resources available exploring how to build a proactive response to future pandemics. For example, McKinsey outlined an approach for revitalised healthcare systems characterised by greater research, detection apparatuses, and “always on” systems that can scale and surge as needed. Some have also called for the creation of vertically integrated organisations that are purely focussed on public health management. This type of organisation could function in a similar way to central banks across the world. A central bank is responsible for managing the money supply and inflation (among other goals) in an economy through controlling interest rates. They are politically independent bodies of experts who are solely responsible for stable economies and are equipped to handle global economic crises as they emerge through monetary policy. Pandemics can emerge due to unforeseen systemic frailties in health systems in a similar manner to economic phenomena, as seen in the Global Financial Crisis wherein vulnerabilities following deregulation in the financial sector triggered a global economic collapse. This necessitated an immediate response by central banks around the world that minimised the downturn and promoted a quicker recovery. While there are obvious differences between these scenarios, a dedicated health body similar to a central bank in function could enable a similarly proactive response.

Collaboration

COVID-19 is an all-encompassing global issue that pervades society, which therefore merits a correspondingly pervasive response. National and subnational governments, intergovernmental organisations, the healthcare sector, NGO’s, media outlets, community groups, businesses, and individuals are all required to mobilise for an effective and comprehensive response. For this response to be coherent, high degrees of coordination are necessary so as to minimise overlapping of responsibilities and the presence of response gaps, while ensuring policy consistency.

Collaboration within the international sphere was ultimately lacking and this had dire consequences. WHO guidelines were not consistently adopted or respected and principles of scientific openness weren’t always maintained. Countries began to turn insular; and xenophobic and bigoted attitudes emerged as Donald Trump dubbed COVID-19 the “Chinese virus” and “kung flu”, which coincided with a rise in anti-Asian discrimination.

Greater international collaboration could have resulted in more effective global containment and support provided to lower income countries. For example, this study in an East Asian context explores how early collaborative efforts could have minimised the spread of the virus, and that ongoing collaboration is essential to maintain global value chains (which are essential for the provision of medical supplies) and to propel a more resilient economic recovery.

Successful collaboration was employed in the development of various vaccines, which involved sharing of knowledge via the COVID-19 genome, fundraising, and collaborations between pharmaceutical companies with labs internationally. While it remains to be seen if the vaccine itself will ultimately be distributed effectively and equitably, this is nonetheless a collaborative model that could have been replicated across all aspects of the pandemic response and can still be for future outbreaks.

Interdisciplinarity

Given the multitudinous and complex nature of COVID-19’s impacts and responses, it is of fundamental importance that diverse and interdisciplinary teams coordinate to address the problem. Within the health space, epidemiologists, mental health professionals, pharmacologists, geneticists, nurses, physicians, and innumerable other professionals are required to treat patients, advise policymakers, and develop vaccines. This degree of complexity and professional collaboration also extends to the political, economic, and social spheres, which all need to coordinate and coalesce into a coherent, comprehensive, and consistent response. Managing problems with high interdisciplinary requirements necessitates mutual understanding, collaboration, and coordinating bodies to ensure no contradictions or discrepancies emerge. 


An example of this can be seen in the interplay between health, economic, and social policy. Social and economic policy both seek to mitigate the broader negative implications of social isolation and fragmentation, as well as the loss of livelihoods associated with the resulting economic recession. However, these solutions need to be compatible with sound public health interventions and professional advice, as failing to address COVID-19 would exacerbate both issues in addition to the negative health ramifications. Likewise, the design of public health interventions needs to be cognizant of the broader social and economic implications, such that the overall negative effects of this crisis can be minimised.

Effective and Empathetic Communication

Ensuring that the populace understands and accepts both the realities of outbreaks, their impacts, and the necessary responses is critical to ensuring containment and minimising suffering. 

The prevalence of COVID-19 denial, anti-vaccine movements, media that downplayed the severity of the pandemic, and state apparatuses that denied, minimised, or lacked transparency regarding public health developments represents communication inadequacies across multiple stakeholders. This can lead to destructive partisan and subgroup divides on the perception of risk and adherence to medical advice such as social distancing, which exacerbates the spread of the virus and places additional strain on healthcare systems. Moreover, if true, allegations of a lack of governmental transparency in the US, Belarus, and China creates additional risk both for a country’s citizens and internationally.

This necessitates impartial, scientifically grounded, socially responsible, and transparent communication between governments, scientists, media outlets, civil society, and the public. Pandemic communication needs to be centred around the attitudes, subjective norms, and perceived behavioural control responses that determine whether an individual will adhere to public health advice, such as social distancing rules. Communication issues such as anti-vaccine sentiment are also related closely to scientific illiteracy and education gaps which need to be remedied with substantial formal and informal educational programs that communicate and explain scientific principles with clarity.

Beyond science communication, there is also a need to communicate in terms of ethical imperatives and social responsibility, which can be an effective communication tool in similarly global and science-based issues such as climate change.

Connection

It is with this ethical imperative in mind in addition to the necessity of a proactive and collaborative response that the overarching lesson of our need for interconnectedness emerges. This is especially needed given extended periods of isolation and an international community that has been made fragmented and insular by this crisis.

Several innovative social activities, mutual aid programs, entertainment venues, community organisations, NGO’s, social workers, community health workers and many more have all mobilised and organised to provide that sense of connection and ameliorate the wider impacts of the pandemic. These connections have formed the social fabric of societies that have threatened to be torn apart by the pandemic, and it is only through collective solidarity that societies can pass through the societal crucible of a devastating pandemic. 

Understanding and appreciating these interconnections can form the basis of a just and equitable approach that addresses the disproportionate impact COVID-19 has brought to marginalised groups while ensuring a united and resilient global response.

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