Preparing the world for the next pandemic

Preparing the world for the next pandemic

Covid-19 claimed millions of lives and damaged economies around the world, particularly in lower income countries. How can we build more resilient and equitable health systems to prepare for future global health threats? By Sarah Harrop.

In the three years since the Covid-19 pandemic took the world into its grip, there has been the feeling from some quarters that the outbreak could have been predicted, or that its spread could have been better contained. By August 2023, data from World Health Organization (WHO) metrics revealed that there had been over 760 million cases of Covid-19 and at least 6.9 million deaths. The economic impact of the pandemic triggered what the World Bank describes as ‘the largest global economic crisis in more than a century’.

“The world tends to move on quickly, with new crises taking centre stage, resulting in the now familiar cycle of “panic and neglect”. This is a concern: although the timing and nature of the next pandemic spark is unknowable, it is certain to happen,” said the World Bank’s Juan Pablo Uribe, Priya Basu ad Magnus Lindelow in a 2021 article for the World Economic Forum.

The pandemic “revealed a collective failure to take pandemic prevention, preparedness and response seriously and prioritize it accordingly”, agrees the Global Preparedness Monitoring Board (GPMB), an independent global health crisis monitoring and accountability body.

But with the cost of Covid-19 estimated to be well over $11 trillion, the estimated $39 billion cost of preparing for pandemics is considerably lower than the cost of responding to the next pandemic to rear its head. Considering these facts, few would dispute that we should be better prepared for future pandemics and global public health emergencies.

Impact of COVID on low to middle income countries (LMICs)

With lower financial resources to rely upon and sometimes less developed healthcare systems than wealthier countries, LMICs were hit particularly hard by the pandemic. What is more, the crisis has led to a dramatic increase in health-related and economic inequality within and across countries worldwide. Recovery from the pandemic has been uneven, with emerging economies and economically disadvantaged groups taking longer to recover their losses of income and livelihoods after the pandemic, says the World Bank.

Inequity with wealthier countries in terms of research capacity, surveillance, and the availability of Covid-19 medicines and vaccines has also been exposed in the three years since the outbreak. Furthermore there are wide disparities in terms of research and coordinated national responses towards so-called ‘long Covid’ between LMICS and higher income countries.

A study published in The Lancet in 2021 showed the pandemic also had a huge impact on mental health in low and middle-income countries, with high rates of psychological distress and early warning signs of an increase in mental health disorders which could further burden healthcare services in future.

Building back better

So what can be done to narrow the inequalities gap, create more resilient health systems and prepare for future health emergencies on a global scale?

Achieving Universal Health Coverage by 2030 (UHC2030) is a target of one of the UN Sustainable Development Goals (SDGs), and if this could be achieved it would go some way towards addressing inequities in essential health services, health systems strengthening and being better prepared for future pandemics. However, gains made in health services coverage have in fact flatlined since 2015, and ever greater proportions of populations across regions and countries have faced ‘catastrophic levels of out-of-pocket health spending’ since 2000, reports the WHO. At the height of the pandemic in 2021, essential services were disrupted in 92% of countries and by 2022, 84% of countries were still facing disruptions, WHO data shows.

Therefore, to ‘build back better’ in the wake of the pandemic, the WHO has recommended reorienting health systems using a primary health care approach. The organisation says that nine in ten essential UHC interventions can be delivered in this way, which could potentially save 60 million lives and raise life expectancy for everyone on the planet by 3.7 years by 2030.

Other recommended strategies for future pandemic preparedness laid out by GPMB which are relevant to policymakers, include:

  1. Responsible leadership – fast, evidence-based decision-making, led by the science, is needed in a rapidly moving pandemic situation. Nations should appoint high-level coordinators to lead responses and carry out regular simulations to stay ahead of the game. Fair and equitable access to vaccines – the central principle of the WHO-supported COVAX scheme – is also a must, with healthcare workers and the most vulnerable being prioritised and every country getting enough vaccine to cover at least 2% of its population.
  2. Engaging civil society. We should all demand accountability for emergency preparedness from our governments. Better community engagement would enable citizens to educate themselves with accurate information to counteract the spread of misinformation and play their part in adopting health-promoting behaviours, (eg mask wearing), to protect the most vulnerable.
  3. Strong and agile systems for global health security. While the collaborative scientific research to understand Covid-19 and develop vaccines at unprecedented speed was impressive, there needs to be even greater coordination and support for R&D in health emergencies. Sustainable mechanisms for vaccine and medicine development and distribution should be created.
  4. Invest more money in the ‘global common good’. Extraordinary events need extraordinary financing, so sustained investment will be needed to support emergency R&D at the global level. G20 leaders should ensure adequate finance is made available to protect against future pandemics. Furthermore, UN member states, the WHO and the International Financing Institutions (IFI) need to develop a mechanism to sustainably finance global health security, says the GPMB.
  5. Robust global governance. Government of preparedness is a complex web of players, as Covid-19 threw into sharp relief. While the global scientific community reacted quickly to form partnerships and develop diagnostics, there was delayed decisive action from many countries which had been slow to pick up on the danger. GPMB therefore recommends that the International Health Regulations (IHR) ­– a global framework that exists to protect people from health emergencies – should be amended. This would include stronger processes for disseminating information about such emergencies, making evidence-based health policy recommendations on domestic and international travel and trade and developing initiatives to assess IHR compliance.

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