Preparing For Future Disease Threats – Lessons From Pandemics That Didn’t Happen
A patient getting tested for COVID-19 at the Paris Charles de Gaulle Airport in January 2021.

Though the COVID-19 pandemic has largely been a story of failure, strong preparedness of public health systems coupled with decisive responses have shown that it is possible to prevent and prepare for future disease threats, according to a new report.  

The report, conducted by Resolve to Save Lives, an initiative of Vital Strategies, highlights eight case studies that show the success of epidemics that didn’t happen, or whose impact was lessened, because of careful planning and strategic action. 

“No response is perfect and there’s no one size fits all approach, but taken together, these studies demonstrate that in moments of crisis, communicating clearly and effectively while working collaboratively with partners and communities can prevent epidemics, [guiding] our conversation on the future of global health security,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives on Thursday.

The report reviews how the trajectory of an epidemic can be altered when a country invests in and prioritizes preparedness for infectious diseases outbreaks, such as Uganda and Brazil. 

Uganda’s Rapid Response and Mobilization Against Ebola Outbreak

Surveillance for Ebola Virus at the border between Democratic Republic of Congo and Uganda.

Within days of the Ebola outbreak being declared in the Democratic Republic of the Congo (DRC) in August 2018, Uganda was able to rapidly mobilize its response teams to prevent further infection. 

Within weeks, Uganda opened multiple Ebola Treatment Centers and rapid testing laboratories near the DRC border, where border screenings were conducted for all people entering the country. 

By November 2018, the Ugandan government had vaccinated nearly 5,000 health care workers and response staff.

This was all done before any cases had been identified in Uganda. 

Ugandan Minister of Health Dr Jane Ruth Aceng attributes the country’s strong outbreak response to collaboration and partnerships across sectors.

“Strong partnerships for support, both financially and also technically, as well as stakeholder engagements are critical in responding to any public health emergencies,” said Aceng.

Brazil: Mass Vaccination Against Yellow Fever 

Brazil’s successful response to containing yellow fever in 2019 produced dramatic results, with only 85 yellow fever cases and 15 deaths reported.

Brazil’s successful response to its 2016 – 2018 yellow fever outbreak was due to its scientific expertise on the disease and its role as one of the largest producers of the yellow fever vaccine – making the country well-positioned to address its yellow fever outbreak. 

However, at the time of the outbreak, vaccine supplies were low. 

To manage a large number of vaccinations needed amid a vaccine shortage, health officials requested additional supplies from an international stockpile, and stretched supply further by using partial doses of the vaccine.

Studies have shown that one-fifth of a standard dose can provide up to a year of immunity, and can be beneficial for containing outbreaks. 

Health officials also prioritized surveillance of yellow fever outbreaks among animals, which would provide advance warning of where human cases would later appear. 

By the end of the 2019 yellow fever season, these measures had produced dramatic results, with only 85 yellow fever cases and 15 deaths reported. 

Highlighting Brazil’s successful response to containing yellow fever, Dr Sylvain Aldighieri advocated for increased investments in healthcare workers – a critical issue, he said, should be stressed in the upcoming G-7 and G-20 Global Health Summits.  

“We have this population of healthcare workers dealing with a day-by-day battle for more than 16 months.”

Investment in healthcare workers includes Personal Protective Equipment, vaccinations, training, and adequate ratio of staff-to-patients.  

Aldighieri pointed out that integrated and strong primary health care was also what aided Brazil during its outbreak.

“If you have a strong primary health care system it avoids a lot of trouble in the following steps of response.”  

Seven-One-Seven Approach to Pandemic Preparedness

From these case studies, and from existing recommendations, Resolve to Save Lives has proposed a goal of seven-one-seven – identifying any suspected outbreak within seven days of its emergence, responding rapidly through investigation and reporting within one day, and establishing an effective response within seven days. 

This type of goal, said Frieden, will provide impetus and accountability to make substantial and sustained financial, technical, and political investments needed to improve global health and our capacity to find, stop, and prevent future pandemics.” 

“The COVID-19 pandemic has reinforced the need to work together. We’re all connected. And it’s on all of us to prevent epidemics.” 

Effective Global Health Governance and Collective Investment in Preparedness Needed 

Recommendations for addressing future pandemics and looking beyond COVID-19 through more effective global health governance were also considered, in light of the recently released Independent Panel Report

“We need a strong World Health Organisation (WHO), but we [also] need a more independent WHO that could operate independently and actually make decisions faster, said Dr John-Arne Rottingen, Ambassador for Global Health at the Norweigian Ministry of Foreign Affairs.

He emphasizes that though achieving this type of leadership is a ‘tricky balance’, it demonstrates the need for strong public health capacities not just in the WHO, but across the globe.

This is important in developing countries, which have limited resources to prepare for disease outbreaks. Though countries would ideally like to focus on themselves and their key priorities, the ‘collective investing’ in the health systems of low-and-middle-income countries would be a ‘public good’, not just at the national level but also at an international level, added Rottingen. 

“It’s good for everyone. We can avoid infectious disease threats and it’s a collective investment,” he said, noting all countries should contribute, from high-income to low-income countries, investing both domestically and to collective finance mechanisms. 

As seen with the vaccine nationalism of the current COVID-19 pandemic, countries primarily focus on the needs of their people before considering the ripple effects of disease outbreak in other countries. 

Investment towards countries with ‘lower purchasing power’ would contribute to pandemic preparedness. 

“We need to demonstrate that we can deliver equitable access in this pandemic; if not we will not be trusted in the future.” 

Image Credits: Flickr – International Monetary Fund, WHO Afro, Matt Taylor, WHO.

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