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Pandemic preparedness at the forefront

142157361 - bengaluru / bangalore, india - march 4 2020: a hospital ward for testing covid-19 or coronavirus setup in bangalore, india. the infectious disease has over 93,000 confirmed cases worldwide, with india has reporting 28 confirmed coronavirus cases. COVID-19 case count concept. Image credit: Ajay Bhaskar / 123rf. Critical COVID-19 concept. COVID-19 tests concept. Pandemic preparedness concept.
A hospital ward for testing COVID-19 in Bengaluru. Image credit: Ajay Bhaskar / 123rf

The 74th session of the World Health Assembly (WHA), the highest-level decision-making body of the World Health Organization (WHO), is to foreground pandemic preparedness whilst advancing measures to end the ongoing COVID-19 pandemic.

COVID-19 has dominated headlines and the public health discourse for well in excess of a year. The public health crisis is unprecedented in modern memory and has resulted in near-universal disruption to the economy, society, livelihoods, and — of course — our healthcare systems. India is brutally familiar with the stark tragedy of the pandemic as it continues to be crushed under the weight of a second wave which, on Wednesday, saw a record 4,529 COVID-19-related deaths in the preceding 24 hours alone.

The WHA session will acknowledge the current pandemic which, as the WHO notes, saw “cases of COVID-19 [rise] 40-fold to 162 million globally, while the number of deaths has increased eleven times, to more than 3.3 million.” That there will be much discussion about ending the COVID-19 pandemic is hardly surprising — but it is also key to note that the discussion will heavily centre around pandemic preparedness and prevention.

WHO Director-General Dr Tedros Adhanom Ghebreyesus. MONUSCO Photos, CC BY-SA 2.0 <>, via Wikimedia Commons

“This year’s World Health Assembly will play a vital role in shaping the global health architecture of the future, and in strengthening WHO to fulfil its mission and mandate”, said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Tedros saluted the efforts undertaken, stating “a crisis often brings out the best in people and organisations.

“From the WHO Strategic Preparedness and Response Plan to our technical guidance, the Solidarity Trial, the UN Supply Chain Task Force, the learning platform and initiatives like the Access to COVID-19 Tools Accelerator, including its COVAX partnership, and the Solidarity Response Fund, WHO has given countries effective and evidence-informed tools to prevent infections, save lives and maintain essential health services. I am especially proud of the incredible work that WHO staff have done all over the world in the past 17 months to support countries to put these tools to work.”

It is crucial to note that while COVID-19 is the pandemic on our minds right now, it is hardly implausible to think that it will be the last crisis of this magnitude. The notion of ‘the next pandemic’ is at the forefront of the minds of the agencies playing a crucial role in combating the COVID-19 outbreak.

Indeed, the idea of the next pandemic is far from a new concept. Last year, in the nascent stages of COVID-19’s emergence — my colleague Nicholas Parry speculated that the novel coronavirus could be the so-called “Disease X”. This refers to “a placeholder name adopted by the WHO for any new pathogen which may cause disease and potentially an epidemic in the future but has not yet been discovered by scientists.” At that time, Parry queried “COVID-19, or the novel coronavirus, is now being hailed as a contender for this portent of doom” — said portent being “an international pandemic of vast proportions.”

That article was published on February 27th, 2020. On March 11th, the WHO classified COVID-19 a pandemic. But will there be a next one?

The answer, unfortunately, is likely yes.

Importance of pandemic preparedness concept.
A WHO guide to inform and harmonise national and international pandemic preparedness and response. Image credit: World Health Organization, Public domain, via Wikimedia Commons

The Coalition for Epidemic Preparedness Innovations (CEPI), which co-leads the COVAX facility, is making preparations. “I strongly believe that what this pandemic has shown is that having the governance right, the cooperation framework being right, is the key to deliver anything at the global level,” said Amadou Sall, the director of Senegal’s Institut Pasteur in Dakar. “That’s the role that CEPI is playing.”

One way in which CEPI is working towards pandemic preparedness is, as Devex reports, “a “moonshot” objective of reducing the timeline for future vaccine development to 100 days…To do so, CEPI is building on the idea of prototype pathogen preparedness, where researchers develop an in-depth knowledge of — and possible response to — prototype viral pathogens, essentially giving them a head start when threats from within those viral families actually emerge.”

The launch of the Coalition for Epidemic Preparedness Innovations (CEPI) at the World Economic Forum in Davos, Switzerland in 2017. A co-leader of COVAX, CEPI has sounded the alarm over the prospect of the next pandemic. Image credit: Ciaran McCrickard, CC BY-SA 2.5 <>, via Wikimedia Commons

Gavi, also a COVAX co-leader, is drawing attention to the notion of the next pandemic, explaining that the public health crisis engendered by COVID-19 and its resultant manifold effects were far from unforeseeable

“The COVID-19 pandemic felt for many of us like it came out of the blue, but scientists have long been sounding the alarm about a potential pandemic from a coronavirus. We already had warnings with the SARS and MERS outbreaks, both caused by coronaviruses, and both spilled over from animals into humans. Given the way people continue to encroach on animal habitats, trade wildlife and eat bushmeat, it is increasingly likely that zoonotic diseases that come from animals will cause future pandemics.

“This already happens more often than you might think. Since the 1940s more than 330 emerging infectious diseases have been identified, of which sixty percent were zoonotic. And when a new infectious disease does emerge, human migration, population growth, rapid global travel, climate change urbanisation and dense urban slums can all hasten its spread. Given that more people are living in closer proximity to each other than ever before and that normally more than a billion people cross international borders each year, it has never been easier for outbreaks to escalate and spread globally.”

For India, pandemic preparedness is a somewhat unique challenge. The country’s healthcare system, when one factors in the diversity and size of its population, has long weathered severe underfunding and a dearth of resources. This is especially true of rural areas, where healthcare infrastructure has been lacking and where COVID-19 has surged.

Physical distancing being observed during the COVID-19 pandemic in India. Image credit: Phadke09, CC BY-SA 4.0 <>, via Wikimedia Commons

Writing for The Lancet in April of last year, Patralekha Chatterjee outlined as much regarding the health system. At that time, Chatterjee acknowledged, India was “not among the worst-hit countries.” Nonetheless, “its grossly under-funded and patchy public health system, with huge variations between different states, poses special challenges for the country’s disease containment strategy.” Shoring up patient trust and reducing stigma were also key components Chatterjee identified, quoting Giridhara Babu, Head-Lifecourse Epidemiology at the Public Health Foundation of India, who asserted “infectious disease surveillance and in particular, the timely detection and early warning of disease outbreaks are a function of strength and capacity of the health system.

“This is the time to win the trust of people with a thoughtful approach. This can only be done by increasing the health expenditure by [the] government as a percentage of GDP [gross domestic product] compared to what it is now and not just through health insurance. Creating a reliable system with a public health cadre will address these problems.”

For the next pandemic, these same issues will be present and impede a response as we have seen during COVID-19 — unless pandemic preparedness action is taken. This will involve extra investment into the health sector, a responsible public policy, and fortifying health infrastructure so as to avoid the visceral scenes of tragedy we are witnessing as public health systems throughout the country are, or on the verge of, collapsing.

Globally, we need to think seriously about pandemic preparedness. It’s not as though we were not warned. As Stat reports, “over the last thirty years, infectious disease outbreaks have emerged with alarming regularity. The World Health Organization lists an influenza pandemic and other high-threat viral diseases such as Ebola and dengue among the top ten biggest threats to public health. The rate of animal-to-human transmission of viruses has been increasing, with the U.S. Centers for Disease Control and Prevention estimating that 75 percent of new infectious diseases in humans come from animals.” SARS and MERS were not merely warning shots — they were calls to action. And it is crucial to note that, as Stat puts it, “luck is not a pandemic strategy.”

The far-reaching disruption of COVID-19 notwithstanding, the article highlights that — relatively speaking — “by scientific measures the world was lucky this time. COVID-19 was far less lethal than its predecessors, less contagious than previous pandemic viruses, and we were able to quickly develop a cadre of effective vaccines.” The question therefore remains: will we be lucky next time? To bank on good fortune is errant, irresponsible, and likely to cost lives. As such, pandemic preparedness is unquestionably the need of the hour. That it is being burned into the WHA agenda is important — but as important if not almost certainly more important, is that we learn from the collective tragedy of the last year-and-a-half and work to be vigilant against emergent threats so that COVID-19 is not a prequel to a more taxing and deadlier disaster.

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