As the coronavirus pandemic continues to circulate around the world, scientists are already looking ahead to the next possible pandemic and seeing what can be learned from the mistakes that were made during COVID-19.
“Preparing for Future Pandemics and Other Biological Catastrophes,” a discussion led by Professor Saad Omer, director of the Yale Institute for Global Health, was held at the Yale School of Public Health on Sept. 19 and featured three professors who are tackling different areas of this multi-faceted challenge, searching for solutions.
The panelists were Professor Jennifer Nuzzo, inaugural director of the Brown University School of Public Health’s Pandemic Center; Honorary Professor of Public Health Wilmot James, a senior research scholar at Columbia University’s Graduate School of Arts & Sciences and a former member of South Africa’s Parliament; and Professor Beth Cameron of the Brown University School of Public Health, who was formerly senior director for Global Health Security and Biodefense for the National Security Council.
Better Surveillance
Nuzzo, who has worked in pandemic preparedness for more than a decade, stressed the need for better pandemic surveillance and being vigilant and rigorous in gathering data. She conceded that setting global reporting standards can be extremely difficult when dealing with so many countries.
For example, she presented a chart from the Johns Hopkins University School of Public Health, showing the number of reported cases of COVID-19 around the world, including a massive spike in cases on one day in November 2021, which caused great concern at first.
“And it isn’t until you look at data and realize it’s all coming from one country, that you realize what’s happening, which is that there was a day where a single country decided to change its case definition,” she said. “So, one country’s policy decisions can greatly change our understanding of how the pandemic is unfolding, and what it means for the global community.”
Compounding the problem, she said, was a lack of widespread testing in some places and a lack of testing of people who may be asymptomatic for COVID-19.
“If we want to get a standardized picture, we need to level the playing field and make sure all countries have the same capacity and probability of finding cases, finding deaths, determining causes of deaths, and being able to record them,” Nuzzo said.
She also cited the need to increase funding for public health and for training and retaining an epidemiology workforce. The current pandemic has caused “a hemorrhaging” of qualified and experienced health care workers due to burnout and feelings of being threatened, she said. In addition, she said the workforce needs to be empowered to act on data to get ahead of a crisis – a failure seen in both the COVID pandemic and the monkeypox epidemic.
“I think we have to take a hard look at how we are training and empowering public health workers to act on situations such that we can get ahead of them instead of constantly looking backward and leading based on our retrospective understanding of what’s happening,” she said.
Global Vaccine Manufacturing
James reiterated Nuzzo’s call for better surveillance and training, then pivoted to another facet of preparedness: creating a decentralized global system of vaccine manufacturing. He talked about the “breathtaking” speed and innovation of the development of the COVID-19 vaccine, and how the framework is slowly being built for such a system throughout Africa as part of a collaboration between governments and industry.
The need for such a network is especially critical in Africa. Currently, James said, citing World Bank figures, the continent produces just 1% of its vaccine needs. Also, it’s dealing with declining vaccination-immunization rates. One in five African children lack all the necessary basic vaccines and the continent accounts for approximately 33% of the world’s cases of vaccine-preventable diseases. James stressed the economic benefits of vaccination in general, not just during the current pandemic. He said that every dollar spent on child immunizations in Africa returns $44 in economic benefits.
The World Health Organization, James said, has introduced a mRNA (messenger RNA) vaccine transfer technology hub in his hometown of Cape Town, with seven sites for manufacture throughout the continent, in Kenya, Rwanda, Senegal, South Africa, and Ghana. There is also a growing hub of partnerships working on manufacturing a non-mRNA vaccine platform; countries so far include Algeria, Morocco, South Africa, Egypt, Nigeria, Botswana, and Uganda.
“In the longer term, it is a completely worthy intervention and investment from a moral point of view, from a life-saving point of view, and from an economic point of view,” he said. “So there is a case to be made. It is a case to be presented to politicians.”
Global Health Security
Cameron focused on the architecture needed to ensure global health security and pandemic preparedness – factors that she said weren’t there for much of the COVID-19 pandemic.
Her presentation showed the consequences of being caught unprepared in 2020: millions of lives and livelihoods impacted, and trillions of dollars lost because decision-makers lacked the tools to rapidly detect and respond to COVID-19. The situation was compounded by disinformation spread by “malign actors.”
Global health security, she said, “is being prepared to prevent, detect, and respond to public health emergencies that have high consequences, including health emergencies that are national concerns, whether they’re naturally occurring, accidentally caused, or deliberately caused.”
And the world is not prepared, she said.
Cameron, Nuzzo, and James have worked on the Global Health Security Index, a joint effort of the Economist Impact, the Nuclear Threat Initiative, the Johns Hopkins Center for Health Security, and Brown University. All WHO-member states were given 100 questions in several categories measuring their ability to prevent, detect, and respond to health crises. The average score was 38.9 out of 100.
Cameron concurred with James about the collaborative efforts that have arisen since 2020. One in particular was the ACTaccelerator; it’s a tools accelerator created by a number of major organizations (the WHO, UNICEF, the Wellcome Trust, the Gates Foundation, the Global Fund, GAVI), along with several governments, to facilitate obtaining tools such as supplies, oxygen and personal protection equipment.
But much more needs to be done, she said. More funds need to be raised. The vaccine-manufacturing architecture must be strengthened. More organizations and governments need to come together to work out cohesive plans where everyone is much closer to being on the same page. And many more professionals need to be not only trained but entrusted with the authority to make decisions based on changing situations.
“Maybe the only good thing that’s come out of this pandemic is we now have all the tools, we have the ingredients, we have the thought leadership that we need …that will make us prepared for anything that comes our way,” Cameron said. “Now we need the recipes and the practice, so that the next time, we actually are prepared.”