Covid-19 is no ‘black swan’ and this crisis shows pandemic prevention must be part of government policy the world over
- Global health agencies have spent 25 years helping countries prepare for pandemics but recent operational lapses, including for Covid-19, are a reminder that nations must prioritise funds for emergency response plans
For example, in 2007, Singapore funded the development of Duke-NUS Medical School’s new programme in emerging infectious diseases, of which I am the founding director, and which played an instrumental role in Singapore’s effective early control of the Covid-19 epidemic.
Singapore, with its much-lauded science-led approach, provided a model for the first innovative use of antibody testing, by my colleagues at Duke-NUS, to support contact tracing and containment measures, preventing fatalities for the longest time compared to peer countries and, even now, keeping the fatality rate among the lowest in the world.
International health agencies have spent 25 years preparing for such occurrences, with global efforts led by the US Centres for Disease Control and Prevention and the WHO to help countries develop pandemic response plans and update their laboratories.
Moreover, drug companies that invested in vaccine development lost financially because the pandemic had ended by the time vaccine candidates were ready for clinical trials.
The reasons for such failures are complex. Nonetheless, several lessons can be learned. First, epidemic infectious diseases do not occur regularly, and when the period between them is prolonged, an “out of sight, out of mind” mentality kicks in, resulting in deprioritisation of funding for surveillance and emergency response plans.
Second, administrative changes and long inter-epidemic intervals result in the loss of first-hand knowledge and experience from personnel who have weathered at least one major epidemic. Third, while emergency response plans are developed by public health officials, implementation of the plan is a political decision.
Most policymakers do not like to initiate emergency response plans until it is certain that there is a true public health emergency, to avoid criticism for overreacting and potentially wasting public funds. By that time, however, it is usually too late to effectively contain the disease.
To conclude, if we are to successfully reverse the trend of epidemic infectious diseases and prevent pandemics, we must develop the following capabilities:
Second, we need effective laboratory-based infectious disease surveillance, prevention and control programmes that are intersectoral and involve urban planners, demographers, economists, environmentalists, sociologists and community-based groups, in addition to animal health, public health and infectious disease experts.
Third, epidemic response plans – which include guidelines to trigger an automatic response by local, national and global public health communities, with regular drills by key agencies to maintain operational readiness – are vital.
Fourth, there must be full responsibility at country level for developing and supporting public health infrastructure and operational programmes without an overreliance on international sourcing and funding.
Fifth, we need high-level funding for research to develop new and innovative tools for surveillance, prevention and control of infectious diseases, including vaccines, drugs, diagnostic tests and vector control.
Implementing these measures will not be easy, but global public health and economic security depends on reversing this trend of emerging epidemics of infectious diseases.
Dr Duane J. Gubler is an emeritus professor and founding director of the Emerging Infectious Diseases Signature Research Programme at Duke-NUS Medical School, Singapore, and chair of the Global Dengue and Aedes-Transmitted Diseases Consortium
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