Pandemic Preparedness: “Learning Lessons” and Restructuring National and Global Responses to Future Pandemics.
On 12 October 2021, the UK’s House of Commons released a 151-page report, titled “Coronavirus: lessons learned to date”. The title may appear somewhat optimistic, as lessons can only be considered learned when there is actual proof of learning. The joint inquiry by the Health and Social Committee and the Science and Technology Committee, both comprising MPs from across the political divide, had been launched in October 2020. England’s prior preparedness for a future pandemic was the first of six key areas of the response to COVID-19 to be investigated. The parliamentarians concluded that England’s pandemic planning was too narrowly and inflexibly based on an influenza model and had not considered the lessons from previous coronavirus outbreaks (SARS, MERS), instead focusing on the outcomes of the 2009 Swine Flu pandemic.
A pandemic, of which COVID-19 is the most recent example, is a global outbreak of an infectious disease that spreads across international borders and affects large numbers of people, overwhelming existing national healthcare systems as well as stressing their economies. In recent years, a growing, and increasingly mobile, human population and changes in human behaviour have substantially increased the risk of future pandemics. An increased likelihood of inter-species spillover of zoonotic organisms with pandemic potential from animals to humans has come about as a result of closer and more frequent contacts between humans and animals, both domesticated and wild. This closer proximity has followed man-made impacts on ecosystems that have destroyed natural animal habitats and led to the loss of biodiversity, along with disruptive agricultural and animal breeding practices, and a continued but mostly illegal trade in wildlife. Once human-to-human spread of a new strain of virus or even an altogether new virus takes place, the organism can potentially spread rapidly and widely thereafter, especially in larger towns and cities, and cab soon be transported across the world as a result of growing international trade and travel.
Pandemic diseases are currently identified as a civil emergency risk, in the updated 2020 National Risk Register of the UK government. Identification of a particularly risk naturally requires a plan to both prevent its occurrence and to mitigate its effects if it does. Pandemic preparedness requires effective planning. Plans need to reviewed and updated regularly, guided by new information from fresh outbreaks and by the identification of potential shortcomings through regular simulation exercises.
The early recognition of developing clusters of new infections is facilitated by effective systems of reporting, early identification of the causative organism, including sequencing of its genome, and the rapid introduction of diagnostic tests that are both sufficiently sensitive as well as specific for the purpose. Once an outbreak is confirmed, continued community surveillance, in the form of diagnostic testing and contact tracing, allows confirmation of transmission and determination of transmissibility (infectiousness), which can be further clarified by epidemiological tools, such as mathematical modelling. Early declaration of a pandemic by the WHO can then follow when deemed appropriate.
The last pandemic, influenza A (H1N1) or Swine Flu, took place in 2009, making it the first pandemic of the 21st century. It was much less disruptive in its effects than the present pandemic. The response to that pandemic, caused by a less virulent and more predictable virus, was made easier by the efficient procurement of vaccines and the stockpiling of adequate supplies of anti-viral drugs. The UK Influenza Preparedness Strategy of 2011 followed an update, as recommended by the report of “an independent review of the UK response to the 2009 influenza pandemic”, led by Dame Deirdre Hine and published in July 2010. This revised strategy was to form the basis of the UK’s early response to COVID-19. That review determined that the response of the four devolved administrations was “proportionate and effective” and also “highly satisfactory”. Exercise Cygnus, from October 18 to 20 2016, thus focused on the treatment and escalation phases of the pandemic, during week 7 of a fictitious pandemic, and did not further test preparedness. In 2019, the Johns Hopkins Global Security Index even identified the UK and the US as the best-prepared of nations to deal with a future influenza pandemic.
Complacency may have crept in, causing unpreparedness to deal with COVID-19, except in East and Southeast Asian nations that had faced a previous coronavirus (SARS) outbreak in 2002-3. While the UK did indeed secretly conduct Operation Alice in 2006, targeting another coronavirus outbreak (MERS), it was not followed by any demonstrable actions. The existence of this was only revealed after a Freedom of Information Request made by a British consultant haematologist.
The COVID-19 pandemic revealed a lack of preparation at many levels, both in national as well as in global responses, as the world was mostly caught unprepared to deal with the new coronavirus. The frequency of asymptomatic infections, the delayed recognition of the role of airborne transmission by aerosols, and the long incubation period of the new virus further delayed progress in combating the new virus. Nations differed widely in their adoption of containment procedures, conveying inconsistent messages about social distancing, handwashing, the public wearing of masks, contact surface and ventilation hygiene, and in the provision of PPE to key workers. This was compounded by the lax enforcement of isolation policies and lockdowns, and failures to restrict domestic and international travel. The global response was also delayed and similarly ill-coordinated, being made worse by inefficient sharing of data about infections and by inequitable distribution of protective equipment, testing kits, drugs, vaccines, and ventilators, all of which particularly disadvantaged the world’s poorer nations.
COVID-19 compromised national health systems and led to poor outcomes in most countries. While many lessons are yet to be learned, there is a more pressing need for better pandemic planning by individual nations and enhanced cooperation between nations on matters of health, even as nationalistic tendencies continue to flourish and to increasingly dominate the political agenda
Ashis Banerjee