How do health systems prepare for new pandemics?
Ornella Moreno Mattar
MSc in Public Policy,
health economics lead
At the beginning of 2020, the COVID-19 pandemic was spreading from China to the rest of the world (1). During that year, this pandemic caused two million deaths around the world and implied costs of about US$20 trillion; This demonstrates the low preparation of countries to face this pandemic and the need to strengthen response mechanisms for the future (2).
For decades, numerous researchers have talked about anticipating the risks of new pandemics and preparing health systems. To have an example, in 2005 the researcher Mary Grace Duley published in the Yale Journal of Biology and Medicine a study entitled “The Next Pandemic: Anticipating an Overwhelmed Health Care System”. In this publication, 15 years before the COVID-19 pandemic, the researcher already anticipated the need for strategies to increase the number of beds, equipment, medical supplies and trained health personnel (3).
Despite these forecasts, influential countries in the world made big mistakes in handling the pandemic. In countries such as England, Sweden and Brazil, they were slow to implement measures of physical distancing and border closure, basing their strategy on herd immunity (4).
The lack of preparation to deal with the COVID-19 pandemic has caused terrible consequences worldwide and shows that addressing these problems in the future requires, not only greater financial resources, but also the development of technical and operational capacities of the systems. health (2).
For this, governments must commit to work within nations, as well as through international cooperation. It is necessary to invest resources in the construction and maintenance of public health laboratories, medical equipment and supplies, and support for health institutions, including the salaries of professionals in this area; Furthermore, the financing of research in different fields of health and the social economy is of vital importance.
Another of the greatest needs that has been evidenced during this pandemic is to strengthen primary health care systems so that they are more effective in the prevention and early detection of infectious diseases (2).
Effective country responses to the COVID-19 pandemic:
In February 2020, in the absence of sufficient information to treat the virus and the lack of a vaccine, China opted for public health measures such as strict quarantines, airport closures, monitoring of positive cases and their respective contacts, the restriction of social encounters and the mandatory use of masks; which contributed to rapidly reducing the impact of the first wave of the pandemic (1).
These population strategies directly influenced the decisions made by the government of New Zealand, one of the countries that has most effectively managed the health crisis caused by COVID-19. This country implemented strict measures of physical distancing and monitoring of positive cases during March 2020, which mitigated infections (1).
Many of the measures that have been considered most effective in controlling the COVID-19 pandemic have been the product of experiences in the management of previous epidemics, such as the case of Hong Kong with the avian influenza A (H5N1) virus. ) in 1997, A (H7N9) in 2013 and the SARS epidemic between 2002 and 2003. Another case is that of Liberia, which in 2014 had to implement strong measures and restructuring in its primary health care system to face the outbreak. of the Ebola epidemic; Singapore in 2003 implemented measures to address the SARS epidemic, later adapted for influenza A (H1N1) and then for COVID-19 (5).
How do we prepare for the future?
It is difficult to prepare nations, especially low- and middle-income nations, for future epidemics when today there are so many visible and imminent health problems, such as tuberculosis, HIV or malaria. However, there are measures that can be put in place to address current problems effectively, while at the same time leaving us prepared for the future. Some of these measures are the strengthening of primary care centers, investment in laboratories, research, the protection of human talent and epidemiological surveillance (2).
These preparedness strategies for future pandemics are not a recent recommendation, since 2005 the International Health Regulations, prepared and revised by the World Health Organization, raised the need to strengthen national surveillance and response systems, proposing, among other activities, designing pandemic preparedness plans.
Some international medical organizations have suggested the design of national plans for the care of future pandemics. New Zealand, had a six-phase plan for epidemic care since 2017, focused on respiratory viruses due to its experience with influenza A (H1N1), and did not contemplate the elimination of the virus as its final objective but the mitigation of its impact on the health of the population (1). However, this country warns about the risks of having rigid plans or focused only on specific pathologies.
Along these lines, and thanks to their experience, researchers who have worked on successful strategies for pandemic management, such as that of New Zealand, recommend that new strategies for future pandemics be designed taking into account the following (1):
- Transmissibility and dynamics of infection
- Severity and lethality
- Need for additional controls and necessary resources
- Level of knowledge and characterization of the pathology
These characteristics must be taken into account, in accordance with the objective of the strategy for the care of the pandemic, that is, it must be defined if what is sought is to control the incidence or reduce the cases to zero (See figure 1).
Others that should be considered when developing response strategies for future pandemics are border control to limit the geographic scope of the pandemic, case- and / or population-based management to cut the chain of transmission, and finally prevention based on immunity through vaccination and antiviral treatments (1).
All the measures and recommendations for governments and health systems made by researchers worldwide are based on the experiences of the latest epidemics. However, the success of the implementation of these measures depends on the will of the rulers and the availability of resources of the countries to invest in effective and sustainable measures in the long term, with flexibility to address current problems and adaptable to future situations. .
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1. Kvalsvig A, Baker MG. How Aotearoa New Zealand rapidly revised its Covid-19 response strategy: lessons for the next pandemic plan. JR Soc New Zeal [Internet]. 2021; 51 (S1): S143–66. Available from: https://doi.org/10.1080/03036758.2021.1891943
2. Frieden TR, Buissonnière M, McClelland A. The world must prepare now for the next pandemic. BMJ Glob Heal. 2021; 6 (3): 6–8.
3. Duley MGK. The next pandemic: Anticipating an overwhelmed health care system. Yale J Biol Med. 2005; 78 (5): 351–8.
4. Iacobucci G. Covid-19: Thousands died needlessly from UK pandemic response, says PM's former aide. BMJ. 2021; 373 (10): 1–2.
5. Chua AQ, Al Knawy B, Grant B, Legido-Quigley H, Lee WC, Leung GM, et al. How the lessons of previous epidemics helped successful countries fight covid-19. BMJ. 2021; 372: 1–3.