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Sustainable pandemic preparedness: beyond health systems in poor countries
By: Anne Roemer-Mahler
Last updated: Wednesday, 10 November 2021
It’s not that nobody had seen this coming. The World Health Organisation had been ringing the alarm bells for years. Bill Gates, chairman of world’s largest foundation working on global health, warned that a pandemic was just around the corner. And only last year, the Global Preparedness Monitoring Board found that the world was ill-prepared. Yet, few had predicted that the UK and the US would have some of the world’s worst responses. These countries had been at the forefront of global initiatives to strengthen pandemic preparedness. Moreover, in the Global Health Security Index, which ranks countries’ according to how prepared they are for a pandemic, the US came 1st and the UK 2nd.
Strengthening pandemic preparedness, like most global health issues, has long been perceived as being predominantly about poor countries. Poor countries are considered the ‘weak link’ in global preparedness due to poor health systems, poor hygiene, overcrowding and other ‘development’ problems. The Sustainable Development Goals (SDG) are an attempt to change our perspective on development and look also at wealthy societies. The current pandemic is a case in point. Not only does it originate from a comparatively wealthy part of the globe, but it has also revealed severe problems in the ability of some of the world’s powerful states to respond to it. Sustainable pandemic preparedness, it has become very clear, is about poor and wealthy countries alike and cannot be taken for granted in either.
COVID is not the first pandemic in recent history: HIV/AIDS in the 1980/90s, SARS in 2003, the so-called ‘swine flu’ in 2009, and the Ebola outbreak in West Africa in 2014 (although this was not called a pandemic). Each time, the world moved into crisis mode, mobilised political attention and resources, vowed to learn lessons – and forgot as soon as the crisis was over. The lack of sustained political commitment and funding for pandemic preparedness has long been lamented. Yet, again, much of the focus was on low- and middle-income countries.
The current outbreak highlights that sustained high-level political attention has been a problem also in wealthy countries. In both the UK and the US, government analyses, conducted in the last few years, predicted severe shortfalls in equipment, medical supplies and clinical care capacities and revealed unclear decision-making structures. But these issues were not addressed. Resources were not made available to move from planning to implementation and high-level positions to coordinate a response were downsized.
So how can we get over the cycle of crisis and fatigue and move to more sustainable preparedness? An important insight from some Asian countries is that lessons learned during an outbreak need to be institutionalised. For instance, after being hit by SARS in 2003, Taiwan created a National Health Command Center as a central point to lead operations and communications among national, regional, and local authorities. Its chair has equal rank with government ministers. South Korea, after its experience with another coronavirus, MERS, in 2015, created regulation to speed up approval for newly developed testing kits in emergencies. In addition, it worked with local companies to plan for the rapid production of such kits.
This leads to another aspect of sustainable preparedness: it is about more than the health system. Most measures to reduce infections involve social, economic and political systems beyond health. Handwashing requires (free) access to clean water and soap. Large-scale testing and treatment require manufacturing capacities (for test kits as well as healthcare and protective equipment). Social distancing requires housing that is not overcrowded. Isolation requires labour policies and welfare systems that enable people to stay at home.
The current pandemic highlights that preparedness has to go hand in hand with working towards the SDGs, including ending poverty, ensuring the availability of water, achieving food security, reducing inequality, and making human settlements safe. And while these issues are particularly visible in low- and middle-income countries, they are pertinent here too. Only a few weeks into this pandemic, and we are seeing the disproportionate effects it has on the poor, on ethnic minorities, and on women in our wealthy societies. Sustainable pandemic preparedness, this outbreak highlights, means looking beyond health systems in poor countries and rethinking some of the building blocks on which our wealthy societies rest.
Written by Dr Anne Roemer-Mahler, Reader in International Relations in the School of Global Studies and Deputy Director of the Centre for Global Health Policy at the University of Sussex. Anne's research focusses on global health governance, health security and antimicrobial resistance.
Find out more about Anne's Sussex Sustainability Research Programme (SSRP) project 'Building global surveillance with local data: a sustainable response to antimicrobial resistance'.
This blog is part of the
SSRP Forum: the Pandemic and Sustainability
This forum aims to contribute to the analysis of the impact of the pandemic on sustainability and the Sustainable Development Goals (SDGs), and to offer policy recommendations on how to respond to this unprecedented challenge.
The spread of coronavirus (COVID-19) presents us with an unprecedented challenge. We see losses of human life around the world, while one can hardly think what will happen if and when the pandemic reaches poorer countries with weaker economic and health structures. We see countries shutting down their economies to avoid the spread of the virus, as well as employing unprecedented measures of social distancing and population lockdown. We see whole economic sectors and households entering the intensive care of public financial support. In less than a month, the pandemic has redefined the priorities, parameters and boundaries of ‘what is possible’ in much of the world that we constructed since the Second World War.
The most urgent question is how to deal with the humanitarian crisis currently evolving and prevent it from getting out of control at a global scale. But a question we must also face is how the currently unprecedented mobilisation of public resources will be used to support our transition to a sustainable future, rather than a return to a socio-environmentally unsustainable past. One can hardly overstate the urgency of both these tasks. We in the Sussex Sustainability Research Programme (SSRP) community aim to contribute to this ‘mobilisation’ effort by setting up this Forum which aims to bring together experience, knowledge, ideas and recommendations to inform public responses to the pandemic and the implementation of Sustainable Development Goals (SDGs) at both local and global levels.