By Chioma Okafor, Global Technical Assistance Team Lead
Although most of the world did not expect to deal with a pandemic in their lifetime, the truth is that large pandemics are not unlikely and the likelihood of more pandemics is increasing. There are many reasons why the likelihood of outbreaks increases over time, including trends in food system and land use changes, urbanization, more contact between humans and animals, greater environmental exploitation, and ease of/increase in global travel. Since it appears that many of these trends will continue, the risks of pandemics will also increase. Therefore, it is even more important to take lessons learned from the COVID-19 pandemic and apply them starting now so that the next time we experience an outbreak at this magnitude, we are better prepared.
COVID-19 has taught us the importance of vast and resilient health systems and trained health care personnel. During many of the COVID-19 surges, we saw hospitals reaching capacity. When this happened, makeshift surge facilities were established. However, many of these facilities did not have enough staff or equipment to run smoothly, and they often took too long to organize due to logistical and supply chain challenges. In addition, staff working in hospitals and other medical facilities were overworked and stressed with women experiencing higher stress levels especially nurses, nursing assistants, medical assistants and social workers. This has also led to many individuals in the health field burning out and pursuing different lines of work. For many years, the United States had been facing growing physician shortages, and the pandemic further exacerbated this problem.
Therefore, surge capacity facilities need extensive pre-planning to be successful and timely. They also require collaboration across multiple stakeholders including public-private partnerships, local government and community gatekeepers. These private public partnerships must be sustainable and ensure that proper governance mechanisms are in place, acknowledging any conflict of interest and investing time in relevant stakeholder perspectives and limitations. A great example of this is Project Last Mile, a collaboration between country governments, private corporations and foundations to support the growth of public health systems’ capacity in supply chain and marketing by sharing the expertise and network of the Coca-Cola system. These are relationships that should be established and maintained to learn best practices and promote innovate ways of working.
During the pandemic, we also realized the importance of adapting public health messaging for specific populations while also communication approaches that are in plain language, visually highlight a credible source and employ evidence based health practices. Globally, community health workers played an integral role in fighting the pandemic, especially in countries with less resilient health systems. The pandemic reminded us that Community Health Workers (CHWs) who are equipped, trained, and paid as part of a well-functioning health system can help contain pandemics and maintain health services equity and access. Recent evidence from 27 districts across 4 countries in sub-Saharan Africa (Kenya, Mali, Malawi, Uganda) found that CHWs supported in line with the WHO Guidelines (i.e., paid, equipped, and continuously trained) and protected with adequate PPE were able to maintain speed and coverage of community-delivered care during the pandemic. Therefore, we cannot underestimate the importance of community health workers as they engage with those in their communities and often times, reflected the diversity of those communities. We need programs that ensure CHWs are well-supported in order to build resilient and equitable health systems that can withstand future threats.
During the pandemic, we saw collective efforts to combat the spread of the disease including the COVAX facility launched in 2020 as well as the development of safe, highly effective covid-19 vaccines in under one year. However, global vaccine inequity is still an issue as evidence shows that in low income countries, fewer than 10 percent of the people have received at least one dose of a vaccine. This is in comparison with about 80 percent in high income countries. For middle income countries, vaccination rates remain uneven as well thus threatening the economic recovery and social and political stability of low and middle income countries. Therefore, we must promote national sovereignty and encourage countries to set their own vaccination agendas for their most vulnerable populations. Vaccine Self-reliance must be promoted where low and middle income countries are financial and operationally supported to manufacture their own vaccines to ensure the supply is consistent and reliable, this will also include addressing any supply bottlenecks, increasing health financing, capacitating the health workforce and developing proper data management systems. We see this in Cuba, where five COVID19 vaccines have been developed in country and approved by the WHO for use and as of January 2022 Over 92% of Cubans have received at least one dose of the countries domestically produced vaccines.
Finally, we must address COVID-19 misinformation which ran rampant throughout the pandemic. Social media companies did their best to find and stop misinformation from circulating, but that was a reactive move. In the future, we need to become proactive in our approach. That requires identifying gaps in information and filling them before misinformation begins to circulate in response to those gaps. It will also require strategic partnerships with public, private, and academic institutions as well as faith based groups to spread clear, consistent, and credible information outside of the public health echo chamber. It is also important to acknowledge that the messenger is just as important as the message, we must enlist trusted messengers that move the conversation beyond academic journals into community forums and platforms in a way that encourages public discourse and increases trust.
Preparing for the next pandemic will require concerted and transformational efforts from country governments, private and public sector organizations as well as bilateral and multilateral groups such as the WHO, World Trade Organization, the World Bank etc. It will also require us to consider the links between HIV/AIDS, TB and Malaria and ensure that we continually investing in community networks and surge capacity that help countries combat these diseases and ensure that globally we are safer from any future pathogens.