Pandemic preparedness vital to building back better process

BEFORE 2020, the danger of a pandemic disease was recognised by many health experts and institutions, including the World Health Organization (WHO) and the US Centres for Disease Control and Prevention, but their warnings were either ignored by governments or failed to spur them to action. The US and British governments actually weakened their countries' ability to respond to an outbreak in recent years through budget cuts. The Covid-19 outbreak certainly grabbed attention and forced lessons upon the world about how (and how not) to respond.

This terrible experience should make it easier to impress upon governments and the general public the need to sustain and reinforce the capability to respond to further pandemic disease outbreaks.

Pandemic diseases should not be regarded as "once in a hundred years" events by reference to the 1918 influenza outbreak. Several threatening animal and human diseases (including Sars, Mers and Ebola) were contained successfully in the past 20 years, but there was clearly a danger that took considerable efforts, without which our understanding of the frequency of pandemics might now be radically different. With a global population of over seven billion people, most of whom live and work in situations where they come into close contact with many other people in the course of a week and with the ease of movement from country to country afforded by efficient transport systems, the conditions for an infectious disease to spread, once it has first broken out, are ideal.

Further, once a viral disease does spread widely, the chances of mutations emerging that might make it harder to treat increase enormously, simply because there are a vast number of potential unwitting hosts to a devastating change in the infectiousness and damage a disease can do.

Covid-19 has disrupted social life around the world, shaken the entire global economy, and strained health services. Yet this is a disease that kills 3 per cent of those it infects, while making making many more ill. What would be the impact of a disease that spreads on a similar scale and that killed 5 or 10 per cent of those infected and perhaps incapacitated people for longer or more seriously? It has become easier to imagine.

The current emergency could be the springboard for instituting protocols for a more effective response to any future pandemic.

One important learning step should be an international inquiry into the global response to the Covid-19 outbreak that goes beyond what has been attempted thus far. It won't do to focus mainly on China. Any investigation that does that would be likely to be seen there as harmful to the country's standing and be suspected of being motivated by hostility. An inquiry, probably under the auspices of the WHO, that was committed to considering the strengths and failings of all countries and health institutions in responding to the pandemic would be much more likely to secure China's cooperation, and be a more genuine collective learning experience.

The importance of reducing the pace at which any disease spreads so that medical services can cope and time be bought for vaccine research to produce results has been clearly demonstrated. One way of doing this that ought to be considered is by being prepared to introduce curbs on international movement as soon as the danger becomes apparent.

After breaking out of China, Covid-19 was spread rapidly by people leaving places of infection and dispersing over a wide variety of regions and countries: infection among skiers in the Austrian resort of Ishgl was blamed in part for the rapid dissemination of the disease in Western Europe, and the virus was reportedly brought to Brazil by holidaymakers returning from Europe. A few initial sites of infection thus easily gave rise to multiple new sites.

The best future policy might be an immediate lockdown on international movement of people, with host countries taking first responsibility for isolating and supporting non-locals trapped within their borders and being reimbursed for their costs later by their home countries. People would then only be repatriated through a rigorous screening and quarantining process. This would take a specific international agreement.

'FIREBREAKS'

Health services, it has been shown, cannot be treated as a burden on the "real economy" to be maintained on a 'just coping' basis. The Covid-19 pandemic has underlined how vital well-equipped, properly staffed public health services are, but has also pinpointed the role of vital workers in jobs that often have a low status and poor pay: bus drivers, for example and those working in transporting necessities and working in the shops that sell them. In any future pandemic, rapid action to protect them as far as possible should be standard practice.

This is not only to protect them and allow them to continue to work, but also to reduce infection: most need to interact with many other people as part of their jobs, so they not only risk infection, but could convey it more readily than people who can work from isolation. This might be compared to the creation of firebreaks in extensive forests.

Health services have been stretched to their limits in many countries: in some cases, beyond them. In future, this strain could be lessened through the use of trained auxiliary staff who would take on basic care work, particularly with recovering patients, so that doctors and nurses might be deployed full time to where they are most needed. The auxiliaries would be volunteers who normally do other jobs, but who would receive basic training in care provision through day release programmes and be freed for service the moment the need arose.

In the long term, we might think more about how we shape our lived environment and this would have consequences for population and housing policies. Smaller populations, with more living space per capita, cities with more localised shopping and facilities and segmented by green corridors and parkland should reduce vulnerability to pandemic infections.

If not from human experience, it should be evident, from what happens when an infectious disease takes grip on factory farmed animals such as chickens or pigs, that mass living at close quarters is a risky way of life. Our distant ancestors probably did not have any problems with infectious diseases. Their relatively small numbers and their dispersal meant that serious infections either did not occur or burnt themselves out without spreading far. We can't put the clock back to those times, but we might try to learn from them.

Pandemic preparedness ought to be part of the building back better process.

• The author is a Singapore-based freelance writer