More agile global governance of the pandemic response must be established while COVID-19 is still prominent.
COVID-19 turned into a US$22-trillion disaster killing more than six million people globally partly because the dots between warning and action were not connected.
Some governments took quick and precautionary action, especially those that had invested in their public health infrastructure in the wake of SARS, as in Taiwan, Thailand, Vietnam and South Korea. Most sat on their hands until the early weeks of March 2020 when they had domestic evidence of widespread disease.
With contested authority and a deluge of conflicting information, where national public health institutions had been under-funded and were sidelined, they were unable to cope. Commercial information-management operations spotted the gap in the market. They nimbly pivoted their data and information management systems to the pandemic, promising governments support to make critical decisions amid all the uncertainty of a fast-moving crisis.
Palantir, an American software company, begins its latest product pitch like this: “The dominant nation-states and companies that define our way of life will be the ones that get software and use of data right”. The UK National Health Service and the US Centers for Disease Control used Palantir’s data-integration products in the early months of the pandemic.
Salesforce, another US company, was brought in to bail out the Australian state of Victoria when its contact-tracing system buckled under the pressure of soaring case numbers in mid-2020. Danish-owned UK health-data-management company Airfinity found its niche as the go-to source for data on vaccine production, supply and delivery, and was used widely by news organisations, governments and multilateral institutions. There are lessons to be drawn from this type of targeted innovation, but long-term public health goals do not sit comfortably with providers whose raison d’être is to sell a product that gives you a comparative advantage over others. The agenda needs to be set by governments – private organisations can bring a set of agile tools to help, but they need to be within parameters of equity and national good defined by the public sector.
The Independent Panel for Pandemic Preparedness and Response, has recommended the United Nations General Assembly and the G20 create a global health threats council, bringing together selected heads of state and international luminaries to give pandemic response urgency and political weight.
The WHO has expanded its surveillance efforts by creating a new Berlin-based Hub for Pandemic and Epidemic Intelligence, headed by Chikwe Ihekweazu, formerly director of Nigeria’s Centre for Disease Control. The hub intends to go beyond epidemic surveillance to apply collective intelligence efforts across a whole range of epidemic-relevant public health, social, political and economic domains.
The Epidemic Intelligence for Open Sources network, a core part of the hub, will continue to trawl through thousands of signals, including 34,000 web pages daily, to pick up and verify reports that may require closer attention. In 2021 it analysed 519 million COVID-related tweets. It links other networks including the ProMED network of infectious disease scientists that noticed the first Chinese press reports of the Wuhan cases. And while extensive negotiations are required to bring 194 states into agreement, the WHO is edging towards a new pandemic treaty.
Among the most contentious issues will be inspection powers – some are calling for the new treaty to enshrine powers like those of chemical weapons or nuclear-accident inspectors, who are able to bypass red tape to speed to outbreak locations. But despite the global good such powers might represent, national sovereignty is fiercely guarded.
The systems for an orderly global vaccine rollout collapsed in a flurry of vaccine nationalism; conclusive demonstration that health – nationally and globally – is better protected as a public good and not a competition. Successive variant waves have been driven by rampant transmission and replication of SARS-CoV-2 in unvaccinated populations, quite aside from the inequitable burden of disease and death. The task now in front of the multilateral system is whether short-term beggar-thy-neighbour approaches can be put aside in favour of the greater good.
As the wash-up of the global pandemic begins, the major questions are: what has been learnt, and more importantly, which of those lessons will inform future changes? The key finding of the independent panel was that the global system for pandemic alert and response failed to join up. It was not that the early warning came too slowly — Wuhan clinicians were aware of an unusual cluster of pneumonia of unknown origin in the city’s hospitals. The problem was that the global response to this early warning was too slow.
It is not clear that the proposals made so far to remedy the gap between alert and action will get to the nub of the problem. They mainly build on what worked well during COVID-19.
In May 2021 the UK under its G7 presidency announced a global pandemic radar to protect health systems by “spotting diseases before they cause future pandemics and enabling the rapid development of vaccines, treatments and tests”. The Coalition for Epidemic Preparedness Innovations (CEPI), a global non-profit vaccine-development body established in the wake of the 2014-16 Ebola crisis, was among the first to spring into action at the advent of the pandemic, commissioning vaccine research in January 2020 – within days of publication of the SARS-CoV-2 genome sequence. In March 2022 CEPI committed to a ‘100 day’ target for safe, effective vaccines in response to the next “disease X” but in a sobering warning that global attention may already be moving on, it garnered only US$1.5 billion of the US$3.5 billion in funding replenishment it was seeking.
The race is now on to establish more agile global governance that recognises pandemic preparedness and response as a global public good. There are plenty of technical advances that can populate such a system, but what is fast running out is the political will to create it while COVID-19 is still fresh in our minds.
Michael Bartos is Honorary Associate Professor, School of Sociology, at the Australian National University. He was lead editor attached to the Secretariat of the Independent Panel for Pandemic Preparedness and Response.
He has conducted research on gaps in pandemic prepareness and for the Independent Panel for Pandemic Preparedness and Response funded by WHO through consultancy contracts.