It’s been two years since COVID-19 took the world by storm, altering life as we know it. Prior to its emergence, the Global Health Security Index noted that no country was fully prepared to deal with a pandemic. This lack of preparation, however, was not due to a lack of scientific or technological progress. Rather, it was the result of our collective failure to adapt each nation’s economic and political systems to take full advantage of these tools, a step that “Breakthrough” editors Homi Kharas, John McArthur and Izumi Ohno view as critical. . for success. In our book chapter, we outline not only the technologies, but also the political and economic needs that must be met to achieve what we define as success – basic pandemic preparedness in every country – by 2030.
Two major technological breakthroughs have fueled our global response to COVID-19. First, advances in biomedical and genomic technologies have allowed us to detect and characterize viruses like SARS-CoV-2, and develop countermeasures like vaccines and therapies at unprecedented speed. Second, powerful new technologies and information systems have enabled us to collect real-time data, conduct virus surveillance, and coordinate local, national, and regional health systems. While scientists are constantly working to optimize and expand this arsenal, the technologies we have today hold great promise for the future of global health.
But technology alone is not enough. In our chapter, we note three fundamental elements necessary for the successful implementation and scaling of every technology breakthrough. They include regular coordination and collaboration between scientists, public health and world leaders; equity and community empowerment; and sustainable funding. In the context of COVID-19, many countries have failed to lay these foundations, leading to a response marked by inequity and frustration.
Despite several improvements in technology, diagnostic testing remains a challenge as hoarding of supply, prioritization of some communities over others, and failure to build local capacity exacerbate access issues everywhere . For example, individuals in several high-income countries can now purchase antigen tests that deliver results at home in 15 to 30 minutes. At the same time, socio-economically disadvantaged populations and/or communities of color in many of these wealthy countries like the United States continue to face barriers to accessing testingincluding cost, long test lines, remoteness from test centers and other systemic inequalities policy makers have yet to address. In low- and middle-income (LMIC) countries, barriers to testing are more widespread, ranging from high testing costs (direct and indirect) for limited testing capacity on community sites.
The global distribution of countermeasures like vaccines and therapies is also full of inequities. In the United States, as in many high-income countries, fully immunized people now include 64% of the populationbeginning of February 2022. In comparison, barely 10.6% of individuals in low-income countries received at least the first dose, in part because of vaccine hoarding by their high-income counterparts. Socioeconomic and racial disparities around vaccine access in wealthier countries reflected the same dynamics present with testing, particularly in the early stages of vaccine rollout. In the United States, some of these disparities have reduced over timebut various obstacles remain, including English proficiency, technology and access to informationas well as vaccine hesitancy and mistrust. A global analysis of access to monoclonal antibodies, which have been shown to be effective in treating diseases such as COVID-19, reveals similar challenges, with the United States, Canada and Europe possessing 80% of existing global supply.
Our chapter also describes recent advances in information technology that have facilitated the collection, sharing and analysis of data on COVID-19. Yet a lack of coordination, as well as gaps in existing capacity and infrastructure, have also marred the data side of the pandemic response. Even two years later, data collection is often done through paper, email, or electronic medical systems, especially in low-resource settings. In Sierra Leone, Dr. Isatta Wurie and Dr. Nellie Bell of the College of Medicine and Allied Health Sciences note various “data integrity bottlenecks” that prevent “timely policy change during the pandemic,” including paper-based data collection, missing data and entry errors, system downtime, lack of resources and limited staff capacity. In the United States, a number of laboratories use fax, mail or even email to report data, while health services depend on disparate manual data tracking systems.
A major theme of this book is that technology should reduce inequality and empower people. But too often it achieves the exact opposite, widening the gap between those with resources and those without. Kharas, McArthur and Ohno note that the pandemic has brought this reality to light, deepening inequalities both within countries and between countries, as rich countries have deployed vaccines and other mitigation tools at a record speed, leaving many PRITIs behind. In the context of infectious diseases, competition for resources is not only unethical but also counterproductive, because a virus anywhere is a threat to global health everywhere. It is therefore essential that we create a new culture of global cooperation and collective responsibility around the response to infectious diseases. To overcome COVID-19 and prepare for the next pandemic, world leaders must understand the following:
Equity is closely linked to empowerment
As we strive to increase the global supply of vaccines, detection tools and therapies need to be more evenly distributed. In the immediate term, high-income countries and global organizations should strive to increase community testing capacity in low-resource settings by providing more affordable rapid diagnostic tests and setting up “pop-up” community testing centers in high need areas. In the long term, the global community must also empower local scientists, PCR expansion and genomic surveillance capacity in laboratories around the world through technical, financial and logistical support.
To address vaccine equity, the global community needs structures and standards to discourage vaccine hoarding, increase vaccine supply, and rapidly distribute vaccines to those who need them most. In addition to easing patent protection, high-income countries and multilateral institutions must also empower local manufacturers in underserved areas, through technology transfer, material assistance and local capacity building. On the delivery side, organizations like COVAX have made significant progress, but many have criticized their vaccine targets not ambitious enough. As the global community strives for higher goals, the support of last mile vaccine distribution and delivery efforts will remain critical. Leaders everywhere must also strive to earn the newfound trust of the public in science, health care and government through community education and clear, transparent communication about the value and safety of vaccines.
Sustainable financing means increased investment both in the short and long term
In addition to efforts undertaken by coalitions such as the Access to COVID-19 Tools Accelerator (ACT), rapidly scaled-up national and international investments will be essential to bolster global pandemic preparedness. According to G-20 Independent High-Level Group convened in early 2021, the LMICs will have to add around 1% of their GDP to national public health spending over five years, while cross-border funding will have to increase by at least $15 billion a year. At a systems level, the panel also recommended a system of global governance for equitable distribution of tools and coordination of goals, involving advice, counsel and a fund on global health threats, guided by the World Organization health at the center.
Public health infrastructures across the world must be modernized and systems rebuilt for maximum efficiency
Real-time communication and coordination, as well as the sharing of open data, enables public health, scientists and leaders to better understand and meet the needs of communities. To make this a reality, we need global digitization of data collection, regional standardization of data infrastructure, as well as an interoperable ecosystem where information is easily accessible. Regional digitization efforts by organizations like the Africa Centers for Disease Control and Prevention (CDC) are currently underway, according to Drs. Wurie and Bell, but these efforts can be further supported by global partnerships for capacity building, integration into the local context and sharing of best practices.
Ultimately, preparing for the next virus threat will require the creation of new infrastructure, sustainable funding, and a global spirit of collaboration marked by equity and empowerment. As we enter the third year of the pandemic, we all face an important question. Technology is already evolving to meet the many challenges of a pandemic-sensitive world. Are we, as a global community, ready to evolve with it?