Will COVID-19 generate global preparedness?

In The Lancet, Nirmal Kandel and colleagues report their analysis using an operational readiness index to summarise countries' national performance across 18 indicators of preparedness to prevent, detect, and respond to an outbreak of a novel infectious disease. The authors' analysis shows that only 104 (57%) of 182 countries had the functional capacity to perform crucial activities at national and subnational levels. 32 (18%) countries had low readiness and would require external resources to control an emerging infectious disease event.

Kandel and colleagues' conclusions are similar to those of the Global Health Security Index and previous assessments from WHO. Increased concern about these shortfalls in readiness is not surprising, given that coronavirus disease 2019 (COVID-19) cases have been identified in dozens of countries. A similar pattern of increased awareness about global health security has been observed during previous public health emergencies of international concern. Later in 2020, after the initial anxiety about COVID-19 has waned, we might expect that the calls to strengthen infectious disease preparedness will have gone unheeded and will drop down the list of global priorities. The cycle of panic then forget has become routine.

Several specific actions can mitigate future threats to the health of the global population. First, we need to fully implement the International Health Regulations (IHR) in countries of all income levels. Reports from WHO and the Global Preparedness Monitoring Board have shown that responses to urgent crises have improved under the IHR (2005), but important deficiencies in coverage still exist.3, 4 We must scale up laboratory capacity and other surveillance capabilities, augment the readiness of health systems to care for large numbers of seriously ill patients while safeguarding the health-care workforce, and improve communication and coordination strategies and implementation. Procurement and supply chain management must also be enhanced to ensure adequate stocks of personal protective equipment and essential medications and to enable equitable access to new diagnostics, therapeutics, and vaccines during health emergencies.

Second, we need to accelerate progress towards achieving the priorities and targets of the Sendai Framework for Disaster Risk Reduction, which was adopted by UN member nations in 2015. The Sendai Framework applies an all-hazards approach to increasing international, regional, national, and local resilience to withstand a broad spectrum of disasters, including epidemics, pandemics, and epizootics. Preparedness for emerging infectious diseases requires strengthening health systems and developing response plans that account for the social, environmental, political, and institutional factors that can either support or disrupt emergency management efforts. The Sendai Framework complements the IHR by integrating infrastructure, climate change, and economic considerations into disaster management plans and promoting inclusive policies that protect vulnerable populations during all phases of mitigation, preparedness, response, and recovery.

Third, plans for preventing, detecting, and controlling outbreaks of emerging infectious diseases need to be built on a One Health foundation that emphasises the interconnectedness of humans, animals, and ecosystems. Transdisciplinary, multisectoral strategies are necessary when seeking to solve complex problems that threaten global public health and safety. More specifically in relation to diseases such as COVID-19, One Health focuses on the danger existing at the human–wildlife interface. The ability to detect viruses in livestock and wildlife is a crucial component of early warning systems for human pandemics.

The COVID-19 outbreak is yet another reminder of the necessity of intensified and sustained commitment to global public health preparedness. The world does not need more evidence of the health, social, economic, environmental, and other problems that arise when we fail to invest adequately in global health security. What is required to break this panic-then-forget cycle is to follow through on prioritising, funding, and implementing preparedness interventions.